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Understanding Mental Health with Doc Ayomide: Clarifying Misconceptions About the Inheritance of Mental Health

Doc Ayomide

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dreamstime_l_12526090“Can I inherit a mental illness?”
I want to consider this very important question through the lenses of familiar cultural beliefs about inheriting mental illness.

You know the kind I’m talking about…
• If a person has a mental illness, that means their child will have it
• Nursing mothers with mental disorders should not be allowed to breastfeed
• Don’t marry into a family with a history of mental illness
• We don’t have mental illness in my family
• The mental illness was caused by [insert stressful event]

So let’s break them down. But first let me make a distinction.

Sickle cell and the key thing you need to understand about mental disorder genetics
Most people I’ve spoken to seem to think of inheritance along the lines of what happens in a condition like sickle cell, so I think it’ll help to use the difference to explain things more clearly.

In sickle cell, transmission is relatively straightforward: if a parent has the sickle cell gene (S or C), they transfer it to their kids. If both parents have it, there’s a chance each of their children could have SS. (Of which it’s still a chance, but it’s a relatively high chance, at about 25% for each child if both parents are AS.)
In most mental disorders, it’s nothing like that. Number one, there’s almost never a single gene that the disorder can be traced to. Often it’s many genes, and it’s not even that the disorders can be traced to them, but more that they are known to be associated. And in many cases this association is still a subject of study.

Also, the chances of inheriting stuff based on what we know so far, are often fractions of 1, or single digits at best, and those chances are affected by lots of other stuff that isn’t genetic, like events surrounding birth and personal experiences.

In other words, if you think of them as stories, the story of the genetics of sickle cell is like a single episode of Friends: if that’s all you see, it’s enough, you don’t have to see everything to get it. For most mental disorders, however, the story is rather more like following a series lasting years. There are many parts to the story, and many sub-plots, and we don’t even know yet how it all ends.

So keeping that in mind, let’s get back to our traditional ideas…

1. If a person has a mental illness, that means their child will have it
That someone has a mental disorder doesn’t mean their child will have it, any more than a part having hypertension or breast cancer guarantees that their children will have it. It does mean they are more likely, but this is relative. That is, if there’s a 1% chance of just anyone having that condition, and a parent having it raises that by fourfold, that’s still comes to a 4% risk. Which is, you know, still pretty small. And the risk of the more serious mental health problems is often smaller than 1%.
You can’t make such predictions.

2. We don’t have mental illness in my family
Um. Sorry to bust your bubble, but you don’t really know, do you? I mean, let’s face it, how well do most of us know our own families? Heck, if you’re like most Nigerians, you’ve probably been introduced to some distant cousin or previously unknown uncle as recently as within the last couple years. (Especially when one takes into consideration the larger polygamous families we often hail from.)
Of course, part of the issue is our belief that mental health disorders are obvious and we’d know if anyone had one. But that’s simply not the case. Also keep in mind that mental health problems are not exactly a great topic for discussion over lunch. Like I often point out to people, if you had a mental disorder, how much of your family would you want it known to, if you could help it? What makes you think they’d tell you?

3. Don’t marry into a family with a history of mental illness
As I explained in my previous post, although it’s true that mental illnesses can be inherited our ideas of how are often very wrong. In a sense, you could say people don’t mostly get mental illnesses from their parents: they get it from their families. And they don’t mostly get it from one single gene, but from a complex interaction involving a little of everything from multiple genes to early childhood events and life stresses and even protective factors. In other words, the heredity of mental illnesses is so complex, making predictions is useless.
Which includes marriage-related predictions.

Don’t forget that a) most of us don’t even know our families, and b) you’d be amazed how many families have a history of one mental illness or the other. Making predictions based on something so complex really is just not very useful.

4. Nursing mothers with a history of mental disorder should not be allowed to breastfeed
There’s no good reason for this. The traditional basis is that breastfeeding may transmit the illness to the child (unless there’s some other reason I’m missing?), but that’s just not real. Like I explained in my previous post, genes are the transmitters of inheritable traits, and genes don’t exactly go through breast milk, sorry.
It’s really that simple, though.
The truth is, given what we know about the benefits of breastfeeding, nursing mothers should be breastfeeding as soon as they possibly can. Those early days are key and breastfeeding is a key part of establishing the bond between mother and child. We should be looking for more ways to make that possible, especially for those who find it difficult, not the other way around. That’s why even in nursing mothers who have to be admitted for treatment of mental illness, you want to see them get well real quick so they can go back to their babies.

