Emotional distress causes psychosis

Sometimes it’s not genetic: how Emotional Distress causes psychosis, and not the other way around

The main reason to talk about emotional distress instead of a disease based approach is that it’s more accurate. The well shared theory is that genetic predisposition causes psychosis which causes emotional distress. However, when you look at the details, you’ll find that instead it’s the other way around. Emotional distress causes psychosis which causes genetic change. Many times the root cause is not genetic at all.

Genetic research leads to evidence that emotional distress causes psychosis

The claim that’s been made for many years that “mental illness is genetic.”  This is the idea that people experience severe emotional distress because of some kind of weakness or predisposition in their genes. Instead it turns out that emotional distress is a normal human reaction to a really lousy life situation. People who suffer intensely mentally may be more sensitive or perceptive of their situation, as Ken Rosenthal shows in the excellent documentary called Crooked Beauty. He tells how emotional distress causes psychosis and many other symptoms on a complete continuum with “normal” behavior. As Paula Caplan says about PTSD, “Many veterans are being called sick when in fact they are having understandable, normal human reactions to war. War is horrible, and of course people have emotional distress afterwards. Why should not feeling anything be called a “normal” reaction?”

Over 25% of the human genome has been linked to mental illness at one point or another, but very few of these studies can ever be replicated.  According to Tim Crow of Brown University, what people say seven times does not neccessarily make it true:  “A chorus of reviews come out all the time with titles including ‘The discovery of susceptibility genes for mental disorders’, ‘Genes for schizophrenia ?’,  ‘The molecular genetics of schizophrenia’, ‘Schizophrenia – genes at last ?’ This blog borrows heavily from his analysis of those claims to show that emotional distress causes psychosis.

The futile $10 billion search for a “mental illness gene”

Leonard Gray from California sports a T-shirt showing how emotional distress causes psychosis or lack of attention

Leonard Gray from California sports a T-shirt showing how emotional distress causes psychosis or lack of attention

The classical approach to find a “mental illness gene” is to use linkage to detect the general region within which a disease-causing gene is suspected. Then a different kind of study called association can locate a particular gene with greater precision, and thus to lead to its identifcation.  The reality is that in spite of a plethora of well-hyped findings no linkage claim has proven robust. In each case an apparent finding in a modest-sized population of families that was then used to ‘identify’ a candidate gene has not been found linked in more systematic and larger studies.

Thus the advent of genome scans (unbiased surveys with markers across the whole genome) has not strengthened any of the claims for a genetic cause for emotional distress. The bigger the studies get, the less confirmation there is. Two meta- analyses of the genome scans of schizophrenia and bipolar disorder revealed no strong findings and failed to agree on places in the genome that might even be of interest.

The three largest genome scans, with over 300 sibling pairs, still show little agreement between the studies. There’s also no consistent support for any candidate named as the “mental illness” gene (Crow, 2007).  The large genome scans that have recently come out (Sanders et al. 2008) have refuted nearly all of the previous papers claiming a genetic linkage, even though 57 of these papers have been cited over 200 times. The Sanders study looked at a huge list of candidate genes in over 1870 patients and 2002 screened controls and was by the far the biggest of its kind.  No evidence of an association at any of the sites was found.

Crow talks about the World Congress of Psychiatric Genetics held in New York in October 2007,

“The discussion was somber. In the morning Francis Collins, Head of the Human Genome Project, had predicted sure future progress with these technical advances. In the afternoon it was seen that just such a strategy had failed to yield decisive findings showing the location of a gene predisposing to psychosis, still less are they in agreement concerning the identity of such a gene.”

Ionnnidis et al. pointed out in Nature Genetics 2009 that lack of reproducibility is an innate characteristic of the majority of microarray-based gene expression profiles. There are several theories about why a “mental illess gene” can’t be found. One is that lots of people might have different genes, despite the fact that psychosis tends to show up the same way at the same age with the same structural brain changes worldwide.  Another theory is that maybe there are tons of different “mental illness genes” that each have a very small effect. However, if the effect is that small, maybe it’s not really the cause, anyway.  The third theory is that we just aren’t doing big enough association studies yet, even though the bigger studies get, the less evidence we find. This “magical thinking” is pushing funding decisions at places like NIMH who aren’t willing to admit that emotional distress causes psychosis. A great question is why are the thought leaders in academic mental health still talking about evidence based medicine but then working from this disproved genetic narrative?

