Dear Therapist,

I have an older (half) brother who has a serious mental condition. I'm not sure exactly what it is but he has often had to go to the hospital for a few days till he gets "stabilized". My parents don't really like to talk about it and I try not to bother them with it. I think there are also some other people in my mother’s family who have mental issues. My question is:  People have told me (and I have also read online) that these types of things are in the genes and that I could also have these issues. As I get older I am more worried about it. Can you please clarify if this is true? And is there anything I can do to prevent it?

Response:

The “Nature versus Nurture” question has been hotly debated for generations.  Strict proponents of the nature argument dismiss the notion that there are factors other than inborn ones that contribute to mental illness, while those who argue for the nature side insist that genetics have no role in the manifestation of mental illness.  Although strict proponents of either side will probably always exist, research continues to indicate that mental illness is typically caused by a combination of psychological, biological, and environmental influences. 

There are many factors that can contribute to mental illness, including family dysfunction, physical trauma, psychological trauma, death in the family, divorce, and low self-esteem.  In addition, each factor impacts on the others.  For instance, though we are born with all the genes that we will ever have, interactions between experiences, maturity, medications, illnesses, and many other factors determine whether or not particular genes are expressed.

Having a genetic predisposition to cancer and high blood pressure will not necessarily cause a person to develop these diseases.  However smoking, alcohol use, and being overweight can turn the predisposition into an illness.  From this perspective, we can recognize that although genetics can make us susceptible to a disease, they are in no way a clear predictor of that disease. 

The psychiatric illnesses that appear to have the most research showing a genetic component are OCD, schizophrenia, bipolar disorder, and depression.  Again, this means that genetics can play a role—not the only role—in the development of these disorders.  With regard to age of onset, schizophrenia is most often diagnosed in late adolescence or early twenties.  Bipolar disorder most often presents around age 25, and OCD typically manifests by age 25.

More information about your brother’s symptoms and diagnosis can help you to better research possible issues and symptoms.  Awareness of these can help you to identify and deal with them early on should they appear.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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