The Gene-Environment Connection: Can We Change It?

Hey, Knowthyself. Thanks for pointing out the truly complex nature of gene-environment interactions. Literally, we're talking about a self-governing system where the sum is way greater than its parts. And the more questions we answer, the more that keep popping up - like all the ones you just asked.

I try to take a hopeful approach when I'm writing on this stuff, as it is clear we are not hard-wired for life. But as anyone who has ever tried sticking to a diet knows, old habits die hard. And you don't just will away something like PTSD overnight.

But, based on what we're learning, we are bound to see the rise in a lot of new therapeutic and learning techniques aimed quite literally at laying down new road work in specific regions of the brain. I came across some of this at a schizophrenia conference I attended. Things like computer games to develop working memory and reaction time.

Also, I never discount the idea of the brain performing a lot of its own healing in the background, when nobody notices. I like to think I am better at managing my illness, thanks to all the recovery tools I've developed. But I should also give my brain credit. Maybe when I wasn't looking, some dendritic pruning went on that made me a bit more mellow. Maybe "I" was part of the pruning process, as well.

There's no simple answers, and I know we will never find "the" answer in my own lifetime. But you can see why I love writing about this stuff.

John,

There was no intention to tatter the sail of hope driving your post.  The winds of change are ever present and blow in all directions.  An unpredicted storm can easily take a sailing ship off course.  It is much more difficult to get back on course and make way to port.  The gene is activated by a single of series of stressfull events.  Then many chemical, physical, and psychological changes take place in the course of the illness.  We can get back on course by how we interact with the environment and what environment we choose to interact with.  

We can sort through the psychological issues and change how we view the world.  We can learn to cope with stress and avoid or decrease its presence in our environment.  We can exercise and engage in fullfilling activities and surround ourselves with supporting individuals.  We can take medications which can counteract the chemical imbalances and allow the brain to heal. 

Remission is what we can achieve.  We can live a life free of symptoms but we have to remain vigilent.  The genes that were turned on by that first stressor and activated again by others can still awaken.  We can change it and stability is possible.  It may not be easy to get back on course but it is well worth it to arrive again in port.

Hey, Knowthyself. Definitely agree. And when you get blown off-course you can crash against the rocks. Not easy getting your life back when you're jobless and friendless and homeless. I think our winner-takes-all society makes the stakes a lot worse. My guess is in the old pastoral societies where communities were more stable and everyone knew their place we cut people a lot more slack. Moreover, you could make a case that a lot of the work was conducive to healing (such as outdoors on a farm). So - a case of environment mitigating genes. Or, with a lot of people, the genes never getting switched on in the first place. Fuller Torrey has compiled stats showing that a huge increase in mental illness coincided with the start of the industrial revolution. Ironically, he was making a different point. I think you can make a good case that our stressful environment switches on a lot of bad genes, and makes things worse once they're switched on.

I'd be interested to hear your views on this.

Hey, Knowthyself. Definitely agree. And when you get blown off-course you can crash against the rocks. Not easy getting your life back when you're jobless and friendless and homeless. I think our winner-takes-all society makes the stakes a lot worse. My guess is in the old pastoral societies where communities were more stable and everyone knew their place we cut people a lot more slack. Moreover, you could make a case that a lot of the work was conducive to healing (such as outdoors on a farm). So - a case of environment mitigating genes. Or, with a lot of people, the genes never getting switched on in the first place. Fuller Torrey has compiled stats showing that a huge increase in mental illness coincided with the start of the industrial revolution. Ironically, he was making a different point. I think you can make a good case that our stressful environment switches on a lot of bad genes, and makes things worse once they're switched on.

I'd be interested to hear your views on this

John,

America does still seem to adhere to and value rugged individualism.  If you have a mental disorder and you can not cope, it is hard to make your case to society that you are rugged.  Little do they know you must be rugged to have a mental illness and function or even survive.

You had mentioned pastoral societies and the work of Fuller Torrey.  Sometime during this period, that we have been discussing the effects of environment, I started to wonder about the incidence of mental illness through the early hunter gatherer societies to the present and how the different environments affected prevalence. 

First, I started thinking about Darwins therory, about survival of the fitest.  Hunter gatherers led a stressfull life and if you were a man and had issues with fight or flight or were prone to psychosis you may be subdued by your prey or make some other life ending mistake and not have a chance to pass on your genes. 

Pastoral societies revolved around the flock and were small and tight knit.  There were most likely stressfull times; a drought that had the group constantly on the move or other groups that would steal sheep or women, but still much less stressfull than industrialized societies and much more caring of their members.

Then agrarian societies put an end to the wandering and division of labor sprang up,  access to goods and services increased, individuals had time to pursue crafts, become artisans and did not have to toil to produce or seek out the items to sustain life.  There still had to be some degree of stress, more or less depending on your status or trade.

