Precision Medicine, Mental Disorders and Toxic Stress

By Andrea Blanch, Ph.D. and David Shern, Ph.D.

As Thomas Insel, Director of the National Institute of Mental Health wrote in a recent blog, precision medicine is a hot new topic in the research world. The basic idea is simple: Get the “right treatment at the right time to the right person” by addressing the underlying cause of the disorder, not the symptoms. In practice, accomplishing this goal may be a bit more complicated. 

Dr. Insel points out that in many areas of health – including mental health – multiple genes each contribute a small amount of vulnerability to the overall risk profile, along with life experiences, neurodevelopment, and social and cultural factors. In other words:

Different people with the same diagnosis may have developed their symptoms through very different pathways.

The developmental pathways for serious mental illnesses are quite varied. Some may reflect genetic abnormalities directly resulting changes to the brain.  Others may reflect environmental problems such as toxic stress and trauma.  All are likely to involve the interaction of experience and personal vulnerabilities. Our recent review of the literature supports this conclusion.

The implications for treatment are profound.

In mental health, “getting the right treatment to the right person” will require more than a diagnosis and more than knowing about specific genetic vulnerabilities. It will also require understanding the types of potentially harmful events and circumstances the individual has experienced, the stage of development when exposure occurred, protective factors that were in place at the time, and the cultural lens through which experiences are interpreted. An individual’s reaction to a specific therapy is likely to be seriously mediated by his/her experience. 

We believe that the behavioral health field is ready to respond to this challenge. Evidence-based trauma-specific treatments for people with mental health and substance abuse disorders are beginning to spread. Growing awareness of the impact of trauma and toxic stress and of “trauma-informed approaches” has helped providers recognize and respond to adverse experiences affecting the lives of people they serve. Patient-centered approaches and peer support models individualize treatment and respect the individual’s experience and perspective. Precision medicine could build on these promising directions by providing a framework for integrating multiple sources of information about the individual. 

In many ways, precision medicine echoes one of the mantras of trauma-informed approaches: “Don’t just ask what’s wrong, ask what happened.”

	Andy Blanch, PhD, has been an advocate for the development of trauma-informed public policies and programs for the past 30 years.
	Dr. David Shern is the Senior Science Advisor at Mental Health America having served as its President/CEO from 2006-2014. He also has a faculty appointment in the Department of Mental Health at the Hopkins Bloomberg School of Public Health and previously was a Dean and Professor at the University of South Florida.