The biggest misconception about mental illness is that it reflects a weakness

Audrey Tyrka, MD, PhD

What do you think is the biggest misconception that people have about children with depression, mood disorders and stress?

The biggest misconception about mental illness is that it reflects a weakness and that the individual is just not trying hard enough to push through it. I believe that people who are struggling with these kinds of problems are often much stronger and much harder working than people without major problems.

With severe mental illness, every minute can be a battle at times. I think it is critically important for people to understand that what is easy for some people is terribly difficult for others. What I would say is, the world is a very complex, scary, difficult place. You know we all will experience problems with health, with our loved ones, we are all going to lose people we love and we are all going to die eventually. And, in order for us to be able to handle all of those incredible challenges and live our lives without paralyzing anxiety, we need to have the genetic and biological make up that helps us to feel reasonably calm. And, we need to learn from our parents and our teachers and our community that even if bad things happen, we’ll have the support and the love to be taken care of and to get through it.

When we don’t learn that, and in fact instead learn that those very people who are entrusted to care for us are the ones who are making life traumatic, then it’s very difficult to come out of all of that feeling like things can be okay and behaving in the ways that society expects you to behave. So, that’s why I think we really need to put resources into our communities – toward education, addressing poverty, in addition to helping parents to deal with the challenges that they have. Parenting is an incredibly difficult job, one that requires patience and stability and skill and good role models, yet we somehow imagine that everybody should be naturally good at it.

What does your research focus on?

My research program is primarily focused on the effects childhood adversity, childhood maltreatment, childhood parental loss and other forms of severe stress and adversity. Initially, we were focused on how those experiences impact risk for psychiatric disorders like major depression and PTSD (post-traumatic stress disorder).

In recent years, we’ve been expanding that focus as more and more information has been obtained showing that childhood adversity or childhood trauma predisposes one to a variety of health conditions like obesity, diabetes, cardiovascular disease and other conditions. Stress and trauma are pervasive; they’re incredibly influential for psychological health, but it turns out they also impact a whole host of medical conditions.

What is the purpose of your research?

In addition to expanding our knowledge of the effects of childhood stress and trauma so we can better understand risk and treatment of related disorders, one of my greatest hopes is that people will see my research and say to themselves, “You know, this really isn’t something where you can just ‘pull yourself up by the bootstraps.’” I hope people realize this isn’t something most people can just decide to change; it’s something that can get embedded in your genome at some point and then can influence a variety of psychological and biological functions.

I don’t mean that to sound fatalistic—I believe that understanding our individual health circumstances and their origins is important to good health. If you know what your risk factors are, you can respect you body’s needs and limits and lead a healthier, more fulfilling life.

What are some examples of the studies you’ve conducted?

We’ve been studying this problem for about 15 years and we’ve done a lot of different types of research studies. Right now, our two biggest studies are both funded by the NIH (National Institutes of Health). One of them, called Life study, is a study of adults with and without a history of severe childhood adversity, and the other is a study of children who had been abused and neglected when they were preschool-aged children.

What have you found?

When we began this research years ago, we were focused on understanding how changes in functioning of our stress hormones are linked to risk for psychiatric conditions. More recently, we have focused on genetic and epigenetic influences of stress on risk for psychiatric conditions. So, we’ve had a number of very interesting and important findings come out of that research, principally showing that childhood maltreatment and other forms of stress lead to changes in the genome, in the genes that regulate the stress response.

Some of these epigenetic changes are associated with the development of depression, even in very young children. Epigenetic effects are changes that we don’t think are inherited, but we think that they occur from exposures that you have and it alters the likelihood of whether your genes are “turned on” or “turned off.” So, it can alter the sensitivity of your whole stress system. It’s not clear yet, but some research suggests that these changes can be reversed with medications and, possibly, behavioral treatments.

Our recent work also shows that stress and trauma is associated with faster aging that can be seen at the cellular level. There is now evidence that very stressful experiences can affect mitochondria, which, in addition to being the “powerhouses of the cell” because they convert molecules from food into energy, are also involved in cell aging and cell death.

Why aren’t there more resources for kids who need early intervention and proper mental health services?

Because we haven’t decided as a society to really take care of our most vulnerable people. I believe we are responsible for providing the basic necessary resources that all human beings need to develop into productive and healthy human beings. We do some of this, but it is not nearly enough. We also need to do a lot more with respect to prevention. Poverty and stress and trauma often occur together because kids often don’t get the care they need when parents are stressed and working too much, or have problems they need help with.

What are some of those simple signs that people (parents, teachers, counselors) can look out for?

Well, certainly, changes in behavior, especially persistent changes in behavior, are often a red flag. A child who was previously a happy and engaged learner who becomes withdrawn and starts doing poorly in school, that can be a sign that abuse or maltreatment has begun. Any child who is disengaged, who seems persistently sad or is having behavioral problems, acting out, engaging in violent behavior or otherwise not engaging in pro-social behavior may be experiencing trauma or neglect at home, or may have other problems that should be investigated and treated. Other signs include lack of sleep—though many things can cause sleep disruptions—and things like failure to gain weight.

What does the future hold for this area of study and treatment?

I think it’s very hopeful for us to learn about how these systems work because the more we can understand how mental illness works, and the more we can educate people about that, I think we’ll all be better off. I also believe that this understanding of the biology of risk and the biology of resilience will lead us toward being able to really identify the ingredients needed to help people get through this.


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Butler Hospital

Audrey Tyrka, MD, PhD

Director of research and director of the Laboratory for Clinical and Translational Neuroscience at Butler Hospital

A world-renowned researcher, Dr. Audrey Tyrka has devoted her career to investigating the link between childhood trauma and maltreatment and physical and psychiatric illnesses. Her research is some of the first to uncover evidence of the connection between intensive childhood stress and biological changes at the genetic level. The goal of her work is to understand the biology of risk and protection in order to inform prevention and treatment efforts. In addition to her roles at Butler Hospital, Dr. Tyrka is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

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