Not By Genes Alone

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.

Comments

[allis1]

There is so much we do not know at this point about the causes and cures for mental illness, but
I take exception to the writer strong stance on heredity vs. environment. To me, mental illness is no
different from any health issue from the standpoint that numerous factors play a role, with some
mental disorders environment maybe a major factor, but in others heredity might be the primary
cause. I think it is really important to keep an open mind and not exclude any primary factor. We are incredibly complicated creatures. I have worked for many years with young children with special needs.
Certainly a positive, loving environment is huge but the basic disability is still a fact of life. On the issue of
the use of drugs to assist in dealing with mental illness; I think they have their place, but should be used
in a supervised and prudent manner, but to dismiss their importance out of hand is a mistake.

[FredricD]

While a person's environment clearly has an impact on how our brains and minds develop, it would be an error to understate the contribution of heredity. We're born with a DNA template that we inherit. That DNA template is the foundation on which the environment acts. The challenge that science is just starting to decipher is how our genes and environment interact in each of us. This is turning out to be far more complicated that thought earlier.

One strong piece of evidence supporting the role of environment is the sharp functional improvement in people born with Down's Syndrome. There was a time when the children were placed in institutions. Their measured IQ was low as was their survival. A shift came when the children were left in with the parents. Measured IQ rose dramatically, to a level where many can function in society.

A key value of this dialogue is to be open to the prospect that our exploration of human behavior is actually just starting, as we now have low cost tools to delve inside to identify our DNA blueprint.

[salsmom]

Very good article. My brother is a district court judge and he is absolutely concerned about the lack of mental health services/resources (out patient as well as institutional placements) for young people who he sees in his court. He has made it a core mission of his to try move the community on this very important issue. Sadly, pharma and researchers donate money to politicians, mentally ill and developmentally disabled folks do not.

[Polyphant]

This is interesting and, surely, important.
As your own conclusion seems to suggest, the words that spring to mind in answer to the question are Big and Pharma.
Who needs people? We have pills developed by scientists using computers!

[antaeus]

Aren't you overstating the "neural plasticity of the brain"? The push back against espousers of the so-called Mozart Effect, which advocated immersing infants in classical music, includes research that suggests there is a modest limit to the real effects of brain-grooming efforts.

[SocActivist]

I recently read that major mental illness (schizophrenia, bipolar disorder, major depression) may be caused by genetic errors that occur in the very early stages of pregnancy. If this is true, then these afflictions are genetically-based, but not inherited!

Also, Dr E Fuller Torrey has a theory that people who completly recover from "schizophrenia" really were afflicted with a viral brain infection that goes away on it's own, whereas "genuine schizphrenia" is a genetically-based brain disorder.

Perhaps another question to ask about mental illness is whether they are caused by problems W/human "hardware" or "software" (of course, that might not be a simple distinction W/humans because "software" problems can cause "hardware" problems.) Computer viruses, by analogy, suggest that a mental illness W/no physical basis is at least a logical possibility.

[ailbhe]

Excellent article. What we do know could be used to help people recover from their illnesses. Until the resources are invested we will not know what possibilities we are missing out on.

I remember reading an article in the UK Sunday Times on how researchers found that taxi drivers had different pathways lit up in their brains that were not representative of the general population. Obviously these pathways had been activated through the manner in which they must think in their jobs. It does suggest that how you train your brain determines how it turns out.

Very interesting possibilities.

[Phoebe Deutsch]

With all due respect to the author (and empathy for his ill brother), this is a strange and misguided article.
I don't understand why Mr. Neugeboren feels he needs to pit research against health care. This is like saying we shouldn't study HIV, but only spend money on caring for AIDS patients. We need both, research *and* care.
Also, what makes him think that psychiatric research is only concerned with genes? The sad truth is that talk therapy is not terribly effective in treating psychiatric disorders, probably because most of them are developmental in origin. It's just difficult to reverse conditions that originated in the womb or perinatally.
In the long term, we need to know what factors (genetic and otherwise) cause autism or schizophrenia and which genetic predispositions exist, so that we have a chance to prevent them or even cure them.
This seems a "no-brainer" to me.

[davispty5]

You said, "we need both" and you were absoultely correct. The point the author is making is that we don't HAVE both! As a parent of an autistic child I lay awake nights worrying about what will happen to him when my husband and I are no longer able to care for him. So, while it's important to research and study the causes of metnal illness, it is just as important to provide for the well-being of those that can't take care of themselves!