imagine imagine you live in a utopia
what does it look like
maybe it’s filled with futuristic cities
maybe it’s a rural world in which people
live in harmony with the natural
environment I wonder if my utopia is the
same as your utopia or the person
sitting next to you I wonder if there’s
mental illness in your utopia about
about 10 years ago I was driving around
the m25 and my car helpfully decided to
dump its coolant to all over the road I
called the breakdown service and a very
nice guy called Graham came out looked
at my car and confirmed that it did
indeed it did in the deed need to be
towed it’s a couple of hours drive from
London to Oxford so he had quite a long
time to chat on the journey as as you do
he asked me what it is that I do for a
living and I explained that I’m a
scientist I’m interested in the
biological basis of mental health and
mental illness he then told me the most
extraordinary story about his childhood
extraordinary because he was raised by
his mum who was later diagnosed with
bipolar disorder he told me very vividly
what it was like to see her symptoms
through a child’s eyes and there was one
thing that he said in particular that
has really struck struck me and stuck
with me he said that one day she taken
to her bed she was very depressed and
she couldn’t get up he’d gone in to see
if he could coax her out of bed but he
said as soon as he walked in the door he
knew that that wasn’t going to happen in
his words I looked at the bed and I saw
this woman in the bed that looked like
my mum but I could see it wasn’t my mum
really in subsequent years I’ve had the
privilege to talk to lots and lots of
people about their experiences with
mental health and mental illness I doubt
there’s a single person here who hasn’t
been touched by this in some way and
what I’ve learned is that everybody’s
experience is different some people see
their illness as entirely separate from
themselves you may have heard how
Churchill used to refer to his
depression as a black dog but for other
people it’s more complicated they find
their symptoms into oven with who they
are as individuals some people have told
me they see their ill self is like a
shadow self of themselves whilst for
other people their symptoms are a core
part of who
their personality and who they are as
individuals it’s this complexity that
drove me to work in this field I think
it’s absolutely fascinating that we can
start to understand these things from a
biological point of view and
fundamentally I think that understanding
the biology of mental health and mental
illness tells us a lot about who we are
as humans before we can consider whether
there would be mental illness in a
utopia I’d like to spend a few minutes
telling you about what we know about the
causes of mental illness
the first thing probably the most
important thing is that there is no
single cause of mental illness instead
and the symptoms that we see in people
appear to arise from lots of things that
individually slightly increase
somebody’s risk of becoming ill we call
these risk factors another thing that we
know is that genes are really important
we know that genes form a major
component of all of the major mental
illnesses the extent to which genes are
important varies between different
diagnoses for example they seem to be
less important in depression than they
are in schizophrenia and bipolar
disorder but nonetheless genes are
important in all of these conditions in
the last year’s it’s really exciting
time for me to be working in the field
because we’ve started to move from the
sort of generic understanding that genes
are important to understanding the
specifics in the last few years people
have started to identify the precise
parts of the human genome that is our
entire genetic makeup that predispose us
to develop mental illness as a biologist
this is hugely exciting but it’s also a
massive challenge because what genes
absolutely don’t do is to encode mental
illness genes don’t encode
hallucinations psychosis low mood mania
or edit any of the other complex
symptoms that we see in people instead
what genes do is to encode molecules
these molecules form to build cells
these cells form networks in the brain
and it’s this network activity that
gives rise to the complex psychological
processes that are altered in patients
with mental illness so for me the
challenge that is to understand these
links how do we get from a single part
of the human genome up to the complex
symptoms that people experience
it’s a massive challenge but I think it
has huge potential not only in
understanding these illnesses better but
also in terms of developing treatments
to give you an example from my own
research
I’m currently interested in a family of
genes that encode calcium channels what
these genes do is they sit on the
surface of electrically active cells
like heart cells and brain cells and
they allow calcium into the cell when
the cell is electrically active
the thing is though these genes are
really complicated they don’t each gene
doesn’t just encode one calcium channel
but instead encodes tens or maybe even
hundreds of different slightly different
calcium channels so what my research is
trying to do is to understand which of
these calcium channels are most
important for mental illness because I
think this will give us some insight
into the biology in addition I’m also
trying to identify those that are
present in the brain versus other
electrically active tissues like the
heart I think this could be really
important for developing new treatments
because obviously if we want to treat
the symptoms of psychiatric illnesses
mental illnesses we probably want to
target the calcium channels that are
present in the brain and not those that
are present in the heart because doing
so is likely to cause side effects
well they genes are really important
they’re far from being the entire story
we know that the environment plays a
huge role in predisposition to mental
illness stress and trauma for example
are big risk factors for developing
depression and birth complications and
the use of cannabis during adolescence
have small but measurable effects on
risk for things like schizophrenia it’s
tempting always to kind of argue about
where the genes environment are more
