Staying Sane May be Easier Than You Think

Psychological woes are not your fault. But if there are ways you can keep your body from breaking down, then why not your mind?
by John Cloud TIME - Special Health Report June 22, 2009

"In the early 1970's before Dr. William McFarlane was one of the world's top authorities on preventing mental illness....back when he was a student at the Albert Einstein College of Medicine in New York City, few psychiatrists talked about prevention.

A key break came in the late 1970s when a UCLA team began to publish the results of an influential long-term study called the UCLA Family Project. The study found that you could predict, with remarkable accuracy, which 16 year-olds would develop schizophrenia later in life based on only a few characteristics. The teenagers whom the Family Project tracked had already sought treatment for a psychological problem, although the study excluded actively psychotic teens, since it would not have been a surprise if they had developed schizophrenia.

Studying such kids for more than a decade, the researchers discovered that those who became schizophrenic were most often from families that, when first interviewed, displayed "communication deviance" (unclear, unintelligible or fragmented speech) and highly critical and intrusive parenting. There weren't merely families that argued with difficult sons and daughters; they were families that had lost all ability to cope.

McFarlane and others began working with some of the families to address their interactions and teach them how to communicate better - more slowly, with less anger and intrusion. Even after they are on medication, people with schizophrenia have a difficult time tracking rapid, highly emotional speech, yet that's the kind they often hear from family members. These patients would improve in hopsitals but relapse once they got home, even when they continued to take antipsychotics.

For several years McFarlane developed and tested the Multi-Family Group approach, which brought several families together at a time to learn from one another how they sounded to outsiders. In twice-monthly sessions, the families modeled greater clarity and compassion and troubleshot daily-living problems like kid's marijuana use or sexual activity. It was a simple intervention that, when combined with antipsychotic drugs, worked to reduce schizophrenic relapse rates significantly more than the drugs alone.

A Theory Goes Wide

Even as McFarlane was exploring his schizophrenia-prevention idea, other researchers were having similar what-if-moments with respect to other, more routine conditions. Suppose irritable infants who become fearful toddlers who become shy children could be stopped from becoming adults with anxiety disorders. Suppose men and women who go to war or become cops in inner cities could be helped before developing post traumatic stress disorder. Could you, similarly, identify the children of depressed parents early and give them skill to prevent their own first depressive episode?

In any given year, approximately 17% of American under 25 have a mental, emotional or behavioral disorder. (Over our lifetime, 46% of us will receive such a diagnosis.) If we reduce the proportion of young people who become mentally ill by even one-quarter, that would mean about 3.8 million saved each year from what can turn into a lifelong struggle.

But if most mental illnesses have a genetic origin, isn't even that modest 25% reduction goal unlikely? The science can get tricky here, but the simple answer is that genes aren't destiny. Your can't do anything to change your genome, but your environment and experiences have powerful effects on the way those genes are expressed. A susceptibility to cancer may remain just a susceptibility - until you start smoking and kick the disease process into motion. Similarly, change a child's emotional experiences for the worse and you can trigger mental illness; change them for the better and you may hush the problem genes. One concrete example of this: in 2003, a study in Science found that the larger the number of copies an individual carries of a serotonin-transporter gene called 5-HTTLPR the greater the risk of developing major depressive disorder and suicidality - but only if the individual suffers stressful early-life experiences like abuse.

How long is the window between first symptoms and actual diagnosis? The National Academies report says that across several mental illnesses - including obsessive-compulsive disorder, depression and substance dependence - we have about two to three years to intervene and keep short-term symptoms from becoming long-term afflictions.

Depression offers particularly good evidence of this idea at work. Currently about 5% of adolescents experience an episode of clinical depression in any given year. Rates of depression are three to four times as high among the children of depressed parents as among those whose parents aren't depressed. Dr. William Beardslee of Children's Hospital Boston, one of the authors of the National Academies report, has spent more than 25 years studying how some kids of depressed parents avoid the illness, and he has found that resilience is key. The kids who don't develop depression are "activists and doers," Beardslee says. Even growing up in the darkness of a depressed home, they muster the capacity to engage deeply in relationships. They also are likelier than other kids to understand that they aren't to blame from their parent's disorder - and that they are free to chart their own course.

How do you foster resilience in order to prevent depression? Over the past 17 years, Beardslee's team has developed an early intervention that targets kids from families in which at least one parent is depressed. Like McFarlane, he uses a family-based approach because a bad home environment tends to be more predictive of adolescent mental illness than dysfunctional peer relationships are. Beardslee's Family Talk Intervention includes both separate meetings with parents and kids as well as family meetings with social workers or psychologists that focus in part on demystifying depression - explaining that it is a treatable illness, not a beast that will necessarily crush a family. In a randomized trial, Beardslee found that just seven sessions of this intervention decreased predepression symptoms among the kids and improved the parent's behavior and attitudes. All this makes kids more resilient."