Life Events Can Trigger Mental Illness

March 17, 2000

Medical Tribune

It's not all in the genes. Having experienced misfortune or extreme adverse circumstances can make a person more vulnerable to psychiatric disorders.

"Over the past 25 to 30 years, the assumption about the primacy of environment has tended to give way to a Zeitgeist favoring biological factors, especially those that trace biology to genetic inheritance," said Bruce P. Dohrenwend, author of a new study. Dohrenwend is chief of the department of social psychiatry at New York State Psychiatric Institute and Foundations' Fund for Research in Psychiatry Professor and professor of public health at Columbia University, New York.

The study is published in the March issue of the Journal of Health and Social Behavior.

In the study, Dohrenwend makes reference to the play, "Death of a Salesman." The main character, Willy Loman is 60 years old, has no job, no money, many debts and is alienated from his two sons. Yet he is unable to question, much less abandon his dreams of material success and respect. His psychiatric response is to become depressed.

Dohrenwent quotes playwright Arthur Miller describing his character: "Willy Loman is not a depressive ... He is weighted down by life. There are social reasons for why he is where he is."

Willy Loman is someone, Dohrenwend noted, whose problems cannot be solved by Prozac alone.

Although genetic factors exert a powerful influence on the development of psychiatric disorders, like post-traumatic stress disorder, depression, alcoholism, substance abuse and antisocial personality disorder, they are not the sole cause, said Dohrenwend.

In his study, Dohrenwend described three lines of environmental research that strongly suggest that adversity is important in the development of psychiatric disorders.

One line of research concluded that post-traumatic stress disorder can develop in previously normal people exposed to uncontrollable negative events. A second line of research found a link between low socioeconomic status and the prevalence of psychiatric disorders. The third set of studies strongly suggested that social factors are more important than genetics in the link between low socioeconomic status and the occurrence of depression in women and antisocial personality, alcoholism and substance abuse in men.

Analyzing the results of these three lines of research, Dohrenwend came to a single conclusion: the greater the uncontrollable changes following a negative event, the greater the likelihood that a disorder will develop. The source of "uncontrollable change" varies with the part played by the behavior of the individual in the occurrence of the event.

Journal of Health and Social Behavior (2000;41:1-9)

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