How emotional distress causes psychosis by modifying gene expression

Crow’s article in Psychological Medicine says that if we don’t have a “mental illness gene,” then how does mental illness happen? He points out that DNA can be changed in a grown person. This is done by three different processes, called methylation, acetylation or phosphorylation of the histones.   Histones are bodies that the DNA wraps around so that the 5 feet of DNA in each cell can fit inside. Histones have a big role in gene regulation. In genetics, it turns out that the genes a person has are not nearly so important as figuring out which ones get turned on and off.  It also turns out that one gene get removed, altered or turned on, other genes have other effects, so the $10 billion search for a single “mental illness gene” has been completely futile.

Sporting my Undiagnosing Emotional Distress T-shirt and matching helmet mohawks with my mom at Critical Mass

Sporting my Undiagnosing Emotional Distress T-shirt and matching helmet mohawks with my mom at Critical Mass. My mom, a family practice doctor, was key in helping me learn how emotional distress causes psychosis.

Phillip Seeman is a geneticist who has worked his whole career looking at the genetic basis for schizophrenia. He is a person who might, in a slightly different history, have won the Nobel Prize for finding that all psychosis comes from the same source: supersensitivity of the D2 subtype of the dopamine receptors. After a very long and prolific career in this field, Phillip Seeman’s current publication in Future Medicine shows that emotional distress CAUSES psychosis which CAUSES genetic changes.

He says that people’s nervous systems can be exposed to risk through genes, toxins, chemicals, infective agents, lack of oxygen, trauma, or social isolation.  This causes the dopamine receptor to move to a state where it’s more sensitive to dopamine. This is a general neural mechanism that helps the nerve cells adpat, repair, and regenerate. It helps to protect the brain from further injury. However, people experience this process as overstimulation. The ways that people psychologically adapt to the overstimulation are the signs and symptoms that have been identified with schizophrenia and other psychoses.

Video showing what I feel like when emotional distress causes psychosis


The sequence of events when emotional distress causes psychosis

To explain how emotional distress CAUSES psychosis, we can look at this cascade that is explained in Phillip’s Seeman Future Medicine Paper.  This in an integrated brain and behavior process that provides a much better theory than a single gene weakness to describe how emotional distress causes psychosis, mania, depression, or inability to pay attention.

  1. brain injury (This could be sexual abuse or other trauma, lack of friends, job stress, drug abuse, toxins, lack of sleep, poor nutrition, or any of the other 30 causes shown for psychosis.)
  2. adjustment of the nerve cells (This is where the dopamine receptors convert to a high affinity state which has been shown to be common to ALL forms of psychosis. More dopamine receptors also form in a given part of the brain increasing the density of receptors for a double whammy.)
  3. increased neurotransmission (More affinity and density of the dopamine receptors)
  4. people’s awareness of being overstimulated (Ken Braiterman is writing a blog now about practical solutions for this awareness)
  5. psychological adaptation (Symtoms arise from attempts to deal with the stimulus overload.)
  6. symptom production (Thoughts, self-talk, waking dreams, or vivid recollections are seen as coming from outside oneself and labeled voices or hallucinations. Attempts to withdrawal from social roles, relationships, and expectations are labeled negative symptoms or “avolition”. People who try to shut out the world are told they have a lack of interest, “anhedonia”.)

How Wellness Wordworks provides solutions to emotional distress:

We are using Instant Peer Support to help people in the depths when emotional distress causes psychosis or other problems that are typically seen as mental health issues. We talk to people about their problems and figure out what is going on the with them and reassure them about our own tools for wellness and ways to handle similar problems. Most mental health care uses a first step of describing and labeling emotional distress in order to find medications to blunt the problem. Instead we look at the root causes.
I hope to be a leader of the recovery movement like Mary Blake, Jean Campbell, and Jackie McKinney gathered here at Alternatives 2010.

I hope to be a leader of the recovery movement like Mary Blake, Jean Campbell, and Jackie McKinney gathered here at Alternatives 2010.