Still, we can only assume that the survival rate and contribution to the gene pool by those that manifested symptoms of a serious mental illness was low.  We know that Neolithic people practiced trephination and cave paintings indicate mental illness as one of the possible reasons for this procedure.  The procedure was also used in ancient Greece and Egypt and through to the Middle Ages.  Needless to say, medical treatment was not at its best and not all of the patients survived.

I will have to see if I can find some information of Fuller Torrey's study.  I am interested how he reconciled the prevalence rates, as diagnostic criteria was not uniform and cases were less documented in the past.  Maybe we can inferre that stress increased as well as survival rates, for the mentally ill, during and prior to the industrial era.

When we consider what environmental factors lead to the activation of genes, we can brainstorm for possibilities.  Since monozygotic twins with an inherited mental illness do not always both develop the illness, we must attribute this to differences in their environment.  Some possibilities are; having different social groups, encountering different stressors outside the home, favoritism of one twin over the other by the family or peers, one twin is more adept with learning skills and better learns to cope with life stressors and personality characteristics may develop that help one twin with reducing life stressors.

We do see early chilhood trauma as a precursor for some individuals that develop Bipolar Disorder.  Childhood trauma can affect an individual in different ways that could have an impact on coping with stress.  Children can become withdrawn and not develop good social skills, limiting friendships and support.  Their behavior in the home can become disruptive and parent-child relations may suffer.  School perfomance may be decreased.  And all of these could lead to low self esteem and contribute higher stress levels.

Beside inherited genes, the environment plays its role and this probably happens long before to fatal stressor that breaks the camel back.  We may also be looking at deficits in development and their effect on our ability to cope with stress that happened prior to our illness.  There are changes with how we interact with our environment, due to having a mental disorder; changes due to stigma and illness related changes, which all contribute to stress.  The world becomes a more stressfull environment due to our perception of it, perceived relation to it, ability to function in it and ability to interact with it.  We are one with our environment.  If we change, our environment essentially changes, due to our change in perception.  If we change our environment, our condition may change and how we see our world will also change.

Hey, Knowthyself. Wow! Lots to think about here. Brilliant anaylsis. I'm just gonna say many thanks for this for now, and will get back to you later on this.

I also am convinced, at least in my case that both genes and environment play a part in the development of bipolar disorder.  In my own family, I am the only one on either side with diagnosed bp 1.  Yet I look at my family and extended family, and I see many personalities that are similar to mine. Aggressive, outgoing, creative, somewhat heedless of other people's opinions, apt to pick alternative choices rather than following the status quo.

My sister and brother both suffer from minor depression, but other than one cousin on my mother's side who killed herself after her son was murdered as a child by his step-father, (who eventually turned out to be on the run from American police for bigamy and other murders), the incidence of mental illness is minor.

So what is the difference in my situation? I firmly believe that physical abuse is a large factor in the triggering of the gene/s.  My father was a professional athlete, and dealt with my personality quirks and teenage defiance by hitting me, sometimes to the point of knocking me out.  My mother felt that not fighting with her husband was the best strategy for dealing with my father's aggression, and did not defend, help or protect me in any way. In fact, she even would tell me to lie about the bruises on my face and body. (In those days, there were no child abuse numbers to phone). My father was also a respected professional and university professor. When I finally sought help for the deep mood swings I was experiencing at age 16, the psychiatrist minimized my problem, because I came from such a "good home". 

When I experienced post partum mania 6 years later, the same doctor diagnosed me with schizophrenia, and put me on heavy medication to suppress the hallucinations.  I signed myself out of the hospital, because I knew my husband was not properly caring for my young son, on the basis on the fact that he was extremely abusive to me.  After a short period of time, I ended up in the "psych ward from hell", given huges doses of Thorazine, and shock treatment by a doctor who was definitely crazier than any of the patients.  Ironically, I turned to my parents, who "rescued" me, and took care of me and my baby for 8 months. During that time I cut my meds in half, and then reduced them to nothing.  It was many years before any more psychosis appeared, and I smartened up and left this abusive man, only to find that "the nicest man" in the world," was also an abuser. 

Which leaves me with issues about battered wife syndrome, versus wrong choices in husbands, and my anger, and out of control temper triggering these batterer's insecurities and mental problems.  A complex interaction.  I finally, after 25  years of abuse and 3 more children, finally kicked out this man, and got help for my life situation. 

However 10 years earlier, during an extensive summer depression episode, I sought help from a pdoc who had to wisdom to put together highs and lows, and a correct diagnosis.  Lithium was an answer to a dream, which unfortunately eventually turned into a nightmare about 4 years later, when I suffered toxicity on an extremely low dose, and went psychotic, as well as uncovering kidney damage.  I had also developed a severe auto-immune disease by this point (Rheumatoid Arthritis), and was slowly being crippled to death.

