Those psychologists who winced two years ago when NIMH Director Steven Hyman, M.D., announced in a press release (see National Psychologist, November/December 1996, p.3) that “anxiety disorders, like other mental illnesses, reflect dysfunctions within the brain,” have reason to cry out with pain these days.
Few days go by without data about the relationship between the brain, genes, and behavior. What many psychologists hoped was a flash-in-the-pan event designed to corral congressional health-care appropriations for genetic research has become an avalanche of “news” about genetic determinants of behavior.
As the human genome project gathers momentum and heads toward completion within the next few years, those associated with the project and those who hope to harvest the bounty of information and financial reward grow ever more enthusiastic. It is not unusual to hear and read of new discoveries that will demonstrate that all human behavioral patterns are genetically determined and, thus, subject to change by means of genetic manipulation.
Translate “genetic manipulation” into a more familiar word: “drugs.” Even the most common pharmaceutical interventions can be seen as genetic manipulation. Where we might not have known how, say, Valium worked, we now can infer that it works by interfering with a protein produced on order from a section of DNA that has dispatched messenger RNA to the ribosomes–the intracellular factories that create hormones and other proteins. How long after such discoveries will it be before the pharmaceutical industry and NIMH researchers begin to look for more precise tools for getting into the intracellular message loop?
And how long before well defined and “undesirable” behavior patterns are seen as fair game for the magic bullets of genetic interveners? Not long.
Given the high confidence levels achieved in the studies of the genetics of such entities as Huntington’s disease, Down syndrome, and cystic fibrosis, enthusiastic researchers are riding hard in the chase for genetic explanations of anxiety, depression, obsessive-compulsive disorders, schizophrenia, bi-polar disorder, and everything else in DSM-IV. Forget that each of these diagnostic entities are of questionable definition; guests espousing such skepticism are likely to find themselves unwelcome at the table.
The emerging field of genetic psychiatry has now cataloged many of the old diagnostic categories, previously explained as results of developmental events. Some of the new catalog entries seem more credible than others. For example, the linking of depression to a specific neurotransmitter, in turn linked to a specific genetic site, could–if valid–be understood easily. However, the linking of an idiosyncratic ritualized obsessive behavior to a genetic site tests the credulity of even sympathetic observers. Some of the old diagnoses are being tailored to fit more comfortably with a genetic approach.
Some of the apparently mechanical movements associated with childhood obsessiveness are being herded into symptom complexes characteristic of Tourette’s syndrome–an entity that is presumed to arise out of a specific genetic mutation.
All these developments within the field of genetic psychiatry are but a small part of the “brave new world” that some see coming over the horizon. Some conjecture that this new world will include a number of different genetic interventions in utero, accurate predictions of intellectual ability, simplified treatment and prevention of attention disorders, and a return to the glorious years when mentally healthy psychiatrists and psychologists were careful observers of those unfortunates who had been dealt poor constitutional and genetic hands.
Psychologists and other non-medical mental health workers have grown accustomed to articles and letters to editors of local newspapers calling for public recognition that mental illnesses are in fact “brain diseases.” One of the missions of The National Alliance for Mental Illness (NAMI) is to inform the public of the organic nature of behavioral disorders, thus reducing the public’s tendency to blame parents for their children’s behavioral difficulties. The joining of that chorus by the NIH sponsored genetic scientists will, of course, be welcomed by NAMI, even as it casts another shadow over the practice of psychotherapy.
While most practicing clinicians see psychotherapy as the treatment of choice for most mental disturbances, and the most cost-effective as well, the word is spreading through insurance providers and medical schools that pills are cheap, rational, and quick. Nor does the administration of pills include as part of treatment the sometimes troubling relationships between physicians and patients that is an integral part of psychotherapy. It is not difficult to understanding the excitement with which insurers and medical trainers are welcoming the genetic gospel.
Robert Barasch, Ph.D. is a retired psychologist in Montpelier, VT.
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