Early intervention is the key in psychology and psychiatry.

The epidemiological studies or surveys conducted over the past three decades show that more than three quarters of all mental disorders emerge before the age of 25.

So if we were to diagnose people before the age of 25, we will prevent 70, 80% of later life or late onset mental health disorders.

The P-factor concept applies not only to adults, it applies mostly I think to children. It’s much more visible and discernible, clear and crystallized in early childhood and early adolescence and young adulthood.

The thing is that early onset of mental illness, for example, borderline personality disorder, conduct disorder, ADHD, autism, early onset predicts much more severe, much harder to treat conditions. ADHD becomes schizophrenia in some cases.

So it’s crucial to screen for mental illness starting at age five, latest eight, borderline emerges fully developed at age 12. Early intervention would be a powerful way to prevent patients from spiraling into mental health crisis.

And so if the P-factor is a common seed of adult psychopathology, could we prevent it somehow? Is there a way to reverse the P-factor or I don’t know, uproot it or transform it or transmute it somehow? Can we use drugs? That’s a common enemy. Can we develop a single weapon like a vaccine or something? And how do we deal with the multiplicity of symptoms?

All these symptoms according to the P-factor approach share an internal single vulnerability. And yet not a single drug can deal with all these symptoms. Not a single intervention is known to work with all these symptoms.

So how do we penetrate through the veil of the symptoms? How do we go deeper and deeper and deeper into the earth to use Jules Verne’s phrase? How do we go into the earth so that we locate the pernicious and nefarious and malevolent P-factor, surround it and kill it in its cradle?

Myrna Weissman is a psychiatric epidemiologist from Columbia University. And she says the P-factor is a very interesting topic.

Others disagree. Some psychiatrists say the P-factor is show business. It’s not science.

There are, and I’m quoting, there are some common pathways that link disorders to each other. But that’s like saying that there are a lot of physical disorders that involve inflammation and are related to each other through a common mechanism.

It’s true, but only as a tiny piece of the story.

This, by the way, is a very wrong objection. It’s true that if you look at multiple biological disorders, multiple medical conditions, you can see a common thread or a common symptom. For example, inflammation. Inflammation appears in several hundred medical conditions, but inflammation is not the cause of these conditions, some manifestation of these conditions. And these conditions are not linked to a single organ.

Mental health is linked to a single organ, the brain. That’s our current thinking at least.

I believe that the body has multiple brains. And I believe that one of the main brains is actually in the intestines in the gut, but leave it aside.

Right now, the orthodoxy, the mainstream thinking is that all mental illness is a reflection of processes in the brain. Something has gone awry in the brain.

So inflammation is a bad example. The inflammation can happen in any organ of the body, in any part of the body, while mental illness happens only in the brain.

So if there is a P-factor, it will be a brain factor, not a systemic factor, not something that happens in your feet, for example, or in your eyes or in your brain.

And so studying the activity of the brain seems to be intimately linked with the idea of the P-factor.

What about neural pathways? What about dopaminergic pathways, neurotransmitter pathways? What about neural circuits?

The truth is that if you look at the literature in neuroscience, there is something that stands out almost immediately. All mental health disorders share the same neuroscience.

When you go down to the level of multiple unit activity, neural circuiting, neural pathways etc, you discover that most mental health disorders share the same neurology, activate the same areas of the brain.

There was a meta-analysis in 2018 and it found that communication between brain circuits involved in vision, in thought, in motivation are similarly hyperactive across many common psychiatric disorders.

And that’s one of several hundred studies that I found. All of them say the same thing.

Regardless of the type of mental health disorder, the same brain circuitry activates and interacts. Now this is strongly powerfully indicative of a common factor. It seems to lend incredible support to the idea of the P-factor, how we perceive the world, for example, via vision, sensor, sensory input, and how it is translated by the brain. These are core components of mental disorders.

So Caspi and others say that a common P-factor may lead to more effortful or less efficient processing when internally generated thought and externally generated sensory information compete for attention. The same text appears in the 2018 study.

The same brain circuits are targeted, for example, by psychedelics.

And so this explains, I think, the promising results in trials with psychedelics. Psychedelics now are beginning to be commonly used in depression, anxiety, PTSD, alcoholism, same with hypnosis, hypnotic state, trance. Same brain circuitry is targeted regardless of the problem.

