Why Mental Health Disorders Emerge in Your Early 20s
There's a reason the image of the floundering, scared, shaky post-teen struggling to enter adulthood is a cliché. Between moving out of your parent's home, going to college and getting a job, lack of sleep, drugs, and unrestricted access to alcohol, becoming an adult is fucking hard. So it's no wonder that this period is popularly associated with having a mental breakdown. But is there any truth behind the pop culture trope? What about kids from wealthy families who don't have the stresses the rest of us do in early adulthood, or people whose most trying times come in their 30s or 40s? Is the appearance of mental illness in young people a matter of environment or biology?
To better understand these questions, I phoned Johanna Jarcho, Ph.D., a postdoctoral fellow at the National Institute of Mental Health whose work studies differences in brain development in healthy people versus those who have mental health problems, with a focus on anxiety. She explained how our brains interact with social conditions to influence our mental health, and why the best way to deal with a problem is to get it diagnosed early.
I've often heard it repeated that mental illnesses frequently begin in a person's late adolescence or early 20s. Anecdotally that seems consistent with what I've seen, but is there any scientific basis to this claim?
Dr. Johanna Jarcho: Yeah, the vast majority of mental health disorders do emerge during one's adolescence or early 20s. If you're going to have an anxiety disorder as an adult, there's a 90% chance that you'll have had it as an adolescent. Basically, you're not going to develop an anxiety disorder as an adult. You're going to develop it as a kid and then it'll carry through to adulthood. Emerging research suggests that this is because adolescence is a time when the brain is changing to a great degree. We once thought that the brain didn't change that much after earlier childhood, but what we've seen is that the brain continues to undergo really profound changes up until your early 20s. It's still quite malleable, so being exposed to different influences in your social environment can really have a profound impact on the way that your brain continues to develop.
You said that much has to do with brain development. At the same time, young adulthood seems to be a time where people are going through major upheavals, both socially and economically—things like college, entering the workforce, or living away from your parents. Is there a way to quantify the effect of environment versus biology?
Some types of mental health disorders are much more genetically based than others. Schizophrenia and bipolar disorder have a much higher rate of inheritance. If you have a first degree relative like a parent or sibling who has one of those disorders, you're at a much greater risk for developing it yourself, and there are things in the environment that can potentiate that. For other disorders like depression or anxiety, it's less heritable. Whether or not you develop one of those disorders is a lot more contingent on your environment. Young adults go through all these different social changes, but we evolved to be able to make this big transition from being with parents to forging adulthood. What happens during this transition can definitely have a profound effect on whether you grow to be "healthy" or to have these types of disorders.
We're still finding out more about how much of this is biologically based and how much is environmental. We've learned from genetics that it's not just the genes and it's not just the environment, it's an interaction between the two.
So a mental illness is not just an inevitable thing that people either will or won't have?
No. A lot of us tend to focus on the negative, but it's really important to focus on the fact that there's a lot that can be done to protect against developing mental health disorders, even if you are at risk. The social environment could tip you over into becoming sick, but in a good social environment you can actually thrive.
What kind of things should people be aware of?
It's important to know what you're at risk for. Let's say you had a parent with psychopathology; that certainly is a risk factor. If you've had a difficult time engaging in your social world as a kid, that's another risk factor. If your parents sheltered you instead of giving you some exposure to difficult things and showing you how to cope, that's another risk factor. The type of parenting that you had as a child can really affect the way you cope with the new challenges as you launch into adulthood.
Let's say a person is starting to experience symptoms of a mental health disorder. What can they do to mitigate harm?
The most important thing that you can do to mitigate the effects that any kind of psychopathology might have is to get treatment earlier and when you're younger. It's like how habits are formed: they get strengthened over time and once they're established they become biological, in a way. It's much more difficult to break them and they stick around for a long time. If you think there's something that may be wrong, you should try to get help before things become a crisis, before you feel like it's having profound effects on your life.
Health care is so expensive and opaque that I think a lot people have a feeling that, "Maybe I'm depressed, maybe I have anxiety, but I'm probably fine." They don't want to potentially spend thousands of dollars seeing a doctor, so they wait until it's absolutely necessary.
If you wait on getting treatment, your symptoms can become much more intractable. You save money in the short term, but your long term spending is much higher. We do preventative care for physical illness, but as a society we aren't quite there with mental health.
What do you make of self-diagnosis forums, WebMD, and other online health tools?
I think that because health care has not been readily available in the past, and because there is still a stigma against going to see a mental health professional, people have relied on the internet to understand what's going on with them. That can be a good first step, and certainly it can underscore the fact that you're not alone in the types of symptoms that you're having. But that doesn't necessarily get you to treatment. It's important to be able to go to a professional and say, "I think I need help with this." Certainly the more resources the better, especially for people who haven't had a lot of exposure to receiving mental health care. It can be scary. The internet can be useful but it doesn't get you a diagnosis and it doesn't necessarily get you treatment. But more information is always better.
Is misinformation a problem?
Well, let's say someone diagnoses themselves with depression. For one person, giving themselves a label in that way may be harmful, but for another person it might be helpful. In terms of misinformation, everyone is different, so getting treatment that's specific to your situation is really important.
There are certain things that get put out online about, say, computerized health services or video games that make you have less anxiety and people are hopeful about that, but it's not there yet. I think that there is this false hope that there is an easy, inexpensive, low side-effect cure for certain things and the data just hasn't supported that. It's something to caution people about. There are sort of wacky strategies people are promoting on the internet that don't really have that much scientific backing. I think it's better to seek professional care than to try some of these things.
You're saying there's not going to be a quick and easy mental health equivalent of penicillin that makes everyone healthy?
That would be lovely, but it's just not happening. There hasn't been a new medication that really helps with mental health disorders in a really long time, which is disappointing.
With mental health and with health in general, what we "know" seems to always be changing. To pick an obvious example, I'm constantly seeing articles about new studies saying red wine is bad for you, and others saying it's good. For someone who's not too knowledgeable it can become very confusing. How much of what we think we know now will be different in a few years?
I think we all thought that by now we'd know more than we do. I go back to this example of genetics: When the human genome was decoded we thought, oh, now we'll know everything. We'll be able to fix stuff and it'll all become clear. By having a greater understanding of what's behind mental health disorders, we're learning that it's just really complicated.
One thing that happens a lot is that the lay press puts things in very simplistic terms that give people a false hope. They'll say, "Here's this spot on the brain where depression lives," as if we could fix this one spot and then everything would be OK. It's really so much more complicated than that. At this point we're just starting to know what we don't know. It's a little terrifying. It's a totally changing field. I really do hope that in 10 or 15 years we're in a place where we can better identify symptoms earlier. It's still pretty early in terms of neuroscience.
Is there anything else you think that the average young adult should know about mental health?
They should know that most of the mental health disorders that people have in their 20s do dissipate. That can give you hope. But they should also know that if you're one of the people for whom it's not going to dissipate, it's much better to get help sooner rather than later. Don't think of seeing a mental health professional as something stigmatizing that you only do in a moment of acute crisis. Think of it as a general wellness thing, like going for an annual checkup. Talk about problems early instead of letting things build up.