![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Dr. Bob on August 18, 2002, at 8:41:38
[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
Posted by Dr. Bob on August 18, 2002, at 8:50:34
In reply to Genes PLUS environment: Environment?? « Randal, posted by Dr. Bob on August 18, 2002, at 8:41:38
[Posted by jay on August 18, 2002, at 4:13:44]
>
> Hi:
>
> I understand your frustration with the Nature/Nurture concept...and you certainly aren't the first to be so.
>
> The interplay between 'environment' and genetics is still far too complicated for us to have lengthy, absolute answers on. In the book 'The Noonday Demon', the writer Andrew Solomon(sp?) gives a good example. He was talking to a psychiatrist whose wife was an endocrinologist. The P.Doc's wife treats many kids for diabetes in which many of them come from poor and lower-class families. Of course, those kids live with the stresses that poverty can bring to a family, which can also shoot the kid's blood-sugar levels way out of whack...hence the susceptibility to diabetes. (This is a paraphrase from the book.) I have also been reading a fair bit lately about child diabetes and psychological state. It's very far from being some exact 'theory'..but it gives us something more to think about.
>
> OK..hang with me here. Levels of ADD and Depression also seem to be greatly impacting wealthy, as well as 'stable family' (and the two are *not* exactly co-related) children. Many don't have to face going a day without a meal, or feel the stress between parents having an argument over how to spend the last 15 dollars they have that week. (Again..please understand...I know "wealthy" parents argue..and many are dys-functional..etc.) I am sorta using a bit of a wide stroke here, but can you see where both Nature and Nurture can predominate?
>
> I hope that makes sense...
>
> Thanks,
> Jay
Posted by Ritch on August 18, 2002, at 10:00:15
In reply to Genes PLUS environment: Environment?? « Randal, posted by Dr. Bob on August 18, 2002, at 8:41:38
> [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
>
>
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
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
> >
> >
>
>
> 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
>
>
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
Posted by Randal on August 18, 2002, at 15:27:54
In reply to Re: Genes PLUS environment: Environment?? « jay, posted by Dr. Bob on August 18, 2002, at 8:50:34
Jay,
Since you bring up diabetes, I'll use that as an analogy. Type I diabetes is an autoimmune disease and clearly has a strong genetic component. If one identical twin has diabetes, the chance the other will is 50%. The rest of the 50% is then due to "environmental" causes, which in this case are probably things like viral infections that set off an immune response. Can SYMPTOMS of the disease be set of by what we would normally consider environmental factors? Certainly diet can play a huge role. Does this mean that the "environment" as it is interpreted by most people for psychiatric disorders can "cause" the disease? I don't think there is any evidence for this. Do doctors tell parents of at-risk children to provide a stable family life so their kid won't get diabetes? I hope not.
Type II diabetes also clearly has a genetic component (as a quick example, women who tend to distribute fat in their upper bodies are much more prone to the disease than are "pear-shaped" women) In this case I'm sure you CAN probably make a strong argument that "environment", most likely diet, exercise, etc. does play a role in "causing" the disease in the context of a genetic predisposition. Rates of type II diabetes, along with obesity have increased dramatically over the last several years, presumably largely due to such factors.
I am concerned that we simply assume psychocial factors are the MAJOR influence that is not purely genetic, when it is not clear to me that they play a significant role. Many psychiatrists use to think that all mental illness, including the real hard core ones like schizophrenia and bipolar I disorder were caused ENTIRELY by psychosocial factors. Only recently has it been shown that this is not the case.
So are we just holding on to mistaken beliefs from the past? My impression is that for schizophrenia the balance has shifted far, far in the direction of biological causation. Is this true for bipolar disorder as well?
Randal
> [Posted by jay on August 18, 2002, at 4:13:44]
>
> >
> > Hi:
> >
> > I understand your frustration with the Nature/Nurture concept...and you certainly aren't the first to be so.
> >
> > The interplay between 'environment' and genetics is still far too complicated for us to have lengthy, absolute answers on. In the book 'The Noonday Demon', the writer Andrew Solomon(sp?) gives a good example. He was talking to a psychiatrist whose wife was an endocrinologist. The P.Doc's wife treats many kids for diabetes in which many of them come from poor and lower-class families. Of course, those kids live with the stresses that poverty can bring to a family, which can also shoot the kid's blood-sugar levels way out of whack...hence the susceptibility to diabetes. (This is a paraphrase from the book.) I have also been reading a fair bit lately about child diabetes and psychological state. It's very far from being some exact 'theory'..but it gives us something more to think about.
> >
> > OK..hang with me here. Levels of ADD and Depression also seem to be greatly impacting wealthy, as well as 'stable family' (and the two are *not* exactly co-related) children. Many don't have to face going a day without a meal, or feel the stress between parents having an argument over how to spend the last 15 dollars they have that week. (Again..please understand...I know "wealthy" parents argue..and many are dys-functional..etc.) I am sorta using a bit of a wide stroke here, but can you see where both Nature and Nurture can predominate?
> >
> > I hope that makes sense...
> >
> > Thanks,
> > Jay
Posted by Randal on August 18, 2002, at 16:24:56
In reply to Re: Genes PLUS environment: Environment?? « jay, posted by Dr. Bob on August 18, 2002, at 8:50:34
Jay,
Just to clarify my previous post, in case it wasn't clear.
Type I diabetes (formerly called child onset diabetes) is not caused by diet and is an autoimmune disease in which the body destroys cells of the pancreas. Type I is not called child onset anymore because recently some adolescents have developed Type II diabetes.
If poverty disrupts children's blood sugar levels predisposing them to diabetes, this would have to be type II diabetes. What we normally think of as children with diabetes is in fact type I.
Randal
> [Posted by jay on August 18, 2002, at 4:13:44]
>
> >
> > Hi:
> >
> > I understand your frustration with the Nature/Nurture concept...and you certainly aren't the first to be so.
> >
> > The interplay between 'environment' and genetics is still far too complicated for us to have lengthy, absolute answers on. In the book 'The Noonday Demon', the writer Andrew Solomon(sp?) gives a good example. He was talking to a psychiatrist whose wife was an endocrinologist. The P.Doc's wife treats many kids for diabetes in which many of them come from poor and lower-class families. Of course, those kids live with the stresses that poverty can bring to a family, which can also shoot the kid's blood-sugar levels way out of whack...hence the susceptibility to diabetes. (This is a paraphrase from the book.) I have also been reading a fair bit lately about child diabetes and psychological state. It's very far from being some exact 'theory'..but it gives us something more to think about.
