보호 요인은 '항아리'에 용량을 추가하여 정신 건강 회복력을 높여 질병 에피소드의 발생 가능성을 줄일 수 있습니다.

### 항아리 비유: 정신 건강의 이해와 보호
* 💡 항아리 비유는 모든 사람이 시간이 지남에 따라 유전적, 환경적 요인으로 채워질 수 있는 **'항아리'**를 가지고 있으며, 가득 차면 **정신 질환을 일으킬 수 있다**는 것을 시각화하는 데 도움이 됩니다.
* 항아리의 유전적 취약성은 일정하게 유지되지만 **환경적 요인은 시간이 지남에 따라 누적**될 수 있습니다.
* 📊 양극성 장애와 같은 정신 질환은 **유전적 요인과 환경적 요인의 상대적인 기여도**가 다르기 때문에 발병하는 경우가 많습니다.
* 🎯 "기본적으로 모든 사람에게 **양극성 장애가 발생할 가능성**이 있습니다."
* 🏞 보호 인자는 병 위에 고리 역할을 하여 **병이 가득 차지 않고 환경 요인을 수용할 수 있는 용량**을 늘립니다.
* 💊 스트레스를 줄이거나 독성 환경을 없애는 등 **일부 환경적 요인을 제거**하면 도움이 될 수 있습니다.
* 🛡 양질의 수면, 사회적 지원, 영양, 운동, 스트레스 관리 등 다양한 보호 요소를 통해 **회복력을 강화**하고 정신 건강을 보호할 수 있습니다.

this visual analogy I'm going to share with you right now is what we've developed as a way of helping people to make it more tangible for people, I suppose. So, the visual analogy concept that we developed is that everybody has a mental illness jar, right? So, in the context of today's conversation, we can think about this as being a bipolar jar, if you want. Okay, so every single person has one of these jars, right? Everybody, doesn't matter whether you have bipolar or not, we've all got a jar. And that, um, for each of us, there are different kinds of factors that we can use to fill our jar. So, in this picture on the right, you can see that we're representing genetic vulnerability factors that we were just talking about with little orange balls. And on the left, we're representing that environmental or experience stuff that we were talking about with these little blue, like, pyramids, I guess they are. Yeah, let's call them pyramids. And so, this beautiful image was developed by my brother who is a

wonderfully talented art kind of person. Anyway, so the idea is that you can add both of these types of factors into your jar over time, right? That's what this set of images is showing. So, if we look first at the jar all the way to the far right, you can see that it's full all the way to the top. In our analogy, when your jar is filled all the way to the top, that's when we experience an active episode of some kind of mental health problem, like bipolar, right? So, this full jar could be representing an episode of mania or hypomania, or it could be representing an episode of depression. Okay, so if your jar is full, you're experiencing an active episode of illness of some kind. So, there's a couple of things I want to make sure I point out to you here. One is that, as you can see, the amount of orange balls in the jar stays the same over time, and that reflects what we know from

reality, which is the amount of genetic stuff we have when we're born, is what we're stuck with. We can't change it, right? It's just what it is. But we will all have some. That's a really important point. We'll talk about that in a minute, maybe, but we all have some. So, it's not just people who have bipolar who have some of this genetic vulnerability, but what changes over time is the amount of that blue pyramid business in the jar, right? So, that can accumulate over time as we experience things in our lives, you know, like those, for example, stressful life events that we were just talking about. That would be an awesome example of something that can add um blue pyramids into your jar. And so, at a certain point, if you get to the point where your jar fills up, that's when somebody will experience a first active episode of illness. Got it? Cool so far? Yeah, all right. So, I'm gonna move on to the next bit, which is just what it kind of gets at what we

