Childhood Vulnerabilities and Mental Health Issues

"Is depression, a low mood or a complex range of symptoms. Is it a single diagnosis or a range of mental disorders requiring different treatment? And is there a way of curing such a complex and diverse condition?"

 In the first part of this post, I share the abnormal behaviour of a person I came to know. As a writer and an author, I observe human behaviours and read works of literature in human psychology. 

I didn't have the slight inkling that his abnormality would develop into mental issues until he developed anxiety and depression. He is an academician with impressive records in his professional fields- soft-spoken to people outside but violent and cruel towards his wife and children and submissive to his blood relations, kith and kins. 

Then suddenly, he turned fearful about everything and subdued, appealed to his wife to manage his phone calls and the family matters on his behalf. He suspected that everyone around him was trying to sabotage him financially, harm and jail him. As a precaution, he remained elusive in social interactions.  

His panic-stricken wife and children urged that he needed psychological or psychiatric interventions, which he turned down. The mental health experts are there to extract his money, and he should guard against that.

Then giving in to his family's persuasion, he consulted a psychiatrist who gave him a clean chit suggesting he needed psychological evaluations. He never took that route but slowly showed recovery signs that did not last long. 

He had a poignant childhood-his mother informed him at the tender age of nine that his father would pass away at seventeen, as per astrologer predictions. He told me that marked the end of his childhood. He started saving every scent, including his pocket money, eschewing a chocolate bar or an ice stick for the future when his father was no more. As the eldest male, he stood next to his father in the line of responsibility of eight members.

He studied with vigour, was a topper in every course he pursued, and earned employment -his father passed away in the meantime. At the height of the achievement that he considered a silver line in the clouds, he saw a mother different- she began to throw unreasonable tantrums at his every personal inclination. He got too bent over backwards as a dutiful son to please her.

His marriage was a disaster-his mother refrained from welcoming his wife to the house when they reached the gate after the wedding. 

His wife kept the view that his mother caused him trauma by disclosing inconsiderately the impending death of his father at a tender age, which he reciprocated with violence and anger.

I also thought that his weird behaviour and depression were rooted in his childhood trauma but refrained from suggesting it, fearing the repercussions. If my doubts had no stuff in them, I would aggravate his vulnerability, but I wanted to help him from an informed perspective. 

 For that, I began to pursue through Google and bookshelves to get something appropriate until I bumped onto a post in Psyche, a digital magazine from Aeon.

"The Seed of Suffering -The p-factor is the dark matter of psychiatry: an invisible unifying force that might be behind a multitude of mental disorders."

Written by Alex Riley, a science writer, the post was based on his book: A Cure for Darkness-The Story of Depression and How We Treat It.

 I went over it with the belief that I find answers to my problems.

Riely asks the questions:

"Is depression, a low mood or a complex range of symptoms. Is it a single diagnosis or a range of mental disorders requiring different treatment? And is there a way of curing such a complex and diverse condition?"

His answers take one through personal history, hardships in the living conditions, childhood trauma, parents, social deprivation, and the history of global mental health from the colonial past to the present day. 

As a person not in the field, I found everything in the essay crucial, and I share what I consider relevant to my inquiry.  

In the first part of the essay, Riley describes. 

1. The diagnostic system the mental health professionals use based on the reference manuals-DSM-5 and ICO-11 followed by the American Psychiatric Association and the World Health Organisation, respectively, has not decreased the mortality of the mental health cases. “Prevalence rates are similarly unchanged, there are no clinical tests for diagnosis, detection of disorders is well beyond accepted onset of pathology, and there are no well-developed preventive interventions. In short, psychology appears stuck.”  
2. A group of scientists had held that “the true nature of mental disorders remains hidden." 

Riely writes: "Shaking off the shackles of the diagnostic classifications, there is growing evidence that all mental disorders are actually the products of a single underlying dimension, a common liability to psychopathology. Known as the 'p-factor,' this theoretical concept brings the potential for important new ways to treat and prevent psychiatric disorders."  

 

What is the p-factor? 

Riley explains: "P-factor is the dark matter of psychiatry: an invisible, unifying force that might lie behind a multitude of mental disorders. ... It has a gravitational likeness that seems to bind these invisible elements together."

Riley cautions that not all in the mental health field agree with the p-factor idea, but there are enough studies to support its presence. (Those interested in the studies can read the full essay here.)

Avshalom Caspi is a psychologist and epidemiologist who provide substantial support to it through his studies.  

He writes: 

1. "(T)he shapes shifting or 'serial comorbidity'... confirms the existence of a common liability underlying all mental disorders that can germinate at different points in our lives."  
2. "(M)ental disorders that first emerged in childhood or young adulthood were far more likely to show this pattern of serial comorbidity." 
3. "If p-factor is a common seed of adult psychopathology, what if a more general approach to prevention could stop it from taking roots?"

