Interview with Anna: Psychiatric Genetic Counseling
Sarah: How did you become interested in psychiatric genetic counseling?
Anna: I have a BA and an MA in psychology, and was always fascinated by psychopathology. After I completed my MA in Vancouver, British Columbia and started looking into genetic counseling, I came across Dr. Jehannine Austin’s research group. In her research, she uses a clinical genetics approach to understanding mental illness. I found that her research allowed me to incorporate my interest in psychology with my interest in genetics.
S: How were you able to obtain a psychiatric genetics rotation last summer?
A: Dr. Austin had launched the psychiatric genetic counseling clinic a few months before I moved to New York to complete my genetic counseling degree, so unfortunately I didn’t get the chance to observe any sessions. They had taken 2 summer students just as I was leaving, and I was told to keep my eyes open for the following summer. When I found out about the position, I jumped at the chance to work with the team again and to learn more about the clinic.
S: What was one of the biggest differences you noticed when counseling in a psychiatric genetics clinic?
A: For one, they don’t offer genetic testing. Second, the session is extremely psychosocial driven, which makes it longer. I also saw the amount of guilt and shame people experienced when discussing their mental illness, or the mental illness of a loved one. There is so much stigma people face so it’s not something many people talk about. Maybe some think that if no genetic test is offered than what point is having a clinic like this? But I got to see some dramatic changes in peoples’ beliefs about what causes mental illness and how they can protect themselves. I also got to witness a ton of weight lifted off people’s shoulders as they came to terms with the fact that they did not cause their child’s mental illness. That is huge!
S: What are some the mostly “highly genetic” psychiatric conditions?
A: That’s a difficult question to answer. I think with mental illness in particular it’s very multifactorial. However, I don’t think people realize that we all have the capacity to develop a mental illness. This is because we all have some genetic predisposition that we are born with- some more than others- and it’s the different experiences we go through that can determine whether one person goes on to develop a mental illness or not. Someone with a strong family history of mental illness may have a greater vulnerability than someone with less of a family history. But genetics is not destiny and there are things we can do to protect ourselves from getting sick. We do have control and I think that’s an important message for people.
If we see someone with developmental delay and psychosis genetic testing is offered for 22q11 deletion syndrome (DiGeorge), because 22q11 is the greatest risk factor for developing schizophrenia.
S: What other types of health care providers are vital for a Psychiatric Genetics Clinic?
A: Many of the patients we saw were referred by their psychiatrist or psychologist. But the nature of the clinic accepts self-referrals as well, so any health care provider could refer their patients. But it’s really important to have other medical professionals on board because there is a genetics component to mental illness and this clinic really helps people understand that involvement.
S: What did you enjoy most about a multidisciplinary clinic environment?
A: I think working in a multidisciplinary environment is great because you can learn so much from your colleagues. It also allows me to appreciate what patients go through when they see all these specialists; I can be more compassionate because it can be frustrating having to coordinate and attend a bunch of appointments.
S: What is it like to counsel someone with a psychiatric condition? Are there some unique strategies you use/saw utilized in clinic?
A: Honestly, it didn’t feel any different than counseling someone without one. The biggest thing for me though was trying to break down their misconceptions about mental illness and all the internalized guilt and shame. I also very much appreciated that people were willing to discuss their mental health with me- a complete stranger. It’s such a sensitive topic but when you give someone a safe atmosphere to open up, it’s amazing how liberating it is for him or her, and for yourself.
I found it really beneficial for patients when we used diagrams. The flipbook we used illustrates “mental illness jars,” which help explain everyone’s genetic predisposition. ((S: This “mental illness jar” illustration can be found in Dr. Austin’s book, which is noted below… at the top of page 91!)) It helped people visualize what having a genetic vulnerability means and how environment contributes to one’s risk. Also, we allowed the patients to explain their story to us. Why did they think they got sick? What do they think caused their mental illness? And what are some things they do to protect themselves from having a relapse or getting sick in the first place? The sessions were very patient driven, which was nice.
S: What are some “take away points” people should keep in mind if they want to go into counseling patients who have a personal or family history of a psychiatric condition. Or some pros and cons regarding the field, in your opinion?
A: I think it’s really important for counselors to know that it isn’t difficult to counsel people with mental illness. And it is very important not to brush over or skip the psychological assessment on patient intakes. We can’t be afraid to go there with our patients. Our brain is an organ like any other organ in our body. And when our brain doesn’t work as it should, we take medication or go for therapy. That shouldn’t be any different than taking insulin for diabetes or heart medication etc.
I think a big pro of discussing mental health with patients is creating that dialogue about mental illness and creating a greater awareness. Hopefully that will reduce the stigma, shame and guilt people experience. Unfortunately, I think that it has been somewhat of an uphill battle because the genetics of mental illness is so complex. There is no quick fix, easy answer or blood test we can offer, and that can be hard for some people.
I think that it is important for health care professionals to understand that we all have our patients’ best interests in mind and that takes a multidisciplinary approach. And sometimes it’s not about what test we can administer or what drug we can prescribe. Sometimes all it takes is just someone to listen, and as genetic counselors, I think that’s one of the things we do best.
Those who are interested in learning more about counseling people with mental illness can read Dr. Austin’s book: How To Talk With Families About Genetics And Psychiatric Illness.
((Huge thanks to Anna for the interview, very enlightening! Hope you all enjoyed this post and her answers as much as I did! –Sarah))