A Deeper Look into Mental Illness

By Schmidt, Charles W. | Environmental Health Perspectives, August 2007 | Go to article overview

A Deeper Look into Mental Illness


Schmidt, Charles W., Environmental Health Perspectives


Mental illnesses produce some of the most challenging health problems faced by society, accounting for vast numbers of hospitalizations, disabilities resulting in billions in lost productivity, and sharply elevated risks for suicide. Scientists have long known that these potentially devastating conditions arise from combinations of genes and environmental factors. Genetic research has produced intriguing biological insights into mental illness, showing that particular gene variations predispose some individuals to conditions such as depression and schizophrenia.

Now, thanks to a growing union of epidemiology and molecular biology, the role of the environment in the etiology of mental illness has become more clear. Indeed, E. Fuller Torrey, president of the Treatment Advocacy Center, a nonprofit organization that promotes treatment advances in psychiatry, suggests that mental illnesses increasingly fall into the realm of environmental health. And from that platform, he says, new treatment advances could soon emerge.

"Some of the greatest advancements in twentieth-century medicine were achieved by identifying and preventing infectious diseases through vaccination, improved sanitary measures, improved nutrition, and diminished hazards of environmental contaminants," adds Alan Brown, an associate professor of clinical psychiatry and epidemiology at Columbia University Medical Center. "If environmental risk factors for [mental illness] can be validated and confirmed, there is every reason to expect they will point to preventive measures that lower their risks and morbidity."

Everything But the Gene

Scientists define "environment" in the realm of mental illness broadly, some going so far as to suggest it encompasses everything that isn't an inherited gene. That's a departure from traditional thinking in environmental health, however, which has historically viewed environmental threats in the context of infectious agents, pollutants, and other exogenous factors that influence the individual's physical surroundings. Environmental threats to mental health include these traditional parameters- along with pharmaceutical and illicit drugs, injuries, and nutritional deficiencies--but also consist of psychosocial conditions that relate to the individual's perceptions of the social and physical world.

Any number of circumstances--for instance, sexual abuse, falling victim to crime, or the breakup of a relationship--can produce psychosocial stress. But experts assume each of these circumstances triggers more primal reactions, such as feelings of loss or danger, which serve to push victims toward a particular mental state. "Feelings of pure loss might lead to depressive disorders, while feelings of pure danger might lead to anxiety disorders," explains Ronald Kessler, a professor of health care policy at Harvard Medical School. "And feelings of loss and danger might lead to both simultaneously." Either alone or in combination, psychosocial and physiological stressors can interact with genetic vulnerability to alter brain chemistry and thus alter the individual's mental health.

Several lines of evidence point to an environmental role in psychiatric disease. Among identical twins, if one becomes schizophrenic, the risk to the other is on average less than 50%, suggesting that environmental influences must somehow be involved. Similar findings have been observed with depression and other mental disorders.

Scientists have traditionally been challenged in their efforts to link mental illness with underlying causes, in part because the diseases are so amorphous, says Ezra Susser, a psychiatrist and department chair in epidemiology at the Columbia University Mailman School of Public Health. Unlike cancer or heart disease, which have clearly visible end points, mental disorders yield vague behaviors that vary widely among individuals. "They're defined mainly by thoughts, behaviors, and feelings," Susser says. …

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