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Jay Neugeboren


Not By Genes Alone

Posted: 11/18/08 12:23 PM ET

This past week, the New York Times heralded a new theory of brain development as providing "psychiatry with perhaps its grandest working theory since Freud." ("In a Novel Theory of Mental Disorders, Parents' Genes Are in Competition," November 11, 2008) Even if the theory is flawed, the Times noted, it is "likely to provide new insights into the biology of mental disease."

The new theory posits that an "evolutionary tug of war between genes from the father's sperm and the mother's egg can, in effect, tip brain development in one of two ways." If there's a bias toward the father, the developing brain is pushed along the autistic spectrum; if the bias is toward the mother, the growing brain moves along what researchers call "the psychotic spectrum" (schizophrenia, bipolar disorder, depression).

While the more we know about mental disorders, the more we may be able to find useful treatments for them, this new theory seems, in fact, to reinforce old, unproven deterministic notions: that mental disorders are primarily biological and/or chemical and genetic in origin and course, and that since (if!) they are, what follows is that "science" will some day be able to "cure" them by treating and/or manipulating our genes (or biology, or chemistry).

"Someday they'll see," my mother used to wail after visits to my brother Robert, when he was locked away in mental hospitals, "someday they'll see that it's all chemical!"

Ah, that it were so, and how free of responsibility we might all be then. But what (as with my mother) reductively chemical, biological, and/or genetic explanations for the causes of mental disorders do not take into account is what we have learned in recent years about how the brain develops and evolves.

Researchers and neuroscientists such as Nobel prize winner Eric Kandel have demonstrated that experience itself -- sexual and emotional abuse, neglect, abandonment, loss, love, music, sports -- all of experience, in fact, whether ordinary or extraordinary -- actually changes the chemistry, synaptical connections, and neuronal circuitry of the brain. Our brains, that is, have minds of their own, and thus are not subject, across our lifetimes, exclusively or even primarily to the genetic hands we are dealt at birth.

And there's something else: while researchers such as Crespi and Badcock are generously funded for work on their theory of how mental disorders come into being, and the Times and others take heart from it, back in the hospitals, wards, and residences where these people live, there are no funds for basic, human care. Five years ago, the New York Times ran a front page Pulitzer Prize-winning series of articles about conditions in New York City's "adult homes," where some 15,000 people, most of them with mental disorders, lived in conditions that were sub-human ("psychiatric flophouses," the Times called them). Despite the world-wide attention to this dismal, criminally negligent situation, in the years since, little or nothing has changed. People in these homes still live without air conditioners in summer, without heat in winter, and without anything resembling competent or humane care.

My brother Robert, who has suffered the ravages of mental illness for more than 40 years, lives in a residence far superior to these adult homes, but when he and I asked the staff psychiatrist about getting some kind of talk therapy for him -- he has always thrived when he was in an ongoing therapeutic relationship, and these relationships have been crucial, in his life, to well-being and recovery -- the answer, again and again, has been: "No Resources."

So while, with the Times, we welcome yet another way of trying to understand mental disorders, we ask how, given what we now know about the neural plasticity of the brain, along with the often positive role non-pharmaceutical treatments can play in people's lives, this theory will prove useful. And we also wonder why it is generally so much easier to find funds for people who study mental disorders in laboratories than it is to find funds that make a difference in the lives of people with mental disorders.

Jay Neugeboren is the author of 17 books, including several award-winning books on psychiatric disorders (Imagining Robert, Tranforming Madness). His essays on these conditions have appeared recently in the New York Review of Books, Psychiatric Services, Commonweal, as well as the Huffington Post. He serves on the boards of many mental health organizations. His novel, 1940, was published in April.