> >
> > OK..hang with me here. Levels of ADD and Depression also seem to be greatly impacting wealthy, as well as 'stable family' (and the two are *not* exactly co-related) children. Many don't have to face going a day without a meal, or feel the stress between parents having an argument over how to spend the last 15 dollars they have that week. (Again..please understand...I know "wealthy" parents argue..and many are dys-functional..etc.) I am sorta using a bit of a wide stroke here, but can you see where both Nature and Nurture can predominate?
> >
> > I hope that makes sense...
> >
> > Thanks,
> > Jay
Posted by Ritch on August 18, 2002, at 21:39:42
In reply to Re: Genes PLUS environment: Environment?? --Randal » Ritch, posted by Randal on August 18, 2002, at 12:49:20
> > > [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
> > >
> > >
> >
> >
> > 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
> >
> >
> 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
>
>
Randal,I think I can respond to some questions. I think the stressors and the new fabric of contemporary life (a non-cotton tyranny)contributes to the expression of the illness. After the mid-1930's, more folks lived in an urban instead of a rural environment. To earn a living, you might have to stay up all night working in a local factory. Artificial lights are everywhere, so you can get the stuff you need anytime of the day or nite. Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you. It would be sad to die from an artificial chaos.
Mitch
Posted by Randal on August 19, 2002, at 1:21:07
In reply to Re: Genes PLUS environment: Environment?? --Randal » Randal, posted by Ritch on August 18, 2002, at 21:39:42
Mitch,
Sure, we can speculate about all sorts of such factors, but is there really any EVIDENCE for this?
I found a paragraph from a review earlier this year about schizophrenia by Sawa and Snyder in the journal Science that you might find illuminating. (Sawa and Synder, "Schizophrenia: Diverse Approaches to a Complex Disease" Science 296: 692-695 (2002)
"The recent convergence of neuropathologic, neurotransmitter, and genetic studies indicates that we may be coming much closer to
understanding the molecular causes of SZ [schizophrenia]. Although our focus here was on genetic contributions, it is clear that environmental factors also play an important role, as among identical twins the concordance rate for SZ is only 40 to 50%. It had long been thought that the key environmental factors predisposing to SZ are psychological stresses exerted by emotionally distant or manipulative parents, especially mothers. Abundant literature characterized “schizophrenogenic” mothers who place their children in emotional “double binds.” However, familial studies have not supported such notions. Thus, in studies of schizophrenics adopted at birth, the incidence of behavioral disturbance is greater in biologic than in adoptive parents. Studies of identical twins discordant for SZ have identified relevant environmental factors. For instance, the schizophrenic twin is more likely to have suffered birth trauma or experienced a neo-natal viral infection. Interestingly, a recent study of cerebrospinal fluid showed sequences homologous to retroviral pol genes in 29% of recent-onset SZ or schizoaffective patients. These sequences were not detected in subjects with noninflammatory neurological diseases or in normal control subjects."We can (and many have and still do) postulate causes for schizophrenia such as breakdown of the family, stress in modern society, etc. These may sound very plausible, but they just haven't stood up to scientific scrutiny. I would emphasize that schizophrenia is, like bipolar disorder, a heavily genetic disease, again with a concordance rate of 50% for identical twins.
While it may seem like just merely an intellectual exercise to discuss the causes of mental illness, I'll use an extreme (but still very real and common) example to illustrate the importance of not blindly assuming that psychosocial factors are crucial to cause disease. Say someone with schizophrenia or bipolar disorder commits suicide. Traditional theories say that a dysfunctional home environment are responsible for causing the disease in the first place. If the parents of the suicide believe this, it must be a horrible, horrible burden to bear. As indicated by the current understanding of schizophrenia described above, the parents of a schizophrenic child are now "let off the hook".
So is there evidence for bipolar disorder that psychosocial factors CAUSE the disease? Not to my knowledge. Or is it like schizophrenia, a disease where purely genetic factors play an equivalent role? In the absence of any proof is it fair to say that an "environmental" contribution means that the "surroundings" are responsible and suggest the parents can "Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold" as asserted in the Time article? If indeed such statements are not true, this unfairly places an immense burden and a lot of guilt on parents.
As time passes, the severe, lifelong mental illnesses are increasingly found to be caused by genetic and biological factors, especially those affecting the developing brain. Remember how mental illness used to be blamed on evil spirits/demonic possession? Then, with Freud, the focus shifted to psychosocial factors, particularly the early family environment. I think historical beliefs are largely responsible for our current assumption that "psychosocial" factors are the environmental component not accounted for by genes alone.
Sorry to get so preachy, but these issues are of vital importance for how people and their families cope with these horrible, life-threatening diseases. To assign blame, without any evidence, to a less-than-ideal family environment is in my opinion both unnecessary and cruel.
Randal
>
> I think I can respond to some questions. I think the stressors and the new fabric of contemporary life (a non-cotton tyranny)contributes to the expression of the illness. After the mid-1930's, more folks lived in an urban instead of a rural environment. To earn a living, you might have to stay up all night working in a local factory. Artificial lights are everywhere, so you can get the stuff you need anytime of the day or nite. Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you. It would be sad to die from an artificial chaos.
>
> Mitch
>
>
Posted by Ritch on August 19, 2002, at 11:04:18
In reply to Re: Genes PLUS environment: Environment?? --Randal » Ritch, posted by Randal on August 19, 2002, at 1:21:07
Randal,
If you re-read my post you would see that I mentioned "contribute to the expression of the illness". I didn't say *cause*. I don't believe psycho-social factors cause bipolar or schizophrenia. I have bipolar disorder and I don't have any doubts about the genetics. Of course when I mentioned "Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you", that could be construed to be "the environment" *causing* the bipolar. I didn't intend that. I have a fragile mind and the environment can be helpful or can aggravate my symptoms, greatly. I don't think that psychotherapy (i.e.), can cure my bipolar disorder. If psycho-social variables *do* contribute to the expression of the illness, then logically, psycho-social variables could be manipulated to *reduce* the expression of the illness. Perhaps it would be more accurate to say "non-genetic" variables? Then you can include, diet, sleep patterns, and exercise in the mix of treatment options.
Mitch
> Mitch,
>
> Sure, we can speculate about all sorts of such factors, but is there really any EVIDENCE for this?
