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Controversial P Factor Unifying Mental Illness

Uploaded 11/5/2022, approx. 33 minute read

Another day, another haircut. Do you like this one? No, please, don't tell me.

Okay, Shoshanim, as you can see, I'm in an excellent mood and I apologize for this. I know you're not used to it. Gradually, it's traumatic, but you will get used to it.

So today we are going to discuss the biggest controversy in the world of psychology.

It is very telling that no one on YouTube has heard of it. It shows you the disconnect between academe, the ivory towers, universities, higher education, and the world of YouTube, where self-styled experts are the only experts.

So today we are going to discuss the mysterious P factor.

Get your minds out of the gutter. That's P, like the letter P. Peter, right, the P factor.

My name is Sam Vaknin and I'm the author of Malignant Self-Love: Narcissism Revisited. I am also, unfortunately for many of my students, I'm also a professor of psychology.

On we go to the controversies and arguments and fights and fistfights and artillery barrages when it comes to the P factor and mental illness.

This is first in a series of videos I'm going to do about the P factor.

But before we go to this new, relatively new construct, I want to make a few comments.

When I went to Vienna last, I gave a speech, kind of, a part of a training, to several psychologists and psychiatrists. And I was astounded that the vast majority of them had confused bipolar disorder with borderline personality disorder. Only one got it right.

To my utter shock, they were also not amenable to any attempt to correct their misconceptions.

They insisted to the end that bipolar disorder, which is essentially a mood disorder, is the same as borderline personality disorder, which is a personality disorder, as the name implies.

I thought to myself, oh, my God, how ignorant these people are. These are people in charge of tricking thousands of patients in mental institutions and so on and so forth. I mean poor patients.

So I went back home and started to read on things. And then I was reminded of an article, I think it was published in 2011 or 2012, which had actually suggested there is a common denominator to all mental disorders, all mental illnesses.

Mental illness itself had been reduced to a single factor, the P factor.

So should we continue diagnosing people? Should we continue to adhere to lists of symptoms or lists of behaviors, such as the ones included in the various editions of the Diagnostic and Statistical Manual or the International Classification of Diseases? Is this the right approach, categorical or even dimensional? Or is all of mental illness reducible to a single factor known as the psychopathology or P factor?

Should we focus on symptoms or should we focus on labels? Is labeling people helpful or should we merely try to ameliorate, mitigate the symptoms? Are we on the right path when we administer generalized treatments or should we tailor each and every treatment to each and every individual, specifically customize it?

All these questions also tie or are linked intimately to a field of psychology known as psychiatric epidemiology.

When we try to understand trends in mental illness, for example, is depression increasing in the wake of COVID-19? Are anxiety disorders more rampant and among which demographics, which cohorts, which age groups or populations in the wake of the pandemic?

When we try to answer these questions, we are firmly in the territory of psychiatric epidemiology.

But then how can we answer these questions if we don't use labels anymore, if we don't use diagnosis anymore?

Are we to be reduced to listing symptoms and then just discussing the prevalence and incidence of these symptoms in the population and then in which population?

Is depression not real? Ask anyone who has experienced depression, they will tell you it's very real, this black dog.

Is anxiety unreal? Or are they merely symptoms of something more profound, something deeper, something abysmal? Are we coping with a hidden occult monster with multiple faces, a multifaceted chimera?

Is there something in there, dark, penumbral and underlying lurking in the depths of the human soul? The shadow, the dark part, is it there and just emanates in different forms throughout life?

This is indeed the conception underlying the P factor.

Comobility is a classificatory problem. Comobility, the diagnosis of several mental health disorders in the same individual. Comobility is the outcome of an outdated and wrong classification system, say the protagonist of the P factor.

Not so, say the antagonist. Diagnosis are real. Labels are real. The P factor is a statistical artifact and the battle rages.

This is World War III in terms of the state science of psychology and psychiatry.

I'll read to you a few quotes.

For millennia, we have put all these conditions in separate corners. That's neuroscientist Anke Hammerschlag at Vrije University at Amsterdam. She says, but maybe that's not how it works biologically.

Another scientist in a paper published in 2013 wrote, mortality has not decreased for any mental illness. Prevalence rates are similarly unchanged.

He is wrong by the way. They went up.

There are no clinical tests for diagnosis. Detection of disorders is delayed well beyond generally accepted onset of pathology and there are no well-developed preventive interventions.

Yes, this is a very good description of the state of the art of psychiatry and psychology.

There is no reduction in endpoints. In other words, there's no curing. There's no healing. There are no clinical tests, not rigorous ones. Most of them rely on self-reporting and other such nonsense.