5. The mental illness was caused by [insert stressful event]
That word, “cause,” is a hard word for us doctors to use. And it’s even harder to use in mental health, where defining a cause is no small matter. To say A caused B is to imply that B would not have happened if not for A. And that’s not something you can often prove in real life.
I explained this more fully in the first post, but I’ll just add here that we also happen to know that although mental disorders are largely genetic, a lot more things are involved: events surrounding labour, early childhood experiences, life challenges and adverse events, the nature of families and upbringing, individual personality and biochemistry.

How does one muster the confidence to say what caused what in such a milieu? (Except of course one oversimplifies it to one or two causes that are one’s personal favourites, but how is that helpful?)

This is obviously not an exhaustive list, so feel free to mention in the comments any others you’d like to learn more about. But I hope it’s a long enough list that you can appreciate my two main points, which I’ve repeated throughout but will summarise here.
1. We know enough about most mental illnesses to know that they are inheritable in complex ways.
2. The complexity of inheritance is, however, such that making predictions is at best, largely useless, and at worst, even harmful.

I hope this has helped you. And if it has I hope you share it: too many people need to understand this issue better. And don’t forget to mention in the comments about any beliefs you would like to understand better that I didn’t mention.
Live richly!

Photo Credit: Dreamstime

Dr Ayomide Adebayo is a medical doctor, mind health consultant and founder of Maximise Your LIFE, a community for people who want to live to the full. Grab your copy of his FREE resources here — plus instant access to his potentially life-changing email course!He writes at DocAyomide.com and tweets @DocAyomide. To ask a question, book a session — or just say hello — simply e-mail him ([email protected]).

19 Comments

  1. michy

    April 19, 2016 at 11:35 am

    My mum will not hear of it.

  2. Moyo

    April 19, 2016 at 12:20 pm

    I have heard of a family that had mental illness in 3 generations. The mother always behaved in a strange manner, infact nobody knew when she died, someone went to check on her and found her dead body. I was told her father also behaved in a strange way. Her son also had some form of mental illness although some of his own was brought on by smoking weed. How does one explain this.

    • Doc Ayomide

      Doc Ayomide

      April 19, 2016 at 7:50 pm

      It happens, Moyo, and what we say is that such families may have a strong genetic loading. What that means is that they may have a strong loading of genes predisposing the family to the particular mental illness. (or group of illnesses). I didn’t mention that in the article (although I hinted at it) because it’s not a very common scenario.

  3. smallworld

    April 19, 2016 at 12:29 pm

    It is impressive to see the topic of mental health is gradually being addressed.
    I have a sibling who has been on and off the wagon for the past 6 – 7 years. We initially thought she was just being head strong until we were told it was depression and recently, schizophrenia.

    Yes, we traced it to most of the points you have raised here, especially family and upbringing (my father was not exactly an easy man to discipline a child). The hard thing about mental illness is that most times (as in my family’s case), the patient never comes to term with the diagnosis and is usually hesitant with treatment (then throw in a dose of the blame on the spiritual). My sibling recently had to undergo sessions of ECT and the fear of such aggressive treatment has kept her diligent with medication.

    Thank you so much Dr Ayomide; hopefully, more light will be shed on this topic even more and the stigma attached to the ‘name’ will be greatly reduced, as there many families with member(s) diagnosed with mental illness.

    • Doc Ayomide

      Doc Ayomide

      April 19, 2016 at 7:53 pm

      Thank you too, smallworld! I know from professional experience how it can be to deal with that, and I’m glad you’re being there for your sibling.

      About coming to terms with the diagnosis, I wouldn’t say “never.” It can be hard to come to terms with, but it’s not impossible, and it really depends a lot on how it’s explained. In the long run though, coming to terms is one of the most important factors in long-term wellness.

      Live richly!

