If science gives us something, it is the possibility of having a starting point for discussion. That is basically what the data does: they show a reality in a shared language. In return, science asks us that this data be reproducible. That any research team that performs the same process in any place and at any time will obtain the same result. This aspect of reproducibility is key for the discussion to be civil and to allow progress on the problem. The discussion is, therefore, about the interpretation of these data, about what that number means. But the starting point, the initial meeting point, must be reproducible and the method shared. The scientific evidence is such insofar as it comes from this context.
As progress was made in the coding of the human genome, great expectations were generated about finally finding the genes for schizophrenia, depression, and other mental illnesses. These findings were expected to lead to improvements in the diagnosis and treatment of these symptoms, and in general to an improved quality of life for patients and families. Unfortunately, expectations were not met, and it was not for lack of initiative. Massive research consortiums were formed and titanic efforts were made to overcome methodological and technical limits that were unimaginable a few years earlier. But the data indicated another reality. To date, the data shows us that the appearance of a mental illness cannot be explained solely by the presence of certain genetic variants. Something else must be added, and that something else is non-genetic.
We are in the field of risk factors in mental health, and the range of potential options is even broader than that faced by scientific research teams on genetic bases. Potentially, any situation, element, relationship, or context that occurs throughout a person’s life is plausible to be included as a factor that could be involved in changes in mood, anxiety levels, or even the interpretation of reality. In addition, these factors (in contrast to the genetic profile) are modified throughout life as the person grows, establishes new relationships, visits new places, studies or changes jobs. There are those who throw in the towel in front of this immensity for considering it incomprehensible. But there are those of us, based on data we have known for a long time, who welcome the challenge.
For years, even before the discovery of the human genome, there has been data on the impact of some life experiences on people’s mental health. I am not referring to some personal experience that most of us have (problems in the couple, job change) that has made this relationship evident. I am referring to scientific data from studies based first on some groups and, more recently, on populations, which show a clear relationship between disease and exposure to certain life situations. The clearest example, and the one with the most supporting evidence, is that of suffering abuse during childhood. This experience increases between 2 and 4 times the risk of having symptoms of psychosis and depression in adult life. There are other risk factors with scientific evidence, but for today I will focus on this fact.
So let’s imagine an adult person, about 45 years old, with severe depression. Let’s imagine it man, why not. This man is in treatment with mental health professionals, and he is part of a community whose functioning is governed by public policies and actions. With the data we have today, it is expected that those in charge of his treatment will be interested in his history during childhood and know whether or not this man is a survivor of abuse. The chances that it is are much higher than for other 45-year-old men who don’t have depression, so the question is more than justified. It will not be an easy task given the stigma that surrounds mental health and even more so child abuse. But the team of professionals is well trained to face tasks that are not easy.
At the level of public policies and actions, what is expected is that those who have health management in their hands join their efforts with those who work in the social and judicial spheres to prevent further abuses from occurring. Because, although suffering abuse in childhood does not decree mental illness and not all people with a mental illness have suffered abuse, eradicating abuse in childhood is probably, today, the most powerful and most accurate prevention measure for mental illness that can be executed. If we look at it from a community and population perspective, preventing abuse during childhood can mean a reduction of up to 50% in the prevalence of mental illness.
In order for this type of policy (clinical and public) to become real actions, it is necessary to understand a fundamental idea: mental illnesses can be prevented. The data tells us that there is a very clear factor that increases the risk of having a mental illness. By pure logic, eliminating this factor will reduce the risk. Undoubtedly, more actions, based on evidence, will be necessary to accelerate a process focused on reducing mental suffering in all people. Undoubtedly there are other factors that can modify this relationship, such as personal characteristics or social support. Risk implies probability and therefore chance, not fate. Risk also implies that the control we have over the course of our lives is not completely within our control. But our ability to recognize our own vulnerabilities and limitations is, and then seek answers to them.
A common argument is that these adverse events are rare, and that collective prevention actions will only benefit a minority. If so, prevention will not have the effect we hope for (significant reduction in the prevalence of mental illness) and is therefore – put quickly – not worth it. Unfortunately, childhood abuse is more common than we dare to admit. It is not, therefore, a lack of data, or low numbers. It is time to question the role of fate and the unchangeable character of mental illness, to recognize the limited scope of genes and determination. It is time to initiate clear collective actions. The probability of success is on our side.
Ximena Goldberg She is a clinical psychologist and doctor in neuroscience. She has been working in mental health for almost two decades, specializing in the area of health determinants and their processes of change. She writes about mental health, behavior, and psychology.
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