If my daughter's environment has triggered her mental illness all I can say is I feel heartbroken. So what I think this piece is saying is that families can create mental illness in individuals who may be described as sensitive people. What can be done to help our sons and daughters once the damage has been done.
Posted by: Yaya at December 4, 2006 09:07 AM
I think that we are mixing apples and oranges.
Here are my points:
- Severe illnesses that affect the brain are due to something biologically awry in the organism.
- Various therapies can help a person cope with their biology and lead a better life.
Therapy can also help people with diabetes, heart disease, cancer and lupus. - Stress can exacerbate any illness, so therapy and lessening the perception of stress can help any disorder.
However, some disorders directly affect the area of the brain that perceives and handles stress. In these disorders, what is "stress" to that brain might not even be a blip on the radar of the brain of someone not already compromised.
Schizophrenia runs in my family. Our mother had it in spite of an ideal childhood. My 3 brothers and myself seem to carry "the gene" for something that can affect our brain, but it must be mild. In spite of divorce, sexual abuse, emotional abuse, orphanage, and more - none of us have a severe brain disorder, although we do have some signs that we carry "the gene". Collectively, we have several children more affected than others - other kids in the same family are resilient, happy and emotionally strong.
My younger daughter with TWO grandmothers with schizophrenia did not have a chance - she showed signs since infancy.
Is it biological? Yes. Do emotional life events affect it? Yes... but that holds true for every illness there is, and how MUCH lany emotional life events
affects the illness depends again on the biology of the person with that illness.
Another example - my daughter with SZ-A has shown signs of hypothalamic/pituitary axis dysfunction since birth. Without medication, she gets hives from heat, hives from happiness, hives from excitement, hives from
stress, hives from fear, and hives from joy. If the medications were not available to mitigate those hives, I guess there we would not have had any recourse but to have her go through some kind of cognitive/psychological therapy (if available) to help her suppress all emotions - like becoming a Zen Buddhist... or I don't know what.
Sure - given enough years of intense therapy, her own brain could possibly have helped mitigate the hives arising from her hypothalamic dysfunction. A NORMAL brain would not NEED that.
Even if intense therapy to control both her positive and negative emotions could have been available, it would not have worked because her biology would have interfered because that was not the only problem. The stress of having to go to school AND participate in that therapy would have been overwhelming.... and we all know about the stress cascade and schizophrenia.
Maybe if she could have not gone to school, been raised by Buddhist monks in an isolated monastery, AND had me there to provide maternal love and comfort... MAYBE it could have helped her. Let's get real.
In the meantime, during her childhood, if these doctors had focussed more on the physical, they might have tested ALL her hypothalamic-pituitary-thyroid axis hormones and FOUND other problems she has yet did not find and start treating for YEARS (because, after all - her problems were a "mental" illness)-who knows the impact treating that earlier would have had. Less anxiety, less psychosis, depression, fatigue and missed days of school might have translated to a milder course of illness - less STRESS which also exacerbates illness. And now - her brain might not have lost some of the intelligence she had in childhood (hypothyroidism in childhood permanently lowers IQ and can cause mental retardation), which would mean college might be easier for her now... again - less stress. And less stress means less exacerbation of an illness which she has battled with since birth.
I would much rather scientists focus on the underlying biology and fix it so that these kids can live a normal life.
-Jeanie
Posted by: Jeanie at December 4, 2006 09:19 AM
Yaya and Jeanie,
This article was not a commentary directed at people who have children who already have schizophrenia. It is impossible to tell, given the state of the science, whether any person's mental illness was caused by any given level of genetic loading or stressors - so that discussion is really counter productive. Rather, the objective is for the extended family members - to provide hope and possible directions to help lower risk for children who may be at risk. The news on what we can do to help people who have developed schizophrenia already is something we cover on the site on a daily basis - so all I can say is stay tuned.
I believe that Jeanie is correct in much of her assessment - certainly the research supports the idea that in some percentage there are people who have such a high genetic loading or early biological factor that they are extremely sensitive to the environment and may be highly likely to get schizophrenia or other mental illness. And certainly - its very important to evaluate all potential physical root causes of an illness as part of an evaluation.
My point of this article is different though - and its directed at the extended families of those effected. Increasingly it seems that very good prenatal care, early high-quality childcare, positive and sensitive and supportive parenting, secure parental relationshiops, safe neighborhoods and schools, strong and positive friendships and social networks, etc. - all can make a significant difference in lowering the rate (by up to 86%, as suggested in recent research we've cited) in many cases of schizophrenia. I think this provides great hope for many people - and while nobody can create the "perfect" environment, what the research suggests is that any difference can probably lower the odds.
Just as people may be biologically susceptible to diabetes but with good care in diet and exercise probably 98% of people can avoid Type 2 diabetes -- it seems increasingly possible that in the future research will have identified the key environmental factors to a level that will allow families with the genes for mental illness to avoid getting the disorders, by controling the environment (pre and post natal) of their children). Of course, research should also be continued in finding a cure too.
Posted by: szadmin at December 4, 2006 10:09 AM
I don't agree. Despite recent trends back to the old 'schizophrenogenic' model, with a multifactorial model coming back into public popularity, I don't feel there will be an 'environmental prevention' for this illness. I think that it will be possible to treat it earlier, perhaps even before the person is born, thru genetic therapy or vaccines, but I don't think that mom will prevent schizophrenia in little Mary by not asking her to take gymnastics and ballet at the same time, or even, (i know this statement will make people lash out angrily at me but i have a right to speak my opinon) by reducing her 'stress', such as by not pressuring her to get an 'A' in school or go to college. I certainly feel that avoiding abuse and mistreatment people will wind up happier in their life, but this is a biological disease, not a psychological one. I don't feel a parent's choices in how they take care of their child will prevent schizophrenia - ever, in any one. Sorry....but I have a right to say so. For me, the genetic evidence is mounting and mounting. I feel it's regarded as an 'inexact science' by the public only because the research is hard to understand and grasp. Except it wouldn't be one single gene at all, but a large number, one for each cognitive area.
Posted by: slc2 at December 5, 2006 12:36 PM
So - SLC2 - just so we have it clear here - you're firmly in the minority view in believing that there is a clear distinction between and separation of biology and psychology - despite what the experts we talk to in the field are saying, despite what many of the medical schools are teaching (Demian Rose just finished his PostDoc at University of California, San Francisco Medical School), and despite what a vast body of evidence suggests.
Thankfully - the number of people that hold your view is shrinking rapidly given the evidence (please read the links in the article above and check out the book by Daniel Goleman). You seem to hold amazingly strong convictions that are contrary to all the researchers and psychiatrists I talk to, and yet you provide very little evidence for these beliefs. Perhaps, to move the conversation forward - you can suggest some evidence that you see supports your view that there is a clear difference between biology and psychology? What is this important evidence that you hold - that the researchers I talk to seem to have missed or undervalued?
Also - just to be sure I'm understanding you correctly - you seem to think that genetics is 100% of the cause of schizophrenia - even though many research studies show that in identical twins (i.e. same genes) only 50% to 60% of the twins the second twin will get schizophrenia if the first one gets it.
Posted by: szadmin at December 5, 2006 01:32 PM
on the highly personal attack, again, eh szadmin, and again accusing me of of believing things i don't believe and have never stated...as usual.
Posted by: slc2 at December 5, 2006 02:22 PM
the fact that a certain percentage of identical twins both get schiz is no proof the cause is not genetic.
i understand only too well that it is ok for you to ceaselessly attack me and to again and again repeat that educated and reasonable people have moved away from my idiotic points of view etc, etc, etc, etc, ad nauseum, what i don't understand is, do you really think i would bother to reply, to collect and present information that would illustrate these ideas, given the highly personal and nasty nature of your repeated attacks on me? the other thing i don't understand is why is it ok for you to be so nasty to me and then you change and delete posts where people are being far less nasty than you are?
Posted by: slc at December 5, 2006 02:27 PM
First of all,are you feeling ok?
I am asking because although you are prone to being somewhat dogmatic i have never known you post in such an aggressive/defensive style.
Secondly whilst accepting that genetics has a major role to play
twin studies show that there is more involved than just **genetics**.
I concur with the diathesis-stress model.
Posted by: Tim at December 5, 2006 02:51 PM
Goodness, whoever said that "Environment = Mom & Dad"?
Sure parents play a part of the environment, but really, we all experience many different things in life.
No "stress" (boredom) may be a greater stressor than having some positive stressors in life, such as school or college and part-time work or volunteer work. My parents are real supports to this person with schizoaffective disorder! They help me keep this whole thing in balance, so I don't go off the deep end.
Posted by: Someone at December 5, 2006 03:21 PM
SLC - this is not personal. You I think you are saying (and please correct me if I'm misinterpreting your opinion) that its all genetics and biology, and nothing but genetics and biology (and you seem think that psychology has nothing - or little - to do with biology)- and all I'm asking for is evidence, and to understand why you dismiss the evidence and input provided.
Is asking for the evidence on which you're basing your opinion - considered nasty? I'm sorry if it comes across that way. I think its fine if you disagree with the expert opinion - but I just don't find it productive to say "this is my opinion and I'm sticking to it" - without providing any evidence, or discussion of the information provided. Your comments seem to suggest that you have not even read the links to the supporting evidence for the blog entry - thats what I find particularly frustrating. You disregard the evidence without even reading it. Why do you find all the studies and expert opinions unpersuasive?
Posted by: szadmin at December 5, 2006 03:22 PM
Actually, I am in agreement with SLC in that it is not preventable. I also agree with szadmin that there are environmental factors. These two ideas actually are not mutually exclusive because... we are arguing about apples and oranges.
FIRST... schizophrenia is not ONE illness.
SECOND... when one identical twin gets it and the other does not, does NOT mean it is not genetic or biological. Twins may have started from the same egg, but they have different assortments of mitochondrial DNA, different proteins in different quantities distributed even from the very beginning. They can have vastly different places in the uterus thus obtaining different nutrients. Their brains develop differently and thus their resulting neurohormones are different. This is BIOLOGY. One is left-handed, one is right-handed. One has dyslexia, one doesn't. One has exceptional coordination, the other is clumsy. One gets schizophrenia and the other doesn't. Yet they are twins. Their biologies are still unique.
Yes, environment worked with their genes.... in the uterus, and on the playground. Their body's internal environment is different too.
SLC has a point about genetics and biology, and the research does back her up.
szadmin is talking about the interaction of "environment" on the BIOLOGY of the organism. A lot of those environmental factors cannot be altered, and without the underlying biology, those environemental factors would not matter at all.
We always look for "reasons", and "triggers"... and we will always find them, because life is rough. To live, is to experience trauma and joy. And illness. Or not.
We all want the same thing. Prevention and/or a cure.
It is just that calling such a biological illness "psychological" is like a slap in the face and I think that is what is causing a highly charged emotional response from some of us. Doctors often call biological illnesses "psychological" when they don't yet know what the cause really is. They use that term as a cop-out.
They called my mother's chest-pains "mental" and she died of heart-failure. Everyone has stories like that.
Posted by: Jeanie at December 5, 2006 05:36 PM
No, research results do not support the belief of all Schizophrenia = 100% genetics!
Research results do indicate that Schizophrenia = genetic factor + environment factors
That's to say that Schizophrenia = X% genetic + (100-X)% environment
For a very small population of schizophrenics, schizophrenia is mainly caused by genetic factor when X is close to 100. For these people, schizophrenia symptoms occur usually in their early year, and environment factors played a very minor role.
In my wife's sz, genetic factor played very minor role, as I have found no schizophrenia history from her side of family. It is my belief that without high stressful environment, she would never have schizophrenia.
By the way, enviourment factor does not only include Dad & Mom. It includes all external factors that surround and affect a person.
Posted by: JD05 at December 5, 2006 07:30 PM
OK - a related question to Jeanie. Do you think ADHD is any less or more of a brain disease or psychiatric disorder than schizophrenia?
