Reader, what expectations drive you? Are they motivating or debilitating? Energizing or depleting? Is there the expectation of wealth—a drive toward earning a certain income per year in order to feel successful? What about the expectation of beauty—do you feel nagging guilt and shame for making less-than-healthy choices that sabotage your expectations around weight? Now, let me ask you another question: Who or what gave you those expectations? Are you driven to achieve certain ideals dictated by society? Are you your own worst critic? Or are you still motivated—or haunted—by expectations communicated by your parents? Reflecting on these questions can put any of us on the path toward greater self-awareness and understanding. However, the journey toward adjusting expectations to better suit our needs can be long and at times fraught. Why are happiness and life balance so elusive? Because sometimes it’s not just our own expectations that need adjusting. This week, I want to tell you about Tara. This brilliant woman came from a highly successful family who envisioned a great future for her—and when she began to falter and fail to meet the lofty expectations pressed upon her, she almost crumbled under the weight of her shame. But reader—our failure or success is often not entirely up to us. The vastly complex world of our genes and how they express themselves can work for us or against us. And, as you’ll soon read, sometimes learning how our DNA affects our prospects can help ease the burden of unrealistic expectations… for all parties involved.

Tara’s Story: Buckling Under the Pressure of “Greatness”

Tara* timidly walked into my office and immediately sank into an armchair. With her head held  low, and her face filled with gloom, she began to tell her story. “Dr. Kehr, I once had so much promise, and now I am an abject failure in my life. I have let everyone down, my husband, my siblings, my mother, my friends, and most of all… my father.” And as she mentioned her father she burst into tears, and couldn’t stop sobbing for several minutes. I gently said to her, “Tara, if you don’t mind, can we start at the beginning? When did you last feel well, and what happened to change that?”

When this 42-year-old structural engineer was a little girl, she’d been groomed to become a “star”. Her father was a world-renowned energy industry consultant, who hobnobbed with CEOs of Fortune 500 companies and heads of state of oil-rich countries. Tara had gone to the finest schools, and was told she was destined for greatness. Her parents, particularly her father, had scripted virtually every phase of her life, with the goal being that she, too, would become a global powerhouse—a one-woman force to be reckoned with.

Following graduate school, she went to work at a highly prestigious engineering firm that worked on high-profile projects around the globe. Her job was to lead a team of engineers through multiple projects around the world utilizing highly innovative architectural designs, while adhering to tight deadlines and construction budgets that ran from hundreds of millions to billions of dollars. From the start she struggled. She was unable to effectively organize, plan, and execute. She had trouble sustaining a focus and was easily distracted. Deadlines went unmet and budgets were exceeded. Increasingly overwhelmed, Tara suffered from mood swings, began to become disabled by a major depression, and could no longer concentrate or even remember her day-to-day priorities. In short, she developed an existential crisis that threatened her very professional existence and left her in desperate need of a medical leave of absence. As her world was crashing down around her, she first turned toward her family for help.

Can You Recover from Shame? How Your SLC6A4, CACNA1C, and ANK3 Genes May Help

When Tara went to her father for support, he could not have been less compassionate. “Tara, you are shaming me and our entire family. What’s wrong with you?! Are you drinking? Using drugs? You know the CEO of your company is a close personal friend of mine. I vouched for you when you were interviewing there. You are putting me in a very uncomfortable spot. You need to pull yourself together and snap out of it!”

Tara felt devastated by his words, and by the fact that her mother was present and did absolutely nothing to intervene. As Tara recounted this traumatic talk to me, she said, “My entire life is crumbling, and I don’t know where to turn or what to do about it. My family doctor first put me on Lexapro, then Prozac, then Zoloft, and none of them helped me. In fact they all made me feel worse. A friend told me that your practice uses genetic testing to help people like me, what can you tell me about it?”

Tara was an intelligent woman, and I knew she’d appreciate understanding a little more about the vast complexity of our bodies, and how numerous processes can affect our mental health. “Tara, inside your body there are 32 trillion cells, and inside each cell there are up to 2 trillion molecules. And inside your brain there are 200 billion neurons that connect across 40,000 trillion synapses. All of these molecules, cells, and connections comprise a grand symphony orchestra that deeply affects how you feel and function, and the composer and conductor of this miraculous orchestra is your DNA. With a simple cheek swab we will analyze your personal DNA and use it as a roadmap to help restore your mental health. I promise.”

One week later we met to review her genetic testing results. “Tara, the conductor of the grand symphony inside you is suffering from several maladies, and as a result her compositions lack harmony, and are increasingly discordant. Let me explain.” Tara had variants in her SLC6A4 gene (thus the poor response to three different SSRIs), CACNA1C and ANK3. As a result, I recommended that she go on Trintellix and Lithium. Tara was shocked and appalled. “Dr. Kehr, that will never happen! I thought you were going to put me on some supplements. My family will never accept my need for multiple psychiatric medications. They will see me as weak, as a failure, as a disgrace to our storied ancestry. Besides, isn’t lithium used for psychotic people? Are you saying that I am psychotic?”

I empathized with her distress, and patiently explained each of her genetic variants, and how they, along with her job stress and family relationship challenges, had served to bring about her depression, and how my medication recommendations addressed each of her variants. Tara took a medical leave of absence from work, we started the recommended regimen, and she began to improve.

We also uncovered a latent ADHD in her, which had been masked for many years by her high intelligence. Her processing capacities had become overwhelmed by the information processing demands placed upon her at work. We instituted Vyvanse to help these symptoms and she began to further respond to treatment.

In psychotherapy we began to explore the origins of her relentless drive toward stardom, and the enormous price it was exacting on her mental and physical health, and relationships with her husband and friends. We explored her troubled relationship with her father and the origins of her intense yearnings and longings to please him, and be just like him.

In time, Tara was able to sit down with her father and let him know that she was not him—that due to her genotype she was “an Orchid”—less resilient, more vulnerable to certain contexts and cultures, and as a result of her personal genome she had to seek out a less stressful position at a smaller, lower profile firm. She let him know, “It’s not me, Dad, it’s my genes that make me this way.” Somewhat surprisingly, this rigid and demanding man began to soften. He had known of friends whose families had “cancer genes” that had predisposed them to cancer, and conceptualized Tara’s “brain genes” accordingly. He embraced her after their conversation, and she wept tears of relief as she told me.

It is now one year after we began her medication, and Tara is almost fully mended. She left the high-pressure job and took a series of smaller consultancy gigs. She spends more time with her husband and their two cats and their flower garden. We are still working together to help her discover what comes next. What will be a better fit for Tara, and her personal genotype? For the first time in Tara’s life, the possibilities seem endless.

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*Although lessons learned from the treatment of actual patients are included in the patient stories on this website and blogsite, the historical events and facts represented have been changed to protect the identities of any real patients and to protect their confidentiality. For example, the names, ages, careers, the number and sex of their children, as well as the careers of the patients’ parents have been deliberately altered, as well as other alterations that have been made. Consequently, all characters appearing on these sites are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

**(Dr. Kehr holds no ownership interest in Genomind and receives no consulting fees)

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