See Inside December 2011

Hidden Switches in the Mind

Experience may contribute to mental illness in a surprising way: by causing "epigenetic" changes—ones that turn genes on or off without altering the genes themselves

Photograph by Plamen Petkov

Matt is a history teacher. his twin brother, greg, is a drug addict. (Their names have been changed to protect their anonymity.) Growing up in the Boston area, both boys did well in high school: they were strong students in the classroom and decent athletes on the field, and they got along with their peers. Like many young people, the brothers snuck the occasional beer or cigarette and experimented with marijuana. Then, in college, they tried cocaine. For Greg, the experience derailed his life.

At first, he was able to function normally—attending classes and maintaining connections with friends. But soon the drug became all-important. Greg dropped out of school and took on a series of menial jobs in retail and fast-food joints. He rarely held a position for more than a month or two, generally getting fired for missing too much work or for arguing with customers and co-workers. His behavior became increasingly erratic—sometimes violent—and he was arrested repeatedly for stealing to support his habit. Multiple efforts at treatment failed, and by the time the courts sent Greg, then 33 years old, to a psychiatric hospital for evaluation, he was destitute and homeless: disowned by his family and a prisoner of his addiction.

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