were just talking about which is that you can have so it doesn't matter how your jar fills up your if your jar fills up then that's when you experience an active episode of a psychiatric thing like bipolar right so if we look at the two jars on the very far right you can see that the top one has relatively large amount as the orange balls in it the genetic stuff and a smaller amount of the blue pyramids the environmental stuff whereas the one on the bottom is exactly flipped a little bit of genetic stuff large amount of environmental stuff and this reflects exactly what we know happens in reality is that people develop bipolar disorder as a result of different relative contributions of genetic stuff and environmental or experiential stuff right the couple of things I want to point out really explicitly here is that see that set of top three jars where we start out with just the balls and then the middle picture is where there's just a few of the pyramids in there you can get to that point and go no

further right so it doesn't. Even if you've got a lot of those orange balls in your jar, doesn't mean you're doomed. Doesn't mean that your jar has to fill up, and you will definitely develop bipolar. It doesn't mean that at all, right? It might mean is that maybe you have a higher chance than the person at the bottom right. So, maybe you have a higher chance for your jar to fill up. Maybe you would have, maybe it would be symptoms emerging at a younger age, right? It's less time for the jar to fill up, that kind of thing, right? But for basically everybody has a chance to develop something like bipolar disorder. It's not just people who have, who have already experienced the diagnosis. Hang on a second, this is what I'm trying to represent with this picture here. Look, so it's showing that in the population, you know how like if we were to get everybody listening to this podcast today, um, to line up according to how tall we are, there would be some people who would

be like really tall. I'm gonna, I'm gonna call really tall is over six foot three because I'm not really tall. I'm less than five foot three, right? I, I. So you'd end up with like a small number of people like this little group down here, right, who would be really tall, and you'd end up with a small group of people down here who would be really short. I would be in this group, right, but most people are somewhere between five foot three and six foot three, right? That's what this is representing. This is most people, but and that same concept holds true for how much genetic vulnerability we all have to mental illness. There's going to be some people who have a lot in their jar to begin with. There's gonna be some people who have very little in their jar to begin with, but most of us are going to be somewhere in this intermediate moderate range, and it just depends what happens to us during our lifetime that determines whether or not our jar fills up and we experience an active episode.

of illness. So people will often say to me, You know, well, how do I have bipolar because I know that people will say, I know it's genetic, but there's nobody else in my family who has bipolar, so how can that be? And that's really essentially the answer. First of all, it's not entirely genetic. Second, but we all have some genetic vulnerability. And so all it means if you don't have a family history is that everybody else in your family was lucky enough that their job didn't fill all the way up to the top with an experiential or environmental things. It doesn't really, yeah, yeah. So that's the idea. We also weren't very good at diagnosing bipolar disorder back then either. We're not that good now. It's all got some ways to go, straight, yeah, yeah, yeah. So I think one of the things I like the most about this model, I think it is really important to people to understand, like, how did I get this because oftentimes, like, when somebody's developed been

diagnosed with something like bipolar. What I've learned over time is that people will often and and just full disclosure like I live with a mood disorder myself. So I have depression, I have anxiety, and I also have nightmare Disorder. So the the research work that I do is very, very personal to me. I guess the reasons that it's so important to me to try and provide these kinds of answers for people is because they're the kinds of answers I would have wanted to have. Like right. And so you know I think when people have been diagnosed with something like depression, anxiety, bipolar, schizophrenia, whatever, one of our First Reactions is to tend to feel like like we must be defective or different or morally wrong or something. Or like you know like we did something wrong that meant that we deserve punishment. Or like we could have done we could have taken better care of ourselves to prevent it, prevent this in some way, you know self-blame, self-stick, yeah, all of that stuff, all of that stuff. And so I think that you know it is

really important to understand like how these things happen because by having a really good evidence-based research-based you know explanation for why. We've found that actually we can reduce people's feelings of guilt and that sort of thing which is super cool. But it gets even better you know because we can use this model to help people understand. Not only how did they get sick in the first place but how we can better protect our mental health for the future. And so that's what I like the most about this model. So can I show you that stuff? Yeah I regret to see that stuff okay. All right so this is the bit that I love the most. So in the context of this jar analogy that we're talking about. There are things that we refer to as being protective factors. And so what they do in the context of this model is they stack on top of the jar making it taller. So that the jar can accommodate more experienced stuff or environmental stuff without getting full. So you can't change the amount of genetic