importance and this does happen a lot
both in my field and more widely but I
think to do so misses the point because
what these things do genes and
environment is to alter the function of
the brain and it’s the brain and the
psychological processes that it gives
rise to that are core to mental illness
so simplistically you could think that
maybe what your genes do is to build
your brain to be a certain way that
makes you more or less resilient so the
things that you encounter as you go
about your business in the world but I
think this is an
simplification your brain is it just a
blob of jelly hanging about in your
heads waiting to see what happens when
you blunder around the world the brain
is highly dynamic and it’s extremely
plastic it changes in response to
absolutely everything we do so waking up
this morning having a cup of coffee that
you had before you came in here learning
something new all of these things have
measurable effects on your brain so the
environment changes our brain we also
know that the environment changes the
way in which our genes operate but
perhaps counter-intuitively I think that
our genes also influence the environment
in which we find ourselves I know this
is a slightly kind of odd concept so
I’ll walk you through an example we know
that genes influence how light you
people people are to be risk seeking or
risk averse we also know that people who
are more risk seeking are more likely to
use illicit drugs or cannabis so this is
an example whereby if your genes make
you more risk seeking you you might be
more likely to use cannabis which is one
of the environmental risk factors so
taking all of this together the causes
of mental illness are extremely complex
both genes and the environment are
important but I think that what we
should really be thinking about is in
terms of what these things do to the
brain and the psychological process is
that the brain gives rise to notably all
the treatments we have for mental
illness at the moment target the brain
either directly by influencing direct
brain function in the case of drugs or
indirectly in the case of psychological
therapies by acting on the psychological
processes that the brain gives rise to
so what does all this mean for our
utopia what even is a utopia I strongly
suspect that when I asked you to think
about that everybody was thinking about
something slightly different however for
the purposes of argument we need to have
a definition of a utopia because I’m
standing here on this stage we’re going
to go with my utopia and if you want to
live in my utopia you have to live by my
rules rule 1 no changing genes
I’ve seen enough sci-fi movies to know
that this never ends well but there’s
two very good reasons in the case of
mental illness why we absolutely
wouldn’t want to do this the first is
pragmatic
the genetics of mental illness are
incredibly complicated it’s not the case
that it’s just one or two genes that are
altering our risk for mental illness
rather it’s tens hundreds or perhaps
even thousands so I can’t see that we
would ever be able to get to a place
where we can look at somebody’s genetics
and predict with any level of certainty
whether or not they are going to become
ill the second reason is more
philosophical but I think it’s actually
more important and that is this the
genes that alter our risk for mental
illness are the ones that influence
brain function as such I think it’s
highly likely that these are also the
same genes that influence who we are as
individuals our unique personalities in
my utopia I don’t want it filled with
everybody who’s the same with a perfect
brain who thinks in a certain way I want
to capture all of the unique human
diversity in the world
so no changing genes the environment
however that definitely needs to change
my utopia is an egalitarian society
where people are treated with equally
and with equal respect for one another
as a result levels of trauma and stress
plummet and with them risk for things
like depression particularly so we would
definitely see a decrease in levels of
mental illness within the population
other environmental risk factors might
be more difficult to change however if
you think about birth complications for
example obviously in my utopia mental
health medical care will be exemplary
but I think we’re going to struggle to
completely eliminate birth complications
for the simple reason that we’ve evolved
to be a species that has a very large
brain and a very big head and ultimately
a small body and just so the logistics
of birth are inherently risky for us so
some things in the environment we can
change some things we may or may not be
able to change in the middle though I
think there’s quite an interesting gray
area I strongly suspect that when you
take out big risk factors for mental
illness like stress and trauma that
you’ll start to see other environmental
risk factors emerge that we can’t detect
at the moment ultimately I think
anything that’s not great for our brain
is probably going to be an environmental
risk factor for mental
on this so why not get rid of all of
these things well we could do that but
three of my favorite things are surfing
skiing and glass of red wine none of
these things sorry to break it to you
are likely to be terribly good for my
brain but I can’t imagine a utopia in
which I wasn’t allowed to do these
things taking all of this together I
think that there would definitely be a
decrease a dramatic decrease in the
amount of mental illness and utopia but
I think there will still be some level
of mental illness present I also think
the types of mental illness that we see
will change quite markedly so I think
factors that are more affected by
environment like depression for example
and anxiety will be more more reduced in
this utopia than the kind of diagnosis
like bipolar disorder and depression
which are more genetic in origin so I
just want to leave you with one final
thought and that is this I believes
firmly that the risk factors for mental
illness overlap substantially with the
risk factors with the factors that make
us our individual unique people and
therefore I think on some level mental
illness is the price that we pay for our
unique and diverse humanity thank you
[Applause]