Notice in the above links there is one that talks about research that indicates that maternal anxiety during pregnancy increases risk of ADHD. Why is that not "preventable"?
I suspect that the same link will ultimately be proven (instead of just suggested) with schizophrenia and maternal anxiety. So why wouldn't you consider this preventable? Why wouldn't you want to educate people who suffer from anxiety / excessive worry about the potential risk factor - so that they could get therapy (for example cognitive behavioral therapy) which is a proven technique for reducing and eliminating anxiety disorders?
Also - what about all the studies referenced in the list of "Additional Reading" above - about how psychotherapy and drugs show the same impact on brains when brain imaging is done? Or how harmful untreated depression is in mothers, for their babies and children? Or how broken homes seem to increase the risk of schizophrenia? Do you think that they are all 100% inaccurate? Do you not think that there are reasonable precautions that families could take that could "likely" reduce the risk of schizophrenia, based on this information? (certainly it isn't proven, but the evidence seems to just keep on coming - at what point is something "proven", and is it not prudent to take action before something is 100% "proven" and the costs are relatively low?).
Posted by: szadmin at December 5, 2006 08:37 PM
Well, it is well known that increased level of stress (like intensive learning or excitement) can ignite the development of schizophrenia, but can we still say that this is a "psychological" or "biological" factor. Stress also produces brain chemicals that can cause chain reaction etc. So where to draw the line? I believe the resarch is still far from proving one or the other. The thing I know is that without medications my brother would get nowhere with his rehabilitation, and he had such a normal, happy and healthy childhood. Marijuana played part in developing his illness.
Posted by: Marry Ann at December 5, 2006 09:57 PM
Perhaps it would be helpful to disentangle genetics/biology/enviornment/psychology. If I understand, the previous discussion
marks psychology and genetics as two ends of a spectrum, with biology/enviornment
impacting both ends.
It would be helpful to provide stable definitions for these terms. What role do
genetics play in psychology ? Is temperment psychology or genetics, either working through/responding to enviornment ?
Also, to be fair, MZ twins have been discordant for prenatally aquired HIV and
Hepatitis at birth, as well as for some congenital malformations. MZ twin
pairs discordant for MI are also more likely to also show greater discordance for (fingerprint) ridge counts, mirroring, and more likely to show
greater variation in birthweight. Also, relaxing date of onset for psychosis as
well as relaxing diagnostic subtype (Axis I) results for a greater, generalized MI and personality disorder concordance. (Pubmed searches can confirm)
This area is a rough place to go wading, as it tends to easily polarize people.
And truly, I don't think we'll have any conclusions until the "schizophrenias"
themselves can be teased apart. Only then, can relative contributions be determined. Until then, of course it is preferrable to provide a warm, supportive stable enviornment for ALL children. The reality is, that takes both a family and the greater society's involvement.
Concerning the recent "Broken Home" study, I have a few questions:
1. It would be reasonable to conclude then, that SZ rates have increased with the rising divorce rates of the last 30 yrs. Have they ?
2. SZ rates among non-emigre, divorced Afro-carribean family members should also be elevated. Are they ?
3. Have SZ sufferers in this study been sorted for
a. other risk factors (season of birth, obstetric events, parental loading,
pre-morbid diagnosis such as ADHD etc.)
b. SZ subtype (dominant neg. vs. positive symptoms, type of onset, GAF etc.)
4. Recent studies indicate genetic involvement (and subtype) varies somewhat
among ethnic groups. Has this been considered as a loading factor for this group
5. Pubmed search indicates a higher rate of STDs, including chlamydia, among
Afro-carribean immigrants in the UK. Recent studies indicate maternal STDs as a
potential risk-factor for SZ. Has this finding been applied to the "BH" study ?
6. A recent news article posted on this site reports on the danger of enviornmental toxins. Also, dry cleaning chemicals have been found to poss.
increase SZ risk in offspring (Pubmed). In the US at least, populations close to superfund sites are more likely to be poor and minority. Has this be considered
as a confounding factor ?
Epigenetic changes bear an influence on offspring of subsequent generations
(I think up to 4, with BMI). Also, does anyone have resources on CNVariations
in MZ twins at birth ?
Concerning brain changes with psychological interventions: I don't doubt the veracity of these reports, but how much (degree, longevity) do these impact long
term. I don't mean to be silly, but where there is an underlying biological
mechanism, can they alter incoming as well as outgoing factors ? I ask this
because my family has a long history of absence seizures. Each affected family
member (of all known involved generations) exhibit a similar maladaptive behavioral cluster. In fact, prior to EEG, this behavioral cluster was part of the diagnostic work-up for Petit Mal Epilepsy.
I don't wish to be argumentative, but these questions are quite important to me. We have 5 unaffected children, all 6 exhibiting personality traits pre-natally. Certainly, our family is much happier -"normal"- since our SZ-A
child was stabilized. I have observed that coaching and support can alter outlook
and behavior in a child - but only so much. When a family member is ill - either
MI or physical illness in my experience, the window of variation of behavior and
outlook is narrower. The "personhood" or ithos of the family AND its individual
members is affected. This experience leads me to the question of mistaking
correlation/causation in any study investigating psychological impact.
Sorry this has been so long, but I am truly interested in these questions.
Thank-you !!!!!!
flooby
Posted by: flooby at December 6, 2006 07:38 AM
Just as an aside - concerning dietary contributions to type II diabetes:
Yes, it is accepted that diet does play an important role - enviornment -
My dad developed diabetes at age 60. When I was growing up, we had a very
healthy diet (junk food in our home was unbuttered popcorn and ice cream - about
once a month. We rarely ate dessert - usually fruit when we did.
My dad has found that some healthy foods spike his glucose readings
(ex.s, tomatoes, brown rice, cinnamon).
My point - human beings as biological systems are a great deal more complex than generalised advice would suggest.
flooby
Posted by: flooby at December 6, 2006 07:51 AM
In response to the ADHD question. There has always been "ADHD", except that it was called different things, such as "minimal brain damage" and "minimal brain dysfunction".
There are people with ADHD for whom it is 100% UNavoidable. They were born that way. A child with XYY chromosomes exhibits brain anomalies, and often they go through many diagnoses such as autism plus ADHD before having genes tested.
Then there are attentional problems associated with schizophrenia, Tourette's syndrome and more... they get the same label - "ADHD".
Then there is ADHD caused by the way the brain gets formed by early environment such as watching TV. Avoidable - but once the brain is formed that way, it is formed.
Can the "ADHD" be "fixed" by outside intervention? Sometimes. The brain has plasticity and some children can learn to concentrate better with extensive therapeutic measures over a lot of time. Some can be helped nominally, but not nearly fixed - such as those children with chromosomal abnormalities (often coupled with "mental retardation") - and others that would definitely have been classified as "minimal brain dysfunction/damage" before "ADHD" became popular.
So once again - the "psychology" and the "biology" even for ADHD is mixing apples and oranges. We now are lumping many different problems into the same "ADHD" bucket based on external symptoms.
My hope is that someday, with better diagnostic techniques and better treatment, very few people will be left in the "schizophrenia" bucket. Some will be cl;assified as caused by a virus. Will that still be "schizophrenia" or have its own name? Some will be bacterial. Again - is that the same illness? Some will be due to a problem in the hypothalamic/pituitary/thyroid axis. Again - will that still be labeled "schizophrenia"? Some will be personality, genetic vulnerability, plus upbringing and maybe can be "cured" with the help of therapy. Will that version be what is called "schizophrenia"? Another version may be lack of nutrion in-utero causing a malformation of the brain. Will that be "schizophrenia"? Or the version that is triggered by drug-abuse? Or the one caused by child-abuse? Or the one caused by the mother experiencing a severe trauma while pregnant?
-Jeanie
Posted by: Jeanie at December 6, 2006 09:42 AM
My understanding is that neither antipsychotic medicines nor any therapies are aimed to cure schizophrenia. They are all introduced for the same purpose as symptom control.
Since no one really knows what schizophrenia is, we all should be open-minded about this illness. A treatment (medicine, therapy, etc.) failed working for one person doesn't mean it will not work for others.
As Dr.Francis Crick spelled out, we are nothing but a pack of neurons. Any factors that affect us, no matter biologically or psychologically will all have impact on our wellbeing. Thus, I agree with szadmin's view about "biology (i.e., genetics and body chemistry) impacts psychology, and psychology (i.e., thoughts, emotions, and behavior) impacts brain biology."
Posted by: JD05 at December 6, 2006 04:53 PM
Jeanie,
I think what all the psychiatrists and researchers are telling us that it is no longer an issue of psychology / biology being an issue of apples and oranges. Pscyhology and biology are the same thing - you're just looking at different levels of the same thing. Anyway - I recommend the book "Social Intelligence" - Daniel Goleman explains it much better than I ever could.
Hi Flooby,
Let me try to answer some of your questions. You ask:
. It would be reasonable to conclude then, that SZ rates have increased with the rising divorce rates of the last 30 yrs. Have they ?
I don't think it would be reasonable to make this conclusion for these reasons:
1. divorce is just one obvious indicator of a high amount of stress in a family - obviously if the parent's relationship was functioning well, there would be no need for divorce. But the opposite (that if there isn't divorce, there isn't stress) is not necessarily true. Many people, in many cultures stay in marriages despite a great deal of stress and a great deal of unhappyness. They do this because of cultural norms, or family pressure to not break marriages, or because they think its good for the kids, and for many other reasons. So just because a marriage is still together - doesn't mean its functioning well. The increase in divorce rates may be due to people recognizing this - and due to changes in a culture's value of marriage, independent of the happiness of the people in it. So - I don't think you can generalize to the level that just because a family isn't divorced means that their children are experiencing less stress than the family that is married. Its more that divorce is an obvious indicator of stress - and there are not so many other obvious indicators in the still-married group of people. I think that this measure was chosen because its an easily identified marker of stress in a family, for research purposes. That is all. I don't think that the researchers are suggesting that the act of "divorce" is the stressor that contributes to schizophrenia - its the bad relationship stress that seems to be a contributing factor. It may be that by divorce of the parents lowers the risk of schizophrenia in high risk children - if staying together means higher levels of stress (and in fact the research seems to suggest this very thing).
2. Even if you think that a marriage that stays together means there is less stress in it, than ones that break up - there are many, many other factors that influence the incidence of schizophrenia in a society - toxins in the environment (which are probably going up in some areas, and going down due to enviromentalism in others), better healthcare over the past 30 years - which could lower incidences of mental illness, increasing trend for lack of healthcare insurance in the poor (which could result in increased incidence of mental illness), Increased awareness of the negative effect of alcohol during pregnancy, resulting in less drinking during pregnancy, resulting (potentially) in a lower incidence of schizophrenia, Elimnation of lead from paints and from gas - thus lowering the incidence of brain damage in infants and during pregnancy... so as you see - there are many things likely to be going on - some increasing schizophrenia risk, some lowering schizophrenia risk. Its too complex to say that just because divorce goes up, that therefore schizophrenia goes up. That might be true if all other things were held constant - but they aren't.
2. SZ rates among non-emigre, divorced Afro-carribean family members should also be elevated. Are they ?
I don't know - I haven't done that research.
3. Have SZ sufferers in this study been sorted for
a. other risk factors (season of birth, obstetric events, parental loading,
pre-morbid diagnosis such as ADHD etc.)
b. SZ subtype (dominant neg. vs. positive symptoms, type of onset, GAF etc.)
4. Recent studies indicate genetic involvement (and subtype) varies somewhat
among ethnic groups. Has this been considered as a loading factor for this group
I don't know - again - you'd have to read the research reports that we link to - and be able to fully understand them. I don't claim to have done either - and while we have the PHDs here helping us - there are just too many schizophrenia-related research reports to evaluate each one at the level that we'd like to. Perhaps one day when we get really good funding, we can do that. I'd certainly like to see us to do that.
5. Pubmed search indicates a higher rate of STDs, including chlamydia, among
Afro-carribean immigrants in the UK. Recent studies indicate maternal STDs as a
potential risk-factor for SZ. Has this finding been applied to the "BH" study ?
