Can We Prevent Mental Illnesses Before They Happen?

Ever since the White House Mental Health summit, I’ve been hearing about how we can prevent mental illnesses.  I recently googled the subject and found this from the Mental Health Commission of Canada.

By promoting mental health and preventing mental illness, we can increase the number of people who enjoy good mental health and reduce, to the greatest extent possible, the number of people whose mental health is poor, who experience the symptoms of mental health problems or illnesses, or who die by suicide…

By enhancing factors that are known to help protect people (e.g., having a sense of belonging, enjoying good relationships and good physical health) and diminishing those factors that put them at risk (e.g., childhood trauma, social isolation), we can reduce the onset of some mental health problems and illnesses, reduce symptoms and disability, and support people in their journey of recovery. Structural and social factors that reduce adversity and promote a sense of security, such as safe housing and stable income, are also of great importance.

All of us should be in favor of educational programs that target bullying. We should want every child to grow up feeling a sense of belonging, being free of childhood trauma, not being socially isolated and in secure homes with financially stable families.

But would that prevent mental illnesses? Sorry, but I don’t think so.

As is often true in discussions about mental disorders, definitions are important. The DSM-5 lists lots of personality disorders that could be linked to childhood trauma, poverty, isolation, or low self-esteem.  But does poverty cause schizophrenia? Does being bullied cause bipolar disorder?  Does having lousy parents cause serious and debilitating depression?

These are the three disorders most commonly described as Serious Mental Illnesses and although scientists still cannot tell us the underlying causes of these SMIs, the National Institute of Mental Health and our nation’s top researchers insist that they are, in fact, real illnesses that appear to be genetically based.

In my son’s case, there were no obvious warning signs before his symptoms first surfaced while he was in college.  He was not bullied as a child, did not grow up in poverty, did not have low self-esteem or a traumatic childhood. I know hundreds of parents who will tell you the same thing about their child. If anything, many of them will tell you that their son or daughter was extremely bright and/or extremely artistic. This is not self-serving on their part or on mine.  It is the truth.

I realize individual stories are not always representative and I am not suggesting that poverty, trauma, and cruelty do not influence children and impact their personalities. All of us are influenced by our environment. The longer that I live, the more of my father I see in myself.

But I remain skeptical that schizophrenia, bipolar disorder, and major and persistent depression can be “prevented” by social remedies.

Studies by the World Health Organization and others say that schizophrenia :

was found to be (present in) “about seven to eight individuals per 1,000” (0.7/0.8%) (worldwide.) The prevalence of schizophrenia was consistently lower in poorer countries than in richer countries (though not the incidence), but the prevalence did not differ between urban/rural areas or men/women (although incidence did).

Those findings suggest to me that schizophrenia doesn’t care about a person’s culture, ethnicity, or enviornment.

Arguably, I am only focusing on SMIs. But I am doing that because I believe there is a danger in the message that the Canadian Mental Health Commission and other groups are sending when they suggest that we have the scientific expertise needed to prevent mental illnesses. Such optimism implies that those who get mental illnesses, such as schzophrenia, must have undergone something horrific in their pasts or have some fundamental weakeness/character flaw that caused them to develop their illness. Otherwise, they wouldn’t be sick.

That sort of thinking causes stigma. It suggests that people who have SMIs got them for a preventable reason. Take your choice — overbearing mothers, poverty, being socially awkward. I don’t believe that and until someone convinces me otherwise, I do not believe that we know how to prevent SMIs from surfacing — although I certainly wish otherwise.