what does it look like
maybe it’s filled with futuristic cities
maybe it’s a rural world in which people
live in harmony with the natural
environment I wonder if my utopia is the
same as your utopia or the person
sitting next to you I wonder if there’s
mental illness in your utopia about
about 10 years ago I was driving around
the m25 and my car helpfully decided to
dump its coolant to all over the road I
called the breakdown service and a very
nice guy called Graham came out looked
at my car and confirmed that it did
indeed it did in the deed need to be
towed it’s a couple of hours drive from
London to Oxford so he had quite a long
time to chat on the journey as as you do
he asked me what it is that I do for a
living and I explained that I’m a
scientist I’m interested in the
biological basis of mental health and
mental illness he then told me the most
extraordinary story about his childhood
extraordinary because he was raised by
his mum who was later diagnosed with
bipolar disorder he told me very vividly
what it was like to see her symptoms
through a child’s eyes and there was one
thing that he said in particular that
has really struck struck me and stuck
with me he said that one day she taken
to her bed she was very depressed and
she couldn’t get up he’d gone in to see
if he could coax her out of bed but he
said as soon as he walked in the door he
knew that that wasn’t going to happen in
his words I looked at the bed and I saw
this woman in the bed that looked like
my mum but I could see it wasn’t my mum
really in subsequent years I’ve had the
privilege to talk to lots and lots of
people about their experiences with
mental health and mental illness I doubt
there’s a single person here who hasn’t
been touched by this in some way and
what I’ve learned is that everybody’s
experience is different some people see
their illness as entirely separate from
themselves you may have heard how
Churchill used to refer to his
depression as a black dog but for other
people it’s more complicated they find
their symptoms into oven with who they
are as individuals some people have told
me they see their ill self is like a
shadow self of themselves whilst for
other people their symptoms are a core
part of who
their personality and who they are as
individuals it’s this complexity that
drove me to work in this field I think
it’s absolutely fascinating that we can
start to understand these things from a
biological point of view and
fundamentally I think that understanding
the biology of mental health and mental
illness tells us a lot about who we are
as humans before we can consider whether
there would be mental illness in a
utopia I’d like to spend a few minutes
telling you about what we know about the
causes of mental illness
the first thing probably the most
important thing is that there is no
single cause of mental illness instead
and the symptoms that we see in people
appear to arise from lots of things that
individually slightly increase
somebody’s risk of becoming ill we call
these risk factors another thing that we
know is that genes are really important
we know that genes form a major
component of all of the major mental
illnesses the extent to which genes are
important varies between different
diagnoses for example they seem to be
less important in depression than they
are in schizophrenia and bipolar
disorder but nonetheless genes are
important in all of these conditions in
the last year’s it’s really exciting
time for me to be working in the field
because we’ve started to move from the
sort of generic understanding that genes
are important to understanding the
specifics in the last few years people
have started to identify the precise
parts of the human genome that is our
entire genetic makeup that predispose us
to develop mental illness as a biologist
this is hugely exciting but it’s also a
massive challenge because what genes
absolutely don’t do is to encode mental
illness genes don’t encode
hallucinations psychosis low mood mania
or edit any of the other complex
symptoms that we see in people instead
what genes do is to encode molecules
these molecules form to build cells
these cells form networks in the brain
and it’s this network activity that
gives rise to the complex psychological
processes that are altered in patients
with mental illness so for me the
challenge that is to understand these
links how do we get from a single part
of the human genome up to the complex
symptoms that people experience
it’s a massive challenge but I think it
has huge potential not only in
understanding these illnesses better but
also in terms of developing treatments
to give you an example from my own
research
I’m currently interested in a family of
genes that encode calcium channels what
these genes do is they sit on the
surface of electrically active cells
like heart cells and brain cells and
they allow calcium into the cell when
the cell is electrically active
the thing is though these genes are
really complicated they don’t each gene
doesn’t just encode one calcium channel
but instead encodes tens or maybe even
hundreds of different slightly different
calcium channels so what my research is
trying to do is to understand which of
these calcium channels are most
important for mental illness because I
think this will give us some insight
into the biology in addition I’m also
trying to identify those that are
present in the brain versus other
electrically active tissues like the
heart I think this could be really
important for developing new treatments
because obviously if we want to treat
the symptoms of psychiatric illnesses
mental illnesses we probably want to
target the calcium channels that are
present in the brain and not those that
are present in the heart because doing
so is likely to cause side effects
well they genes are really important
they’re far from being the entire story
we know that the environment plays a
huge role in predisposition to mental
illness stress and trauma for example
are big risk factors for developing
depression and birth complications and
the use of cannabis during adolescence
have small but measurable effects on
risk for things like schizophrenia it’s
tempting always to kind of argue about
where the genes environment are more
importance and this does happen a lot
