Last Thanksgiving, Chani wrote a great blog post to remind people that family health history is one of the best tools that we have to assess genetic risks for our patients, and to encourage our readers to discuss this topic over the holidays. This Thanksgiving, I am thinking about this some more and I would like to add another element to this theme.
Recently, I have met with several families with mental health issues. Many of them are particularly worried about the stigma that this can have on the affected individual. But beyond that, I am finding that the siblings of those individuals are concerned about their “marriageability.” These siblings worry that they may not be desirable for fear of developing mental illness themselves and of passing on the mental health problem to the next generation.
It is important to note that all forms of mental illness are multifactorial. This means that there is some genetic component that can actually involve multiple genes, as well as some environmental or situational component to trigger its onset. This is why it is not surprising to see that mental illness will ‘run in a family,’ but that not everyone will be affected. So if a brother has mental illness, each of his siblings and his nieces and nephews will have a higher-than-average risk to develop the same or a related condition, but this is not definite.
Dr. Goldwaser (one of our fantastic genetics attendings) once said something very smart and sensitive that also has been touched on in another blog from our program and at some of our events. We all have something in our families—whether it is mental illness, predisposition to cancer, or more common conditions like diabetes or hypertension. And some of us don’t even realize we have things going on. But the fact is that we are all carriers of about 5-10 autosomal recessive diseases! So while some things may be more public and seem more apparent than others, others are less conspicuous. But they are still there. Nobody is exempt.
I am finding that mental health issues are particularly taboo. People are so scared to talk about this, and even more so, to get involved with families who are affected. This is not unreasonable—we all know which life challenges we think we can handle and which ones we cannot. But I want to urge you this Thanksgiving not only to be open about health history, but to be sensitive to the fact that if you dig deep enough, you will be sure to find something genetic in just about any family. Why should mental health issues be more disqualifying in the realm of marriage compatibility than any other disease?