01 May Nature and Nurture
I was watching a television show yesterday about the actor Michael J. Fox. As you probably know, he starred in some of the most wildly successful movies and TV shows of all time. You also probably know that several years ago, he was diagnosed with Parkinson’s Disease that he continues to fight with great vigor. He has aptly been labelled a role model for those who are facing overwhelming odds but who are unwilling to give up.
As he was being interviewed and talking about his history with this disease, he said a phrase that really stuck out to me and made me think about how broadly applicable it might be. He said in regard to contracting his disease that “genetics loads the gun, environment pulls the trigger.” I was a bit hesitant to use this particular phraseology given all the current public discourse on guns and the second amendment, but I also thought it was in some ways an apt and properly provocative metaphor when applied to certain mental health issues.
Many people who I see in therapy are looking for the causes of what they are struggling with and for many, it is hard to connect the dots very well. But what current research does show is that certain mental health issues have a fairly clear and robust connection to genetics. That is, if there are examples in your family of one of the mental health disorders that I will mention, then it is likely that whether you will get the same disease is genetically influenced. That is not to say that it is genetically determined (as in 100%) but your risk may be slightly but measurably higher for contracting the disease than someone who does not have the same genetic profile.
There are several mental health disorders that current research has identified with the genetic component but the most common ones that I see in my general practice are ADHD, major depressive disorder, and bi-polar disorder. The great news about all three of these is that for many people who are diagnosed, there are treatments that really help. And here is where this genetic awareness comes in. If you have someone and especially more than one someone in your blood family with either of these three problems, then it is important for you first to not panic (remember this is a heightened risk, not an absolute sentence) but also to be aware and make others around you aware so that if signs do start to manifest, you can act and get treatment sooner. And the sooner you catch it, the more likely you will be able to achieve the positive outcome.
Finally, I can’t address genetics without mentioning something that is not a mental health disorder proper but is something I see quite a lot and that is alcoholism. It is well researched that genetics influence who does and does not become alcoholic. The easiest way to look at is to accept that everyone has a level of drinking at which they are likely to develop what is classically considered alcoholism. But for those with especially multiple instances of family of origin and extended family members who have the disease, the risk for them developing it is significantly higher and can be triggered at a much lower level of alcohol consumption. How much you can safely drink must in part be considered through the lens of genetics. This is the perhaps the clearest instance of genetics loading the gun and it is vitally important especially for people with this genetic factor to avoid the environments that can “pull the trigger”.