both in my field and more widely but I
think to do so misses the point because
what these things do genes and
environment is to alter the function of
the brain and it’s the brain and the
psychological processes that it gives
rise to that are core to mental illness
so simplistically you could think that
maybe what your genes do is to build
your brain to be a certain way that
makes you more or less resilient so the
things that you encounter as you go
about your business in the world but I
think this is an
simplification your brain is it just a
blob of jelly hanging about in your
heads waiting to see what happens when
you blunder around the world the brain
is highly dynamic and it’s extremely
plastic it changes in response to
absolutely everything we do so waking up
this morning having a cup of coffee that
you had before you came in here learning
something new all of these things have
measurable effects on your brain so the
environment changes our brain we also
know that the environment changes the
way in which our genes operate but
perhaps counter-intuitively I think that
our genes also influence the environment
in which we find ourselves I know this
is a slightly kind of odd concept so
I’ll walk you through an example we know
that genes influence how light you
people people are to be risk seeking or
risk averse we also know that people who
are more risk seeking are more likely to
use illicit drugs or cannabis so this is
an example whereby if your genes make
you more risk seeking you you might be
more likely to use cannabis which is one
of the environmental risk factors so
taking all of this together the causes
of mental illness are extremely complex
both genes and the environment are
important but I think that what we
should really be thinking about is in
terms of what these things do to the
brain and the psychological process is
that the brain gives rise to notably all
the treatments we have for mental
illness at the moment target the brain
either directly by influencing direct
brain function in the case of drugs or
indirectly in the case of psychological
therapies by acting on the psychological
processes that the brain gives rise to
so what does all this mean for our
utopia what even is a utopia I strongly
suspect that when I asked you to think
about that everybody was thinking about
something slightly different however for
the purposes of argument we need to have
a definition of a utopia because I’m
standing here on this stage we’re going
to go with my utopia and if you want to
live in my utopia you have to live by my
rules rule 1 no changing genes
I’ve seen enough sci-fi movies to know
that this never ends well but there’s
two very good reasons in the case of
mental illness why we absolutely
wouldn’t want to do this the first is
pragmatic
the genetics of mental illness are
incredibly complicated it’s not the case
that it’s just one or two genes that are
altering our risk for mental illness
rather it’s tens hundreds or perhaps
even thousands so I can’t see that we
would ever be able to get to a place
where we can look at somebody’s genetics
and predict with any level of certainty
whether or not they are going to become
ill the second reason is more
philosophical but I think it’s actually
more important and that is this the
genes that alter our risk for mental
illness are the ones that influence
brain function as such I think it’s
highly likely that these are also the
same genes that influence who we are as
individuals our unique personalities in
my utopia I don’t want it filled with
everybody who’s the same with a perfect
brain who thinks in a certain way I want
to capture all of the unique human
diversity in the world
so no changing genes the environment
however that definitely needs to change
my utopia is an egalitarian society
where people are treated with equally
and with equal respect for one another
as a result levels of trauma and stress
plummet and with them risk for things
like depression particularly so we would
definitely see a decrease in levels of
mental illness within the population
other environmental risk factors might
be more difficult to change however if
you think about birth complications for
example obviously in my utopia mental
health medical care will be exemplary
but I think we’re going to struggle to
completely eliminate birth complications
for the simple reason that we’ve evolved
to be a species that has a very large
brain and a very big head and ultimately
a small body and just so the logistics
of birth are inherently risky for us so
some things in the environment we can
change some things we may or may not be
able to change in the middle though I
think there’s quite an interesting gray
area I strongly suspect that when you
take out big risk factors for mental
illness like stress and trauma that
you’ll start to see other environmental
risk factors emerge that we can’t detect
at the moment ultimately I think
anything that’s not great for our brain
is probably going to be an environmental
risk factor for mental
on this so why not get rid of all of
these things well we could do that but
three of my favorite things are surfing
skiing and glass of red wine none of
these things sorry to break it to you
are likely to be terribly good for my
brain but I can’t imagine a utopia in
which I wasn’t allowed to do these
things taking all of this together I
think that there would definitely be a
decrease a dramatic decrease in the
amount of mental illness and utopia but
I think there will still be some level
of mental illness present I also think
the types of mental illness that we see
will change quite markedly so I think
factors that are more affected by
environment like depression for example
and anxiety will be more more reduced in
this utopia than the kind of diagnosis
like bipolar disorder and depression
which are more genetic in origin so I
just want to leave you with one final
thought and that is this I believes
firmly that the risk factors for mental
illness overlap substantially with the
risk factors with the factors that make
us our individual unique people and
therefore I think on some level mental
illness is the price that we pay for our
unique and diverse humanity thank you
[Applause]
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