>
> I found a paragraph from a review earlier this year about schizophrenia by Sawa and Snyder in the journal Science that you might find illuminating. (Sawa and Synder, "Schizophrenia: Diverse Approaches to a Complex Disease" Science 296: 692-695 (2002)
>
> "The recent convergence of neuropathologic, neurotransmitter, and genetic studies indicates that we may be coming much closer to
> understanding the molecular causes of SZ [schizophrenia]. Although our focus here was on genetic contributions, it is clear that environmental factors also play an important role, as among identical twins the concordance rate for SZ is only 40 to 50%. It had long been thought that the key environmental factors predisposing to SZ are psychological stresses exerted by emotionally distant or manipulative parents, especially mothers. Abundant literature characterized “schizophrenogenic” mothers who place their children in emotional “double binds.” However, familial studies have not supported such notions. Thus, in studies of schizophrenics adopted at birth, the incidence of behavioral disturbance is greater in biologic than in adoptive parents. Studies of identical twins discordant for SZ have identified relevant environmental factors. For instance, the schizophrenic twin is more likely to have suffered birth trauma or experienced a neo-natal viral infection. Interestingly, a recent study of cerebrospinal fluid showed sequences homologous to retroviral pol genes in 29% of recent-onset SZ or schizoaffective patients. These sequences were not detected in subjects with noninflammatory neurological diseases or in normal control subjects."
>
> We can (and many have and still do) postulate causes for schizophrenia such as breakdown of the family, stress in modern society, etc. These may sound very plausible, but they just haven't stood up to scientific scrutiny. I would emphasize that schizophrenia is, like bipolar disorder, a heavily genetic disease, again with a concordance rate of 50% for identical twins.
>
> While it may seem like just merely an intellectual exercise to discuss the causes of mental illness, I'll use an extreme (but still very real and common) example to illustrate the importance of not blindly assuming that psychosocial factors are crucial to cause disease. Say someone with schizophrenia or bipolar disorder commits suicide. Traditional theories say that a dysfunctional home environment are responsible for causing the disease in the first place. If the parents of the suicide believe this, it must be a horrible, horrible burden to bear. As indicated by the current understanding of schizophrenia described above, the parents of a schizophrenic child are now "let off the hook".
>
> So is there evidence for bipolar disorder that psychosocial factors CAUSE the disease? Not to my knowledge. Or is it like schizophrenia, a disease where purely genetic factors play an equivalent role? In the absence of any proof is it fair to say that an "environmental" contribution means that the "surroundings" are responsible and suggest the parents can "Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold" as asserted in the Time article? If indeed such statements are not true, this unfairly places an immense burden and a lot of guilt on parents.
>
> As time passes, the severe, lifelong mental illnesses are increasingly found to be caused by genetic and biological factors, especially those affecting the developing brain. Remember how mental illness used to be blamed on evil spirits/demonic possession? Then, with Freud, the focus shifted to psychosocial factors, particularly the early family environment. I think historical beliefs are largely responsible for our current assumption that "psychosocial" factors are the environmental component not accounted for by genes alone.
>
> Sorry to get so preachy, but these issues are of vital importance for how people and their families cope with these horrible, life-threatening diseases. To assign blame, without any evidence, to a less-than-ideal family environment is in my opinion both unnecessary and cruel.
>
> Randal
>
>
> >
> > I think I can respond to some questions. I think the stressors and the new fabric of contemporary life (a non-cotton tyranny)contributes to the expression of the illness. After the mid-1930's, more folks lived in an urban instead of a rural environment. To earn a living, you might have to stay up all night working in a local factory. Artificial lights are everywhere, so you can get the stuff you need anytime of the day or nite. Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you. It would be sad to die from an artificial chaos.
> >
> > Mitch
> >
> >
>
>
Posted by Randal on August 19, 2002, at 12:26:33
In reply to Re: Genes PLUS environment: Environment?? --Randal » Randal, posted by Ritch on August 19, 2002, at 11:04:18
Mitch,
I agree with everything you say here. My apologies for misinterpreting what you said in your previous post.
My point is that the Time article implies, in my opinion: Bipolar disorder = genes + psychosocial factors. This is the simplest interpretation of what they say. They certainly don't suggest that anything else could be going on, and the traditional view is that "environmental" factors are in fact psychosocial factors, as Sawa and Synder point out for schizophrenia. For the twin studies of bipolar disorder, as far as I know, an unaffected twin (the other 35%) does not have the disease at all. It's not just that the other twin has the disease but doesn't have symptoms. Therefore to imply that psychosocial factors are responsible for the nongenetic component, as I think the Time article does, can only suggest that they play a decisive role in causing the disease.
It sounds like we are in agreement here. My beef is that the Time magazine is misleading in my view. I think most people out there are still strongly influenced by the old dysfunctional family idea that has been discredited (certainly for schizophrenia). The idea that bipolar disorder/schizophrenia are genetic diseases is new, and hasn't completely sunk in for the general public.
As I've said, I think the Time article is wonderful overall, however I think they really blew it on this one aspect.
Again, sorry for misinterpreting what you said.
Randal
> Randal,
>
> If you re-read my post you would see that I mentioned "contribute to the expression of the illness". I didn't say *cause*. I don't believe psycho-social factors cause bipolar or schizophrenia. I have bipolar disorder and I don't have any doubts about the genetics. Of course when I mentioned "Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you", that could be construed to be "the environment" *causing* the bipolar. I didn't intend that. I have a fragile mind and the environment can be helpful or can aggravate my symptoms, greatly. I don't think that psychotherapy (i.e.), can cure my bipolar disorder. If psycho-social variables *do* contribute to the expression of the illness, then logically, psycho-social variables could be manipulated to *reduce* the expression of the illness. Perhaps it would be more accurate to say "non-genetic" variables? Then you can include, diet, sleep patterns, and exercise in the mix of treatment options.
>
> Mitch
>
>
>
> > Mitch,
> >
> > Sure, we can speculate about all sorts of such factors, but is there really any EVIDENCE for this?
> >
> > I found a paragraph from a review earlier this year about schizophrenia by Sawa and Snyder in the journal Science that you might find illuminating. (Sawa and Synder, "Schizophrenia: Diverse Approaches to a Complex Disease" Science 296: 692-695 (2002)
> >
> > "The recent convergence of neuropathologic, neurotransmitter, and genetic studies indicates that we may be coming much closer to
> > understanding the molecular causes of SZ [schizophrenia]. Although our focus here was on genetic contributions, it is clear that environmental factors also play an important role, as among identical twins the concordance rate for SZ is only 40 to 50%. It had long been thought that the key environmental factors predisposing to SZ are psychological stresses exerted by emotionally distant or manipulative parents, especially mothers. Abundant literature characterized “schizophrenogenic” mothers who place their children in emotional “double binds.” However, familial studies have not supported such notions. Thus, in studies of schizophrenics adopted at birth, the incidence of behavioral disturbance is greater in biologic than in adoptive parents. Studies of identical twins discordant for SZ have identified relevant environmental factors. For instance, the schizophrenic twin is more likely to have suffered birth trauma or experienced a neo-natal viral infection. Interestingly, a recent study of cerebrospinal fluid showed sequences homologous to retroviral pol genes in 29% of recent-onset SZ or schizoaffective patients. These sequences were not detected in subjects with noninflammatory neurological diseases or in normal control subjects."