When you treat someone for a smoking problem or for PTSD or for aversion or whatever with hypnosis, you are targeting the same brain circuits. Although the presenting signs and symptoms, the problem, the issue, the issues are different.

And it’s very reminiscent of the human genome. In the human genome, there is an enormous overlap between the genetic risk factors for psychiatric disorders. Actually, the same gene arrays, the same groups of genes are implicated in almost all mental health disorders.

As early as 2009, there was a study by the Swedish National Registry and it showed that bipolar disorder and schizophrenia have the same genetic risk factors.

And so the very old distinctions first suggested by Crepling, the very old distinction between psychotic and mood disorders is in great doubt now because they share the same genes, these disorders, depressive disorders, mood disorders, and psychotic disorders. They have the same genes, the same genetic foundation, and the same brain circuits are activated.

What is the difference between them? Just the symptoms, the way we observe them, the way we see them from the outside.

But we have already learned via Caspi and others that symptoms shapeshift across life, across the lifespan, symptoms flow, merge, transform into each other in an eternal dance.

In 2015, the same people who published a study in 2009, they were working at the Kowaliska Institute in Sweden, a very prestigious academic institute. So in 2015, the same researchers extended the sample. You remember that in 2009, they studied schizophrenia versus bipolar, and they reached a conclusion that genetically it’s the same disorder.

So in 2015, they decided to study another six disorders, so a total of eight. And they found out once again that it was a common genetic factor for all eight mental health disorder groups, they all emanated from the same mutations and disruptions in the same gene arrays.

This provides further support for the P-factor, shared genetic risk, shared brain circuitry, probably shared psychogenesis, shared factor, underlying mental health.

Only between 10 and 36% of the predisposition to mental disorders comes from genetic risk factors. No one says the genes determine your mental health or mental illness.

I’m the greatest opponent of trying to reduce mental illness to genes or to the brain, to neuroscience. I think it’s nonsense.

But still, there is a contribution of genes, of genetics. There is a contribution of brain circuitry. And these contributions are quantifiable, and they’re not small, and they are shared.

The variation between mental health disorders is associated with genetics, for example, schizophrenia and bipolar, non-genetic environmental factors, especially mood disorders and anxiety disorders, and brain circuitry.

Today, we have added a fourth factor, chance fluctuations in the womb. So, accidents in the womb.

If you put these four factors together, you get 100% explanation of the origin and development of mental health disorders.

And what is amazing is the commonality, how a very small number of genes, a very small number of brain circuits, and a very small number of fluctuations in the womb, and a very small number of environmental factors, for example, abuse, can account for the majority, if not all, mental illnesses.

The P-factor might represent something very fundamental.

But the question is, what?

We are talking about the psychopathology factor, but what is it? Can we capture it somehow? Can we weight it to something? Can we use a useful metaphor? What is it?

Maybe it’s only distress or impairment of some kind.

Mental illnesses, after all, are stressful, they’re debilitating. Maybe the P-factor is only a statistical marker of human suffering, a hard life.

Caspi doesn’t believe that.

Caspi says that the P-factor is something distinct from distress or impairment or deficiency or even environment. He thinks that harsh, unpredictable environments in childhood are common to all psychiatric diseases.

He says, if you look at every disorder, the core of each disorder is some sort of aberrant way of viewing or seeing the world. It’s the paranoid ideation.

So, Caspi says that when we are subjected to abuse in early childhood, we tend to develop a paranoid view of the world, persecutory delusions or paranoid ideation. We tend to see the world as hostile, how to get us.

The boy who thinks that everyone is against him, later diagnosed with contact disorder and when he grows up, he becomes a psychopath. The skinny girl who looks in the mirror and thinks she’s fat and develops eating disorder. The teenager who thinks he’s guilty for his parents’ divorce or drinking or depression, etc.

So, these are all paranoid ideations.

And Caspi says, one of the most interesting origins for much of this aberrant thought comes out of harsh and inconsistent and unpredictable early environments.

Those kinds of experiences that set up the anticipation of bad things happening, catastrophizing, or they set up the anticipation of being rejected, they set up the anticipation of being violated, they set up anticipation of constantly being threatened and things going wrong, things being unalterable and thereby spiraling out of control.

So, I think a lot of it is about those early experiences and what those early experiences do to you.

They distort our expectations about the future, and that’s why they are so consequential.

Caspi, through the P-factor, harks back, goes back to the very, very, very beginning of psychology, which is essentially psychoanalysis.