The detection of disorders is very late, too late very often, and there's no well-developed prophylaxis, preventive measures.

It's a sorry and sad state and the P concept is a new hope.

The P concept is a recent idea.

Universally, it's accepted that the father of the peak concept is Benjamin Lahey, a psychologist from the University of Chicago. Together with his colleagues, he published a paper in the year 2012, that's precisely 10 years ago.

What he did and his colleagues, they studied the symptoms and prognoses of 11 mental disorders.

It was one of the biggest studies ever conducted. More than 30,000 people participated.

To their complete bafflement and surprise, they found out that the distribution of diagnosis was captured largely by two groupings of dimensions familiar to child psychiatry since the 1960s.

Internalizing and externalizing. Internalizing and externalizing are powerful concepts. We divide personality disorders this way.

At any rate, the internalizing and externalizing dimension is a very powerful form of taxonomy. It's a very powerful classification. It makes sense suddenly of mental illness. It sheds light on dynamics, etiology, development, outcomes.

And because it is such a wonderful organizing principle, the authors of the p-factor decided to use it. It emerged. It emerged from the study, actually.

They discovered that all 11 mental disorders, which were unrelated, could be easily understood and grouped into internalizing and externalizing disorders.

Just to explain the terms, internalizing means inward looking. Internalizing disorders are usually based around fear or distress.

Externalizing means outward looking and is usually explosive. So substance abuse would be externalizing. Conduct disorder, later psychopathy, would be externalizing. ADHD, actually, would be externalizing.

The disorders cataloged or categorized as internalizing or externalizing are not clear cut. They overlap. The border is blurred. The boundary is fuzzy. And this is one of the main arguments against the p-factor.

But we'll come to it a bit later.

Let's first hear what Lahey and his co-authors had to say in the original paper exactly ten years ago when I was much younger and a lot more handsome.

They said, in our culture, we may expect people who experience one fear to experience other fears and for people who worry to be unhappy, etc.

It seems less likely that people in our culture expect antisocial individuals who abuse drugs to also worry, be fearful, and be sad and guilt-ridden.

In other words, the assumption going into this gigantic study was that some people are fearful and distressed and worrying and so on, and some people are happy-go-lucky, antisocial, grandiose and so on.

But the data that had emerged integrally from the study showed this to not be the case, shockingly for everyone involved.

The statistical model that best explained the data that had emerged from the study implied some higher-order vulnerability factor.

Both these categories, the internalizing and the externalizing, seem to be founded on a common factor.

It seems like we were faced with a grand unifying theory of mental illness. There is a single psychopathology that then somehow, in a manner which we are not sure of, somehow breaks, this single psychopathology breaks into externalizing and internalizing disorders. No one knows why, no one knows how.

With this factor, the psychopathology factor was removed from the models. The correlations between the groups became weaker, and this suggests very strongly that this common factor was responsible for the frequent co-occurrence of externalizing and internalizing disorders.

In other words, this P-factor, psychopathology factor, seems to be the reason for comorbidities. Comorbidities just reflect the fact that all mental health disorders have a common genesis, a common foundation, a single etiology.

A bit later, in 2014, Avshalom Caspi, who is a former Israeli and a psychologist and epidemiologist from Duke University in North Carolina, published a study. It was 2014.

He and his colleagues went further. They demonstrated that so-called thought disorders, disorders like schizophrenia, mania and bipolar, obsessive compulsive disorder, and so on and so forth, these are called thought disorders. They demonstrated that thought disorders were also correlated with externalizing and internalizing disorders through a common liability.

Liability is another name for the psychopathology factor. Liability implies that there is some deficiency, some defect, some deformity, some problem, some issue, some disorder. That's why it's called liability.

It seemed that even thought disorders, which are universally believed to be biochemical, biological, even thought disorders were somehow connected intimately with externalizing and internalizing purely mental disorders. They were connected or correlated via a common factor, a common liability.

Now the P-factor has expanded, suggesting that it is relevant not only to some mental health disorders, but to all mental health disorders.

This changed the picture completely. This created a storm within psychology and psychiatry circles.

Mathematical models which underlie the P-factor proposition were then scrutinized to the core and to the bone.

And it's time for a Minnie break. Yes, she's back. Now you understand why I'm in a good mood.

The problem with the P-factor is that it is the outcome of statistical manipulation.

Many claim, as we will hear a bit later, many claim that the psychopathology factor, this common denominator of all mental illnesses, is merely a statistical artifact.

