What causes mental health struggles?

When new clients come in for counselling, many present with resentment and anger for experiencing mental health struggles. Following any emotional upheaval, we search for clarity. We want to understand what causes mental health difficulties, and we want the fastest solution to make it all feel better. Since mental health impacts the whole family, caregivers and parents are also brought into this practice of self-blame. Caregivers are often overwhelmed with frustration or guilt, and are keen to discover how they could have done “better”.

Finding a reason for what causes mental health struggles is a logical first step. We want clarity. We want an answer to help explain why we are doing what we are doing. Unfortunately, the truth behind what influences mental health struggles is complicated.

An Emotion-Focused Family Therapy Lens

What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.

Emotion-Focused Family Therapy provides a comprehensive framework that explains what factors influence mental health struggles. As you go through this framework, please bear in mind that you may experience several of these factors while also feeling at peace with your mental health. Alternatively, you may only experience one or two components, and struggle a lot. This is because there is no single equation that tells us which factors have to be involved for mental health struggles to show up. We are all unique. Therefore, our resiliency and vulnerability varies.


What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.

It is rare that a single gene causes mental health issues; however, our DNA does have some influence on our emotional well-being. Research has confirmed that there are genetic similarities to various mental health issues. For example, the Psychiatric Genomics Consortium found that individuals who have a diagnosis of autism, schizophrenia, bipolar disorder, depression or ADHD share certain DNA variations. The Consortium also presented research finding 30 positions in the DNA sequence that increase the risk of developing bipolar disorder. They have found 108 fixed positions on a chromosome for schizophrenia. So what does genetics mean for those who are struggling with mental health? It reinforces that this is one (unchangeable) factor that plays a role in increasing your vulnerability.

While our genetic codes are permanent structures, epigenetics is the ways in which our environment can influence how our genes are read. At any given point in time, our genes are turned “on and off” based on environmental factors. Difficult situations, like living through a war or a pandemic, can influence the ways in which our genes are read. There has to be the right combination of environmental stressors and genetic reading for a mental health disorder to form. What’s wonderful about epigentics is that, while we cannot change our genetic code, we can influence our environment so that we are less vulnerable.

Emotional Avoidance

When it comes to unpleasant emotions, a natural response is to avoid sitting with these distressing feelings. After all, who enjoys feeling sad or anxious? While we often try and push these emotions aside, in most situations, they come bursting out of the dam in the least convenient moments.

What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.
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One significant factor that causes mental health struggles is our ability to process emotions. By avoiding our emotions, we tend to face more consequences in the long-term. For example, if you experience bullying at school, you may decide to avoid school all together. This works well in the short-term. However, how long can you keep this strategy going? If you do avoid school for months, what are the new consequences that you have in missing so many classes?

We emotionally avoid by using distractions and coping strategies. These strategies are often effective as quick-fixes, but rarely work to address the actual wound and sometimes create more problems. Common coping strategies include: exercising to work off anxiety, excessive drinking to avoid feeling sad, lashing out in anger when stressed, or emotionally eating to deal with loneliness

What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.
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To stop relying on short-term solutions, we have to work at a safe pace to process and talk about our feelings. For example, we have to acknowledge our distress about being bullied, work through the anxiety of returning back to school, and talk with our parents and teachers about a safety plan. We can seek out therapy to learn how to to slow down our emotions, and work through the intensity of these feelings. Once these emotions no longer feel as overwhelming, there is less need to use coping strategies. We feel more empowered to address the emotion if it comes up again in the future.

The “Superfeeler” temperament

What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.

EFFT recognizes that 25% of the population has the “superfeeler” temperament. Consider a scenario where you are wearing a hearing aid that is turned up far too high. This hearing aid will pick up on nuances that others do not notice. Small noises can become highly distressing. This individual will likely be more reactive to noises, and feel overwhelmed by the amount of auditory input.

Similarly, superfeelers are like these highly-sensitive hearing aids. These individuals feel emotions intensely. They quickly pick up on others’ emotional cues and often experience the other person’s distress (e.g. think about a baby who automatically starts to cry when she/he sees another child crying). Like sensitive hearing aids, superfeelers are quicker to respond to emotions. Unfortunately, this can mean small events or arguments are seen as highly threatening.

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Because other people are not wearing these sensitive hearing aids, they are not picking up on the threats or cues that a superfeeler is noticing. While a superfeeler may feel upset about an event, their loved ones do not understand why this superfeeler is reacting so intensely to something that seems mundane. This can often lead to invalidation. Think back to a time when someone dismissed your feelings or called you over-sensitive. While this moment may still sting, this type of experience is common for a superfeeler.