> >
> > We can (and many have and still do) postulate causes for schizophrenia such as breakdown of the family, stress in modern society, etc. These may sound very plausible, but they just haven't stood up to scientific scrutiny. I would emphasize that schizophrenia is, like bipolar disorder, a heavily genetic disease, again with a concordance rate of 50% for identical twins.
> >
> > While it may seem like just merely an intellectual exercise to discuss the causes of mental illness, I'll use an extreme (but still very real and common) example to illustrate the importance of not blindly assuming that psychosocial factors are crucial to cause disease. Say someone with schizophrenia or bipolar disorder commits suicide. Traditional theories say that a dysfunctional home environment are responsible for causing the disease in the first place. If the parents of the suicide believe this, it must be a horrible, horrible burden to bear. As indicated by the current understanding of schizophrenia described above, the parents of a schizophrenic child are now "let off the hook".
> >
> > So is there evidence for bipolar disorder that psychosocial factors CAUSE the disease? Not to my knowledge. Or is it like schizophrenia, a disease where purely genetic factors play an equivalent role? In the absence of any proof is it fair to say that an "environmental" contribution means that the "surroundings" are responsible and suggest the parents can "Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold" as asserted in the Time article? If indeed such statements are not true, this unfairly places an immense burden and a lot of guilt on parents.
> >
> > As time passes, the severe, lifelong mental illnesses are increasingly found to be caused by genetic and biological factors, especially those affecting the developing brain. Remember how mental illness used to be blamed on evil spirits/demonic possession? Then, with Freud, the focus shifted to psychosocial factors, particularly the early family environment. I think historical beliefs are largely responsible for our current assumption that "psychosocial" factors are the environmental component not accounted for by genes alone.
> >
> > Sorry to get so preachy, but these issues are of vital importance for how people and their families cope with these horrible, life-threatening diseases. To assign blame, without any evidence, to a less-than-ideal family environment is in my opinion both unnecessary and cruel.
> >
> > Randal
> >
> >
> > >
> > > I think I can respond to some questions. I think the stressors and the new fabric of contemporary life (a non-cotton tyranny)contributes to the expression of the illness. After the mid-1930's, more folks lived in an urban instead of a rural environment. To earn a living, you might have to stay up all night working in a local factory. Artificial lights are everywhere, so you can get the stuff you need anytime of the day or nite. Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you. It would be sad to die from an artificial chaos.
> > >
> > > Mitch
> > >
> > >
> >
> >
>
>
Posted by Ritch on August 19, 2002, at 13:32:34
In reply to Re: Genes PLUS environment: Environment?? --Randal » Ritch, posted by Randal on August 19, 2002, at 12:26:33
Randal,
I should have clarified the statement to begin with. Sometimes I can be more than a little obscure with my ideas (analogical instead of analytical). What I am *really* wondering is.. *if* you are certain your child (i.e.) has the bipolar genetics (through a test), are there things you can do (sleep/wake cycles, exposure to technology,etc.) to *ensure* they could be one of the folks in that 35% that have the genes and do not develop the disorder? And.. *if* there *are* things you can do, what are those things? Perhaps even more importantly, is that 35% number shrinking due to how kids grow up now (environment), or is it a constant?
> Mitch,
>
> I agree with everything you say here. My apologies for misinterpreting what you said in your previous post.
>
> My point is that the Time article implies, in my opinion: Bipolar disorder = genes + psychosocial factors. This is the simplest interpretation of what they say. They certainly don't suggest that anything else could be going on, and the traditional view is that "environmental" factors are in fact psychosocial factors, as Sawa and Synder point out for schizophrenia. For the twin studies of bipolar disorder, as far as I know, an unaffected twin (the other 35%) does not have the disease at all. It's not just that the other twin has the disease but doesn't have symptoms. Therefore to imply that psychosocial factors are responsible for the nongenetic component, as I think the Time article does, can only suggest that they play a decisive role in causing the disease.
>
> It sounds like we are in agreement here. My beef is that the Time magazine is misleading in my view. I think most people out there are still strongly influenced by the old dysfunctional family idea that has been discredited (certainly for schizophrenia). The idea that bipolar disorder/schizophrenia are genetic diseases is new, and hasn't completely sunk in for the general public.
>
> As I've said, I think the Time article is wonderful overall, however I think they really blew it on this one aspect.
>
> Again, sorry for misinterpreting what you said.
>
> Randal
>
> > Randal,
> >
> > If you re-read my post you would see that I mentioned "contribute to the expression of the illness". I didn't say *cause*. I don't believe psycho-social factors cause bipolar or schizophrenia. I have bipolar disorder and I don't have any doubts about the genetics. Of course when I mentioned "Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you", that could be construed to be "the environment" *causing* the bipolar. I didn't intend that. I have a fragile mind and the environment can be helpful or can aggravate my symptoms, greatly. I don't think that psychotherapy (i.e.), can cure my bipolar disorder. If psycho-social variables *do* contribute to the expression of the illness, then logically, psycho-social variables could be manipulated to *reduce* the expression of the illness. Perhaps it would be more accurate to say "non-genetic" variables? Then you can include, diet, sleep patterns, and exercise in the mix of treatment options.
> >
> > Mitch
> >
> >
> >
> > > Mitch,
> > >
> > > Sure, we can speculate about all sorts of such factors, but is there really any EVIDENCE for this?
> > >
> > > I found a paragraph from a review earlier this year about schizophrenia by Sawa and Snyder in the journal Science that you might find illuminating. (Sawa and Synder, "Schizophrenia: Diverse Approaches to a Complex Disease" Science 296: 692-695 (2002)
> > >
> > > "The recent convergence of neuropathologic, neurotransmitter, and genetic studies indicates that we may be coming much closer to
> > > understanding the molecular causes of SZ [schizophrenia]. Although our focus here was on genetic contributions, it is clear that environmental factors also play an important role, as among identical twins the concordance rate for SZ is only 40 to 50%. It had long been thought that the key environmental factors predisposing to SZ are psychological stresses exerted by emotionally distant or manipulative parents, especially mothers. Abundant literature characterized “schizophrenogenic” mothers who place their children in emotional “double binds.” However, familial studies have not supported such notions. Thus, in studies of schizophrenics adopted at birth, the incidence of behavioral disturbance is greater in biologic than in adoptive parents. Studies of identical twins discordant for SZ have identified relevant environmental factors. For instance, the schizophrenic twin is more likely to have suffered birth trauma or experienced a neo-natal viral infection. Interestingly, a recent study of cerebrospinal fluid showed sequences homologous to retroviral pol genes in 29% of recent-onset SZ or schizoaffective patients. These sequences were not detected in subjects with noninflammatory neurological diseases or in normal control subjects."