The problem is that mathematical models sift through huge data sets, huge databases, and what mathematical models are supposed to do is to find patterns and connections, synoptic views that the human mind wouldn't even consider.

But this raises a very powerful objection.

Mathematical models are not objective. They are not impartial. They are not the eye of God.

They have inbuilt biases of their own, and they can lead to something known as apophenia or pareidolia, finding patterns where they are actually none.

In the case of the P-factor, critics accuse Caspi and his colleagues of using models that are predisposed to overgeneralize. Models that exaggerate the overlaps between disorders.

Of course, if you use such models, you will find overlaps. If overlaps are built into the model, if generalization is built into the model, that's what you're going to find.

In 2017, the psychologist and statistician Riet van Bork from the University of Amsterdam wrote the following.

We already knew before Caspi and colleagues even started their research that they would come up with a general factor as a matter of mathematical necessity.

This sounds very academic and very cold and detached, but actually it was a devastating critique. It implied that Caspi and colleagues introduced the P-factor into the outcomes. It was not there, but they have used statistical models and mathematical tools that guaranteed the emergence of a common denominator of a single factor.

This is as close to murder as you get in academic circles. The accusation resonated through and through, reverberated, and there was a bloody mess.

Current diagnoses share several symptoms. In other words, the same symptoms appear in multiple diagnoses.

Consider, for example, insomnia, irrational moods, irrational thoughts. All of them co-occur, grandiosity. Grandiosity occurs, which is a cognitive distortion.

Grandiosity occurs in multiple disorders. For example, in the manic phase of bipolar, in psychopathy, in borderline, in narcissism.

Because many diagnoses share many symptoms, it may appear erroneously that they share a common etiology.

In other words, it may appear mistakenly that they are one and the same, that there is a common denominator, an underlying foundation, a factor that is common to all of them.

But actually, there isn't. It's just that they are all very similar to each other.

Maybe the classification system has to be changed. Maybe our differential diagnoses are not strong and clear enough. Maybe it's not completely clear what's the difference between, for example, narcissism and borderline, or narcissism and psychopathy, or even borderline and psychopathy. So we have a bad classification. We need to rewrite the diagnostic and statistical manual using, for example, a dimensional model.

All right and true. But we shouldn't discard the baby with the bathtub, with the bathwater, with the bathroom, with the apartment block. That's what van Bork is saying. He's saying bad mathematics can lead to the optical illusion of a common factor where there is none.

And the reason is that our diagnoses are not sufficiently demarcated. They're not sufficiently separated from each other. They share too many symptoms.

Now van Bork's view is that these diagnoses are prime to be correlated with one another. A computer model would simply be picking up on the positive correlations that already exist within this psychiatric classification.

In other words, if I were to feed the computer the description of a narcissist, the description of a psychopath, description of a borderline, the computer may mistakenly reach the conclusion that they all one and the same because they share many symptoms, many cognitive distortions, many psychodynamics, and so on and so forth.

Indeed, by the way, the etiology of these disorders, at least narcissism and borderline, is very similar. So perhaps there is something in common. It may not be a single psychopathology factor.

But I think personally, and I've been saying it for well over 30 years, I think that yes, all mental health disorders are somehow connected, definitely in the field of personality disorders, and definitely Cluster B personality disorders, in my view, are one and the same.

And it's not only my view, it's the view of the majority of the world, the international classification of diseases Edition 11 has adopted this view and now it's a common view.

Consider, for example, an analogy, water quality and biodiversity. Van Bork argues that biologists don't study a single factor. They don't study, for example, the health of the oceans or the health of the seas.

Instead, biologists rely on plausible explanation of data. They realize that high water quality allows for life to vary, allows for more diversity of lifeforms, and more lifeforms improve the quality of the water. There's a positive feedback loop here.

But biologists don't discuss generally the health of a lake. They go deep, they differentiate, they break down, they analyze.

Van Bork's criticism is that the P-factor model is overly synthetic. It does not allow for analysis. It doesn't allow for fine-graining and fine-tuning mental illness, which is a highly complex phenomenon.

Van Bork says that in the case of mental disorders, a positive correlation between symptoms can be explained by a similar way of interconnections without recourse to the P-factor. One symptom leads to another.

A blossoming of anxiety releases the seeds of substance use disorders. When you are anxious, you become depressed. One symptom leads to another. It's a chain.

The common experience of guilt and depression, for example, creates the grounds for paranoia or psychosis and so on and so forth ad infinitum.

That symptoms are connected to each other in chains doesn't mean that they all emanate from a single identifiable source, say van Bork and his collaborators.

