While many people know that genetic counselors work with families concerned about conditions caused entirely by genes, people are often less familiar with the idea that we also work with families affected by health conditions caused by a combination of genes and our experiences. Psychiatric disorders such as schizophrenia, depression, anxiety and bipolar disorder are a few examples.
As a genetic counselor who specializes in psychiatric disorders, I help people understand what we know about how these conditions can result from combined experiences and our genes. I love doing this because we can use this knowledge of how these conditions arise to manage our mental health for the future – and that can be really impactful for people.
The short video clip below is from a documentary that aired in the UK in May 2019. I provided genetic counseling about depression for Alastair Campbell, who’s best known for his work as Prime Minister Tony Blair's spokesman and campaign director. The clip shows the part of the genetic counseling session where I am helping Alastair understand how genes and our experiences work together to cause depression. As you will see, this had quite an impact for Alastair.
The analogy I use in the clip is that we all have a “mental illness jar.” In order to be actively experiencing an episode of illness, the jar must be filled to the top. Different people's jars can become filled with different amounts of genetic and environmental (or experiential) vulnerability factors. An environmental factor might be job stress, financial concerns, family issues or personal loss.
Importantly, we ALL have some genetic vulnerability to mental illness, and that genetic vulnerability doesn’t change. However, we can make our mental illness jar taller by “stacking rings” on top of it, creating more room for environmental factors so that the jar fills up more slowly. The rings on top serve as protective factors against an illness episode, and some of these protective factors (like sleep, nutrition, exercise, good social support) are good for all of us, regardless of our genes. However, some protective factors can be more individual; Alastair talks in the clip about some of his.
Genetic counseling is a lot more than just providing people with information about genetics. Genetic counselors can play a really important role in helping families with the emotions they’re facing that can be associated with health conditions they’re living with. We’re also here to help people understand information about how genetics contributes to conditions that run in the family.
The jar model is just a tool. It is most impactful and effective in the hands of a genetic counselor, and in the context of a personalized genetic counseling session. If you’d like to find a genetic counselor to discuss mental illness or other healthcare questions, you use NSGC’s Find a Genetic Counselor tool.
Jehannine Austin, PhD, CGC, is a past president of the National Society of Genetic Counselors and is a professor in the Departments of Psychiatry and Medical Genetics at the University of British Columbia in Vancouver.
Photo attribution: “How To Talk To Families About Genetics And Psychiatric Illness” by Holly Landrum Peay, Jehannine Claire Austin. Publisher WW Norton.
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