vulnerability in your jar. We talked about that, right? And that's what this picture is showing. Again, you can't change the amount of orange balls. We're going to talk about what you can do to change some of those Loop pyramids, the environment stuff in a minute, but I think what I like even more than this is the protective factors which make the jar taller so you can fit more things in it, basically because remember the jar has to be full in order for you to be actively experiencing an episode of illness, right? So yeah. So first of all, like even if you've experienced the first episode of something, you've experienced a period of mania, you've experienced a period of depression, that means your jar was full, right? For lots of people, including me, right? I'm not depressed today. I'm not currently depressed, which is awesome, frankly. So that means that my jar, although it has looked like the one on the far left, it's not looking like that right now, okay? So how does it get from this

this state to a state where it's not full all the way to the top. There's a couple of ways that we can make that happen. One is by removing some of these Enviro these blue pyramids from the jar, and that can be more or less difficult depending on what the blue things are we're talking about, right? So, you know, so for example, in some, for some conditions that are psychiatric, there's really good evidence, for example, that if you experience a chat, excuse me, a head injury in childhood, that can increase your risk of some kinds of psychiatric conditions in later lap Flex schizophrenia, for example, right? We cannot go back in time and change the fact that that happened, right, right? Yeah, the blue thing that's in the jar, right? I was in the example, the possibility running through my head was childhood abuse or neglect, that's right. That isn't something that we have any control over, but and really, yeah, yeah. So, some of those things are not things that we can go back and change the fact that they

happen to us. We cannot right there. Maybe there are things, of course, that we can do in terms of like um easing the effect that they have on us in a date. Like if we're lucky enough to have a therapist and that sort of thing that we can work through some of that trauma with, and that can be a super helpful thing. Um, but but yeah, I mean, so there are some things that are just blue triangles that are in your jar. That's it, right, right. But sometimes there might be some blue triangles that we can think about trying to remove. Examples would be stuff like if you're in a current situation which is highly stressful, there may be some circumstances for some lucky people where you can remove yourself from that environment. Please know I am not diminishing the significance of what I'm talking about. I am not. But it, you know, it for some people in some circumstances, that can be possible. Can you give us a concrete example? Yeah, sure. Like let's say we're in a work

situation where we're just feeling like really devalued, really overstretched, really, you know, dehumanized by what you're doing. If you're fortunate enough, you might be able to look for and find an alternative place of employment where you don't feel like a human cog, you know, where you feel like, where you feel like, you know, a valued, valued member of society who's part of, you know, contributing something valuable. So, that would be an example. Another example would be, you know, we, you talked about trauma and abuse, and, you know, sometimes, you know, we find ourselves in abusive relationships as adults. So, removing yourself from a situation like that is profoundly difficult, profoundly difficult, but yet, if, if one is able to, then that obviously can be a way in which, you know, you know, it's, it's a way to a clear, clear skies for, for many, many things, essentially. So, those would be some examples. However, as we've been discussing, removing some of the, some, some of those blue things aren't going anywhere because you can't

do anything about them, and some of the things are really difficult to remove so and that all feels really kind of depressing, frankly. Um, so what, so so great, so then what kind of thing? Well, that's the good bit, that's why I love the protective factors so much because what that's about is instead of trying to remove the things that are making the jar full, we're adding tall, you know, tallness, we're acting capacity to the job, you know what I mean, we're making space in the jar in a different way, yeah, it's a strengthening and resiliency kind of model, right, yeah, exactly. So, you know, we use example examples of protective factors would be things that we've got really good evidence for like, you know, good quality regular sleep, yeah, social support is important, regular good quality nutrition if you can, right, extra exercise that, yeah, and then, you know, and then for people like me who've been diagnosed with a psychiatric condition and who are lucky enough to find a medication that works for them, then