Sometimes it’s not genetic. Sometimes it’s trauma, sometimes a poor job fit, sometimes people are putting too much pressure on themselves to be ambitious, sometimes its drug use, sometimes it’s bullying or oppression in society. This is addressing step 1 in the cascade of events above rather than step 6. This is one of the reasons our program is highly evidence based, why we plan to have much higher recovery outcomes, and why our costs are so much lower. Our job is to help people find complete mental health recovery where they no longer need any kind of medical treatment at all for emotional distress.

What do you think? Are you one of the people who don’t see any kind of life situation in you or your loved one’s history where emotional distress causes psychosis? If so, we want to hear from you to show both sides of the story.

28 comments to Emotional distress causes psychosis

  • […] By Advocate Corinna West: The science behind how emotional distress causes psychosis | Wellness Wordworks. […]

  • Good job, Corinna. This weekend, I’ll post the story of how I “cured” your “psychotic episode” a few years ago. It was your normal reaction to abnormal distress, not a disease. Watch this website and mine.

  • This all makes sense to me. Have you read, “A Straight Talking Introduction to the Causes of Mental Health Problems”? The authors, John Read and Pete Sanders hardly mention genetics at all. They see abuse, trauma, drugs and a lot more things as causes – not genetics. Its a small book at just 155 pages – well worth reading.

  • Edward Duff

    The “sequence” matches my own experience precisely. My current response to lots of things, but not quite everything, is… “avolition”. I did go to NAMI of Joplin today and saw some of the tornado damage area. People are still busy picking up lots of debris, making huge piles along the roads outside of town. The stuff inside the city limits has mostly been hauled off. Some businesses must have just walked off, leaving their mess to others, cutting their losses. Maybe the owners perished? Or just couldn’t stand any more? I was happier today before I went over there and saw that. Again.

  • […] (Although this TV reporter does start with some disease language, Paul is one of our fans of using a distress based approach.) […]

  • I am trying to find the words…. just, WOW. This article, this blog, and the work you are doing, has blown me away!

    In 1967, when I was 14 years old ~ after going through a series of extremely nightmarish traumas ~ I had a “breakdown” and was diagnosed with acute schizophrenia. My abusive parents immediately jumped at the chance to get rid of me, by putting me in a state insane asylum. I ran away, was recaptured, and placed on the maximum security ward for the criminally insane ~ even though I had never committed a crime (other than petty childhood shoplifting), nor had I had ever harmed anyone or threatened to harm anyone in any way, myself included.

    During the almost 2 years that I was incarerated on the Maximum Security ward, I witnessed one murder, one suicide, multiple assaults, and was myself assaulted, raped, and nearly murdered, in multiple incidents. By the time that a new, progressive-thinking doctor took over my care and determined that I had been badly misdiagnosed, and then went to bat for me to secure my release, I was far more traumatized than I had been when I was first put in that horrible place, ostensibly “for my own good.”

    More than 40 years have passed since I was released from the mental institution. But, despite being told by numerous doctors over the decades that I am not and probably never was “schizophrenic,” the majority of people in my family of origin still treat me like an embarrassment, and an outcast. Trying to overcome society’s ignorant, hateful, fear-driven stigma against anyone with a “mental illness” label, feels like trying to swim against a riptide. Being shunned and ridiculed for being “crazy,” is in itself deeply traumatizing, depressing, and crazy-making.

    Almost 9 years ago I was diagnosed with Post Traumatic Stress which, in my opinion, finally makes SENSE out of my life. The renowned doctor who diagnosed me, told me that PTSD is a NORMAL reaction to extreme trauma ~ just as it is normal to bleed if you are stabbed.

    Edward Duff ~ although I now live in the southwest, I grew up about 30 miles away from Joplin, Missouri. Most of my worst traumas happened in Missouri, in and near the Springfield area. The large State Hospital #3 in Nevada, Missouri, which was torn down in the 1990s, is where I was incarcerated as a teenager, from 1967-1969. I am so sorry for the devastation that happened to Joplin, it was terrible enough to see on the news, from hundreds of miles away. I can only imagine how traumatic that must have been to actually live through.

    The destruction of the town of Joplin looks very much like the destruction in my life: almost 59 years worth of shattered dreams and broken relationships, as I’ve tried to live with the dual pain of having Complex Post Traumatic Stress, and the deep hurt of being treated like an outcast, because of it. I have lived a very hard life. But, it will all be worth it, if in my lifetime I can see this truth begin to be accepted by society: that Emotional Distress causes Psychosis, and this is a NORMAL REACTION to EXTREME TRAUMA.