Good question - but again, we haven't looked at it.
6. A recent news article posted on this site reports on the danger of enviornmental toxins. Also, dry cleaning chemicals have been found to poss.
increase SZ risk in offspring (Pubmed). In the US at least, populations close to superfund sites are more likely to be poor and minority. Has this be considered
as a confounding factor ?
Again - good question, I don't know.
Concerning brain changes with psychological interventions: I don't doubt the veracity of these reports, but how much (degree, longevity) do these impact long
term. I don't mean to be silly, but where there is an underlying biological
mechanism, can they alter incoming as well as outgoing factors ?
There is a good story comparing the long term benefits of drugs vs. cognitive therapy for depression at this link - check it out:
http://www.healthandage.com/public/article/3169/gm=20!gid2=2960
Posted by: szadmin at December 7, 2006 11:14 AM
I have read nothing to indicate that psychology and biology are one and the same. Every organism, plant and animal, on this planet have "biology", but very few have "psychology". You cannot have psychology without biology, but you definitely can have biology without psychology.
Even in human beings, if they were one and the same, we would not need medicine - we would just need to change our way of thinking. There are religious groups, such as Christian Scientists that do believe this way. Some day they may be proven right.
In the meantime, I am glad that the doctors are treating the many endocrinological/neurological problems my daughter was born with that contributed to her symptoms since birth. It was just unfortunate that permanent damage was done to her brain, and lasting but not permanent damage to the rest of her body - not to mention lost years of her life - because her schizophrenia-spectrum disorder was chalked up to just "psychology".
I agree that there are many environmental factors interacting with an organism's biological make-up that can cause disease states. In some people, it can be their own internal psychological environment.
But I do maintain that when normal human life stresses cause a severe disease state, the organism was already biologically flawed. Otherwise most human beings on this planet would have schizophrenia.
I am reminded of reading about how adversity growing up makes us stronger and that children who are over-protected and coddled can't cope as adults, suffer more depression, and some commit suicide. The truth lies somewhere in-between, and how the child reacts, in large part, depends on their own genetic make-up and personality. SOME kids really need a slower pace, and more protection. For other kids, that would be intolerable, and for others, it would simply stifle their emotional growth.
I just cannot attribute my own lack of schizophrenia, in spite of divorce and a very poor childhood environment, to some kind of mental or psychological strength. That would be incredible hubris. It is like saying that people with shizophrenia have it due to their own mental/psychological weakness. I do not concur.
The only reason I do not have one of the illnesses causing psychosis that are currently getting called "schizophrenia" is due to my biological LUCK.
By the way, my daughter is reading this post of mine and has approved this message.
Posted by: Jeanie at December 7, 2006 02:05 PM
Jeanie,
I don't think there is a huge different in what we are saying... research suggests that:
1. Biological/Genetic predisposition is at the root of schizophrenia - and there are likely significant variations in risk predisposition based on number of associated genes, and prenatal factors, etc. a person experiences early in life.
2. People with this biological predisposition are more sensitive to stressors in the environment and internal to the person (e.g stressful thoughts) - and these stressors likely trigger schizophrenia.
But here is where I think you may benefit from "Social Intelligence" book, and what Demian and others suggested above:
3. psychology (i.e. thoughts, emotions, etc.) are biologically based (i.e. neurotransmitters such as dopamine, serotonin, GABA, etc. as well as neurons, synapses, and stress hormones, etc. - are all ultimately biology. Thoughts and emotions are based on that biology)- and they are influenced by social environment to a degree neuroscience did not understand a decade ago. As Demian says above "biology and psychology aren't just interacting phenomena, they are in fact different levels of analysis of the same phenomena" and why the corpus collosum psychiatrist is saying "people had thought at one point that there was a clear distinction between biological and psychological problems. A student chimed in: "But nobody really believes that any more, do they?"
This is what I think the psychologist and psychiatrists in the initial article above are getting at. For example, people's perception of risk (i.e. our worries, our anxieties) have a cascading effect on other neurotrasmitters and stress hormones - that in turn have impacts on disease conditions in substantial ways (and vise versa - disease conditions frequently have similar effects on thoughts and feelings). Human brain biology/psychology matters - perhaps as much as the underlying predisposition - given the studies that show significant increases in schizophrenia risk based on different social environmental factors.
4. Every person and environment is different - so this discussion is at the "societal" level - its impossible given the science today to say what did or did not cause schizophrenia in any one person.
And yes - I've read many child development books - too much protection is bad - just as too much exposure to stress is bad - the middle path is best, and where exactly that middle path is for any child - is not always clear. Nobody has ever said that the brain is a simple organ.
Posted by: szadmin at December 7, 2006 02:48 PM
I have been browsing this website recently due to a current situation that I have been involved in; this particular article prompted me to add a posting.
First, let me say, that I can see (feel) both sides of the issue, and understand where personal beliefs and/or personal situations (i.e.; environments) can skew an individual's perception of the said issue - biology/psychology.
It is easy to see why someone would take offense to the idea that parenting skills (or lack thereof) would "cause" a person to become schizophrenic. It is easy to understand that they (the person taking offense) would "feel" that they are being made responsible for this disease because of their "bad" parenting and/or environment. They don't want to be named as the catalyst for this horrible affliction. It is easy for them to point the finger at biology alone, because in doing so, they free themselves from the guilt associated with the alternative. However, it is in our human nature to defend ourselves...whether we are afflected with some form of MI or not. So, no fault can be found with these individuals who are simply trying to defend themselves from being labeled a "bad" parent and/or influence simply because they have found themselves dealing with a mixed bag of genes, etc. There is no illusion to anyone here that dealing with MI creates STRESS even under the BEST circumstances. It's unfortunate but true.
However, this inherent urge to defend the biology of it all, does not nigate the fact that psychology does effect the outcome if not the onset of the disease, in and of itself. But, let us ponder on the biological aspect before we start in with our reasoning.
Children are a product of a combination of their parents collective genes. I don't believe that anyone would argue that point. So, it stands to reason that children will be predisposed to any traits, disease processes, and personalities that they recieve from one or both parents. But how those genes are distributed is luck of the draw. You may get more from your father, you may get more from your mother, you may have one (or all) inherited genes passed down that predisposes you to one or all of these traits/characteristics. Now, I am no scientist, and won't even pretend to base any of this information than on anything more than common sense, my sometimes futile attempts to understand the scientic readings on the subject, and my own personal circumstance. But that (in a mediocre nutshell) is biology.
We are what we are based on our genetic makeup. It is, however, a combination of that genetic makeup AND our environment (and our reaction to that environment) that will ultimately determine how those traits are revealed (activated) within ourselves and to the world.
Case in point...If two children are born to alcoholic parents (making the assumption that alcohol was not consumed during pregnancy), which science has labeled a disease (we won't get in to that argument - but will work from that assumption that alcoholism is indeed a disease), and these two children grow up in that very same environment...one grows up to be an alcoholic and the other does not. This scenerio could also be used in identical twins. Which is true...biology or psychology (environment)? If it is biology...then why did only one child grow up to be an alcoholic? If we are to believe that it is purely biological then are we to assume that the non-drinking child is still an alcoholic even though alcohol was never consumed simply because they possess the gene? Then are we also to assume that the one child who is an alcoholic, is so because, of psychology (environment) and the introduction of the precipitator - alcohol?
Perhaps, in common sense terms, it is a combination of both biology and psychology? I think perhaps here in lies the truth. Both children inherit the gene, but only one develops the disease. Why? Because both were subjected to the same psychological/environmental factors that precipated or kept at bay the onset of such.
So, moving forward, and on to my situation and my personal conclusion. My friend (their father) has two children, from two different women, but we will focus on his daughter. She is three years old. She has a combination of both of her parents genes. Her father has ADHD and Dyslexia. Her mother has schizophrenia. Her biological grandmother had schizophrenia. Her half brother has ADHD and a multitude of emotional/behavioral/learning disabilities. Biologically speaking; the cards are definately stacked against her! Psychologically speaking, they are as well...but, to some degree this could be tweaked.
Let's assume that biologically she is spared. Even though she possesses all the genes and potential to have one or all of these combined genetic predispositions...she does not "get" ADHD, Dyslexia or Schizophrenia. Yet, she is raised by her two parents with these vastly intrusive and potentially distructive traits...she comes out unscathed? I think not. Even if she possessed none of their combined genes or traits, she will (and is) be drastically affected by the circumstances under which she is raised and subjected. She is learning her life skills from mentally unstable parents. Regardless, of the good intentions of those parents, she is still molded by their actions. Even when the nurturing is available...the examples are what is seen and followed. Despite the best intentions and love of the parents, the child is ultimately affected by THEIR mental illnesses and it's affect on her.
Assume that she is the exact same child, born of the exact same parents with the exact same genes, but is adopted into a family with no mental illiness and is in a good psychological/loving envirnonment. Does she still get the disease? Perhaps...because she is genetically predisposed. Is the onset delayed or it's effect lessened because of the environment? Perhaps. I don't know that there is any real way to measure that for sure, primarily because you'd have to work off a lot of assumptions. But, I believe that evidence for the psychology of it all is in our own history as a people. All things being equal, abused children suffer more adverse affects than those who are not abused...whether they are MI or not. Mentally well children perform better in school than those who are not. Children who have challenges who are in groups of children who are like them respond better due to the "acceptance" of their "likened" peers, than those who try to "fit in" with children who don't share their sameness. Even if they can succeed in their mental performance; their emotional status is affected by the shuning (environment) of their peers. Before you know it, both their biological and psychological wellbeing are strained. One definately is affected by the other! And from this example we can also assume that this "environment", good or bad, does not just squarely fall on the shoulders of the parents but society and individuals as a whole.
Honestly, I am scared to death for both of his kids, but primarily his daughter. She is being raised by an unmedicated and untreated schizophrenic mother! She has a very high probability of having one (or all) of their combined illnesses/disease processes. Even so, at age three, she is already displaying tendencies that concern me. Problem is, I don't know if it's the early manifestation of the inevitable disease process, or the product of being raised in a chaotic environment (that is putting it kindly) by a mentally unstable mother. In example, she has "nightmares or terrors" every single week. It is not every night but is at least once weekly. She mimicks some of her mothers behaviors; like throwing apparent temper tantrums out of no where for no particular reason. She seems to have very strange fears...and lots of them. Very hyperactive and talkative. She'll scream out and talk in her sleep...yelling things like..."People, People, People" at the very top of her lungs. Has her mother instilled these fears in her because of her own delusional thinking? Can it be reversed? Or is this simply a picture of things yet to come because of her own genetic disposition?
She often arrives at her father's (after a week with her mother) dirty, in unmatching, layered, soiled clothes. She was severely malnourished as an infant as a direct result of her mother's schizophrenia. I try and help make a psychological difference by being supportive and nurturing...but often it does seem futile...because of the biology and the psychology. However, I also believe that my efforts do make some difference because perhaps the knowledge of her parents afflictions can help get her early treatment if she is plagued with this horrific life robber. Perhaps, it won't be as bad when and if it does strike. But, will it always be an up hill battle as long as she continues to be raised by her mother?
Bottom line...the child is in dire straights it seems...due both to biology and psychology. I don't know what can be done to help both. The research may be there...and I believe both to be true...but at what point do we get past research and get answers? I'm really scared for this child. How do I tell the difference between the actual disease and the affects of the mother's disease on the child?
Here is the real clincher for me in this debate...
There is absolutely no guarantee that she will have any of these traits come to fruition, even in spite of her biology. There is also no guarantee that she won't...because of her biology. Will being raised by her unmedicated schizophrenic mother doom her because of the psychology of it all? Will my constant worry about her biological predisposition in effect bring about the disease in an otherwise healthy child? For the life of me...I cannot wrap my brain around the perameters of this disease! I know this much to be true...it is biological...and it is psychological! I experience the psychological effects of this disease just as all of you...and I'm not the one with schizophrenia. We all can learn a bit from our own psychological responses to this posting and topic. If you still feel that psychology doesn't play a role in all our well-beings...well then maybe you should re-think it.