It took a tremendous amount of counselling, a new and very good pdoc, who assisted me in solving the many physical health issues, a lot of research and support on line and in community groups, as well as a renewal of my faith in God to get to the place where I am now.  From taking 22 meds for 7 diseases, I am down to about 9 meds, some sleep disorder related, and 1/4 tab Wellbutrin to control hot flashes, and keep my mood stable.

So obviously, the abuse and neglect played a large factor, I believe in developing my illness, and triggering symptoms. My aggressive, outgoing cousins, and probably my father could all have ended up like me.  However, the "stress" of abuse was never present in any of their lives to my knowledge, and they are all mentally healthy.

As for my 4 children, no matter how bad I got, I tried very hard not to take it out on them, and meet their needs, with love, acceptance, and help them pursue their dreams and desires. They are all happily married, with excellent careers, in spite of finding out that 2 of the boys were abused by a neighborhood pedophile many years after the fact.  Whether they have my "genes" is an issue, but they know to this day, that my love and concern for them is unconditional, and I maintain good relationships with them and their spouses.  My husband and I did reunite, under the condition he get psychiatric help, and medication for his major depression.  Things aren't perfect, but then life never is, and we enjoy and love each other, and have been able to forgive each other for past tragic "mistakes'. 

Angie

Just a further aside, my daughter works as a psychiatric aide in a local mental hospital part time while she pursues her degree in psychology.  She learned in abnormal psych, that mental illness is usually a result of abuse (this includes overprotection, a strange sort of well-meaning abuse!).  It was very significant for her to actually sit in on a pedicure party with the female patients, and listen to the conversations between the women as to what "the bad men" had done to each and every patient.  It was no longer theory for her, but fact!

Angie

Hi, Angela. I wish everyone could read this. The trauma issues are huge - and this would include people who don't necessarily EXPERIENCE traumatic events as we know it, but PERCEIVE ordinary events as traumatic.

And this is where psychiatrist can make terrible mistakes, as your post so forcefully highlights. You flip into psychosis, a psychiatrist assumes you have schizophrenia and tells you that you need to be on antipsychotics the rest of your life.

Or, if the stress/trauma triggers depression or bipolar, you are treated for the symptoms without the underlying issues being addressed. That ain't gonna work. You can have a great initial response to meds, but if you have to go back to the same world - abusive partner, toxic work situation, memories that haunt you - you're going to end up in the same place regardless.

Your daughter is definitely right. A good deal of mental illness involves trauma issues. Which means ALL patients with a diagnosis need to be screened very carefully, with aggressive follow-up.

I agree that BOTH genetics and environment have a role in developing bipolar of other mood disorders.  My mother had a severe case of bipolar and ended up committing suicide when I was a teenager after many attempts.  She was a also abusive to us children when she was out of the hospital.  So I have developed bipolar 1 and have the genetic bacground and the trauma in childhood.

I asked my dhildren's doc if there was a way to prevent my children from developing bipolar since they had my genes.  He said the best way was to provide a stable, loving home life.  I tried the best I could (with a wonderful husband), but both my children had severe bouts of depression.

My son has not had another episode (he was on medication and received therapy for one year after I found a suicide note).  My daughter took a medical leave from college for a semester and received therapy and medication, too.  She got off the medication, though, due to the side effect of severe sleepiness.

 My daughter still has bouts but due to the stigma is fearful of seeking help (lawyer).  She has chosen not to have children so as not to pass on these genes.

I don't know about my son yet as he is not in a long-term relationship.

Hi, Stormy. Two landmark studies in 2000 on Albanian refugess during the Serbian invasion. Tates of depression and other mental illness were off the charts. More details in an article on mcmanweb

Hi John, thank you, I have thought about this for some time. My husband of 38 years has suffered PTSD(Vietnam vet). Our oldest son showed signs of mental illness at about 5 years of age (bipolar 2). I fought so hard to get him help and I heard that children do not suffer mental illness that was 30 years ago. Our middle son was fine until he turned about 27 and was stalked by a person he thought was a friend our son  now suffers PTSD, our last son at the age of 27 was fine I thought until he became a deputy sheriff, and then entered the Army, he never made it through basic ( Bipolar 1).  I have always wondered why my children suffer these illnesses,as there was no abuse.  Then I started working with vets and saw that this happens a lot with the children of Veitnam Vets with PTSD.

 I work with Domestic Violence victims, and I see how trauma has harmed the victim, and their children.

I then started thinking about war, and why it is so hard to find information on how these people handle the horror of war (they live it daily). I see the children on the news with death and fear all around them, and I wonder what is happening in those little brains.