    In 2003, when my PTSD was diagnosed, I coined a saying. You are welcome to use it, if it suits your purpose:

    “Turn PTSD into CURE with Compassion, Understanding, Respect, and Encouragement.”

    Elaina Adams

  • […] I didn’t know how much I need exercise and how exercise makes me human until my best friend and board chairman Ken Braiterman pointed it out. He’d been visiting me and I’d missed two days of workouts because we were carpooling. He said, “Wow, you get sick and grumpy really fast when you don’t work out.” Now I know I have to have a least one good workout each day. It’s like the exercise pulls out all the piss and vinegar that fills up my body from the emotional distress I have in my life. […]

  • […] peer based advocates who question the evidence base for medication and labels and ask for peer services and complementary and alternative medicine […]

  • […] the symptoms that emerge later. We’ve explained in a previous blog the research behind how emotional suffering causes psychosis and not the other way around.  So lately we’ve come to the following solution based advocacy decisions on how to best […]

  • […] model and distress model ARE biochemical models and evidence based. The distress model looks at science saying emotional suffering causes brain changes after really tough life events, not the other way around. The disease model says brain changes come out of the blue with no […]

  • […] scientific evidence is showing that extreme emotional states cause brain changes, not the other way around. Vote here to show support for this model of explaining “mental […]

  • […] December issue of Archives of Pediatric Adolescent Medicine.   Here is the link for more info:Adolescents who were abused and maltreated when they are still children often experience reduction o…was funded by US National Institutes of Health and several foundations. The conclusion was reached […]

  • Olesj

    I find this extremely interesting. Personally I have witnessed my mother’s psychosis, and was until recently quite worried about developing it myself. My mother’s psychosis had, after all, a lot to do with religion, and I have recently adapted a rather unconventional belief in God that borrows heavily from quantum mechanics for its scientific background.

    I’ve done an incredible amount of research, and am as a matter of fact currently developing a personal theory that seeks to unify psychology and sociology into a single science, to formulate the ideal state for an individual and his society to thrive in, and to provide an efficient, failproof form of therapy for both the individual and the society.

    I’m not sure if you are aware of the phenomenon of self-directed neuroplasticity. This is when structural changes in the brain occur as a reaction to consciously directing your attention to certain subjects, and rewriting their significance. The arisal of emotional disstress can, therefore, be considered as a form self-directed neuroplasticity.

    Currently I’m wondering whether it is possible that the conversion of dopamine receptors to a high affinity state could also be a form of self-directed neuroplasticity, and not an unconscious adjustment as the author suggests. While thoroughly examining my mother’s situation, and that of several case studies of people who have had a psychosis I found on the Internet, it has come to my attention that a certain kind of thought process may very well be responsible for a gradual change in brain chemistry during what is known as the prodromal phase, which subsequently develops into a full-blown psychosis.

    Is there anybody I could contact to discuss this topic and perhaps exchange some ideas? We might very well be at the brink of elucidating one of the greatest mysteries psychiatry has faced up till now. Thanks for the wonderful article, by the way.

    • I forwarded your comment to a researcher friend of mine and I’ll also send it to Philip Seeman to see what he thinks. It’s a very interesting idea. Also, feel free to contact me via the contact info on our blog.

  • Olesj

    After having read the summary of the Seeman study on Future Medicine, I theorize that possibly the high-affinity state of the dopamine receptor (an unconscious change after all) allows for the ‘psychotic’ thought process to manifest itself through hallucinations. This might explain why not everybody experiencing severe emotional distress gets a psychosis… the ‘psychotic’ thought process as I describe it depends on a lot of factors, and is therefore rather rare.

