It sometimes seems that half of the papers in mental health research journals describe the co-occurrence of misery.  A typical study would find that people with risk factor or condition X, who experience disadvantage or adversity Y, are more likely to experience bad outcome Z.  For instance: People with bipolar disorder who experienced childhood trauma are more likely to have suicidal ideation.  Or: Children with autism-spectrum disorder who also experience attention deficit symptoms have greater behavioral disturbance.  My colleague, Evette Ludman, and I sometimes joke that we would like to start a new journal exclusively devoted to this scientific genre.  We would call it “The Journal of Job.”  The biblical reference would emphasize that the co-occurrence of misery is not just an old story.  It’s actually an Old Testament story.

This is not to deny that these stories are true in every sense of that word.  The co-occurrence of misery is both a repeatedly confirmed scientific fact and, for many people with mental health conditions, a daily lived experience.  Speaking that truth is often necessary to motivate the prevention of disadvantage and adversity – especially structural disadvantage and adversity.

However true, the narrative of co-occurring misery is usually not a hopeful one.  And, for researchers who aim to improve the effectiveness of mental health care, that seamless narrative does not offer much guidance or encouragement.  Like the original Book of Job, stories of misery begetting misery begetting more misery offer little hope for recovery other than dramatic divine intervention.   

In an unexpected way, the White House and NIH Precision Medicine Initiative (PMI) might offer us some hope, helping mental health research to progress beyond the Journal of Job.  To quote Frances Collins, “PMI is not just Human Genome Project Redux”.  And it is not just a platform for pharmacogenomics, limited to data mining to discover drug-gene interactions.  PMI has a broad scope, including a wide range of environmental influences (both positive and negative) and personal health behaviors (again, both positive and negative). 

A central goal of PMI is to identify and explain instructive exceptions to the co-occurrence of misery.  We hope to identify people with diagnosis X who experience adversity Y without then suffering bad outcome Z.  Stated in statistical terms: Even if we already know that the average or main effects are consistently negative, we can still find hope (and maybe some hints about useful interventions) in the interactions. 

PMI is part of a broader effort (including the NIMH Research Domain Criteria initiative) to reveal and clarify the causal chains leading from genes to the functioning of brain circuits to mental health symptoms and diagnoses.  But that effort is certainly not a plan for lockstep biomedical reductionism.  Instead we hope to discover when and how those causal chains are sometimes broken - with the ultimate goal of breaking them more often. 

For several years, mental health consumers and advocates have asked for more research - and more treatments - focused on resilience and recovery.  Recovery-oriented research should attempt to understand and facilitate good outcomes despite risk factors and adverse circumstances.  I hope that PMI will help us to tell that new story.