What causes mental illness? (Part 2): Risk factors

In my last post on the blog, I started to talk about what causes mental illness, and I tried to establish that there is no known definite cause or causes, and to differentiate between those and risk factors. I promised to talk about some of the risk factors in my next post.
So here we go.

First off, brief recap: causes are the factors that are directly responsible for a medical condition, while risk factors only increase the chances of someone having one. So there aren’t any clearly identified causes of mental disorders, but there are recognised risk factors. And like I pointed out in that post, having a risk factor doesn’t mean you’ll have a condition, and not having it doesn’t mean you won’t.

At this point, I should point out that people don’t develop mental disorders based on one single factor. It’s often a combination of various factors—like a network of factors coming together, within the person (personal) and outside the person (environmental).

Personal factors can be…

  • From genes (genetic—usually not just one, but many genes together).
  • Related to the brain and body (physical, biochemical, other medical conditions—even medications).
  • In the mind (as in psychological—not as in imaginary!)

And environmental factors (or stressors) can include…

  • Difficult life circumstances in childhood (like losing a parent, going through parental conflict, being bullied or experiencing violence).
  • Social factors (like unemployment or retirement, lack of family support , divorce, abuse—physical, emotional or sexual. Also, whether mental health services are even available or not.)
  • Even events right from pregnancy and childbirth have been associated with some mental disorders: mothers having some infections while pregnant or injuries to the child during birth, for instance.

Are you beginning to see how complex it gets? A person might be predisposed by the genes they have, but it takes the combination of other personal and environmental factors for a specific condition to actually appear. So when people say things like someone’s mental mental disorder was caused by…

  • Stress
  • Someone breaking up with them
  • Alcohol or Indian hemp or other hard drugs
  • Losing their job
  • Losing a loved one
  • Being abused or molested
  • Having a long term illness or not sleeping well
  • Being worried or anxious or unhappy
  • And all the other stuff people often say “caused” a mental illness…

None of those things actually caused the illness. They’re all risk factors.

The big question: But, aren’t mental disorders hereditary?

The simple answer: no, they are not. Let me repeat that: mental disorders are NOT hereditary.

But they’re often genetic. I can almost hear you say, “Hold up—aren’t the two the same?” No, they’re not, although they’re often mixed up. “Hereditary” refers to traits passed directly from parent to child. “Genetic” refers to genes being passed, but those genes may not necessarily produce the traits they code for or are associated with.

You can think of it this way: genes are the likelihood that you will inherit a trait, while heredity refers to actually inheriting them. But for things that require a combo of other factors to appear, genes alone aren’t enough. So you can inherit your eyes from your father or mother, that is, they are hereditary. Or your nose or lips or hair colour. But you can’t inherit diabetes or dementia or depression—you might have the genes that predispose to them, but other things need to be in place for them to actually show up.

Another example: a person might have genes that predispose them to growing as tall as 6 feet, but if they don’t get good nutrition, they might never actually achieve that height (which, by the way, partly explains why people who come to the city from the village may end up significantly taller than the people they left behind).

Truth is, we probably all have genes that predispose us to one condition or the other, but many people will live and die without ever finding out. Although science has taken big steps in making sense of all the genetic information we now have, we’re not quite there yet. There’s still a lot we don’t know—and of what we know, there’s a lot we still don’t understand. So there’s enough research to show that there’s a strong genetic factor involved, although it varies: schizophrenia is more genetically based than depression, for instance. But there isn’t enough to predict who will get what.

And you shouldn’t try to, because that would definitely do way more harm than good.

Here’s a useful way to think about risk factors in real life: ever heard about the 3 P’s?

Probably not. But you’re in luck, because you’re about to.

Okay, so here’s a great way to think about all these risk factors: they are either predisposing, precipitating or perpetuating factors.

  • Predisposing factors answer the question: Why this person? These are usually the genetic ones I’ve been talking about. Early childhood experiences come in here too.
  • Precipitating factors answer the question of: Why now? Why not last week or last year or in five years’ time? These are usually the obvious ones that people think are the causes. A breakup. Drugs. Losing someone. Being fired. They’re often precipitating factors, or triggers. But not causes. (I know, I keep repeating that—it’s just such a critical point.)
  • And last, perpetuating factors are those that may allow the condition to persist if they aren’t resolved. Like not taking meds, unresolved family (or marriage) issues and stuff like that. Precipitating factors sometimes also come in here, too.

This isn’t something hard and fast, just a way to think about risk factors. And the most important thing to keep in mind is: precipitating factors are often the easiest to identify, but the roots usually run deeper.

There’s one set of factors I haven’t talked about: protective factors. They answer the question: even with genetic or other predisposition, what can be done to reduce the chances of actually developing a mental disorder? Or of having it bad, even if it happens? In other words, as the question is often asked: Is mental illness preventable—and if it is, how?

That’s the subject of my next post.

See ya!

Hope you’ve learnt a thing or three. :-) If you still have questions, hit me up in the comments. Or just say hello! And remember: there’s love in sharing. Knowledge is power—the power to Rise Above It!




Published by Doc Ayomide

I’m a medical doctor with specialty training in psychiatry, and I love thinking and writing about what it means to be human.

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