  • […] citing its notable therapeutic effects in some medical conditions. Here is the link for more info:Studies have confirmed that early use of marijuana can cause psychotic mental disturbances among ado…another group to enable researchers to study association between initial use of the drug and […]


  • […] our personal resources are overwhelmed. We  begin to get a bit separated from reality.  Here is the biochemical mechanism for how this emotional distress is temporary and reversible. It may be super happy or super sad moods, it may be seeing or hearing things that […]

  • […] outlined on my personal blog the scientific and biochemical cascade of events that shows that emotional distress causes psychosis, not the other way around.  Life situations cause chemical changes all the time or else you’re dead. Everyone’s […]

  • Emma

    I’ve read the Seeman & Seeman 2011 article and I can’t see where you found that they claim that psychosis is caused exclusively (or almost exclusively) by psychological trauma, or that’s at least how I understand what you’re arguing in this post.

    As you rightly point out drug abuse and toxins can be implicated. However nowhere in the paper did they claim that psychosis is caused by lack of friends*, job stress, lack of sleep, or poor nutrition. Nor do they claim that that we have established beyond any doubt further 30 causes of psychosis.

    With regard to the latter they say on p. 234 “[t]here are over 30 animal models of genetic and nongenetic risk factors for psychosis, all showing an elevation in the number of synaptic dopamine D2 receptors that exist in the high affinity state for dopamine and that influence synapse sensitivity.” That is, the number 30 refers to risk factors elicited from animal studies not causes.

    With regard to the former, they list a genetic, physical/biological as well as pychosocial factors – I fail to see where in the article they argue that it is almost exclusively emotional distress that causes psychosis. Seeman & Seeman claim the following:

    p. 234: “The chain of events starts with a nonspecific injury. This can be a gene mutation leading to hypofunction or hyperfunction of a protein. It can be the result of chemicals, toxins, drugs, infectious agents, hypoxia or direct trauma.”

    p. 237: “Supersensitive synapses are associated with supersensitive behavior and neuropsychiatric disease. (This is a sweeping observation that holds true.) For example, the selective removal or knockout of the metabotropic glutamate-2 or -3 receptor genes leads to animal behavior that is supersensitive to dopamine-like stimulant drugs, accompanied by a marked elevation in the number of D2 receptors in the high-affinity state for dopamine [37]. In addition, other nondopamine genes, when mutated, lead to behavioral dopamine supersensitivity and elevated D2High receptors, including GABA-B1 receptors, trace amine-1 receptors, RGS9 receptor regulator protein, G-protein receptor kinase 6, a-1b-adrenoceptors, and postsynaptic density 95 [38,39]. Not surprisingly, dopamine-related genes, when mutated, also lead to behavioral dopamine supersensitivity and elevated D2High receptors, including the dopamine transporter, tyrosine hydroxylase, and catechol-O-methyltransferase. Mutations of genes that do not cause behavioral dopamine supersensitivity do not lead to elevated D2High receptors [38,39]. In addition to gene alterations, long-term exposure of rats to cocaine, amphetamine, methamphetamine, marijuana-like drugs (HU210 and WIN 55,212–2), or quinpirole all induce behavioral dopamine supersensitivity and elevated D2High receptors. While these psychotogenic drugs are known risk factors for inducing psychosis, other risk factors for psychosis also induce dopamine supersensitive behavior in animals and elevate D2High receptors. These factors include hippocampal or entorhinal lesions, social isolation from birth onwards, cholinergic lesions of the cerebral cortex, Cesarean birth with anoxia, and high doses of caffeine.”

    And lastly a summary on p. 238: “Figure 1. Animal models of schizophrenia. All known risk factors associated with the development of psychosis or schizophrenia lead to behavioral dopamine supersensitivity and to a marked increase in the number of dopamine D2High receptors in animal models, although the total number of D2 receptors may remain normal. These risk factors include hippocampus injury or lesion, social isolation since birth, prolonged doses of amphetamine, cocaine, corticosterone, ethanol, phencyclidine, amphetamine, caffeine, cannabinoids or reserpine, and mutations in the genes for the receptors listed in this figure.”

    * I don’t think one can equate not having many friends with social isolation from birth.

    PS Sorry for the double posting!

    • Hi Emma,

      Thanks for the very detailed analysis. I’ll take it point by point. First, I don’t think I said, “psychological trauma” is the only cause. When I saw emotional distress, this could be anything that people find distressing, their own expectations, trauma, nutrition, lack of exercise, social isolation, poor nutrition, or spiritual unrest. So any of these things can cause psychosis. The point is that these things happen before the psychosis, not the psychosis first.