> > >
> > > We can (and many have and still do) postulate causes for schizophrenia such as breakdown of the family, stress in modern society, etc. These may sound very plausible, but they just haven't stood up to scientific scrutiny. I would emphasize that schizophrenia is, like bipolar disorder, a heavily genetic disease, again with a concordance rate of 50% for identical twins.
> > >
> > > While it may seem like just merely an intellectual exercise to discuss the causes of mental illness, I'll use an extreme (but still very real and common) example to illustrate the importance of not blindly assuming that psychosocial factors are crucial to cause disease. Say someone with schizophrenia or bipolar disorder commits suicide. Traditional theories say that a dysfunctional home environment are responsible for causing the disease in the first place. If the parents of the suicide believe this, it must be a horrible, horrible burden to bear. As indicated by the current understanding of schizophrenia described above, the parents of a schizophrenic child are now "let off the hook".
> > >
> > > So is there evidence for bipolar disorder that psychosocial factors CAUSE the disease? Not to my knowledge. Or is it like schizophrenia, a disease where purely genetic factors play an equivalent role? In the absence of any proof is it fair to say that an "environmental" contribution means that the "surroundings" are responsible and suggest the parents can "Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold" as asserted in the Time article? If indeed such statements are not true, this unfairly places an immense burden and a lot of guilt on parents.
> > >
> > > As time passes, the severe, lifelong mental illnesses are increasingly found to be caused by genetic and biological factors, especially those affecting the developing brain. Remember how mental illness used to be blamed on evil spirits/demonic possession? Then, with Freud, the focus shifted to psychosocial factors, particularly the early family environment. I think historical beliefs are largely responsible for our current assumption that "psychosocial" factors are the environmental component not accounted for by genes alone.
> > >
> > > Sorry to get so preachy, but these issues are of vital importance for how people and their families cope with these horrible, life-threatening diseases. To assign blame, without any evidence, to a less-than-ideal family environment is in my opinion both unnecessary and cruel.
> > >
> > > Randal
> > >
> > >
> > > >
> > > > I think I can respond to some questions. I think the stressors and the new fabric of contemporary life (a non-cotton tyranny)contributes to the expression of the illness. After the mid-1930's, more folks lived in an urban instead of a rural environment. To earn a living, you might have to stay up all night working in a local factory. Artificial lights are everywhere, so you can get the stuff you need anytime of the day or nite. Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you. It would be sad to die from an artificial chaos.
> > > >
> > > > Mitch
> > > >
> > > >
> > >
> > >
> >
> >
>
>
Posted by Randal on August 19, 2002, at 14:16:42
In reply to Re: Genes PLUS environment: Environment?? --Randal » Randal, posted by Ritch on August 19, 2002, at 13:32:34
Mitch,
Yes! That is the question. As I've indicated, for schizophrenia, the answer would seem to be NO, as far as I am aware. Now bipolar disorder, if anything, is even more strongly determined by genes (~65% concordance rate for identical twins vs. 40-50% for schizophrenia). So what's up? Are things usually determined by birth or shortly after (by factors like those that contribute to schizophrenia), or can things later in life be the deciding factor(s)? And if so, what are these factors? Is the 65/35 split already determined very early on by biological factors (only part of which are strictly genetic)??
By the way, I do seem to remember from one of Kay Redfield Jamison's books that the 65% number increases as one looks at older and older twins, possibly even going towards 100%. However, I'm not positive I remember this correctly.
So I suppose one question would be whether the onset of (severe) symptoms can be delayed (perhaps indefinitely--prophylactic mood stabilizers???) for someone who, strictly speaking, already has the disease (this may or may not be that "missing" 35%). I think this is what we are both getting at.
Anyone out there know of any hard evidence about this?
Randal
> Randal,
>
> I should have clarified the statement to begin with. Sometimes I can be more than a little obscure with my ideas (analogical instead of analytical). What I am *really* wondering is.. *if* you are certain your child (i.e.) has the bipolar genetics (through a test), are there things you can do (sleep/wake cycles, exposure to technology,etc.) to *ensure* they could be one of the folks in that 35% that have the genes and do not develop the disorder? And.. *if* there *are* things you can do, what are those things? Perhaps even more importantly, is that 35% number shrinking due to how kids grow up now (environment), or is it a constant?
>
>
> > Mitch,
> >
> > I agree with everything you say here. My apologies for misinterpreting what you said in your previous post.
> >
> > My point is that the Time article implies, in my opinion: Bipolar disorder = genes + psychosocial factors. This is the simplest interpretation of what they say. They certainly don't suggest that anything else could be going on, and the traditional view is that "environmental" factors are in fact psychosocial factors, as Sawa and Synder point out for schizophrenia. For the twin studies of bipolar disorder, as far as I know, an unaffected twin (the other 35%) does not have the disease at all. It's not just that the other twin has the disease but doesn't have symptoms. Therefore to imply that psychosocial factors are responsible for the nongenetic component, as I think the Time article does, can only suggest that they play a decisive role in causing the disease.
> >
> > It sounds like we are in agreement here. My beef is that the Time magazine is misleading in my view. I think most people out there are still strongly influenced by the old dysfunctional family idea that has been discredited (certainly for schizophrenia). The idea that bipolar disorder/schizophrenia are genetic diseases is new, and hasn't completely sunk in for the general public.
> >
> > As I've said, I think the Time article is wonderful overall, however I think they really blew it on this one aspect.
> >
> > Again, sorry for misinterpreting what you said.
> >
> > Randal
> >
> > > Randal,
> > >
> > > If you re-read my post you would see that I mentioned "contribute to the expression of the illness". I didn't say *cause*. I don't believe psycho-social factors cause bipolar or schizophrenia. I have bipolar disorder and I don't have any doubts about the genetics. Of course when I mentioned "Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you", that could be construed to be "the environment" *causing* the bipolar. I didn't intend that. I have a fragile mind and the environment can be helpful or can aggravate my symptoms, greatly. I don't think that psychotherapy (i.e.), can cure my bipolar disorder. If psycho-social variables *do* contribute to the expression of the illness, then logically, psycho-social variables could be manipulated to *reduce* the expression of the illness. Perhaps it would be more accurate to say "non-genetic" variables? Then you can include, diet, sleep patterns, and exercise in the mix of treatment options.
> > >
> > > Mitch
> > >
> > >
> > >
> > > > Mitch,
> > > >
> > > > Sure, we can speculate about all sorts of such factors, but is there really any EVIDENCE for this?