Thank you for your time in reading this post and sharing yours.
Posted by: Renee at December 11, 2006 09:33 AM
The point is not that psychology cannot influence biology and vice-versa, but that not every neurobiological brain disorder getting lumped into the "mental illness" bucket had anything what-so-ever to do with something "mental".
Before tests were available, brain effects of hypothyroid and hyperthyroid were considered "mental/psychological". Multiple Sclerosis was likewise considered "mental/psychological". Someone I know experienced severe pain during sex following childbirth, and it was called "mental/psychological for years until a tear in her abdominal wall was finally diagnosed and fixed.
Doctors are still missing many KNOWN underlying causes of illnesses affecting the brain simply because they aren't looking for them. In addition, there are many more children simply born with miswiring in the brain, chromosomal abnormalities, endocrine system problems, absorption problems, and more that all get diagnosed with brain problems classified as "psychiatric" or "mental". They may have night terrors every night from BIRTH! They may have sensory problems and more. And there was no mental trauma experienced other than simply being born.
Can trauma cause "mental" illness? YES!!!! There is NO DOUBT that it can cause it in vulnerable people!!
Can the LACK of trauma PREVENT "mental illness"... according to how we define "mental illness", lumping in all the different sources of it, then the answer is a resounding "NO" since it cannot prevent a child from being born with an extra chromosome, or with an endocrine system abnormality, a leaky gut, exposure to a virus, the umbilical cord getting squashed, misplacement of the placenta in the uterus... and those are just a few examples of factors that can contribute to "mental" illnesses. It doesn't even start to address the myriad of chemical toxin, and internal biochemical and autoimmune traumas that can occur later in life.
That is what I mean when I refer to "apples and oranges". One day, my hope is that many of these illnesses currently being called "mental" will be removed from that bucket. Luckily, some, such as multiple sclerosis, and thyroid disease, already have been... at least, AFTER they get finally diagnosed, although that can unfortunately still take years while damage to the brain progresses leaving people with lasting "mental" illness. Looked at that way, is it not odd that the lasting effects of these illnesses on the brain will be called "mental" if it affects mood, yet is called "medical" if it affects the eyes or cognition?
Posted by: Jeanie at December 11, 2006 02:40 PM
I also might add that by not "buying into" the concept that psychology does play a part...you rob those patients afflicted with such illnesses powerless or their own future. They can change their environments, reactions, etc to have a positive affect on their outcomes and coping skills. They cannot change their biology. I prefer to believe that they have more power than that. We have more power through the Psychology of it to help.
Posted by: Renee at December 11, 2006 03:55 PM
"I also might add that by not "buying into" the concept that psychology does play a part.
Nobody has said psychology does not play a part ... but it plays a part in ALL illnesses. The big question is part of what. Psychology is incredibly important in coping with illnesses and mitigating the negative impact of illnesses, whether the illness is cancer, loss of a leg, or narcolepsy. Did psychology CAUSE the cancer, loss of a leg or narcolepsy - well - that would be blaming the patient and everyone else, and THAT is not a productive accusation in illnesses not caused by a psychology.
Psycholgy is empowering. It can help cure and it can help cause, some illnesses. But psychology cannot cure everything, nor does it cause everything.
Please do not distort what I am saying into "psychology does not play a part" ... since I already stated otherwise above. However, psychology cannot PREVENT many things, especially if that specific thing is not caused by it to begin with.
And what the "it" is differs.
Posted by: Jeanie at December 11, 2006 04:28 PM
Jeanie,
It seems that you believe that because the scientific research that indicates that psychology, biology and social environment are deeply interdependent (and a significant causal factor in mental illness) that this somehow increases the "blame" on parents. Many factors - for example a parents personality, how they parent, how they relate to their husbands or wifes and children - are dictated by their own upbringing and environment - so I don't think that "blame" is something that has much value in this discussion. Are people to "blame" for your own personality and temperment? Are people to "blame" for who you fall in love with? I would suspect that you'd say "No" - that those factors of a person are a result of their upbringing and environment and education - which obviously they don't control entirely (and perhaps not even significantly).
Let me give you an example. Diabetes is the number one public health concern in the US today - with a vast number of our citizens obese and likely to die prematurely due to it. But - we know from reasearch that what the Harvard University web site says is true - i.e. that "The good news is that type 2 diabetes is largely preventable. About 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking."
I don't see a lot of "blaming" parents and self going on around the country because 90% of this biological disease is being caused by people not fully understanding the key nutritional, physiological information that would prevent diabetes. The answer is education - not blame.
Similarly, in schizophrenia and other mental illness, the psychiatrists, psychologists and researchers, and research studies are increasingly suggesting while a biological or genetic factor the base cause of schizophrenia - we are beginning to understand that the psychological, emotional and social environment that children grow up in have a vast impact on their mental health - and yes - risk for mental illness. This is new information that has just been coming out during the past 5 years - so it would be impossible for any parent to understand this and take action - so its impossible to "blame" parents for not knowing something that wasn't known when they were raising their children.
Just as with Diabetes - research is strongly suggesting that if you have the right environment, the incidence of mental illness will go down significantly. Whether you call that "Prevention" or not (I certainly would) - is up to you - but the results are the same - lower incidence of disease.
If you ignore what all the psychiatrists, psychologists and researchers are telling us - I think we're really doing a big dis-service to the many people that could benefit from that information and understanding and who could help the next generation avoid mental illness.
Posted by: szadmin at December 12, 2006 10:10 AM
I guess my real point is that some of the illnesses currently being labeled "mental" are not any more "mental" than cancer.
I will be happy when that subset gets removed from the "mental illness" bucket. In the meantime, because doctors are treating symptoms of these biological disorders as "mental", the patients are the ones who ultimately suffer, especially the children who can have permanent damage to their brains and every other organ of their body.
Right now, the label "schizophrenia" is putting on any illness whose symptoms do not yet fall into another medical diagnosis. Not that long ago even simple cases of hyperthyroid and hypothyroid were getting labeled as "schizophrenia" because there was no test for thyroid hormones. Even today, more complex cases of imbalances in the thyroid hormones are getting put into the "mental" bucket sometimes because doctors fail to use available diagnostic testing, and sometimes because of the complexity, such is in the case of "Thyroid hormone resistance" in which different parts of the same body and brain have varying levels of sensitivity to thyroid hormone.
The question then becomes, should the psychiatric symptoms resulting from this condition - especially when left undiagnosed and untreated for so long still be called "mental" or diagnosed as "schizophrenia" whereas we have removed other illnesses such as Parkinson's, Alzheimers, and Multiple Sclerosis from the "mental" label.
When I first responded to Yaya's plaintive comment(way at the top) it was in acknowledgement that a strong underlying biology cannot completely be overcome in the reality of normal human existence. An example is the person who managed to not get bipolar disorder in spite of a strong genetic predisposition - until that fateful day he'd been staying up late several nights studying for exams, then pulls and "all-nighter" and is never the same again. Would he NOT have gotten the illness if it had not been for that last night? Or would he still have gotten it - if not then, but a few years from then when he's up all night with a sick child?
Statistics are generalities, and say nothing about any individual case. A prognosis is based on generalities. This is a GOOD thing because according to prognoses for childhood-onset schizophrenia, Brooke Katz would NOT have graduated from nursing school, and my younger daughter would likewise NOT be about to graduate from the community college in a few months, my friend's daughter would not have have a job right now, and many others would NOT have the GOOD outcome they now have.
Part of that good outcome is BECAUSE these kids were in a MENTALLY HEALTHY environment from day one. That positive, nurturing environment did not CAUSE their illness. It helped them to succeed IN SPITE of their illness. Another MAJOR PART of their success is the scientific advances which have resulted in more MEDICATIONS and parents fighting for appropriate medical as well as psychiatric care.
Posted by: Jeanie at December 12, 2006 11:34 AM
Actually, I like that Diabetes analogy. There is more than one type of Diabetes. Type 1 diabetes, also known as childhood-onset, has a very different etiology than type 2 diabetes. A Baby can develop it shortly after birth and the only way they can survive is with medication or a transplant, and extreme vigilance on the parent's part.
Type 2 on the other hand, can develop in various ways, some with extreme dietary dysfunction (like schizophrenia in the people who take drugs, or who experienced severe trauma in life), a mixture of biology and diet, or pure biology with very little dietary input... and then all the variations in between. In that case, a very good diet throughout childhood can at the very least delay onset of the diabetes in adulthood, and if the person continues along that good path, can prevent it in most cases.
Good analogy.
Most parents who visit this site and participate on the boards are the ones who did, and are still doing, everything they can for their children. They are the ones whose children most likely had the purely biological form, or whose tenn & adult children's own behaviour (such as taking drugs or their lifestyle) or unavoidable life events, interacted with their biology, to precipitate the illness.
I wish, however that all the mental HEALTH measures being presented was taught to every high school class in this country. I am completely NOT trying to dismiss the importance of nurturing and environmental health on the well-being of ALL children. I suspect however, when it comes to the parents visiting THIS website - it is preaching to the choir - with little acknowledgement of the wonderful work they have done and are doing.... Yes - their children got sick anyway, and here they are - still trying to help their children.
Posted by: Jeanie at December 12, 2006 12:19 PM
Since " Schizophrenia " is " known " to exist, then obviously the cause of it is also " known " of. If the cause is not know of, then this means that problem itself, is not known of, but instead is only being partially seen. To say that Schizophrenia is a mental illness, then it is required to know of what a normal healthy mind actually is, such that the " ill " mind can be separated from the norm by clear differences being present. With the knowledge of the normal mind being at hand, then one also obviously knows what normal consciousness is, and therefore knows its composition, and how to create it.
If this knowledge is not available, then it can not be said that someone is mentally ill, since it can not be related to a healthy mind structure.
Posted by: Need To Know at December 14, 2006 03:24 PM
In my opinion it would be unrealistic to attribute many mental disorders including schizophrenia exclusively to biological or psychological factors. It is quite possible that both factors intertwine and effect each other. But it may be that individual differences would lead to different effects and causes to different people. Some may develop schizophrenia as a result purely from their biology or family history, while others may develop it as a result of faulty learning or family relationships. Each case of any mental disorder should, in my opinion be treated as an individual case and generalizations should not be made because of ill effects such as mis diagnoise or giving the individual the wrong treatment!
Posted by: Isabelle at February 13, 2007 05:51 AM
If you want proof that biology is the main cause of the disease after onset, TAKE ME AS AN EXAMPLE. I have SZ-A disorder, it took 7 years before I found the right anti-depressant for me. If I even reduce the dose I will get depressed within a week and no amount of (psychological) talk therapy can help me. If I miss a dose of my anti-psychotic meds I can't sleep and will be psychotic within 24 hours. Luckily(?) I'm able to know I'm psychotic and take my meds without going into full remission.
I would agree that the enviroment i've been living in the last couple of years has helped my overall health, but if it weren't for the biological effects of the meds I would be a basket case no matter how much psychological help I got.
Posted by: andrew at March 24, 2007 11:05 AM
very interested in knowing a list of environmental risk factors for schizophrenia . thanks . laura
Posted by: laura martin at September 27, 2007 11:04 AM
I think one of the important factors here is that each individual may be different. I feel that environmental factors may play a part in relapse, together with biological. A serious concern I have however is that families are often placed in a "box" by workers who have had limited contact or knowledge, and even where carers and families have become educated on the illness and provide strong support to the consumer they can be inadvertently blamed. I agree with the person who said mum and dad does not equal environment. My experience is that it is often other factors from people who are not knowledgable on the illness or the person, that may impact on the person with Schizophrenia. This may be from workplaces, support agencies or others, who often do not include carers, to ascertain what stressors the individual may have, and what strategies work best for the individual. Every person is different, and should be treated as such. I also believe the biological causes of Schizophrenia and relapse may be overlooked by some workers.
