Thanks for reading and keeping up with this series – Mental illness exists for a reason! In part 1, part 2, and part 3, we discussed the evidence for genetic control of behaviour in primates, and found that variability within a species’ genome allows that species to be adaptable. Humans are an example of a species with a variation in genes within their genome, allowing us to become one of the most successful species on the planet! We discussed that because of this variability, some of us succeed in cities, rural areas, at high elevations, or thrive working underground. It also means that not all of us will succeed – at least in every environment.
So how do we guide treatment and recovery, with this understanding of mental illness?
When I was in grade school, as there tends to be, there was always the one problem child. Teachers would scorn this child, parents would be caught whispering about the kid in hushed after-dinner conversations as they dispersed the latest rumors coming from the school. This child had bad grades, would act out in class, and was the regular example of how not to act when your parents warned you about the repercussions not studying. “Do you want to end up like Johnny? No future?!” You could say that in the eyes of the masses, this child was struggling.
Johnny felt he was struggling too. He didn’t seem to jive with the classroom environment. He had a lot of pent-up energy he felt he had nothing to do with. He intended well, but ultimately was ambivalent regarding his grades. ‘What will I ever need that for, anyway?”
I eventually moved on from grade school, and high school, and university, and medical school. Years later, on a short trip home to Newfoundland, I saw Johnny in the supermarket, He was with his beautiful family, and had three kids. We got to talking and it turned out he entered trade school after high school, was at work a few years later, and now actually owned a home. The thing that stuck out the most was he was glowing. Absolutely glowing., I couldn’t help but feel, this guys got it all figured out.
But Johnny was struggling. So what happened?
Not everybody will thrive everywhere. I could think of lots of examples from my office, but I thought that this example was more down to earth and a great example of how things are not always as they seem.
Johnny was never meant to sit in a classroom, and was intended to use his hands. When given the wide open expanse of a work day and a welders hat, he found his niche, and owned it. The reality is, the filtration system this is our school system didn’t work for him, and he struggled.
The conclusion? Sometimes, a change in environment is the most important intervention when you are struggling with a mental illness. If you live away from your family and friends, and are struggling, my pill will have limited benefit. Until jobs can stop requiring people to work 50, 60 hours a week for next-to=nothing, people will suffer.
Editor’s note: As if it wasn’t complicated enough, I’ll add an asterisk! Often times, when you are in the throes of a mental illness, your judgement can be distorted. In general, I recommend people do not make life-altering decisions while severely unwell. A discussion with your doctor on how to best approach this scenario is my recommendation.
Not all mental illness is a result of person-environment incompatibility. There are true, organic mental illnesses out there. Often times, a combination of medication, therapy, and life changes, is required.
I would like to credit Dr. Albert Wong at the Centre for Addiction and Mental Health for inspiring most of the content of parts 1-3 of this blog series.
Dr. Travis Barron is a resident physician in Toronto, Canada.