Mental Illness and Genes

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Duncan Gill, M.D. 

12/3/06 
Mental Illness and Genes: Why Aunt Mildred’s Alcoholism Might Matter 

In working with children and families for the past ten years in the Nashua area, I have been more and more impressed with the role genetics plays in children’s psychiatric disorders. I do not mean to imply that upbringing and environment do not play a crucial role in children’s development – which they undoubtedly do – but to highlight another important factor that may be easily overlooked or misinterpreted: family history.

That psychiatric disorders have a genetic or hereditary basis should come really as no surprise to any of us. After all, every organ system in the body is affected by genetics. Heart disease, high blood pressure, diabetes, cancer, migraines are all examples of conditions that run in families. Physical traits, such as height and weight, hair color and eye color have more to do with who your parents are than any other factor. As we all know, character traits often seem to be passed from generation to generation, as well. How many times have we heard that some child “laughs just like his father,” or another “has her mother’s temper,” or another “is a spacey kid, just like his grandmother used to be”?

It turns out the human brain is no different from the rest of the body in this regard, and psychiatric disorders run in families the same way medical disorders do. Depression, ADHD, bipolar disorder, obsessive-compulsive disorder, panic attacks, and schizophrenia are all examples of psychiatric disorders heavily affected by genetics and likely to be clustered in families.

Mental illness, however, is often not as easy to spot in families as medical illness, so it may take some real detective work to find hidden disorders or illness in families.

There are several reasons this is the case:

1. Family members tend to be much more secretive about mental illness than physical illness because of the stigma associated with being labeled with a “mental disorder,” though the widespread public perception of mental illness appears to be changing slowly for the better.

2. So much less was known in the past (even just 20 years ago) about psychiatric illness, that so many problems were misunderstood, mislabeled, or entirely missed. Kids, in particular, were often thought to be immune to psychiatric disorders and often misunderstood as being “just troublemakers” or “bad kids”. I can’t tell you how many parents of children whom I treat tell me “that’s exactly the way I was when I was his age, but they didn’t have a name for it back then.”

3. Not only did they not have a name for it back then (whatever “it” was), but they had very few effective ways to help. Fortunately, there have been major advances in both behavioral techniques and therapy techniques for dealing with emotional and behavioral disturbances, as well as a new generation of medications effective in treating a wide range of psychiatric symptoms.

4. Left with neither accurate diagnosis nor effective treatment, many teens and adults with undiagnosed psychiatric disorders were left on their own to manage their symptoms. Those with milder symptoms often learned to manage them on their own (they “pulled themselves up by their bootstraps”) and learned healthy ways to cope with emotional pain, anxiety, or whatever.

5. Others, usually with more severe symptoms, were unable to do so, and found very effective short-term relief from psychiatric symptoms from another source: drugs or alcohol. (Unfortunately, this practice of “self-medication” with drugs or alcohol rarely works out well in the long run, from either a psychological or medical point of view.) Very commonly, I work with children with either mood or anxiety disorders who don’t have diagnosed mental illness running in the family, but I find out that either the mother or father’s own family (or both) have a significant history of drug or alcohol abuse. In these families, addiction to alcohol or other drugs suggests an underlying undiagnosed or untreated psychiatric disorder, that is passed along from generation to generation.

6. Those with the most severe illnesses that have gone untreated may have found a more drastic solution to their emotional suffering: suicide. (But, much like the case of self-medication with drugs an alcohol, this “solution” to the problem for the individual is often is devastating to the larger family). For this reason, I always ask about a family history of suicide or suicide attempts in the family, which may be present even in families without diagnosed mental illness. These are several reasons that mental illness can be harder to spot than their medical counterparts in the larger family tree. I would encourage all of those people currently in mental health treatment, and those contemplating seeking treatment in the future, to share as much of this family-related information as possible with your treatment providers. Doing so can be enormously helpful to us in establishing a more accurate diagnostic picture and in formulating a more effective treatment plan.