Posted by: carer at May 24, 2008 09:56 PM
(written by the Harvard psychologist 
If my daughter's environment has triggered her mental illness all I can say is I feel heartbroken. So what I think this piece is saying is that families can create mental illness in individuals who may be described as sensitive people. What can be done to help our sons and daughters once the damage has been done.
Posted by: Yaya at December 4, 2006 09:07 AM
I think that we are mixing apples and oranges.
Here are my points:
Therapy can also help people with diabetes, heart disease, cancer and lupus.
However, some disorders directly affect the area of the brain that perceives and handles stress. In these disorders, what is "stress" to that brain might not even be a blip on the radar of the brain of someone not already compromised.
Schizophrenia runs in my family. Our mother had it in spite of an ideal childhood. My 3 brothers and myself seem to carry "the gene" for something that can affect our brain, but it must be mild. In spite of divorce, sexual abuse, emotional abuse, orphanage, and more - none of us have a severe brain disorder, although we do have some signs that we carry "the gene". Collectively, we have several children more affected than others - other kids in the same family are resilient, happy and emotionally strong.
My younger daughter with TWO grandmothers with schizophrenia did not have a chance - she showed signs since infancy.
Is it biological? Yes. Do emotional life events affect it? Yes... but that holds true for every illness there is, and how MUCH lany emotional life events
affects the illness depends again on the biology of the person with that illness.
Another example - my daughter with SZ-A has shown signs of hypothalamic/pituitary axis dysfunction since birth. Without medication, she gets hives from heat, hives from happiness, hives from excitement, hives from
stress, hives from fear, and hives from joy. If the medications were not available to mitigate those hives, I guess there we would not have had any recourse but to have her go through some kind of cognitive/psychological therapy (if available) to help her suppress all emotions - like becoming a Zen Buddhist... or I don't know what.
Sure - given enough years of intense therapy, her own brain could possibly have helped mitigate the hives arising from her hypothalamic dysfunction. A NORMAL brain would not NEED that.
Even if intense therapy to control both her positive and negative emotions could have been available, it would not have worked because her biology would have interfered because that was not the only problem. The stress of having to go to school AND participate in that therapy would have been overwhelming.... and we all know about the stress cascade and schizophrenia.
Maybe if she could have not gone to school, been raised by Buddhist monks in an isolated monastery, AND had me there to provide maternal love and comfort... MAYBE it could have helped her. Let's get real.
In the meantime, during her childhood, if these doctors had focussed more on the physical, they might have tested ALL her hypothalamic-pituitary-thyroid axis hormones and FOUND other problems she has yet did not find and start treating for YEARS (because, after all - her problems were a "mental" illness)-who knows the impact treating that earlier would have had. Less anxiety, less psychosis, depression, fatigue and missed days of school might have translated to a milder course of illness - less STRESS which also exacerbates illness. And now - her brain might not have lost some of the intelligence she had in childhood (hypothyroidism in childhood permanently lowers IQ and can cause mental retardation), which would mean college might be easier for her now... again - less stress. And less stress means less exacerbation of an illness which she has battled with since birth.
I would much rather scientists focus on the underlying biology and fix it so that these kids can live a normal life.
-Jeanie
Posted by: Jeanie at December 4, 2006 09:19 AM
Yaya and Jeanie,
This article was not a commentary directed at people who have children who already have schizophrenia. It is impossible to tell, given the state of the science, whether any person's mental illness was caused by any given level of genetic loading or stressors - so that discussion is really counter productive. Rather, the objective is for the extended family members - to provide hope and possible directions to help lower risk for children who may be at risk. The news on what we can do to help people who have developed schizophrenia already is something we cover on the site on a daily basis - so all I can say is stay tuned.
I believe that Jeanie is correct in much of her assessment - certainly the research supports the idea that in some percentage there are people who have such a high genetic loading or early biological factor that they are extremely sensitive to the environment and may be highly likely to get schizophrenia or other mental illness. And certainly - its very important to evaluate all potential physical root causes of an illness as part of an evaluation.
My point of this article is different though - and its directed at the extended families of those effected. Increasingly it seems that very good prenatal care, early high-quality childcare, positive and sensitive and supportive parenting, secure parental relationshiops, safe neighborhoods and schools, strong and positive friendships and social networks, etc. - all can make a significant difference in lowering the rate (by up to 86%, as suggested in recent research we've cited) in many cases of schizophrenia. I think this provides great hope for many people - and while nobody can create the "perfect" environment, what the research suggests is that any difference can probably lower the odds.
Just as people may be biologically susceptible to diabetes but with good care in diet and exercise probably 98% of people can avoid Type 2 diabetes -- it seems increasingly possible that in the future research will have identified the key environmental factors to a level that will allow families with the genes for mental illness to avoid getting the disorders, by controling the environment (pre and post natal) of their children). Of course, research should also be continued in finding a cure too.
Posted by: szadmin at December 4, 2006 10:09 AM
I don't agree. Despite recent trends back to the old 'schizophrenogenic' model, with a multifactorial model coming back into public popularity, I don't feel there will be an 'environmental prevention' for this illness. I think that it will be possible to treat it earlier, perhaps even before the person is born, thru genetic therapy or vaccines, but I don't think that mom will prevent schizophrenia in little Mary by not asking her to take gymnastics and ballet at the same time, or even, (i know this statement will make people lash out angrily at me but i have a right to speak my opinon) by reducing her 'stress', such as by not pressuring her to get an 'A' in school or go to college. I certainly feel that avoiding abuse and mistreatment people will wind up happier in their life, but this is a biological disease, not a psychological one. I don't feel a parent's choices in how they take care of their child will prevent schizophrenia - ever, in any one. Sorry....but I have a right to say so. For me, the genetic evidence is mounting and mounting. I feel it's regarded as an 'inexact science' by the public only because the research is hard to understand and grasp. Except it wouldn't be one single gene at all, but a large number, one for each cognitive area.
Posted by: slc2 at December 5, 2006 12:36 PM
So - SLC2 - just so we have it clear here - you're firmly in the minority view in believing that there is a clear distinction between and separation of biology and psychology - despite what the experts we talk to in the field are saying, despite what many of the medical schools are teaching (Demian Rose just finished his PostDoc at University of California, San Francisco Medical School), and despite what a vast body of evidence suggests.
Thankfully - the number of people that hold your view is shrinking rapidly given the evidence (please read the links in the article above and check out the book by Daniel Goleman). You seem to hold amazingly strong convictions that are contrary to all the researchers and psychiatrists I talk to, and yet you provide very little evidence for these beliefs. Perhaps, to move the conversation forward - you can suggest some evidence that you see supports your view that there is a clear difference between biology and psychology? What is this important evidence that you hold - that the researchers I talk to seem to have missed or undervalued?
Also - just to be sure I'm understanding you correctly - you seem to think that genetics is 100% of the cause of schizophrenia - even though many research studies show that in identical twins (i.e. same genes) only 50% to 60% of the twins the second twin will get schizophrenia if the first one gets it.
Posted by: szadmin at December 5, 2006 01:32 PM
on the highly personal attack, again, eh szadmin, and again accusing me of of believing things i don't believe and have never stated...as usual.
Posted by: slc2 at December 5, 2006 02:22 PM
the fact that a certain percentage of identical twins both get schiz is no proof the cause is not genetic.
i understand only too well that it is ok for you to ceaselessly attack me and to again and again repeat that educated and reasonable people have moved away from my idiotic points of view etc, etc, etc, etc, ad nauseum, what i don't understand is, do you really think i would bother to reply, to collect and present information that would illustrate these ideas, given the highly personal and nasty nature of your repeated attacks on me? the other thing i don't understand is why is it ok for you to be so nasty to me and then you change and delete posts where people are being far less nasty than you are?
Posted by: slc at December 5, 2006 02:27 PM
First of all,are you feeling ok?
I am asking because although you are prone to being somewhat dogmatic i have never known you post in such an aggressive/defensive style.
Secondly whilst accepting that genetics has a major role to play
twin studies show that there is more involved than just **genetics**.
I concur with the diathesis-stress model.
Posted by: Tim at December 5, 2006 02:51 PM
Goodness, whoever said that "Environment = Mom & Dad"?
Sure parents play a part of the environment, but really, we all experience many different things in life.
No "stress" (boredom) may be a greater stressor than having some positive stressors in life, such as school or college and part-time work or volunteer work. My parents are real supports to this person with schizoaffective disorder! They help me keep this whole thing in balance, so I don't go off the deep end.
Posted by: Someone at December 5, 2006 03:21 PM
SLC - this is not personal. You I think you are saying (and please correct me if I'm misinterpreting your opinion) that its all genetics and biology, and nothing but genetics and biology (and you seem think that psychology has nothing - or little - to do with biology)- and all I'm asking for is evidence, and to understand why you dismiss the evidence and input provided.
Is asking for the evidence on which you're basing your opinion - considered nasty? I'm sorry if it comes across that way. I think its fine if you disagree with the expert opinion - but I just don't find it productive to say "this is my opinion and I'm sticking to it" - without providing any evidence, or discussion of the information provided. Your comments seem to suggest that you have not even read the links to the supporting evidence for the blog entry - thats what I find particularly frustrating. You disregard the evidence without even reading it. Why do you find all the studies and expert opinions unpersuasive?
Posted by: szadmin at December 5, 2006 03:22 PM
Actually, I am in agreement with SLC in that it is not preventable. I also agree with szadmin that there are environmental factors. These two ideas actually are not mutually exclusive because... we are arguing about apples and oranges.
FIRST... schizophrenia is not ONE illness.
SECOND... when one identical twin gets it and the other does not, does NOT mean it is not genetic or biological. Twins may have started from the same egg, but they have different assortments of mitochondrial DNA, different proteins in different quantities distributed even from the very beginning. They can have vastly different places in the uterus thus obtaining different nutrients. Their brains develop differently and thus their resulting neurohormones are different. This is BIOLOGY. One is left-handed, one is right-handed. One has dyslexia, one doesn't. One has exceptional coordination, the other is clumsy. One gets schizophrenia and the other doesn't. Yet they are twins. Their biologies are still unique.
Yes, environment worked with their genes.... in the uterus, and on the playground. Their body's internal environment is different too.
SLC has a point about genetics and biology, and the research does back her up.
szadmin is talking about the interaction of "environment" on the BIOLOGY of the organism. A lot of those environmental factors cannot be altered, and without the underlying biology, those environemental factors would not matter at all.
We always look for "reasons", and "triggers"... and we will always find them, because life is rough. To live, is to experience trauma and joy. And illness. Or not.
We all want the same thing. Prevention and/or a cure.
It is just that calling such a biological illness "psychological" is like a slap in the face and I think that is what is causing a highly charged emotional response from some of us. Doctors often call biological illnesses "psychological" when they don't yet know what the cause really is. They use that term as a cop-out.
They called my mother's chest-pains "mental" and she died of heart-failure. Everyone has stories like that.
Posted by: Jeanie at December 5, 2006 05:36 PM
No, research results do not support the belief of all Schizophrenia = 100% genetics!
Research results do indicate that Schizophrenia = genetic factor + environment factors
That's to say that Schizophrenia = X% genetic + (100-X)% environment
For a very small population of schizophrenics, schizophrenia is mainly caused by genetic factor when X is close to 100. For these people, schizophrenia symptoms occur usually in their early year, and environment factors played a very minor role.
In my wife's sz, genetic factor played very minor role, as I have found no schizophrenia history from her side of family. It is my belief that without high stressful environment, she would never have schizophrenia.
By the way, enviourment factor does not only include Dad & Mom. It includes all external factors that surround and affect a person.
Posted by: JD05 at December 5, 2006 07:30 PM
OK - a related question to Jeanie. Do you think ADHD is any less or more of a brain disease or psychiatric disorder than schizophrenia?
Notice in the above links there is one that talks about research that indicates that maternal anxiety during pregnancy increases risk of ADHD. Why is that not "preventable"?
