Gene Genie

Posted on 21 September, 2012

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There’s a new fad in psychology and psychotherapy to discount the role of genes in many psychological disorders because they’ve been unable to link any specific gene with predisposition to disorders like schizophrenia and depression, and the resulting lack of a perfect cure for these debilitating disorders.  To my somewhat jaded eye, this bears a striking similarity to the “sociobiology wars” of the 1970s and the popular backlash against evolutionary and genetic theories on behavior and personality that lasted for decades.  Unfortunately, psychology has seemingly always been host to numerous odious and downright dangerous fads like lobotomies, phrenology, electroshock, etc…, while diligent scientists continued to work, unappreciated, on foundational theories such as neuropsychology and cognitive psychology which continue to be fecund sources of new testable hypotheses in all the various flavors of psychological study to this day.

But what can you do about all the quacks and fads that spring up, aside from call attention to their erroneous nature when you spy one in the wild?  In particular, my interest was piqued when I read a recent column [h/t eXiledonline] by Tanya Marie Luhrmann in the Wilson Quarterly (a sort of quasi-scholarly periodical– Think Scientific American/Newsweek/Time “from the Editor” articles, but a whole magazine of them) which is essentially a backlash against what the author terms the “bio-bio-bio model” of psychiatric treatment.  This amounts to pretty much the standard anti-psychiatry bogeyman: misguided or unconcerned doctors pushing drugs on patients with side-effects worse than the disorder itself because of dogmatic adherence to a biology-only model of human psychology:

“It is now clear that the simple biomedical approach to serious psychiatric illnesses has failed in turn. At least, the bold dream that these maladies would be understood as brain disorders with clearly identifiable genetic causes and clear, targeted pharmacological interventions (what some researchers call the bio-bio-bio model, for brain lesion, genetic cause, and pharmacological cure) has faded into the mist.”

Into the mist, indeed!  While newspaper and magazine headlines have certainly boldly proclaimed that science had found a gene or a cure for this-or-that disorder, professional scientists never published any papers to this effect.  There has never been a consensus in the psychology community that genes were the sole determinant in the emergence of disorders or their symptoms, and the current dominant foundational theory on the epidemiology of psychological disorders is epigenetics, which studies the role of the interaction between the environment and genetics.  Sadly it’s not only lay people who misunderstand the link between genetics and psychology, but the “bold dream” of genes being sole determinants of any aspect of the human being was only ever a pop psychology fad, ginned up by the popular press for revenue generating purposes.

Please bear with this tangent, but the article brings up a few other noxious therapeutic fads, the most distressing of which is the loving portrait of quack psychologist Marius Romme’s Hearing Voices Movement which,

“[. . .] teaches people who hear distressing voices to negotiate with them. They are taught to treat the voices as if they were people—to talk with them, and make deals with them, as if the voices had the ability to act and decide on their own. This runs completely counter to the simple biomedical model of psychiatric illness, which presumes that voices are meaningless symptoms, ephemeral sequelae of lesions in the brain.”

One of the fads that European psychologists seem to have a hard time ridding themselves of is psychoanalysis, and much of Romme’s ideas rest on the psychoanalytic foundation of European psychology.  Fundamentally, he suggests that auditory hallucinations are aspects of our subconscious mind made manifest by repressed trauma.  I wish I had more time to give it a full treatment, but suffice to say that the level of debilitation for each person suffering from schizophrenia covers a very broad range and, anecdotal evidence aside, while it’s at best unhelpful to indulge people with real mental illness in their delusions and hallucinations, depending on the severity of the symptoms it can be incredibly dangerous to the patient.  Importantly, this is not the same as providing non-judgmental understanding to a person with a mental illness.  Having a stable support network of understanding people is important for every person’s well being, but even more so for those suffering from mental illness.