> > > >
> > > > I found a paragraph from a review earlier this year about schizophrenia by Sawa and Snyder in the journal Science that you might find illuminating. (Sawa and Synder, "Schizophrenia: Diverse Approaches to a Complex Disease" Science 296: 692-695 (2002)
> > > >
> > > > "The recent convergence of neuropathologic, neurotransmitter, and genetic studies indicates that we may be coming much closer to
> > > > understanding the molecular causes of SZ [schizophrenia]. Although our focus here was on genetic contributions, it is clear that environmental factors also play an important role, as among identical twins the concordance rate for SZ is only 40 to 50%. It had long been thought that the key environmental factors predisposing to SZ are psychological stresses exerted by emotionally distant or manipulative parents, especially mothers. Abundant literature characterized “schizophrenogenic” mothers who place their children in emotional “double binds.” However, familial studies have not supported such notions. Thus, in studies of schizophrenics adopted at birth, the incidence of behavioral disturbance is greater in biologic than in adoptive parents. Studies of identical twins discordant for SZ have identified relevant environmental factors. For instance, the schizophrenic twin is more likely to have suffered birth trauma or experienced a neo-natal viral infection. Interestingly, a recent study of cerebrospinal fluid showed sequences homologous to retroviral pol genes in 29% of recent-onset SZ or schizoaffective patients. These sequences were not detected in subjects with noninflammatory neurological diseases or in normal control subjects."
> > > >
> > > > We can (and many have and still do) postulate causes for schizophrenia such as breakdown of the family, stress in modern society, etc. These may sound very plausible, but they just haven't stood up to scientific scrutiny. I would emphasize that schizophrenia is, like bipolar disorder, a heavily genetic disease, again with a concordance rate of 50% for identical twins.
> > > >
> > > > While it may seem like just merely an intellectual exercise to discuss the causes of mental illness, I'll use an extreme (but still very real and common) example to illustrate the importance of not blindly assuming that psychosocial factors are crucial to cause disease. Say someone with schizophrenia or bipolar disorder commits suicide. Traditional theories say that a dysfunctional home environment are responsible for causing the disease in the first place. If the parents of the suicide believe this, it must be a horrible, horrible burden to bear. As indicated by the current understanding of schizophrenia described above, the parents of a schizophrenic child are now "let off the hook".
> > > >
> > > > So is there evidence for bipolar disorder that psychosocial factors CAUSE the disease? Not to my knowledge. Or is it like schizophrenia, a disease where purely genetic factors play an equivalent role? In the absence of any proof is it fair to say that an "environmental" contribution means that the "surroundings" are responsible and suggest the parents can "Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold" as asserted in the Time article? If indeed such statements are not true, this unfairly places an immense burden and a lot of guilt on parents.
> > > >
> > > > As time passes, the severe, lifelong mental illnesses are increasingly found to be caused by genetic and biological factors, especially those affecting the developing brain. Remember how mental illness used to be blamed on evil spirits/demonic possession? Then, with Freud, the focus shifted to psychosocial factors, particularly the early family environment. I think historical beliefs are largely responsible for our current assumption that "psychosocial" factors are the environmental component not accounted for by genes alone.
> > > >
> > > > Sorry to get so preachy, but these issues are of vital importance for how people and their families cope with these horrible, life-threatening diseases. To assign blame, without any evidence, to a less-than-ideal family environment is in my opinion both unnecessary and cruel.
> > > >
> > > > Randal
> > > >
> > > >
> > > > >
> > > > > I think I can respond to some questions. I think the stressors and the new fabric of contemporary life (a non-cotton tyranny)contributes to the expression of the illness. After the mid-1930's, more folks lived in an urban instead of a rural environment. To earn a living, you might have to stay up all night working in a local factory. Artificial lights are everywhere, so you can get the stuff you need anytime of the day or nite. Bipolar disorder may be something as simple as an oversensitivity to the natural world's rhythyms expressed around you. It would be sad to die from an artificial chaos.
> > > > >
> > > > > Mitch
> > > > >
> > > > >
> > > >
> > > >
> > >
> > >
> >
> >
>
>
Posted by Ritch on August 20, 2002, at 1:58:07
In reply to Re: Genes PLUS environment: Environment?? --Randal » Ritch, posted by Randal on August 19, 2002, at 14:16:42
Posted by Randal on August 20, 2002, at 12:19:12
In reply to Depends on the accuracy of the kindling theory... (nm) » Randal, posted by Ritch on August 20, 2002, at 1:58:07
Hi Mitch,
A related question:
Say two bipolar parents have a kid. Statistically the chance of having a bipolar kid is 75% according to the Time article. This is even greater than for twins, and you would know this from birth, even without some sort of genetic test. The genetic test of course doesn't yet exist, but this is a scenario that must be faced now by a significant number of parents. Bipolar people are more likely to marry other bipolar people-- I think they called it assortive mating.
Now should the parents give the kid low doses of some mood stabilizer (lithium, depakote, whatever) in the hopes of keeping the disease from ever surfacing? I mean even in the absence of any (clear) symptoms. Would this work?? My *guess* is that it's got to have some effect on at least slowing the progress of the disease. I might worry about giving a kid such drugs from early on and the possible dangers. However these must be known (and I assume they are not a big problem) since so many epileptic kids receive large doses of anti epileptic drugs throughout childhood.
I guess a related question is whether epileptic kids, treated with such drugs throughout childhood, have a lower than expected rate of bipolar disorder. I understand that epileptics as a whole have a higher rate of bipolar disorder than the general population, so of course this would have to be factored in.
More dramatic things have been done for other diseases. I'm thinking about breast cancer, where women with the gene have actually had mastectomies as a preventative measure. Bipolar disorder is also a life-threatening disease, with up to a 20% lifetime fatality rate from suicide.
If I were such a parent I would want to do something like this. Does anyone know if people in fact do?
Just thought I would throw this out to see if anyone else had any thoughts or experiences with this.
Randal
Posted by Ritch on August 20, 2002, at 23:40:31
In reply to Re: Depends on the accuracy of the kindling theory... » Ritch, posted by Randal on August 20, 2002, at 12:19:12
Randal,
Interesting ideas. The first thing you would have to consider is whether or not the parents' bipolar disorder is being controlled or not and whether the parents are themselves taking medication to prevent relapses. If they are non-compliant, should the state have the *right* to intervene to "save their children" with antimanic medications? I think that would fall apart in court, big time. If their parents ARE compliant with their meds and seek a psychiatrist to prescribe prophylactic antimanic medication in the absence of any bipolar symptoms in their child, that psychiatrist could risk a big future lawsuit (not to mention possible ethical conflict in the doctor), so I think that scenario fails legally as well. EVEN if a genetic test were readily available that would show that 75% likelihood, it would still be on shaky legal grounds to prescribe (and especially enforce) medications in absence of any clinical *symptoms*. My conservative idea on the whole issue would be for compliant, knowledgeable bipolar parents to identify the *non-medication* approaches that could be helpful in preventing or delaying the onset of bipolar symptoms in their children regardless of positive genetics in the absence of any current clinical symptoms. Anticonvulsant medications are NOT innocuous substances. My mother had severe nocturnal generalized seizures for many years. She was on 400mg of Dilantin every day for about 20 years. She lost all of her teeth before she was 30 because of the Dilantin. However, many children suffer *life-threatening* seizures that require control with anticonvulsants. I would not want to treat anybody(if I was a doctor) with antimanic meds in absence of any clinical symptoms.