I suspect that the same link will ultimately be proven (instead of just suggested) with schizophrenia and maternal anxiety. So why wouldn't you consider this preventable? Why wouldn't you want to educate people who suffer from anxiety / excessive worry about the potential risk factor - so that they could get therapy (for example cognitive behavioral therapy) which is a proven technique for reducing and eliminating anxiety disorders?
Also - what about all the studies referenced in the list of "Additional Reading" above - about how psychotherapy and drugs show the same impact on brains when brain imaging is done? Or how harmful untreated depression is in mothers, for their babies and children? Or how broken homes seem to increase the risk of schizophrenia? Do you think that they are all 100% inaccurate? Do you not think that there are reasonable precautions that families could take that could "likely" reduce the risk of schizophrenia, based on this information? (certainly it isn't proven, but the evidence seems to just keep on coming - at what point is something "proven", and is it not prudent to take action before something is 100% "proven" and the costs are relatively low?).
Posted by: szadmin at December 5, 2006 08:37 PM
Well, it is well known that increased level of stress (like intensive learning or excitement) can ignite the development of schizophrenia, but can we still say that this is a "psychological" or "biological" factor. Stress also produces brain chemicals that can cause chain reaction etc. So where to draw the line? I believe the resarch is still far from proving one or the other. The thing I know is that without medications my brother would get nowhere with his rehabilitation, and he had such a normal, happy and healthy childhood. Marijuana played part in developing his illness.
Posted by: Marry Ann at December 5, 2006 09:57 PM
Perhaps it would be helpful to disentangle genetics/biology/enviornment/psychology. If I understand, the previous discussion
marks psychology and genetics as two ends of a spectrum, with biology/enviornment
impacting both ends.
It would be helpful to provide stable definitions for these terms. What role do
genetics play in psychology ? Is temperment psychology or genetics, either working through/responding to enviornment ?
Also, to be fair, MZ twins have been discordant for prenatally aquired HIV and
Hepatitis at birth, as well as for some congenital malformations. MZ twin
pairs discordant for MI are also more likely to also show greater discordance for (fingerprint) ridge counts, mirroring, and more likely to show
greater variation in birthweight. Also, relaxing date of onset for psychosis as
well as relaxing diagnostic subtype (Axis I) results for a greater, generalized MI and personality disorder concordance. (Pubmed searches can confirm)
This area is a rough place to go wading, as it tends to easily polarize people.
And truly, I don't think we'll have any conclusions until the "schizophrenias"
themselves can be teased apart. Only then, can relative contributions be determined. Until then, of course it is preferrable to provide a warm, supportive stable enviornment for ALL children. The reality is, that takes both a family and the greater society's involvement.
Concerning the recent "Broken Home" study, I have a few questions:
1. It would be reasonable to conclude then, that SZ rates have increased with the rising divorce rates of the last 30 yrs. Have they ?
2. SZ rates among non-emigre, divorced Afro-carribean family members should also be elevated. Are they ?
3. Have SZ sufferers in this study been sorted for
a. other risk factors (season of birth, obstetric events, parental loading,
pre-morbid diagnosis such as ADHD etc.)
b. SZ subtype (dominant neg. vs. positive symptoms, type of onset, GAF etc.)
4. Recent studies indicate genetic involvement (and subtype) varies somewhat
among ethnic groups. Has this been considered as a loading factor for this group
5. Pubmed search indicates a higher rate of STDs, including chlamydia, among
Afro-carribean immigrants in the UK. Recent studies indicate maternal STDs as a
potential risk-factor for SZ. Has this finding been applied to the "BH" study ?
6. A recent news article posted on this site reports on the danger of enviornmental toxins. Also, dry cleaning chemicals have been found to poss.
increase SZ risk in offspring (Pubmed). In the US at least, populations close to superfund sites are more likely to be poor and minority. Has this be considered
as a confounding factor ?
Epigenetic changes bear an influence on offspring of subsequent generations
(I think up to 4, with BMI). Also, does anyone have resources on CNVariations
in MZ twins at birth ?
Concerning brain changes with psychological interventions: I don't doubt the veracity of these reports, but how much (degree, longevity) do these impact long
term. I don't mean to be silly, but where there is an underlying biological
mechanism, can they alter incoming as well as outgoing factors ? I ask this
because my family has a long history of absence seizures. Each affected family
member (of all known involved generations) exhibit a similar maladaptive behavioral cluster. In fact, prior to EEG, this behavioral cluster was part of the diagnostic work-up for Petit Mal Epilepsy.
I don't wish to be argumentative, but these questions are quite important to me. We have 5 unaffected children, all 6 exhibiting personality traits pre-natally. Certainly, our family is much happier -"normal"- since our SZ-A
child was stabilized. I have observed that coaching and support can alter outlook
and behavior in a child - but only so much. When a family member is ill - either
MI or physical illness in my experience, the window of variation of behavior and
outlook is narrower. The "personhood" or ithos of the family AND its individual
members is affected. This experience leads me to the question of mistaking
correlation/causation in any study investigating psychological impact.
Sorry this has been so long, but I am truly interested in these questions.
Thank-you !!!!!!
flooby
Posted by: flooby at December 6, 2006 07:38 AM
Just as an aside - concerning dietary contributions to type II diabetes:
Yes, it is accepted that diet does play an important role - enviornment -
My dad developed diabetes at age 60. When I was growing up, we had a very
healthy diet (junk food in our home was unbuttered popcorn and ice cream - about
once a month. We rarely ate dessert - usually fruit when we did.
My dad has found that some healthy foods spike his glucose readings
(ex.s, tomatoes, brown rice, cinnamon).
My point - human beings as biological systems are a great deal more complex than generalised advice would suggest.
flooby
Posted by: flooby at December 6, 2006 07:51 AM
In response to the ADHD question. There has always been "ADHD", except that it was called different things, such as "minimal brain damage" and "minimal brain dysfunction".
There are people with ADHD for whom it is 100% UNavoidable. They were born that way. A child with XYY chromosomes exhibits brain anomalies, and often they go through many diagnoses such as autism plus ADHD before having genes tested.
Then there are attentional problems associated with schizophrenia, Tourette's syndrome and more... they get the same label - "ADHD".
Then there is ADHD caused by the way the brain gets formed by early environment such as watching TV. Avoidable - but once the brain is formed that way, it is formed.
Can the "ADHD" be "fixed" by outside intervention? Sometimes. The brain has plasticity and some children can learn to concentrate better with extensive therapeutic measures over a lot of time. Some can be helped nominally, but not nearly fixed - such as those children with chromosomal abnormalities (often coupled with "mental retardation") - and others that would definitely have been classified as "minimal brain dysfunction/damage" before "ADHD" became popular.
So once again - the "psychology" and the "biology" even for ADHD is mixing apples and oranges. We now are lumping many different problems into the same "ADHD" bucket based on external symptoms.
My hope is that someday, with better diagnostic techniques and better treatment, very few people will be left in the "schizophrenia" bucket. Some will be cl;assified as caused by a virus. Will that still be "schizophrenia" or have its own name? Some will be bacterial. Again - is that the same illness? Some will be due to a problem in the hypothalamic/pituitary/thyroid axis. Again - will that still be labeled "schizophrenia"? Some will be personality, genetic vulnerability, plus upbringing and maybe can be "cured" with the help of therapy. Will that version be what is called "schizophrenia"? Another version may be lack of nutrion in-utero causing a malformation of the brain. Will that be "schizophrenia"? Or the version that is triggered by drug-abuse? Or the one caused by child-abuse? Or the one caused by the mother experiencing a severe trauma while pregnant?
-Jeanie
Posted by: Jeanie at December 6, 2006 09:42 AM
My understanding is that neither antipsychotic medicines nor any therapies are aimed to cure schizophrenia. They are all introduced for the same purpose as symptom control.
Since no one really knows what schizophrenia is, we all should be open-minded about this illness. A treatment (medicine, therapy, etc.) failed working for one person doesn't mean it will not work for others.
As Dr.Francis Crick spelled out, we are nothing but a pack of neurons. Any factors that affect us, no matter biologically or psychologically will all have impact on our wellbeing. Thus, I agree with szadmin's view about "biology (i.e., genetics and body chemistry) impacts psychology, and psychology (i.e., thoughts, emotions, and behavior) impacts brain biology."
Posted by: JD05 at December 6, 2006 04:53 PM
Jeanie,
I think what all the psychiatrists and researchers are telling us that it is no longer an issue of psychology / biology being an issue of apples and oranges. Pscyhology and biology are the same thing - you're just looking at different levels of the same thing. Anyway - I recommend the book "Social Intelligence" - Daniel Goleman explains it much better than I ever could.
Hi Flooby,
Let me try to answer some of your questions. You ask:
. It would be reasonable to conclude then, that SZ rates have increased with the rising divorce rates of the last 30 yrs. Have they ?
I don't think it would be reasonable to make this conclusion for these reasons:
1. divorce is just one obvious indicator of a high amount of stress in a family - obviously if the parent's relationship was functioning well, there would be no need for divorce. But the opposite (that if there isn't divorce, there isn't stress) is not necessarily true. Many people, in many cultures stay in marriages despite a great deal of stress and a great deal of unhappyness. They do this because of cultural norms, or family pressure to not break marriages, or because they think its good for the kids, and for many other reasons. So just because a marriage is still together - doesn't mean its functioning well. The increase in divorce rates may be due to people recognizing this - and due to changes in a culture's value of marriage, independent of the happiness of the people in it. So - I don't think you can generalize to the level that just because a family isn't divorced means that their children are experiencing less stress than the family that is married. Its more that divorce is an obvious indicator of stress - and there are not so many other obvious indicators in the still-married group of people. I think that this measure was chosen because its an easily identified marker of stress in a family, for research purposes. That is all. I don't think that the researchers are suggesting that the act of "divorce" is the stressor that contributes to schizophrenia - its the bad relationship stress that seems to be a contributing factor. It may be that by divorce of the parents lowers the risk of schizophrenia in high risk children - if staying together means higher levels of stress (and in fact the research seems to suggest this very thing).
2. Even if you think that a marriage that stays together means there is less stress in it, than ones that break up - there are many, many other factors that influence the incidence of schizophrenia in a society - toxins in the environment (which are probably going up in some areas, and going down due to enviromentalism in others), better healthcare over the past 30 years - which could lower incidences of mental illness, increasing trend for lack of healthcare insurance in the poor (which could result in increased incidence of mental illness), Increased awareness of the negative effect of alcohol during pregnancy, resulting in less drinking during pregnancy, resulting (potentially) in a lower incidence of schizophrenia, Elimnation of lead from paints and from gas - thus lowering the incidence of brain damage in infants and during pregnancy... so as you see - there are many things likely to be going on - some increasing schizophrenia risk, some lowering schizophrenia risk. Its too complex to say that just because divorce goes up, that therefore schizophrenia goes up. That might be true if all other things were held constant - but they aren't.
2. SZ rates among non-emigre, divorced Afro-carribean family members should also be elevated. Are they ?
I don't know - I haven't done that research.
3. Have SZ sufferers in this study been sorted for
a. other risk factors (season of birth, obstetric events, parental loading,
pre-morbid diagnosis such as ADHD etc.)
b. SZ subtype (dominant neg. vs. positive symptoms, type of onset, GAF etc.)
4. Recent studies indicate genetic involvement (and subtype) varies somewhat
among ethnic groups. Has this been considered as a loading factor for this group
I don't know - again - you'd have to read the research reports that we link to - and be able to fully understand them. I don't claim to have done either - and while we have the PHDs here helping us - there are just too many schizophrenia-related research reports to evaluate each one at the level that we'd like to. Perhaps one day when we get really good funding, we can do that. I'd certainly like to see us to do that.
5. Pubmed search indicates a higher rate of STDs, including chlamydia, among
Afro-carribean immigrants in the UK. Recent studies indicate maternal STDs as a
potential risk-factor for SZ. Has this finding been applied to the "BH" study ?