medication can be a really profoundly important ring on top of that jar. That's how I'm lucky enough to experience my medication so so. Through all of these different and obviously finding more effective ways to manage the stress that we experience can be a really good protective Factor too. Um, so there's a whole bunch of things that we can do to add these rings on top of our jar to make it taller so it can come it can accommodate more of this environmental stuff without getting full. And I think that is really like it's really empowering it makes me feel knowing that makes me feel like there are things I can do and I'm not just a victim of whatever is going on in my in my brain, you know, with my depression. I don't I know I want people to know this, right? I am not saying nobody is saying it's incorrect to say that anybody has the power to prevent an episode of mental illness. No, that's not it. This is literally just about reducing the chance, essentially, right?

there's nothing foolproof here. Um, you know, so this is no cast-iron guarantee, but these are just things that we can employ that are sort of low risk, if you like, that we know work, and that combined, in my experience, can make a really, you know, positive difference to how we manage these things.

How Genetics & Your Life Experiences Cause Bipolar Disorder | Dr. Jehannine Austin 🫙

Welcome to the talkBD Bipolar Disorder Podcast - where we gather researchers, people with lived experience, healthcare providers, and top bipolar disorder experts from around the world to break down and answer the most important questions about living with bipolar disorder. 


CREST Bipolar Disorder Network

누구나 시간이 지남에 따라 유전적, 환경적 요인으로 채워질 수 있는 '정신 질환 항아리'를 가지고 있습니다.

항아리가 가득 차면 양극성 장애와 같은 정신 건강 문제의 활성 에피소드를 경험하는 것을 의미합니다.

유전적 취약성의 양은 동일하게 유지되지만 환경적 요인이 누적되어 질병이 발병할 수 있습니다.

양극성 장애의 발병은 유전적 요인과 환경적 요인의 상대적인 기여도에 의해 영향을 받습니다.

유전적 요소와 환경적 요소가 포함된 항아리 그림은 일부 사람들은 더 높은 소인을 가지고 있지만, 대부분의 사람들은 중간 정도의 취약성 범위에 속한다는 것을 보여줍니다.

환경적 요인이 취약성의 '항아리'를 채우는 데 중요한 역할을 하기 때문에 양극성 장애를 경험할 위험은 유전적 요인에 의해서만 결정되는 것은 아닙니다.

유전적 취약성이 정신 건강에 미치는 영향 이해하기

유전적 취약성은 정신 건강 상태에 중요한 역할을 하지만, 반드시 같은 가족력이 있는 것은 아닙니다.

이 모델은 개인이 어떻게 병에 걸렸는지 설명하는 데 도움이 될 뿐만 아니라 향후 정신 건강을 보호하는 데 필요한 통찰력도 제공합니다.

유전적 취약성 위에 보호 요인이 겹쳐지면 병이 넘치지 않고 더 많은 것을 담을 수 있어 환경적 요인의 영향을 완화할 수 있는 방법을 제시합니다.

스트레스를 유발하는 환경 요인을 제거하는 등 보호 요인은 정신 건강 에피소드를 경험할 위험을 줄이는 데 도움이 될 수 있습니다.

어린 시절의 트라우마와 같은 일부 블루 피라미드 요인은 바꿀 수 없지만 치료를 통해 그 영향을 완화할 수 있습니다.

유독성 작업장과 같이 스트레스가 심한 환경에서 벗어나는 것도 청색 피라미드의 부담을 줄이는 방법이 될 수 있습니다.

회복탄력성 구축 및 권한 부여 찾기

양질의 수면, 사회적 지지, 약물 치료와 같은 보호 요인은 정신 질환에 직면했을 때 회복력을 강화할 수 있습니다.

이러한 요소는 '항아리 위에 있는 고리' 역할을 하여 환경적 스트레스를 처리할 수 있는 능력을 높여줍니다.

개인이 자신의 정신 건강을 관리하고 질병을 경험할 가능성을 줄이기 위해 능동적인 조치를 취할 수 있도록 힘을 실어줍니다.