Posted by Randal on August 18, 2002, at 12:49:20
In reply to Re: Genes PLUS environment: Environment?? --Randal, posted by Ritch on August 18, 2002, at 10:00:15
> > [from http://www.dr-bob.org/babble/20020814/msgs/116746.html]
> >
> > > Hi,
> > >
> > > I read with interest today Time magazine's cover story on bipolar disorder in kids http://www.time.com/time/covers/1101020819/story.html Overall, it is an outstanding article, wery well done. However, one passage struck me:
> > >
> > > "Bipolar disorder, like Schizophrenia, depression and certain anxiety conditions, is powerfully influenced by surroundings. When an identical twin suffers from bipolar, the other twin has only a 65% chance of developing it too. Conversely, adopted children with no genetic legacy for bipolar have a 2% chance of coming down with the condition if they are raised in a home with one nonbiological bipolar parent. Clearly, something is in play besides mere genes, and that something is environment. Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold, which is why counselors work hard to teach parents and kids how to minimize family discord."
> > >
> > > So mental illnesses are partly genetic, partly environmental. Fine. However, it is not at all clear to me that "environmental" means the social/psychological environment of the kid, particularly his family life. While I am admittedly not familiar with the research in the field, it seems more much more likely to me that "environmental" would turn out to be largely things that affect the early development of a child's brain--most likely during fetal development and very early childhood. This could include things like infections, physical trauma, hormonal changes in the mother, drug/alcohol abuse by the mother, etc. I do know that there is a tremendous amount of research in the schizophrenia field about how infections (influenza for example) while the mother is pregnant might turn genetic susceptibility into the actual disease.
> > >
> > > Factors that would affect the brain and are not "genetic" start at conception and would presumably have the greatest impact at early stages of development. The article in Time implies that the "environmental" component of the disease is the child's "surroundings" neglecting completely the period before birth when most of brain development occurs. Not to mention physical influences on a child's brain such as illness, nutrition, head trauma, etc.
> > >
> > > To me, suggesting that the "surroundings" are what comprises the non-genetic component seems a bit simplistic and almost certainly wrong. Worst of all, if I were a parent with a bipolar kid I would interpret the Time article to mean that I am responsible for providing an environment that turned my child's genetic susceptibility into a potentially debilitating disease. I would be astonished if the environmental component of a child's bipolar disorder were caused by something like his parent's divorce instead of a physical factor that affected brain development. I don't think "blame the parents" is the right answer.
> > >
> > > Anyway, I just wanted to make sure that people reading such an article do not misinterpret what is meant by environment.
> > >
> > > I am curious whether there is anyone doing research or who is familiar with research on the non-genetic factors influencing the development of mental illness and could provide some insight here.
> > >
> > > Just hoping I could stimulate some debate here and see if there is any real evidence as to what "environmental" influences can increase the chances of the serious, biologically and genetically based mental illnesses.
> > >
> > > Randal
> >
> >
>
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> Randal,
>
> I read the article a couple of days ago when it was on the newstands. It was lengthy and detailed (which is why I avoid TV news at all costs). I think when they say "environmental" they primarily mean psycho-social variables, but they probably wouldn't disagree if you made that all inclusive of the things you mention above (such as head trauma, drug/alcohol abuse by Mom during pregnancy, etc.). That's how I see it anyhow-all things besides the genetic makeup at birth. "Environmental" factors *do* weigh heavily on my mood cycling. I told someone once, that if all the good stuff happened while I was depressed, and the bad stuff happened only when I was hypomanic I would appear to be more of a cyclothymic (on less meds) instead of a BP-II. They mentioned enforcing sleep patterns for bipolar kids. That is where you can "control" your environment (sleep/wake cycles) to some level of success to help stabilize your moods. They mentioned bipolar kids wanting to sleep late in the morning and staying up late at night. That was my sleep patterns to a tee as a teenager. My Mom used to sing to us in the morning (my sister is bipolar, too) trying to get us awake, and when that failed-yelling and screaming and throwing an object or two usually commenced. That worked. OTOH, most teenagers stay up and sleepin the same way, and they are moody too. I would hate to see a lot of kids get diagnosed with this and NOT have this problem, however. I wished they would have gotten more involved with ideas of WHY more kids are becoming bipolar earlier than they ordinarily would as adults. Technology? School-stress? Anomie-alienation?
>
> Mitch
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>
Mitch,I agree that sleep/wake cycles, drug abuse (including alcohol), etc. of course can affect the severity and frequency of symptoms and episodes. Perhaps they can also lead to severe symptoms of the disease appearing earlier in life than they otherwise would. However, I'm not convinced that they "cause" the disease in the first place.
CLEARLY medications such as mood stabilizers and antidepressants can affect the expression of symptoms and probably the development of mental illness. These are "environmental factors" Certainly they don't qualify as psychosocial factors, at least not in the usual sense.
From what I understand, for Schizophrenia at least, the evidence continues to mount for the importance of biological factors (things directly affecting brain structure, etc) as the main "environmental" factors in addition to a genetic propensity. I don't know if this is true for bipolar disorder and other illnesses.
How many of us think that we or our children were "born" bipolar (or with other mental illness) and that no matter what happened the disease would still be there?
Is there any evidence of this either way?? Are the more "physical/biological" components such as prenatal factors responsible for 99% of that not attributable to genetics, or 1%? What exactly is known? Even if traumas, stress, whatever can trigger an initial episode, clearly everyone will experience these at some points in their lives!
Again, I am talking about the origins of disease, not the severity of symptoms or even whether it starts at 15 years old instead of (inevitably?) 40 years.
Randal
poster:Randal
thread:28868
URL: http://www.dr-bob.org/babble/social/20020813/msgs/28879.html