Good question - but again, we haven't looked at it.
6. A recent news article posted on this site reports on the danger of enviornmental toxins. Also, dry cleaning chemicals have been found to poss.
increase SZ risk in offspring (Pubmed). In the US at least, populations close to superfund sites are more likely to be poor and minority. Has this be considered
as a confounding factor ?
Again - good question, I don't know.
Concerning brain changes with psychological interventions: I don't doubt the veracity of these reports, but how much (degree, longevity) do these impact long
term. I don't mean to be silly, but where there is an underlying biological
mechanism, can they alter incoming as well as outgoing factors ?
There is a good story comparing the long term benefits of drugs vs. cognitive therapy for depression at this link - check it out:
http://www.healthandage.com/public/article/3169/gm=20!gid2=2960
Posted by: szadmin at December 7, 2006 11:14 AM
I have read nothing to indicate that psychology and biology are one and the same. Every organism, plant and animal, on this planet have "biology", but very few have "psychology". You cannot have psychology without biology, but you definitely can have biology without psychology.
Even in human beings, if they were one and the same, we would not need medicine - we would just need to change our way of thinking. There are religious groups, such as Christian Scientists that do believe this way. Some day they may be proven right.
In the meantime, I am glad that the doctors are treating the many endocrinological/neurological problems my daughter was born with that contributed to her symptoms since birth. It was just unfortunate that permanent damage was done to her brain, and lasting but not permanent damage to the rest of her body - not to mention lost years of her life - because her schizophrenia-spectrum disorder was chalked up to just "psychology".
I agree that there are many environmental factors interacting with an organism's biological make-up that can cause disease states. In some people, it can be their own internal psychological environment.
But I do maintain that when normal human life stresses cause a severe disease state, the organism was already biologically flawed. Otherwise most human beings on this planet would have schizophrenia.
I am reminded of reading about how adversity growing up makes us stronger and that children who are over-protected and coddled can't cope as adults, suffer more depression, and some commit suicide. The truth lies somewhere in-between, and how the child reacts, in large part, depends on their own genetic make-up and personality. SOME kids really need a slower pace, and more protection. For other kids, that would be intolerable, and for others, it would simply stifle their emotional growth.
I just cannot attribute my own lack of schizophrenia, in spite of divorce and a very poor childhood environment, to some kind of mental or psychological strength. That would be incredible hubris. It is like saying that people with shizophrenia have it due to their own mental/psychological weakness. I do not concur.
The only reason I do not have one of the illnesses causing psychosis that are currently getting called "schizophrenia" is due to my biological LUCK.
By the way, my daughter is reading this post of mine and has approved this message.
Posted by: Jeanie at December 7, 2006 02:05 PM
Jeanie,
I don't think there is a huge different in what we are saying... research suggests that:
1. Biological/Genetic predisposition is at the root of schizophrenia - and there are likely significant variations in risk predisposition based on number of associated genes, and prenatal factors, etc. a person experiences early in life.
2. People with this biological predisposition are more sensitive to stressors in the environment and internal to the person (e.g stressful thoughts) - and these stressors likely trigger schizophrenia.
But here is where I think you may benefit from "Social Intelligence" book, and what Demian and others suggested above:
3. psychology (i.e. thoughts, emotions, etc.) are biologically based (i.e. neurotransmitters such as dopamine, serotonin, GABA, etc. as well as neurons, synapses, and stress hormones, etc. - are all ultimately biology. Thoughts and emotions are based on that biology)- and they are influenced by social environment to a degree neuroscience did not understand a decade ago. As Demian says above "biology and psychology aren't just interacting phenomena, they are in fact different levels of analysis of the same phenomena" and why the corpus collosum psychiatrist is saying "people had thought at one point that there was a clear distinction between biological and psychological problems. A student chimed in: "But nobody really believes that any more, do they?"
This is what I think the psychologist and psychiatrists in the initial article above are getting at. For example, people's perception of risk (i.e. our worries, our anxieties) have a cascading effect on other neurotrasmitters and stress hormones - that in turn have impacts on disease conditions in substantial ways (and vise versa - disease conditions frequently have similar effects on thoughts and feelings). Human brain biology/psychology matters - perhaps as much as the underlying predisposition - given the studies that show significant increases in schizophrenia risk based on different social environmental factors.
4. Every person and environment is different - so this discussion is at the "societal" level - its impossible given the science today to say what did or did not cause schizophrenia in any one person.
And yes - I've read many child development books - too much protection is bad - just as too much exposure to stress is bad - the middle path is best, and where exactly that middle path is for any child - is not always clear. Nobody has ever said that the brain is a simple organ.
Posted by: szadmin at December 7, 2006 02:48 PM
I have been browsing this website recently due to a current situation that I have been involved in; this particular article prompted me to add a posting.
First, let me say, that I can see (feel) both sides of the issue, and understand where personal beliefs and/or personal situations (i.e.; environments) can skew an individual's perception of the said issue - biology/psychology.
It is easy to see why someone would take offense to the idea that parenting skills (or lack thereof) would "cause" a person to become schizophrenic. It is easy to understand that they (the person taking offense) would "feel" that they are being made responsible for this disease because of their "bad" parenting and/or environment. They don't want to be named as the catalyst for this horrible affliction. It is easy for them to point the finger at biology alone, because in doing so, they free themselves from the guilt associated with the alternative. However, it is in our human nature to defend ourselves...whether we are afflected with some form of MI or not. So, no fault can be found with these individuals who are simply trying to defend themselves from being labeled a "bad" parent and/or influence simply because they have found themselves dealing with a mixed bag of genes, etc. There is no illusion to anyone here that dealing with MI creates STRESS even under the BEST circumstances. It's unfortunate but true.
However, this inherent urge to defend the biology of it all, does not nigate the fact that psychology does effect the outcome if not the onset of the disease, in and of itself. But, let us ponder on the biological aspect before we start in with our reasoning.
Children are a product of a combination of their parents collective genes. I don't believe that anyone would argue that point. So, it stands to reason that children will be predisposed to any traits, disease processes, and personalities that they recieve from one or both parents. But how those genes are distributed is luck of the draw. You may get more from your father, you may get more from your mother, you may have one (or all) inherited genes passed down that predisposes you to one or all of these traits/characteristics. Now, I am no scientist, and won't even pretend to base any of this information than on anything more than common sense, my sometimes futile attempts to understand the scientic readings on the subject, and my own personal circumstance. But that (in a mediocre nutshell) is biology.
We are what we are based on our genetic makeup. It is, however, a combination of that genetic makeup AND our environment (and our reaction to that environment) that will ultimately determine how those traits are revealed (activated) within ourselves and to the world.
Case in point...If two children are born to alcoholic parents (making the assumption that alcohol was not consumed during pregnancy), which science has labeled a disease (we won't get in to that argument - but will work from that assumption that alcoholism is indeed a disease), and these two children grow up in that very same environment...one grows up to be an alcoholic and the other does not. This scenerio could also be used in identical twins. Which is true...biology or psychology (environment)? If it is biology...then why did only one child grow up to be an alcoholic? If we are to believe that it is purely biological then are we to assume that the non-drinking child is still an alcoholic even though alcohol was never consumed simply because they possess the gene? Then are we also to assume that the one child who is an alcoholic, is so because, of psychology (environment) and the introduction of the precipitator - alcohol?
Perhaps, in common sense terms, it is a combination of both biology and psychology? I think perhaps here in lies the truth. Both children inherit the gene, but only one develops the disease. Why? Because both were subjected to the same psychological/environmental factors that precipated or kept at bay the onset of such.
So, moving forward, and on to my situation and my personal conclusion. My friend (their father) has two children, from two different women, but we will focus on his daughter. She is three years old. She has a combination of both of her parents genes. Her father has ADHD and Dyslexia. Her mother has schizophrenia. Her biological grandmother had schizophrenia. Her half brother has ADHD and a multitude of emotional/behavioral/learning disabilities. Biologically speaking; the cards are definately stacked against her! Psychologically speaking, they are as well...but, to some degree this could be tweaked.
Let's assume that biologically she is spared. Even though she possesses all the genes and potential to have one or all of these combined genetic predispositions...she does not "get" ADHD, Dyslexia or Schizophrenia. Yet, she is raised by her two parents with these vastly intrusive and potentially distructive traits...she comes out unscathed? I think not. Even if she possessed none of their combined genes or traits, she will (and is) be drastically affected by the circumstances under which she is raised and subjected. She is learning her life skills from mentally unstable parents. Regardless, of the good intentions of those parents, she is still molded by their actions. Even when the nurturing is available...the examples are what is seen and followed. Despite the best intentions and love of the parents, the child is ultimately affected by THEIR mental illnesses and it's affect on her.
Assume that she is the exact same child, born of the exact same parents with the exact same genes, but is adopted into a family with no mental illiness and is in a good psychological/loving envirnonment. Does she still get the disease? Perhaps...because she is genetically predisposed. Is the onset delayed or it's effect lessened because of the environment? Perhaps. I don't know that there is any real way to measure that for sure, primarily because you'd have to work off a lot of assumptions. But, I believe that evidence for the psychology of it all is in our own history as a people. All things being equal, abused children suffer more adverse affects than those who are not abused...whether they are MI or not. Mentally well children perform better in school than those who are not. Children who have challenges who are in groups of children who are like them respond better due to the "acceptance" of their "likened" peers, than those who try to "fit in" with children who don't share their sameness. Even if they can succeed in their mental performance; their emotional status is affected by the shuning (environment) of their peers. Before you know it, both their biological and psychological wellbeing are strained. One definately is affected by the other! And from this example we can also assume that this "environment", good or bad, does not just squarely fall on the shoulders of the parents but society and individuals as a whole.
Honestly, I am scared to death for both of his kids, but primarily his daughter. She is being raised by an unmedicated and untreated schizophrenic mother! She has a very high probability of having one (or all) of their combined illnesses/disease processes. Even so, at age three, she is already displaying tendencies that concern me. Problem is, I don't know if it's the early manifestation of the inevitable disease process, or the product of being raised in a chaotic environment (that is putting it kindly) by a mentally unstable mother. In example, she has "nightmares or terrors" every single week. It is not every night but is at least once weekly. She mimicks some of her mothers behaviors; like throwing apparent temper tantrums out of no where for no particular reason. She seems to have very strange fears...and lots of them. Very hyperactive and talkative. She'll scream out and talk in her sleep...yelling things like..."People, People, People" at the very top of her lungs. Has her mother instilled these fears in her because of her own delusional thinking? Can it be reversed? Or is this simply a picture of things yet to come because of her own genetic disposition?
She often arrives at her father's (after a week with her mother) dirty, in unmatching, layered, soiled clothes. She was severely malnourished as an infant as a direct result of her mother's schizophrenia. I try and help make a psychological difference by being supportive and nurturing...but often it does seem futile...because of the biology and the psychology. However, I also believe that my efforts do make some difference because perhaps the knowledge of her parents afflictions can help get her early treatment if she is plagued with this horrific life robber. Perhaps, it won't be as bad when and if it does strike. But, will it always be an up hill battle as long as she continues to be raised by her mother?
Bottom line...the child is in dire straights it seems...due both to biology and psychology. I don't know what can be done to help both. The research may be there...and I believe both to be true...but at what point do we get past research and get answers? I'm really scared for this child. How do I tell the difference between the actual disease and the affects of the mother's disease on the child?
Here is the real clincher for me in this debate...
There is absolutely no guarantee that she will have any of these traits come to fruition, even in spite of her biology. There is also no guarantee that she won't...because of her biology. Will being raised by her unmedicated schizophrenic mother doom her because of the psychology of it all? Will my constant worry about her biological predisposition in effect bring about the disease in an otherwise healthy child? For the life of me...I cannot wrap my brain around the perameters of this disease! I know this much to be true...it is biological...and it is psychological! I experience the psychological effects of this disease just as all of you...and I'm not the one with schizophrenia. We all can learn a bit from our own psychological responses to this posting and topic. If you still feel that psychology doesn't play a role in all our well-beings...well then maybe you should re-think it.
