The Detailed Answer

Will you ever develop symptoms of mental illness ?

First, you need to know that mental illness is an interaction between your genes and your environment. (Environment means the people and things around you and everything that happens to you). We develop psychiatric problems, such as depression or hallucinations, if the stressors in our environment exceed our level of vulnerability. Our level of vulnerability is caused by our inherited chemical makeup.

Gertrude's tolerance of life stressors is very low, because of her genetic makeup. As soon as the stress in her life rises above the black line, Gertrude will start to have psychiatric problems.

Grunhilde, on the other hand, can tolerate a high level of stress; her level of vulnerability is high. She goes to 20, even 30, years old without developing recognizable psychiatric problems. But at 40 she goes through a divorce that takes her stress level above the black line. Then she gets depressed or develops other symptoms.

That's if Grunhilde ever hits a big enough stressor. She may go through her life never developing recognizable psychiatric problems. Only a very small percentage of people run into stressors exceeding their own level of vulnerability and are then diagnosed with serious mental illness. 

We're all vulnerable to psychiatric problems. We just have different levels of vulnerability.

Both boys have a low tolerance for life stressors. Humbert's life is full of love: loving parents, great teachers, a good upbringing, everything. Hubert's father left home. His mother is an alcoholic.

Which boy develops psychiatric problems? Both boys. Just because you have symptoms of a mental illness does not mean that you had a bad environment or bad parents or are a poor problem-solver. It just means your life stressors were greater than your body's ability to cope.

So, will I go crazy?  

Which question are you asking?

A. Will I suddenly break down and feel unable to cope with my kids, my boss, or whatever, any more? Not if you get rest, take vacations, and/or confide in your friends or a counselor when you need to. You cannot change your genes, but you can change your lifestyle.

B. Will I suddenly become a schizophrenic or a manic depressive and have to be locked up in a mental hospital? Whoa! Let's break that down:

1. You don't suddenly become a schizophrenic or a manic-depressive. Either you are born with schizophrenic or manic-depressive vulnerability genes or you are not.

2. Will I suddenly find out that I have the vulnerability genes? If you have the genes you will find out only if your life stressors exceed your stress tolerance level.

3. Can the police hospitalize me involuntarily? The current law (It can be changed.) in most states is very strict about this. You cannot be committed to a psychiatric institution against your will unless you pose a clear and present danger to:

• yourself, that is, you have told somebody that you are thinking of killing yourself or have actually made a suicide attempt, or at least have seriously hurt yourself.

• or others, that is, you have seriously hurt somebody or threatened somebody with serious harm.

Even if you are dangerous, a psychologist or psychiatrist must sign a form before you can be hospitalized. Besides that, the law sets limits on how long you can be kept in the hospital involuntarily.

C. You still have not answered my question. I'm under 30. My husband, my boss, my kids, are all driving me crazy. I can't change my lifestyle. I want to know if I'm about to find out I'm vulnerable to mental illness -- the hard way. Unfortunately, the hard way is the only way; I can't tell you for sure. But I don't think you have the vulnerability genes. Here's why:

A vulnerable mind represses (pushes into the background) the tension that results from a stressful life. That means, much of the time, you don't actually feel tense. But the repressed tension builds up in your mind and may explode into psychiatric problems.

You have told me that you feel very stressed out and concerned that you might go crazy. So, chances are, your mind is letting out your tension; that's why you can feel it. That's healthy; you are probably not going to develop psychiatric symptoms.

Ironically, the more aware you are of your tension, the less you have to worry about. The people who have been hospitalized as serious dangers to themselves or others tend to have little or no understanding of their illness.

D. My stress comes out in the form of depression. That IS a mental illness. And depression is no fun. But if you see a therapist and deal with your depression now, you are likely to keep yourself from developing more serious psychiatric symptoms, or even suicidal thoughts, later.

E. My friends say I'm a weird duck. Do I have a serious mental illness? I can't answer that. But neither can they.  Only a psychiatrist can diagnose mental illness.

F. Can you look at people (or yourself) and see symptoms of mental illness? No chance. Only a psychiatrist can diagnose mental illness, and even a psychiatrist is guessing part of the time. 

First, there's no way of walking, no way of talking that means that somebody is "mentally ill." Why not? Because there's no such dichotomy: mentally ill vs. "not mentally ill." So you can't "go crazy", i.e., suddenly go from "not mentally ill" to mentally ill.

We're all potentially mentally ill. And that's great, because it means that there are no bad people. We're all good, and we all might need help some time.

Second, heaven knows what signs and symptoms psychiatrists look for when diagnosing people; they're not telling. Some people call folks who act "nerdy" or "uncool" "mentally ill." That's not the psychiatrists' criterion. Any non-psychiatrist who tries to play psychiatrist this way is prejudiced.

G. If I do have bipolar disorder or schizophrenia, and break down one day, I'll know it, right? It will just take control of me and make me do whatever it wants. No. Mental illness cannot make you kill somebody or do some other awful thing. Whether you like it or not, you are going to be you, all your life. That's whether you are drunk, hypnotized, locked in a sensory deprivation tank, or experiencing a psychotic episode. If you would never kill anybody, you will never kill anybody while under the influence of anything.

Your body's chemical makeup may or may not give you a low stress tolerance level. But whatever your stress tolerance level is, the main thing determining what you actually do will not be your chemical makeup. You are controlled mainly by the kind of person you are. And nothing, not even a psychotic breakdown, can change the kind of person you are.

Jean M. Bradt, Ph.D.

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