Linking the p-factor with harsh environments.

According to Caspi,

• "Harsh, unpredictable environments in childhood are the common node of psychiatric disease.”
• "If you look at every disorder, the core of each disorder is some sort of aberrant way of viewing or seeing the world... It's that paranoid ideation." 
• "There's the boy who thinks that everyone is out to get him and is later diagnosed with a conduct disorder. The skinny girl who looks in the mirror and thinks that she's fat -an eating disorder. The teenagers who think they are guilty of their parents' disputes and drinking - depression."
• "One of the most interesting origins for much of this aberrant thought comes out of harsh and inconsistent and unpredictable early environments."
• "Those kinds of experiences that set up the anticipation of bad things happening, or they set up the anticipation of being rejected, they set up the anticipation of being violated, they set up the anticipation of being threatened, and things going wrong. Things, you know, being unalterable. And thereby spiralling out of control. So, I think a lot of it is about what those early experiences do-they distort our expectations about the future. And that is why they're so consequential."

Riley, a sufferer of depression, documents his own and his cousin Victor's teenage experiences. 

In his teenage years, his mother, an alcoholic, had poor mental health, his dad struggled to find work, and they lived isolated from friends and families. When he needed his mother emotionally and physically, she wasn't available to him, and when he confronted her, she would become irritable, explosive and threaten suicide. 

He suffered a typical mood disorder such as depression at 16 when he did not disclose to his therapist his home conditions. His mental health improved on the medications his therapist prescribed. 

He joined the university and graduated. Later, his home conditions deteriorated later-his parents got separated-family home got sold. He broke up with his girlfriend and moved to shared accommodations. His panic "attacks returned, and depression that had lain dormant started to deepen. The allure of suicide resurfaced."  

His recent mental crisis, "including thoughts of suicide," occurred in February 2021. After a thorough assessment, "alongside antidepressants and anxiolytics (drugs that combats anxiety), the consultant psychiatrists wrote to me suggesting an antipsychotic to keep me stable." That was the same drug Oliver, his cousin, was prescribed at 17 when he was diagnosed with schizophrenia. 

"If we're prescribed the same drugs," Riely asks, "are we (his cousin and he) battling against a common enemy? Do our contrasting symptoms mark a shared vulnerability?"

"Caspi and his colleagues published a study in 2020, the successive surveys showing depression becoming substance abuse and anxiety; 'ADHD in childhood led to a thought disorder such as schizophrenia in adulthood.' Even depression and psychosis are seen to switch places."

Oliver, Riely writes, has a stable home having no addiction or separation. In his case, the p-factor is the harsh environment. "A common risk factor for early onset psychosis is being bullied, for example."  

Difficulties in childhood can come from failed social systems. "Unemployment, poverty, emotional neglect, and domestic abuse: they are the common factors underlying the diversity of mental disorders, and each has been exacerbated by the stresses of the Covid-19 pandemic." 

The Person in Question

I was ready to talk to the person in question when I learned his health had deteriorated again. His food intake went down, dis-spiritedness and lethargy kept him in bed for days and nights and deprived of sleep at night, and his body weight declined.

And he was adamant about consulting the mental health professionals. 

I waited until his health improved, sent him a copy of Riely's essay with a note to let me know his impressions, and he did it with positive reactions. 

The essay helped him scrutinise his life in the light of the mental vulnerability in his childhood days. His life was an incomprehensible whole, ugly, shameful, unresolvable, and sinking into the depth of guilt and self-hate, having no escape. The essay gave him answers—he related himself to Riley’s experiences. He remembered bursting into tears and spending lonely hours in bed in the foetal poster for days in his teen years, as the first spell of panic attacks and depression. 

He recollected his childhood memories of people with abnormal behaviours locked away in secret rooms, and children serving their families was the norm, which is changing now. 

He could relate to Caspi's explanations about the 'aberrant way of seeing the world' and the 'paranoid ideation'. 

He wrote that he now thinks about him in a new light. His health improved, and a regime returned to his life. Whether he maintains it for the rest of his life or not, I have no idea. The chances for his teenage vulnerability recurring are there, as the p-factor suggests. 

I remain grateful to him for allowing me to share his story with others, and I wish the readers reward him by spreading that childhood is precious and vulnerable.  

Conclusion: 

• More than ever, I realise how crucial is childhood experiences.  
• To those who want to read the post in full, which I recommend, click here.  
• Psyche "is a digital magazine from Aeon that illuminates the human condition through psychology, philosophical understanding, and arts."