By Emalee Gruss Gillis, NAMI Spokane Blog Editor.

When participants attend NAMI Spokane’s Family-to-Family eight-week course to gain insight into how to help their loved ones manage a mental health condition, one of the questions covered is “Are you born with a mental health condition?” The answer is multi-dimensional. Mental health conditions are biological, but it may take something to happen later in life that causes symptoms to develop.

Just like cancer and diabetes, mental health conditions are complex. Even though identical twins share the same genes and many of the same life events, only one may develop cancer, diabetes or a mental health condition.

Looking back at brain development in the fetus can help shed light on this question. The gray matter of the brain is made up of neurons which are cells in the brain that send and receive messages, glial cells that support and protect neurons, and capillaries that provide blood supply. At about 12 weeks gestation, neurons begin multiplying at the rate of about 50,000 per second.

A baby is born with more neurons than he or she will need. The cells then begin a process of elimination and rewiring. Neurologists refer to this process as pruning, just like when we prune a bush or tree to help it grow.

The environment is believed to play a major role in determining what connections are strengthened as the brain matures. In the twin example, the trauma of a messy divorce, homelessness, and abuse may have different levels of impact on each twin even though their genes are identical.

The brain continues to prune and rewire well into our 20s when the frontal lobes mature. Whether a mental health condition is present or not, the front lobes of the teenage brain are not fully developed until we are 25 to 26 years old.

Research suggests that although scientists aren’t certain if we can produce new cells after the brain is complete, it is believed that we can rewire our connections, at least some of them, throughout our lifetime.

For relatives of people with mental health conditions, most want to know, “What are the chances that I or someone else in my family will also develop this condition?” Studies show a higher risk for first-degree relatives like children and identical twins. In addition to trying to find specific genes that may cause a mental health condition, science is also exploring how a gene’s composition and function may change over time.

For mental health conditions, research is showing that something is transmitted genetically, but it’s not enough to guarantee that a mental health condition will develop. Something else needs to occur for mental health distress to begin. Biological scientists call it a “second hit” and believe it comes from a virus, an injury in the womb or during birth, exposure to toxins, or problems with the immune system. Even though this “second hit” may occur before birth or in infancy, the distress and behaviors resulting from any abnormalities don’t begin to show until the child enters the developmental stage of adulthood.

Social scientists look at how social and cultural environments impact the development of mental health conditions. They look at the neighborhood a person lives in, their health habits, the traumatic events they have experienced, and every other social aspect of the person’s life.

The Vulnerability Stress Model is one theory that shows how biological and social environments might work together. A person may have inherited a gene that makes them vulnerable to developing a mental health condition. Then when they experience an additional social or environmental stressor, that increases the likelihood of developing a mental health condition.

Environmental factors affect not only the development of the first symptoms of a mental health condition, but also how those symptoms continue and change over the person’s life.

Regardless of the specific causes, it’s important for family members of someone of a mental health condition to take action and move forward to find needed support and be a health partner in a loved one’s recovery.

NAMI Family-to-Family Educational Course is a free 8-week educational course for family, significant others and friends of people living with mental health conditions. It’s designed to help you support an adult with a mental health condition while maintaining your own wellbeing, too. It meets for 2 ½ hours each week, and each class builds on the knowledge of previous classes.

NAMI Family-to-Family is taught by NAMI-trained family members who have been there, and includes presentations, discussions and interactive exercises. It is a designated evidenced-based program, which means that research shows that Family-to-Family significantly improves the coping and problem-solving abilities of the people closest to a person with a mental health condition. Email NAMI Spokane to get class notifications of programs at


This article is based on materials from the NAMI Family-to-Family 8-week Course.

Emalee Gillis is a writer and blog editor. She is the author of the memoir Adventures on the Path to Living Well with a Mental Illness and has a related TEDx Talk.