      The article that showed that 30 different paths lead to psychosis was by the same authors, published in PNAS, and referenced in that paper. Here’s the link. It’s got 185 already, so it’s an important part of the literature. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC548961/

      The point of this blog post is that many times psychosis is a biographical situation, not a biological situation. In other words, we can change what is going on in our lifestyles and we may never experience pschosis again. In the words of Duane Shery, psychosis is an event, not a person.

      Do you disagree with this premise? Is there any more of this research article I can help clarify for you?


  • Emma

    Sorry but I don’t seem to be able to work these HTML tags. So here are the references:

    The two meta-analyses:

    1) Matheson et al. (2012): http://journals.cambridge.org/download.php?file=%2F5937_93A1D8E6C34380A0E44073982F0E90EC_journals__PSM_S0033291712000785a.pdf&cover=Y&code=f208285fb15d97268eb4aa14d4bda045

    2)Varese et al. (2012): http://schizophreniabulletin.oxfordjournals.org/content/38/4/661.full

    Individual studies:

    3) Alemany et al. (2012): http://www.sciencedirect.com/science/article/pii/S0924933812000260#
    4) Rössler et al. (2011): http://www.sciencedirect.com/science/article/pii/S016517811100165X
    5) Lataster et al. (2011): http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2011.01805.x/full
    6) van Os et al. (2010): http://www.nature.com/nature/journal/v468/n7321/full/nature09563.html
    7) Galletly et al. (2011): http://www.sciencedirect.com/science/article/pii/S0920996410016841

    PS Please do delete the first of these messages (and sorry for making as mess of you discussion board).

  • Emma

    Hi Corinna,

    Thanks very much for a prompt reply! And thanks for correcting my misunderstanding re what you meant with emotional distress – I get it now!

    Well, to answer your question first, I certainly do not, or rather would never, disagree with the premise that psychosis is strongly associated with non-biological factors. (Given the available evidence at this moment in time however, I don’t think one can call this relationship causal since the presence of emotional distress does not necessarily result in psychosis.) I must admit that the antediluvian attitudes that still persist in certain quarters are simply infuriating. But more importantly such attitudes are extremely worrying they directly lead only to (forced) medical treatment whether appropriate or not. It’s as if no correlational studies looking into psychosocial factors have ever been done! I mean all one needs to do is look at some of the most recent studies from 2011 & 2012 to realise that such talk is utter drivel. See, for instance, the following individual studies and a couple of recent meta-analyses.

    I’ve also read through the article you linked to, Seeman et al. 2005, but I’d like to emphasise that these were animal studies & further that the authors discuss how D2High is found to be elevated in conditions showing dopamine supersensitivity (hippocampal lesions; treatment with antipsychotics, ethanol, amphetamine, phencyclidine; gene knockouts of Dbh, Drd4 receptors, Gprk6, Comt, or Th / , DbhTh; Caesarean-section). The authors do not claim, as far as I understand, that emotional distress is correlated with D2High states.

    Thanks again.

  • Well, the authors do claim that D2 High is shown in pychosis. That there are 30 paths that lead to psychosis. So again, psychosis is one of the things that people find distressing, that we call emotional distress. So maybe another definition of emotional distress is “Things that would land us in mental health care unless we knew better than to talk to those people.”

    So, yes, treatment with antipsychotics, street drugs, various gene knockouts, social isolation, and social oppression also have been shown to cause psychosis. I haven’t chased down connections with all other mental health labels, but I suspect if you asked people how they entered the mental health system, very few would say, “I dunno, it just hit me out of clear blue sky.” And those who do say this, often if you poke deeper you’ll find some funky background family dynamics or quite often a sense of perfectionism and a lack of ability to measure up to one’s own standards. An existential crisis is not an illness.

    We are talking about this same stuff right now on the Alternatives Facebook discussion group – You should join us there.

  • Emma

    Can you please send me the link to your Alternatives discussion group? Thanks.

  • Galeane

    Hi I’m homeless due to not submitting to contaminating dental offices! 25 years losing my job! 15 times across the USA and back to CA. Handeling relocation and paying off leases I Love dentistry its killing me! I have suffered so much abuse childhood and homeless, no water or elecc. Hook ups living inn from.V without basic needs met pushed around by police and those who do not want me parked there! Far away from family in CA 2800.00 gas to relocate home!Louisiana