There is a significant level of fatigue in having a superfeeler temperament. Because superfeelers are so attuned to emotions, they experience difficult feelings like shame, anger, or guilt that much more intensely than others. Understandably, there is a strong desire to lower the intensity of these feelings in any way or form. A lot of people with this type of temperament will cope by distracting themselves, avoiding situations, becoming quick to anger, feeling hopeless, numbing emotions, or sticking rigid rules in order to control an environment.

Social and Cultural Influences

What causes mental health issues? Kasi Shan Therapy, EFFT, Emotion-Focused Family Therapy.

What do you see in the media? How do your favourite celebrities and influencers act? What are the cultural expectations of “appropriate behaviours”? Social and cultural influences can play a pivotal role in making us feel more vulnerable. There is pressure to be a certain weight or look a certain way. There is the “right way” to express our emotions. More often than not, emotional avoidance is glorified. There is an insinuation that being independent is best, and that it is weak to need others for our emotional stability. Society and culture gives us inconsistent messages about our emotions, our appearance, and our behaviours. The “rule book” changes with time, and it’s a continuous race of trying to catch up. Mental health issues can rise in trying to meet these demands and feeling as if we are falling short.

Life stressors

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The most unique factor that causes mental health is life stressors. Life stressors can vary for each individual. It can include events such as bereavement, workplace stress, divorce, bullying, breakups, large transitions (e.g. moving, deployment), injury or illness. Our resiliency factors influence our ability to manage these events. Meaning, if our environment is secure and supportive (e.g. stable home, strong friendships, access to medicine and help), we are better able to recover or work through these stressors.

Life stressors becomes a concern when we feel ill-equipped to handle all of the demands that come with this stressful experience. We feel a sense of fatigue because our body is perpetually in a state of fight or flight. These are challenging events for us; therefore, it can be difficult to create safety and balance in light of these stressors.


Whether it’s puberty, pregnancy, lactation, or menopause, we know that hormonal shifts can create vulnerabilities for our mood and mental health. Hormones act as communicators between various organs and glands in the body. We are always producing hormones to regulate our system. However, when our production levels are affected, our entire system responds.

Here are some ways that hormones may be influencing your mental health. When your insulin level is affected, there is a higher likelihood of poor concentration, fatigue, anxiety and panic. Oxytocin is connected with our sense of pleasure, belonging, and joy. When this hormone is imbalanced, people struggle with more symptoms of depression and sadness. Cortisol and adrenaline are both considered “stress hormones”. They are activated and produced by our body whenever we are in a stressful situation. Low levels of these stress hormones often shows up in individuals who are depressed and exhibit signs of emotional shut down. Alternatively, high levels of cortisol and adrenaline can lead to an individual feeling more irritable and panicky.

Family Environment

A lot of caregivers blame themselves for their children’s mental health. If the above sections do not convince you that there are a multitude of factors involved in mental health, please let me say it plainly. Caregivers are not at fault. You are one piece of the puzzle, and while your influence is important, you are not the cause of your loved one’s mental health.

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Family environment can play an important role in shaping mental health issues. Consider the family rules about emotions and behaviours. What is seen as acceptable in your family? Some families are expressive, and accepting of a wide range of emotions. On the other hand, some families are incredibly uncomfortable with displays of affection, tears and tantrums, or “unhappy” feelings. In the situation of the latter, we become vulnerable to emotional avoidance. We may shut down, or keep our feelings bottled up in order to fit the family norms.

Parents and caregivers are usually the first form of attachment for an infant. Depending on how parents attend to their baby’s needs (be it avoidant, anxious or comforting), the child will pick up on these cues. If parents frequently hover or fret, their baby learns that he or she is not safe in the world and requires extra protection. This child may then present with anxious tendencies as he or she grows up. On the other hand, children of avoidant parents may learn that their emotions are not important and that relationships are not safe places to be vulnerable.

There is no simple cure

For what can never have a single cause. 

-Aldous huxley

I get what causes mental health issues. What do I do about it?

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There are many ways to support the above needs. We know that attachment can change over time. If you find a secure and loving friendship where there is safety to express freely, you are more likely to start accepting your emotions. With help from friends, family or professionals, we can work on problem solving skills and gain support to address life stressors. We can learn to empathise with the superfeelers in our lives. Our healthcare providers can help us with hormonal changes to find better balance in our internal system. We can work on regulating our emotions using skills like emotional coaching and validation to shift us out of emotional avoidance. Mental health does not have to be a life sentence, but it does require some patience and effort. If you are struggling, please reach out.

If you are interested in Emotion-Focused Family therapy, please stay tuned for my Advanced Caregiving workshop. This two-day workshop is for caregivers (parents, spouses, grandparents, friends) to learn techniques to help their loved ones living with mental health struggles.

Take care,


Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.