Caspi retaliated or retorted in 2020. He published an article. By the way, one of the main collaborators of Caspi is actually his wife, the clinical psychologist Terrie Moffitt. And they published a study.

And in this study, they avoided the main pitfall, which I think had been justly criticized by Van Bork. They avoided computer models altogether.

What they did is they simply arranged the data neatly, graphically, beautifully, in matrices and tables and so on. And they arranged a lot of data and they didn't choose a single computer model. They didn't use statistics.

So Van Bork's main objection had been removed. And again, as you look at the data in this article in 2020, as you look at the arrangements of symptoms and so on and so forth, it's quite visible to the naked eye that there is something common in there. There is some commonality.

This study was much smaller than the original study in 2012. It included only 1,000 people. It's limited to New Zealand, which is not representative of the rest of the world. And that is the British understatement of the millennium, probably.

But still, it gives some indications. And it was longitudinal in the sense that Caspi and collaborators followed people over several years.

So there was a rich portrait of the evolution of mental health and mental illnesses over the lifespan.

And so suddenly, suddenly it became strikingly visible. Without the intermediation or intervention of computer models, statistics, mathematics, it's clear to the naked eye, totally, totally discernible, that mental illnesses are not static, static entities. They're dynamic. And not only are they dynamic, but they shape-shift. They morph into each other.

That's something I've been saying for many, many years, long before Caspi. I kept saying that personality disorders shape-shift and that they morph into each other and that the symptoms are common because all personality disorders are one and the same.

And this is striking support for the assumption of a p-factor, a psychopathology factor, that is a common denominator and a single source of all mental illness.

Successive surveys have shown that depression tends to become substance abuse. Anxiety tends to become depression. ADHD leads to thought disorders such as schizophrenia, depression and psychosis switching places. It's all very evident, not only in this study, but in clinical practice, any therapist and psychiatrist would tell you this.

So the analogy between biology and psychiatric diagnosis is irrelevant, is not true and is very misleading. Biology is essentially a taxonomic science. It started as a taxonomy, botanic, the botanic science of Carl Linnaeus and it's a taxonomic science.

And if we want to borrow any metaphor from biology and apply it to the life of the mind, it would be the split between animals and plants, but with species that metamorphose.

In other words, the closest analogy to mental illness in the field of biology is actually evolution theory. Exactly as evolution is founded on certain very basic principles such as natural selection, the entire field of psychology and psychiatry can and should be founded on commonalities like the p-factor and some basic dynamics.

P-factor plus one or two dynamics give you the entire diagnostic and statistical manual and that is the truth.

In biology, life forms grow, transform, they become wholly unrecognizable. A cocoon becomes a butterfly or a cocoon becomes a chrysalis and then grows wings and becomes a butterfly.

So the three forms are kind of distinguished from each other. If you see a cocoon, you wouldn't guess it could become a butterfly. If you see a butterfly, you would never believe that it used to be a chrysalis.

So in the same with mental illness, if you see a depression, you will not tend to link it to anxiety and if you see anxiety, you would not think that it has anything to do with schizophrenia. If you see schizophrenia, what's the connection with ADHD?

But actually, yes, they're all one and the same. They are like the cocoon, the chrysalis and the butterfly, three phases of the same organism, three stages in the same dynamic.

It's a unifying view of psychology and psychiatry that I've been advocating for decades and I'm very excited that it's coming to fruition. Nothing to do with me, but still I'm excited to be on the right side of history and the right side of psychology and psychiatry.

Caspi says that the shape-shifting or serial comorbidity seen in his studies confirmed the existence of a common liability underlying all mental health disorders, common liability that simply germinates at different times in our lives.

Of course, everything in psychology and psychiatry has its critics and Caspi is no exception. So critics wonder about the generalizability of the study from New Zealand.

But this is not a strong objection because we have by now other studies from different locations and they all demonstrate the same.

For example, there's a study from 2019. It's a longitudinal study and it was in Denmark and it used health registers in Denmark. We found identical patterns, serial mental health diagnosis through the lives of nearly six million people.

So mental health disorders shape shift, they transform, they grow, they change unrecognizably, they become one and the same. They are very fuzzy.

Caspi found mental disorders that first emerge in childhood or young adulthood and then discovered that they are far more likely to show this pattern of serial comorbidity. That's a very important point.

The earlier we catch mental illness, the easier it is to fix and heal and cure for life.

What Caspi had discovered is that mental illnesses that first emerge in childhood tend to shape shift and morph and become more severe in adulthood.

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.

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