Mitch
> Hi Mitch,
>
> A related question:
>
> Say two bipolar parents have a kid. Statistically the chance of having a bipolar kid is 75% according to the Time article. This is even greater than for twins, and you would know this from birth, even without some sort of genetic test. The genetic test of course doesn't yet exist, but this is a scenario that must be faced now by a significant number of parents. Bipolar people are more likely to marry other bipolar people-- I think they called it assortive mating.
>
> Now should the parents give the kid low doses of some mood stabilizer (lithium, depakote, whatever) in the hopes of keeping the disease from ever surfacing? I mean even in the absence of any (clear) symptoms. Would this work?? My *guess* is that it's got to have some effect on at least slowing the progress of the disease. I might worry about giving a kid such drugs from early on and the possible dangers. However these must be known (and I assume they are not a big problem) since so many epileptic kids receive large doses of anti epileptic drugs throughout childhood.
>
> I guess a related question is whether epileptic kids, treated with such drugs throughout childhood, have a lower than expected rate of bipolar disorder. I understand that epileptics as a whole have a higher rate of bipolar disorder than the general population, so of course this would have to be factored in.
>
> More dramatic things have been done for other diseases. I'm thinking about breast cancer, where women with the gene have actually had mastectomies as a preventative measure. Bipolar disorder is also a life-threatening disease, with up to a 20% lifetime fatality rate from suicide.
>
> If I were such a parent I would want to do something like this. Does anyone know if people in fact do?
>
> Just thought I would throw this out to see if anyone else had any thoughts or experiences with this.
>
> Randal
Posted by Randal on August 22, 2002, at 15:07:30
In reply to Re: Depends on the accuracy of the kindling theory... » Randal, posted by Ritch on August 20, 2002, at 23:40:31
Mitch,
Very good points. The ethics and legality of all this would get complicated. A 30 year-old woman *at risk* for breast cancer certainly can do something as radical as get a double mastectomy, or perhaps less extreme like take Tamoxifen. Can parents do something like give drugs to their kid in the absence of symptoms? I honestly don't know. (I'm sure the "right" doctor could somehow find symptoms in just about any kid though...).
Wouldn't vaccines be similar in concept to a medicating a kid who is at risk of a disease but doesn't in fact have it? Beyond the usual childhood vaccinations, I once got a shot of gamma globulin when a roomate came down with hepatitis. A kid exposed to Anthrax would certainly go on antibiotics even in the absence of symptoms. Are these really that different than giving medication to a kid likely to get bipolar? I'm trying to think of other examples--there must be some.
Regarding environmental vs. pharmacological prevention. Say, hypothetically, that it is found that sleep cycle, caffeine and alcohol intake are the most important environmental factors in triggering the disease. Are you sure these sorts of things can be controlled? What if something else comes in to play? It seems to me like you might be shooting at a moving target here.
Isn't Dilantin one of the old AEDs (anti-epileptic drugs) with the worst side effects? I would assume there are second and third-generation AEDs that have fewer side effects. And I'm *guessing* you wouldn't have to take them at the full dose needed for epilepsy.
You know, if the current studies pan out, maybe omega-3 fatty acids (in the large doses people use for bipolar) would be the "drug" of choice to prevent the disease. I think a lot of parents already do this. If I were in that position, even with the preliminary results out there on fish oil I would probably try this. It might be hard to get the kid to take the smelly pills, though! Gerber omega-3 fish mush??
Randal
> Randal,
>
> Interesting ideas. The first thing you would have to consider is whether or not the parents' bipolar disorder is being controlled or not and whether the parents are themselves taking medication to prevent relapses. If they are non-compliant, should the state have the *right* to intervene to "save their children" with antimanic medications? I think that would fall apart in court, big time. If their parents ARE compliant with their meds and seek a psychiatrist to prescribe prophylactic antimanic medication in the absence of any bipolar symptoms in their child, that psychiatrist could risk a big future lawsuit (not to mention possible ethical conflict in the doctor), so I think that scenario fails legally as well. EVEN if a genetic test were readily available that would show that 75% likelihood, it would still be on shaky legal grounds to prescribe (and especially enforce) medications in absence of any clinical *symptoms*. My conservative idea on the whole issue would be for compliant, knowledgeable bipolar parents to identify the *non-medication* approaches that could be helpful in preventing or delaying the onset of bipolar symptoms in their children regardless of positive genetics in the absence of any current clinical symptoms. Anticonvulsant medications are NOT innocuous substances. My mother had severe nocturnal generalized seizures for many years. She was on 400mg of Dilantin every day for about 20 years. She lost all of her teeth before she was 30 because of the Dilantin. However, many children suffer *life-threatening* seizures that require control with anticonvulsants. I would not want to treat anybody(if I was a doctor) with antimanic meds in absence of any clinical symptoms.
>
> Mitch
>
> > Hi Mitch,
> >
> > A related question:
> >
> > Say two bipolar parents have a kid. Statistically the chance of having a bipolar kid is 75% according to the Time article. This is even greater than for twins, and you would know this from birth, even without some sort of genetic test. The genetic test of course doesn't yet exist, but this is a scenario that must be faced now by a significant number of parents. Bipolar people are more likely to marry other bipolar people-- I think they called it assortive mating.
> >
> > Now should the parents give the kid low doses of some mood stabilizer (lithium, depakote, whatever) in the hopes of keeping the disease from ever surfacing? I mean even in the absence of any (clear) symptoms. Would this work?? My *guess* is that it's got to have some effect on at least slowing the progress of the disease. I might worry about giving a kid such drugs from early on and the possible dangers. However these must be known (and I assume they are not a big problem) since so many epileptic kids receive large doses of anti epileptic drugs throughout childhood.
> >
> > I guess a related question is whether epileptic kids, treated with such drugs throughout childhood, have a lower than expected rate of bipolar disorder. I understand that epileptics as a whole have a higher rate of bipolar disorder than the general population, so of course this would have to be factored in.
> >
> > More dramatic things have been done for other diseases. I'm thinking about breast cancer, where women with the gene have actually had mastectomies as a preventative measure. Bipolar disorder is also a life-threatening disease, with up to a 20% lifetime fatality rate from suicide.
> >
> > If I were such a parent I would want to do something like this. Does anyone know if people in fact do?
