What protects us from developing a mental disorder?

Now that mental health has become a major topic of interest and public health care centers are largely overcrowded, it may be useful to remember the factors that have been shown to help protect a person from developing a mental disorder. A commitment to prevention complements the adequate investment in a quality care network, especially for the most vulnerable patients with severe mental diseases.

Starting with the basics, the first thing to understand is that our prodigious mental world is the emergent property of a biological organ called the brain, that gelatinous 3.3-pound mass that, as the renowned neurologist Vilayanur Ramachandran says, “is capable of contemplating a sense of infinity and can contemplate itself by contemplating a sense of infinity.”

Mistreating the brain is always a bad idea, both in the short and long term. Blows to children’s heads (from accidents, falls, riding a bicycle without a helmet, or physical abuse) continue to be a public health problem. Another way of harming their brains is to allow them to consume intoxicants, especially in adolescence. The normalization of binge-drinking and the consumption of pot in 15- or 16-year-olds contrasts with the evidence that alcohol is associated with the development of anxiety and depression, and the link between cannabis and psychosis is clear. In people with genetic vulnerability, marijuana use can trigger schizophrenia that may have remained latent without it. We may have a convoluted discourse on the subject of cannabis, but we also have to think about who will foot the bill for a potential increase in psychotic, often terrifying, experiences. A chronically sleep-deprived brain is also a damaged brain.

Sometimes I think it also has to do with unhinged political polarization, spurred by early morning radio, when listeners lack a couple of hours of rest. Taking care of the body is also taking care of the brain. Nutrition and lifestyle habits (avoiding a sedentary lifestyle, exercising, not smoking) lead to good physical health and also appear to protect a person from Alzheimer’s disease and depression, for example.

Some factors that protect us from or put us at risk for mental pathology appear before we are born. A pregnant woman’s proper nutrition, her protection against infections, a complete refusal to consume toxins during pregnancy and giving birth in the best possible conditions appear in studies as important long-term factors in a child’s life. But, as the pioneer John Bowlby — the psychoanalyst who has best resisted the rise of neuroscience — has pointed out, the secure, close and constant bond between mother (or father) and baby is the primary protection for mental health. Through the attachment experience, the child learns to understand the mind of the self and others, to trust others, and to interact in healthy ways. In contrast, physical, sexual or emotional abuse in childhood increases the risk of developing psychosis or suicidal behavior by 4 times and the risk of using illicit substances in adulthood by 11 times. Thus, two preventive measures are within our grasp: one, allowing the crucial intimate experience of parenting throughout the first year of life (not just the first four months); and two, reducing the rates of child abuse through increased protection of the child. The surveillance and prosecution of pedophiles should be increased significantly.

Bullying and social adversity are two factors that appear in most studies, along with their protective opposites: a healthy and inclusive school environment and adequate rebalancing and social protection policies. In the difficult objective of developing a life project, social determinants (working conditions, salary, housing) are equally important, as is the capacity for resilience and adaptation to adversity. Being unemployed or unable to make ends meet affects mental health, of course. And pointing to an individual’s resilience in such cases seems to blame him for his misfortune to some extent, and to require him to accept and adapt to an unfair reality. But basing the whole understanding of psychic distress on social elements is partial and misleading. With these parameters, one would say that mental health must be formidable in Scandinavian societies, which have a wonderful welfare state, but the reality is that the suicide rate in Sweden and Finland is three or four times that of Madrid, for example. On the other hand, the idealization of meritocracy is unfair because we do not all start from the same conditions; the suppression of the concepts of merit and individual will sends a dangerous externalizing message that does not promote personal adventure, innovation and effort. It may be better to foster three traits in adolescents that have been associated with long-term emotional well-being: a sense of agency or self-efficacy, a tolerance to frustration, and the development of a purpose in life (in a way that is compatible with reasonable social balance policies).

Empirical studies sketch a portrait of the resilient subject: optimistic in nature, perseverant, kind to the environment, able to continually re-evaluate their beliefs and regulate their affect, actively copes with stress and tends to feel positive emotions (if I meet him, I’ll introduce you to him right away). He uses humor, meditates and seeks social support when necessary, is not hostile or rabid (he’s not a hater or troll), is committed to what he does, makes sense of it and tackles challenges. But studies indicate that the resilience of this fantastic person is based on his sense of belonging to a group, whatever it is, in having a certain role in a broader social unit (his family, group of friends, team, club, parish...). He shows gratitude and compassion and feels capable of making a difference. We will have to be resilient to face a mental health crisis. Prevention is possible and perhaps more cost-effective than waiting to treat the disease.

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