  4. truth hurts

    April 19, 2016 at 12:44 pm

    Fiiinnallly! A post that speaks my mind about how backwards a lot of us “modern” Nigerians are. My brother had been battling depression quietly. He told me he had contemplated taking his own life earlier that morning, but could not bear to make our widowed mum cry. I prayed with him and linked him up with the likemynds people. Depression is something a lot of people deal with in Nigeria, but do not know that they can seek professional help with. Great work BN

    • Doc Ayomide

      Doc Ayomide

      April 19, 2016 at 7:54 pm

      Thank you too, truth hurts! 😀 I hope your bro is also getting professional help?

  5. Sunshine

    April 19, 2016 at 3:10 pm

    Thanks for this article! Nigerians have so many misconceptions about mental health. Its good to see knowledgeable light been shone on it.

    • Doc Ayomide

      Doc Ayomide

      April 19, 2016 at 7:56 pm

      Thanks Sunshine! Live richly!

  6. ola

    April 19, 2016 at 3:21 pm

    Thanks for this post. I have been told that my grandmother and mum had mental issues. I have battled depression and my depression normally arises out of minor issues like going over my life and regretting decision made or unmade in the past. I also get very bad anxiety at work; for example, if I have a meeting at work the next day I will think and think about it until the point of having migraines. These days, I cope by not overthinking things and it seems to be helping.

    Can you recommend coping techniques sans medication.

    • Doc Ayomide

      Doc Ayomide

      April 19, 2016 at 7:58 pm

      Hello Ola. You didn’t say anything about professional help: have you considered this? I’d recommend that you do. Trying to deal with mental health problems on your own can be very hard, and you don’t have to stay alone.

      About coping techniques, I would rather recommend you get those in the context of a professional consultation, and not in the kind of general sense that can happen here. You understand?

  7. Gorgeous

    April 19, 2016 at 3:33 pm

    Mental illness IS most times hereditary. Some whole familes have mental illness in varying degrees. Just like if you have diabetes or high blood pressure in your family, that gene is passed from generation to generation. It just depends if the individual triggers it. if there is mental illness in a family, the propensity to fall into Mental illness is higher than those who do not have it in their family.

  8. yewande

    April 19, 2016 at 5:59 pm

    So I was at work one day and the topic of mental illness came up in my office (a bank). Long story short, there was a unanimous agreement by everyone to not marry a female who came from a home who had a relative with any form of mental illness. I was shocked to my roots how supposedly educated and enlightened people generally condemned females to singledom just by the fact that there seemed to be some incident in the family, whether distant or immediate irrespective of the causes.

    My brother passed away a few months ago from complications due to mental illness. My colleagues were not privy to this information but I was very shocked to know they will gladly condemn any relationship I was in just by the mere fact I was related to someone who had mental health issues. I pray for a lot of people and families out there who have to struggle with the stigma associated with mental illness in the family. And I pray people do more to enlighten the general public that mental illness is not like measles, you just cant catch it like that.

    • Doc Ayomide

      Doc Ayomide

      April 19, 2016 at 7:44 pm

      I’m sorry to hear about your brother’s passing. And about your experience, I’m not surprised. The attitude is basically a reflection of the cultural reality we still live with, and it’s because of attitudes like that I wrote this. Like you said, they never considered that one of them (you) might be personally involved.

  9. Oma

    April 19, 2016 at 7:01 pm

    Thank you Doc Ayomide, one area i would like you to shed more light on is epilepsy. This is a fairly common mental health issue. Is it hereditary, what are the triggers, can it be completely cured through extensive medication? thank you.

    • Doc Ayomide

      Doc Ayomide

      April 20, 2016 at 1:48 am

      Wow, Omo, it’s like you got into my mind o! I was just drafting an outline for that exact subject! 🙂 Keep an eye out for it.

  10. Hauwa Dauda

    April 20, 2016 at 6:37 am

    Hello Doc Ayomide, What is schizophrenia and is it hereditary?

    • Doc Ayomide

      Doc Ayomide

      April 20, 2016 at 8:46 am

      Hello Hauwa. Schizophrenia is a mental illness, and no, it’s not hereditary, it’s genetic. I explain that in this post, although it’s in greater detail on my blog, and you can check out my explanation there.

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