> >
> > Just thought I would throw this out to see if anyone else had any thoughts or experiences with this.
> >
> > Randal
>
>
Posted by Ritch on August 23, 2002, at 0:37:47
In reply to Re: Depends on the accuracy of the kindling theory » Ritch, posted by Randal on August 22, 2002, at 15:07:30
Randal,
I would be the first to show up to get an "allergy shot" once a month to prevent my bipolar symptoms in a heartbeat. Who knows? Maybe that is something that myself and others may be looking forward to in the future instead of daily chronic med dosings. You see, the wonderful thing about a vaccine is that you take it very infrequently, your body doesn't have to metabolize it daily and eliminate it, and it doesn't cause secondary health problems due to side-effects of chronic use. A good example would be needing to take an SSRI to prevent a depressive relapse, but it is exacerbating erosive esophagitis and GERD symptoms which increase the risks for stomach and esophogeal cancer in later life. I read something yesterday about a doctor's report on an elderly woman who was in a nursing home and who was on a relatively high dose of lithium and developed toxic symptoms and nearly died. The doctors were confused multiple times about what was precipitating a given symptom complex and were prescribing other meds and treatments to combat it, without much effect. She went into a coma, they withdrew all of the medications and eventually came out of it. They changed and simplified her medication regimen, and she slowly recovered. I view medications very economically-cost/benefit. The costs (in my mind) are the "body-burden" of the medications, not the $$$. The benefit sometimes is not to get better, but simply to not get worse or commit suicide, unfortunately. I just don't feel that subjecting children to these "burdens" without any symptoms are worth the costs. Yes, the newer anticonvulsants are safer than the old stuff, however the old AED's like Dilantin and phenobarbitol (My Mom's meds) are still very highly effective and commonly used. I really do hope that researchers find something silly and simple to resolve this-like an obscure virus or fungus. THAT's the hope for me, anyhow-that is what keeps me on my current meds (the possiblity that I may not have to take those in the future).
Mitch
> Mitch,
>
> Very good points. The ethics and legality of all this would get complicated. A 30 year-old woman *at risk* for breast cancer certainly can do something as radical as get a double mastectomy, or perhaps less extreme like take Tamoxifen. Can parents do something like give drugs to their kid in the absence of symptoms? I honestly don't know. (I'm sure the "right" doctor could somehow find symptoms in just about any kid though...).
>
> Wouldn't vaccines be similar in concept to a medicating a kid who is at risk of a disease but doesn't in fact have it? Beyond the usual childhood vaccinations, I once got a shot of gamma globulin when a roomate came down with hepatitis. A kid exposed to Anthrax would certainly go on antibiotics even in the absence of symptoms. Are these really that different than giving medication to a kid likely to get bipolar? I'm trying to think of other examples--there must be some.
>
> Regarding environmental vs. pharmacological prevention. Say, hypothetically, that it is found that sleep cycle, caffeine and alcohol intake are the most important environmental factors in triggering the disease. Are you sure these sorts of things can be controlled? What if something else comes in to play? It seems to me like you might be shooting at a moving target here.
>
> Isn't Dilantin one of the old AEDs (anti-epileptic drugs) with the worst side effects? I would assume there are second and third-generation AEDs that have fewer side effects. And I'm *guessing* you wouldn't have to take them at the full dose needed for epilepsy.
>
> You know, if the current studies pan out, maybe omega-3 fatty acids (in the large doses people use for bipolar) would be the "drug" of choice to prevent the disease. I think a lot of parents already do this. If I were in that position, even with the preliminary results out there on fish oil I would probably try this. It might be hard to get the kid to take the smelly pills, though! Gerber omega-3 fish mush??
>
> Randal
>
> > Randal,
> >
> > Interesting ideas. The first thing you would have to consider is whether or not the parents' bipolar disorder is being controlled or not and whether the parents are themselves taking medication to prevent relapses. If they are non-compliant, should the state have the *right* to intervene to "save their children" with antimanic medications? I think that would fall apart in court, big time. If their parents ARE compliant with their meds and seek a psychiatrist to prescribe prophylactic antimanic medication in the absence of any bipolar symptoms in their child, that psychiatrist could risk a big future lawsuit (not to mention possible ethical conflict in the doctor), so I think that scenario fails legally as well. EVEN if a genetic test were readily available that would show that 75% likelihood, it would still be on shaky legal grounds to prescribe (and especially enforce) medications in absence of any clinical *symptoms*. My conservative idea on the whole issue would be for compliant, knowledgeable bipolar parents to identify the *non-medication* approaches that could be helpful in preventing or delaying the onset of bipolar symptoms in their children regardless of positive genetics in the absence of any current clinical symptoms. Anticonvulsant medications are NOT innocuous substances. My mother had severe nocturnal generalized seizures for many years. She was on 400mg of Dilantin every day for about 20 years. She lost all of her teeth before she was 30 because of the Dilantin. However, many children suffer *life-threatening* seizures that require control with anticonvulsants. I would not want to treat anybody(if I was a doctor) with antimanic meds in absence of any clinical symptoms.
> >
> > Mitch
> >
> > > Hi Mitch,
> > >
> > > A related question:
> > >
> > > Say two bipolar parents have a kid. Statistically the chance of having a bipolar kid is 75% according to the Time article. This is even greater than for twins, and you would know this from birth, even without some sort of genetic test. The genetic test of course doesn't yet exist, but this is a scenario that must be faced now by a significant number of parents. Bipolar people are more likely to marry other bipolar people-- I think they called it assortive mating.
> > >
> > > Now should the parents give the kid low doses of some mood stabilizer (lithium, depakote, whatever) in the hopes of keeping the disease from ever surfacing? I mean even in the absence of any (clear) symptoms. Would this work?? My *guess* is that it's got to have some effect on at least slowing the progress of the disease. I might worry about giving a kid such drugs from early on and the possible dangers. However these must be known (and I assume they are not a big problem) since so many epileptic kids receive large doses of anti epileptic drugs throughout childhood.
> > >
> > > I guess a related question is whether epileptic kids, treated with such drugs throughout childhood, have a lower than expected rate of bipolar disorder. I understand that epileptics as a whole have a higher rate of bipolar disorder than the general population, so of course this would have to be factored in.
> > >
> > > More dramatic things have been done for other diseases. I'm thinking about breast cancer, where women with the gene have actually had mastectomies as a preventative measure. Bipolar disorder is also a life-threatening disease, with up to a 20% lifetime fatality rate from suicide.
> > >
> > > If I were such a parent I would want to do something like this. Does anyone know if people in fact do?
> > >
> > > Just thought I would throw this out to see if anyone else had any thoughts or experiences with this.
> > >
> > > Randal
> >
> >
>
>
This is the end of the thread.
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