Thank you for your time in reading this post and sharing yours.
Posted by: Renee at December 11, 2006 09:33 AM
The point is not that psychology cannot influence biology and vice-versa, but that not every neurobiological brain disorder getting lumped into the "mental illness" bucket had anything what-so-ever to do with something "mental".
Before tests were available, brain effects of hypothyroid and hyperthyroid were considered "mental/psychological". Multiple Sclerosis was likewise considered "mental/psychological". Someone I know experienced severe pain during sex following childbirth, and it was called "mental/psychological for years until a tear in her abdominal wall was finally diagnosed and fixed.
Doctors are still missing many KNOWN underlying causes of illnesses affecting the brain simply because they aren't looking for them. In addition, there are many more children simply born with miswiring in the brain, chromosomal abnormalities, endocrine system problems, absorption problems, and more that all get diagnosed with brain problems classified as "psychiatric" or "mental". They may have night terrors every night from BIRTH! They may have sensory problems and more. And there was no mental trauma experienced other than simply being born.
Can trauma cause "mental" illness? YES!!!! There is NO DOUBT that it can cause it in vulnerable people!!
Can the LACK of trauma PREVENT "mental illness"... according to how we define "mental illness", lumping in all the different sources of it, then the answer is a resounding "NO" since it cannot prevent a child from being born with an extra chromosome, or with an endocrine system abnormality, a leaky gut, exposure to a virus, the umbilical cord getting squashed, misplacement of the placenta in the uterus... and those are just a few examples of factors that can contribute to "mental" illnesses. It doesn't even start to address the myriad of chemical toxin, and internal biochemical and autoimmune traumas that can occur later in life.
That is what I mean when I refer to "apples and oranges". One day, my hope is that many of these illnesses currently being called "mental" will be removed from that bucket. Luckily, some, such as multiple sclerosis, and thyroid disease, already have been... at least, AFTER they get finally diagnosed, although that can unfortunately still take years while damage to the brain progresses leaving people with lasting "mental" illness. Looked at that way, is it not odd that the lasting effects of these illnesses on the brain will be called "mental" if it affects mood, yet is called "medical" if it affects the eyes or cognition?
Posted by: Jeanie at December 11, 2006 02:40 PM
I also might add that by not "buying into" the concept that psychology does play a part...you rob those patients afflicted with such illnesses powerless or their own future. They can change their environments, reactions, etc to have a positive affect on their outcomes and coping skills. They cannot change their biology. I prefer to believe that they have more power than that. We have more power through the Psychology of it to help.
Posted by: Renee at December 11, 2006 03:55 PM
"I also might add that by not "buying into" the concept that psychology does play a part.
Nobody has said psychology does not play a part ... but it plays a part in ALL illnesses. The big question is part of what. Psychology is incredibly important in coping with illnesses and mitigating the negative impact of illnesses, whether the illness is cancer, loss of a leg, or narcolepsy. Did psychology CAUSE the cancer, loss of a leg or narcolepsy - well - that would be blaming the patient and everyone else, and THAT is not a productive accusation in illnesses not caused by a psychology.
Psycholgy is empowering. It can help cure and it can help cause, some illnesses. But psychology cannot cure everything, nor does it cause everything.
Please do not distort what I am saying into "psychology does not play a part" ... since I already stated otherwise above. However, psychology cannot PREVENT many things, especially if that specific thing is not caused by it to begin with.
And what the "it" is differs.
Posted by: Jeanie at December 11, 2006 04:28 PM
Jeanie,
It seems that you believe that because the scientific research that indicates that psychology, biology and social environment are deeply interdependent (and a significant causal factor in mental illness) that this somehow increases the "blame" on parents. Many factors - for example a parents personality, how they parent, how they relate to their husbands or wifes and children - are dictated by their own upbringing and environment - so I don't think that "blame" is something that has much value in this discussion. Are people to "blame" for your own personality and temperment? Are people to "blame" for who you fall in love with? I would suspect that you'd say "No" - that those factors of a person are a result of their upbringing and environment and education - which obviously they don't control entirely (and perhaps not even significantly).
Let me give you an example. Diabetes is the number one public health concern in the US today - with a vast number of our citizens obese and likely to die prematurely due to it. But - we know from reasearch that what the Harvard University web site says is true - i.e. that "The good news is that type 2 diabetes is largely preventable. About 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking."
I don't see a lot of "blaming" parents and self going on around the country because 90% of this biological disease is being caused by people not fully understanding the key nutritional, physiological information that would prevent diabetes. The answer is education - not blame.
Similarly, in schizophrenia and other mental illness, the psychiatrists, psychologists and researchers, and research studies are increasingly suggesting while a biological or genetic factor the base cause of schizophrenia - we are beginning to understand that the psychological, emotional and social environment that children grow up in have a vast impact on their mental health - and yes - risk for mental illness. This is new information that has just been coming out during the past 5 years - so it would be impossible for any parent to understand this and take action - so its impossible to "blame" parents for not knowing something that wasn't known when they were raising their children.
Just as with Diabetes - research is strongly suggesting that if you have the right environment, the incidence of mental illness will go down significantly. Whether you call that "Prevention" or not (I certainly would) - is up to you - but the results are the same - lower incidence of disease.
If you ignore what all the psychiatrists, psychologists and researchers are telling us - I think we're really doing a big dis-service to the many people that could benefit from that information and understanding and who could help the next generation avoid mental illness.
Posted by: szadmin at December 12, 2006 10:10 AM
I guess my real point is that some of the illnesses currently being labeled "mental" are not any more "mental" than cancer.
I will be happy when that subset gets removed from the "mental illness" bucket. In the meantime, because doctors are treating symptoms of these biological disorders as "mental", the patients are the ones who ultimately suffer, especially the children who can have permanent damage to their brains and every other organ of their body.
Right now, the label "schizophrenia" is putting on any illness whose symptoms do not yet fall into another medical diagnosis. Not that long ago even simple cases of hyperthyroid and hypothyroid were getting labeled as "schizophrenia" because there was no test for thyroid hormones. Even today, more complex cases of imbalances in the thyroid hormones are getting put into the "mental" bucket sometimes because doctors fail to use available diagnostic testing, and sometimes because of the complexity, such is in the case of "Thyroid hormone resistance" in which different parts of the same body and brain have varying levels of sensitivity to thyroid hormone.
The question then becomes, should the psychiatric symptoms resulting from this condition - especially when left undiagnosed and untreated for so long still be called "mental" or diagnosed as "schizophrenia" whereas we have removed other illnesses such as Parkinson's, Alzheimers, and Multiple Sclerosis from the "mental" label.
When I first responded to Yaya's plaintive comment(way at the top) it was in acknowledgement that a strong underlying biology cannot completely be overcome in the reality of normal human existence. An example is the person who managed to not get bipolar disorder in spite of a strong genetic predisposition - until that fateful day he'd been staying up late several nights studying for exams, then pulls and "all-nighter" and is never the same again. Would he NOT have gotten the illness if it had not been for that last night? Or would he still have gotten it - if not then, but a few years from then when he's up all night with a sick child?
Statistics are generalities, and say nothing about any individual case. A prognosis is based on generalities. This is a GOOD thing because according to prognoses for childhood-onset schizophrenia, Brooke Katz would NOT have graduated from nursing school, and my younger daughter would likewise NOT be about to graduate from the community college in a few months, my friend's daughter would not have have a job right now, and many others would NOT have the GOOD outcome they now have.
Part of that good outcome is BECAUSE these kids were in a MENTALLY HEALTHY environment from day one. That positive, nurturing environment did not CAUSE their illness. It helped them to succeed IN SPITE of their illness. Another MAJOR PART of their success is the scientific advances which have resulted in more MEDICATIONS and parents fighting for appropriate medical as well as psychiatric care.
Posted by: Jeanie at December 12, 2006 11:34 AM
Actually, I like that Diabetes analogy. There is more than one type of Diabetes. Type 1 diabetes, also known as childhood-onset, has a very different etiology than type 2 diabetes. A Baby can develop it shortly after birth and the only way they can survive is with medication or a transplant, and extreme vigilance on the parent's part.
Type 2 on the other hand, can develop in various ways, some with extreme dietary dysfunction (like schizophrenia in the people who take drugs, or who experienced severe trauma in life), a mixture of biology and diet, or pure biology with very little dietary input... and then all the variations in between. In that case, a very good diet throughout childhood can at the very least delay onset of the diabetes in adulthood, and if the person continues along that good path, can prevent it in most cases.
Good analogy.
Most parents who visit this site and participate on the boards are the ones who did, and are still doing, everything they can for their children. They are the ones whose children most likely had the purely biological form, or whose tenn & adult children's own behaviour (such as taking drugs or their lifestyle) or unavoidable life events, interacted with their biology, to precipitate the illness.
I wish, however that all the mental HEALTH measures being presented was taught to every high school class in this country. I am completely NOT trying to dismiss the importance of nurturing and environmental health on the well-being of ALL children. I suspect however, when it comes to the parents visiting THIS website - it is preaching to the choir - with little acknowledgement of the wonderful work they have done and are doing.... Yes - their children got sick anyway, and here they are - still trying to help their children.
Posted by: Jeanie at December 12, 2006 12:19 PM
Since " Schizophrenia " is " known " to exist, then obviously the cause of it is also " known " of. If the cause is not know of, then this means that problem itself, is not known of, but instead is only being partially seen. To say that Schizophrenia is a mental illness, then it is required to know of what a normal healthy mind actually is, such that the " ill " mind can be separated from the norm by clear differences being present. With the knowledge of the normal mind being at hand, then one also obviously knows what normal consciousness is, and therefore knows its composition, and how to create it.
If this knowledge is not available, then it can not be said that someone is mentally ill, since it can not be related to a healthy mind structure.
Posted by: Need To Know at December 14, 2006 03:24 PM
In my opinion it would be unrealistic to attribute many mental disorders including schizophrenia exclusively to biological or psychological factors. It is quite possible that both factors intertwine and effect each other. But it may be that individual differences would lead to different effects and causes to different people. Some may develop schizophrenia as a result purely from their biology or family history, while others may develop it as a result of faulty learning or family relationships. Each case of any mental disorder should, in my opinion be treated as an individual case and generalizations should not be made because of ill effects such as mis diagnoise or giving the individual the wrong treatment!
Posted by: Isabelle at February 13, 2007 05:51 AM
If you want proof that biology is the main cause of the disease after onset, TAKE ME AS AN EXAMPLE. I have SZ-A disorder, it took 7 years before I found the right anti-depressant for me. If I even reduce the dose I will get depressed within a week and no amount of (psychological) talk therapy can help me. If I miss a dose of my anti-psychotic meds I can't sleep and will be psychotic within 24 hours. Luckily(?) I'm able to know I'm psychotic and take my meds without going into full remission.
I would agree that the enviroment i've been living in the last couple of years has helped my overall health, but if it weren't for the biological effects of the meds I would be a basket case no matter how much psychological help I got.
Posted by: andrew at March 24, 2007 11:05 AM
very interested in knowing a list of environmental risk factors for schizophrenia . thanks . laura
Posted by: laura martin at September 27, 2007 11:04 AM
I think one of the important factors here is that each individual may be different. I feel that environmental factors may play a part in relapse, together with biological. A serious concern I have however is that families are often placed in a "box" by workers who have had limited contact or knowledge, and even where carers and families have become educated on the illness and provide strong support to the consumer they can be inadvertently blamed. I agree with the person who said mum and dad does not equal environment. My experience is that it is often other factors from people who are not knowledgable on the illness or the person, that may impact on the person with Schizophrenia. This may be from workplaces, support agencies or others, who often do not include carers, to ascertain what stressors the individual may have, and what strategies work best for the individual. Every person is different, and should be treated as such. I also believe the biological causes of Schizophrenia and relapse may be overlooked by some workers.
Posted by: carer at May 24, 2008 09:56 PM