To be sure, there is inability for governments and societies to accept that there may not be a cure for complex, multi-faceted personality and mood disorders.  Anything which seems to enable societies to give the least amount of concern (and importantly, money) to helping people with psychological disorders gets the most political and institutional support.  For governments looking to cut costs, and citizens looking to cut concern, the pill that cures depression, schizophrenia, psychotic disorders, or whatever other ailments is the Holy Grail.  However, long-term, multi-dimensional treatments of, for instance, substance dependence which recognize the reality of a lifelong series of relapses and recoveries of varying degrees of severity, and which don’t rely solely on free support groups like 12 step programs, cost time and money.  They also don’t include the punishment/ostracization aspect that many would like to see as contingent of a substance dependence diagnosis.

This brings us back to epigenetics.  Like substance abuse, we know that many other pervasive mental illnesses have genetic determinants.  However, the failure to find one gene that causes a specific mental illness did not cause psychological researchers to throw up their hands, or defiantly defend a dogma which had been utterly crushed.  Genetics is an incredibly robust field, and it has been able to cozily accommodate the impact of environmental influences on genetic expression.  Specifically, we now know that certain environmental influences can have a cascade of effects on gene activation and protein formation.  This is more pronounced in pre- and postnatal infants, and the effect of the environment decreases dramatically as a person ages, but still persists.  But importantly, it still happens within the framework of, and by the rules of genetics.

This is in contrast to Luhrmann’s assertion that “[t]here is clearly social causation” in mental illnesses such as depression (and presumably many others, including schizophrenia).  As she explains here:

“All this—the disenchantment with the new-generation antipsychotics, the failure to find a clear genetic cause, the discovery of social causation in schizophrenia, the increasing dismay at the comparatively poor outcomes from treatment in our own health care system—has produced a backlash against the simple biomedical approach. Increasingly, treatment for schizophrenia presumes that something social is involved in its cause and ought to be involved in its cure.” [my emphasis]

Social frameworks can’t cause a mental illness any more than genetics can cause them.  Someone’s genetics combined with their early environment can trigger the development of the disorder, and changing the social environment can’t cure anyone any more than drugs can.  The presence of the disorder can combine with the social environment to affect the apparent severity of symptoms, such that if you are ostracized and isolated due to your illness the symptoms are apparently worse (as in, less manageable) and your prognosis is much more bleak (because you lack the support network necessary to make sure you are living healthy in a holistic sense) compared to if you were part of an inclusive and supportive network of social contacts.  To say that someone is cured who is still presenting with all of the cognitive symptoms of a mental illness, even if they are able to lead a relatively stable and safe life, is incredibly dishonest and potentially harmful to the development of effective treatment strategies.

Part of what this all suggests to me is an unwillingness for people to believe that some mental illness might simply never be “cured,” that there will always be people with inalienable human rights who are nonetheless imperfect or broken in some way, supposedly burdening society.  As far as we know right now, the earlier the intervention, the likelier it is to impede or reverse the influence of genetics in a variety of disorders, but past a certain critical threshold (dependent on the individual and the illness, but usually by 7 years old at the latest– often before symptoms of serious personality or mood disorders have had a chance to manifest) it becomes more about managing symptoms and quality of life rather than treating into remission.

Drugs such as anti-psychotics and anti-depressants are important tools in this endeavor, and when they are used as the first, last, and only measure taken to treat a mental illness, that is certainly tantamount to psychiatric malpractice.  They are not cures, no responsible psychology professional is claiming they are, and sadly there may never be any cures for mood disorders or pervasive personality disorders once a person is developed enough to present symptoms.  This is not because scientists know so little, it’s because of how much they do know (in Rumsfeld-speak, this is a case of known unknowns as opposed to unknown unknowns) that no reputable geneticist has claimed to find a cure for any mental disorder.  It would serve people well to be skeptical of anyone anywhere claiming such a thing (especially sociologists, anthropologists, and anyone else involved in ethnographic as opposed to statistical and experimental analysis), as it can be a distraction to the real work of helping the lives of people with serious mental illnesses.

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