If science gives us something, it is the opportunity to have a starting point for discussion. This is essentially what the data do: they show reality in a common language. In return, our science wants this data to be reproducible. That every research team that performs the same process anywhere and at any time will get the same result. This aspect of reproducibility is key to making the discussion civil and allowing progress on the issue. Therefore, the discussion is about the interpretation of these data, about what this number means. But the starting point, the starting point of the meeting, must be reproducible and the method shared. The scientific evidence is as far as it comes from this context.
As advances have been made in coding the human genome, high expectations have been generated about finally finding the genes for schizophrenia, depression and other mental illnesses. These findings were expected to lead to improvements in the diagnosis and treatment of these symptoms and, in general, to an improved quality of life for patients and families. Unfortunately, the expectations were not met and not due to lack of initiative. Huge research consortia have been formed and titanic efforts have been made to overcome methodological and technical constraints that were unimaginable several years earlier. But the data show a different reality. To date, our data show that the onset of mental illness cannot be explained solely by the presence of certain genetic variants. One more thing needs to be added and this other thing is not genetic.
We are in the field of mental health risk factors and the range of potential is even wider than that faced by genetic research teams. Potentially, any situation, element, relationship, or context that occurs throughout a person’s life is likely to be included as a factor that may be involved in changes in mood, anxiety levels, or even interpretation of reality. In addition, these factors (as opposed to the genetic profile) change throughout life as a person grows, establishes new relationships, visits new places, studies or changes jobs. There are those who throw the towel in front of this vastness because they consider it incomprehensible. But there are those of us, based on data we have known for a long time, who welcome the challenge.
For years, even before the discovery of the human genome, there has been evidence of the impact of certain life experiences on human mental health. I don’t mean any personal experience that most of us have (problems in the couple, changing jobs) that made this connection obvious. I am referring to scientific data from studies based first on certain groups and, more recently, on populations, which show a clear link between the disease and exposure to certain life situations. The clearest example and the one with the most supporting evidence is that of suffering from childhood violence. This experience increases between 2 and 4 times the risk of symptoms of psychosis and depression in adulthood. There are other risk factors with scientific evidence, but for today I will focus on this fact.
So let’s imagine an elderly man, about 45 years old, with severe depression. Let’s imagine, man, why not. This person is treated by mental health professionals and is part of a community whose functioning is governed by public policies and actions. With the data we have to date, those responsible for his treatment are expected to be interested in his childhood history and to know whether this man has survived violence or not. The chances of this are much higher than for other 45-year-old men who do not have depression, so the question is more than justified. This will not be an easy task, given the stigma surrounding mental health and, moreover, child abuse. But the team of professionals is well trained to handle tasks that are not easy.
At the level of public policies and actions, those who have health management in their hands are expected to join forces with those working in the social and judicial spheres to prevent further abuses. Because suffering from childhood violence does not cause mental illness and not all people with mental illness have experienced violence, eradicating childhood violence is probably today the most powerful and accurate measure for preventing mental illness. be attached. If we look at it from the point of view of the community and the population, the prevention of childhood violence can mean a reduction of up to 50% in the prevalence of mental illness.
In order to turn this type of policy (clinical and public) into real action, it is necessary to understand the basic idea: mental illness can be prevented. The data tell us that there is a very clear factor that increases the risk of mental illness. By pure logic, eliminating this factor will reduce the risk. Undoubtedly, more evidence-based action will be needed to accelerate the process of reducing mental suffering in all people. Undoubtedly, there are other factors that can change this relationship, such as personal characteristics or social support. Risk presupposes probability and therefore chance, not fate. Risk also implies that the control we have in the course of our lives is not completely under our control. But our ability to recognize our own vulnerabilities and limitations is to look for answers to them.
A common argument is that these adverse events are rare and that collective preventive action will only benefit a minority. If so, prevention will not have the effect we hope for (a significant reduction in the prevalence of mental illness) and is therefore – to put it quickly – not worth it. Unfortunately, childhood violence is more common than we dare admit. Therefore, there is no lack of data or low numbers. It is time to question the role of fate and the enduring nature of mental illness, to acknowledge the limited scope of genes and determination. It is time to start clear collective action. The probability of success is on our side.
Jimena Goldberg She is a clinical psychologist and neurologist. She has been working in the field of mental health for almost two decades, specializing in the determinants of health and their processes of change. He writes about mental health, behavior and psychology.
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