Mental Illness Actually Starts Very Young

Your brain has definitely not reached full maturity by your eighteenth birthday. A study published in July 2020 reported that some individuals showed a particularly extreme psychological response in the early months of the pandemic, symptoms like nightmares, intrusive thoughts, and compulsive checking. Their brains, for example, might be hyperresponsive to noticing and reacting to potential threat. All of this can mean that stressful experiences are programmed into the brain as particularly vivid memories. Indeed, it is those of us who are disposed to react badly to stress, rather than those who shrug it off easily, who are arguably the braver and more impressive, but any kind of moral judgment is out of place. We just have different minds and bodies that respond differently to the outside world. This has led some people to question whether the label disorder or illness is entirely appropriate. Laing, a prominent early critic of the medicalization of mental distress, said that insanity was a perfectly rational adjustment to an insane world. Of schizophrenia, he said, The experience and behaviour that gets labelled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation. More recently, the psychologist Lucy Johnstone argues that when someone is distressed, instead of asking What is wrong with you? we should ask, What has happened to you? Personally, I don’t think we should drop the label of mental illness or disorder altogether. Calling these illnesses or disorders usefully captures the extremity of the psychological pain involved, and how disabling it can all be. Instead, he says, depression is a response to genuine difficulty and loss in the real world.

Fly Away From Here

If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. Actually, as we’ve seen, researchers have recognized this for decades. This also riled people, because it’s not true that people with depression are only offered drugs. The concern in the academic community was that Hari’s emphasis on social causes, and dismissal of the biological, could be irresponsible and misinterpreted. But I’m not sure there needs to be a battle at all. In fact, the evidence to date shows that individual vulnerability and external factors are both relevant when it comes to mental illness. It was first introduced by Dutch psychologist Denny Borsboom in 2017 and for me, it’s the best explanation of what mental illness really is.31 Borsboom and colleagues argue, as others have done, that it is no use trying to understand mental illness on a single level of explanation like biology or psychology, or to give particular priority to one level over another. Central to this idea is that biological, psychological, and environmental aspects of mental illness exist in an interacting web, all influencing one another. Borsboom and colleagues argue that symptoms don’t arise only from biological dysfunction. Instead, they say that symptoms can cause and influence each other.

Between A Laugh And A Tear

They argue that it’s probably not the case that a pathological process gives rise to insomnia and fatigue separately. This could then set off a chain reaction of other depressive symptoms. In other words, when one symptom gets activated, that symptom in itself can trigger others. In the example above, we don’t need to look for initial causes for anything other than the insomnia. They argue that mental disorders are therefore networks of symptoms that directly influence each other. In this way, a disorder grows out of a network of symptom–symptom relations. The triple network model suggests that what initially triggers the mental illness might be something outside the person, like losing a loved one, but it could also be a biological trigger. In other words, the ties between the symptoms become sufficiently strong that the network sustains its own activation, maintaining the disorder even if the initial trigger has calmed down or disappeared. When a person is struck down with mental illness, they want to know why it’s happened to them. It also doesn’t help that people with anxiety disorders and depression, in particular, are naturally prone to analyze and ruminate. But the truth is that there is no simple explanation for anyone’s disorder or distress. We will tackle each of them in turn.

Window in the Skies

A few years ago, I went to a talk by psychologist, who researches adolescent depression. She asked the audience this question, and we tapped in our answer using electronic audience participation on our phones. She showed us that 60 percent of the audience said no, 21 percent said they weren’t sure, and only 19 percent said yes. If given the choice, few people would want to go through it again. This is for good reason. If you’re ever going to develop a mental illness, more likely than not, it will start in your adolescent years. This finding is based on two big studies conducted in the 2000s. These interviews were conducted by trained interviewers, although not necessarily people with clinical expertise. Data was available for 976 people. Most importantly, 74 percent of them met this diagnosis when they were eighteen, and 50 percent met the diagnosis by the time they were fifteen. This was a landmark finding, because it indicated that the majority of mental illness actually starts very young indeed, in the teenage years. The researchers interviewed participants about any possible current symptoms, but importantly, when they struck upon anything that met criteria for a disorder, they also asked participants to reflect back to when they thought these symptoms first began. Neither study is perfect. The samples are also from within specific countries and cultures, so it’s not clear if we can generalize these findings to other places. Broadly, adolescence is defined as the period of physical and psychological development between childhood and adulthood, but determining the exact ages at which it begins and ends is trickier. It’s hard to make a sweeping claim about when this happens though. Legally, you become an adult when you turn eighteen. But how many of us truly feel or behave like an adult on our eighteenth birthday?