Modern psychology in the body and mind of Freud was built on this understanding that adverse childhood experiences, ACE, they are the reason for the emergence of psychopathology and mental illness in children, adolescents, and adults.

Coming back full circle, we’re coming back home through the most hyper-modern studies, Caspi’s to 2020. Caspi and others are biologically inclined or oriented and yet they are forced to reach a conclusion that early childhood experiences, especially adverse ones, determine who we are.

And this is, of course, supported by the biggest study ever conducted in psychology, the Adverse Childhood Experiences Study, the ACE study.

Linking the P-factor to harsh environments is not a way to blame parents, it’s just a way to elucidate the importance of early childhood in two ways.

Early childhood is critical when it comes to mental health. Early childhood determines whether you’ll be a mentally healthy individual or a mentally ill one.

And the second thing is early intervention in childhood could prevent mental illness and that’s regardless of the quality of parenting.

Now, of course, harsh childhood environments are usually brought on by dead parents. I mean dead in the emotional sense, in the mental sense, dead parents or dead mother like using or borrowing Andrei Green’s term from 1978.

So if the parent is absent, depressed, selfish, the parent instrumentalizes the child, parentifies the child, physically abuses the child, sexually abuses the child, etc. This is a bad parent, this is bad parenting, not good enough parenting.

Of course, that’s a precondition for a harsh environment.

But a harsh environment could be a pandemic, a harsh environment could be war, a harsh environment could be the demise or death of loved ones such as granny and grandpa, a harsh environment could be peer mediated, you could be in a bad school with bad peers, or a teacher who hates you, goes after you.

These are all harsh environments. So parents are only one factor.

By the way, in adolescence, parents are much less important than peers. So that’s not the refrigerater mother theory of autism or the schizophrenogenic mother theory of the 1950s. It’s not about blaming parents. It’s just about throwing light on the criticality of early childhood.

Many difficult experiences happen outside the home, as I mentioned.

But, for example, being bullied is a risk factor in developing late life or late onset psychotic disorders. But the environment in childhood is critical and the parents can have a huge contribution by establishing a safe zone at home, a secure base.

The problem is not only parenting, the problem is society, a social system that fails children, fails children by not providing them, for example, with appropriate mental treatment. If you’re a child today, if you’re an adolescent, it’s excruciatingly difficult to secure psychotherapy or treatment. That’s a failure of society. And society pays an enormous price.

Mental illness is destructive. It is a huge economic cost. And it would cost only a fraction.

If we were to invest these resources in childhood, the damage would be only a fraction of what it is later in life.

Unemployment, poverty, emotional neglect, domestic abuse, they are all common factors and denominators underlying the diversity of mental disorders. But pandemics and wars, I mean, all these, it’s all true.

But parents can create a secure, safe base at home. And society can provide early mental health intervention, psychotherapy, and medication, if needed, early on.

This confluence of a safe home and a society that cares, compassionately provides resources to prevent mental illness, it can prevent most of mental illness.

We don’t know what the P factor is. It’s a little like dark matter or dark energy in cosmology. It’s a force. It is seen only through the effects on other things like symptoms and mental illnesses or mental diagnosis. It’s there somehow. We know it’s there, but we don’t know what it is.

Symptoms, genetics, brain activity, they all somehow correlated with the P factor. It’s a little like gravity. It pulls these elements together somehow.

It is also probably a statistical artifact. There is an aspect of P factor that has to do with statistics.

But if we were to eliminate statistical examination, we would eliminate all of modern psychology and psychiatry. You can say modern psychology and psychiatry are pseudoscience, and the statistics is a fig leaf, just disguising the pseudo element in these pseudosciences.

And I agree with that. Actually, I’ve made several videos making exactly this claim.

But there’s still a world out there. Ignore psychology, ignore psychiatry. There are mentally ill people. No one can deny this.

So just observing them and classifying them is not enough. We need to understand what makes them tick. And then we need to stop the clock of mental illness.

The P factor raises the possibility, the tantalizing possibility that targeted interventions in childhood, measures to ameliorate, mitigate and reverse, budding, nipping mental illness in the bud, prevention of abuse, treatment of mental disorders of parents, not only of children, cognitive behavioral therapies in schools.

Why not? This could reduce the incidence and prevalence of all mental health disorders and enable or re-enable or empower the disabled.

Is there a more noble agenda? If there is, I’m not aware of it.