Will the gene of schizophrenia help you?

So why am I not being too enthusiastic about psychiatric genetics? Why am I not excited by the prospect of uncovering the genetic basis of mental disorders, despite the proponents' claims that it should make diagnosis more reliable and eventually provide avenues for effective treatment?

Because these promises do not sound realistic to me. I have to admit that the question of psychiatric genetics is very interesting academically, and it is also readily funded by both drug companies seeking profit and the government seeking some kind of solution to the overwhelming quantities of mentally disturbed citizens. Still, I find it difficult to buy that genetic advances will benefit the real-world patients, and here is why.

First of all, the genetics of mental disorders is subtle and multifactorial. Therefore, even if some genetic predisposition could be statistically proven, in any concrete individual the environment plays a dominant role in determining whether the disorder will appear. In other words, regardless of whether a particular person possesses the wrong genes or not, his being sick or normal will largely depend on his life situation (which is exactly what we've known for a hundred years).

Let's take an example from oncology. There is a gene called BRCA1 that, if mutant, has been recognized as carrying much higher risk of breast cancer development. Now, in oncology the diagnosis can be made much more accurately than in psychiatry; the genetic association with BRCA1 gene is also simple and straightforward. Nonetheless, oncologists do not usually make predictions about any particular patient; even though the risk may be significantly increased, we still cannot say to the carrier or the mutant gene: "You will have breast cancer", or to the carrier of the normal gene: "You're cool, go home."

Whatever gene associations are found in mental disorders, they will not be enough to make predictions, because the environment plays a major role in the fate of any organism. Hence, we can only afford hunting for genes after we've done everything possible to fix the environment. Talking genetics when there are major problems in people's psychological well-being (look around!) is like cleaning the carburetor when the car's wheels are missing. It could help, but it's not the biggest concern right now.

The second reason why genetics is unlikely to benefit the patients is that psychiatry has a tendency of rushing things into practice as soon as they are discovered (if it can be profitable, of course). It is theoretically possible that genetic discoveries will lead to the creation of the effective treatment for psychiatric disorders, but most likely this simply won't have time to happen. What will happen much sooner is that some type of genetic analysis will be implemented, and people who are at risk will be recommended to take the medications preventively.

This will be catastrophic, because the drugs can make a healthy person sick; so there will be no way of disproving that they were really needed. This will reinforce the sense of scientific correctness, and promote further treatment and propaganda efforts, supported by the drug manufacturers. The tradition of giving drugs to healthy people, mandatory genetic testing of children and adults, and the arising legal battles will change the whole landscape of psychiatry into something entirely different from what we know today.

In the resulting confusion the original goal of the genetic research (to develop treatment) will be postponed, as scientists of the day will concentrate on getting out of the current crisis. And everything will repeat again - only the counter of the innocent victims of psychiatric help will advance by a few tens of millions... but who counts them?

Psychiatry Critique and Antipsychiatry

I would like to make myself clear: I am not an antipsychiatrist.

The easiest way to change your point of view is by changing its sign to create the opposite. In this manner, religion is converted into atheism, love into hatred, promiscuity into puritanism, and psychiatry into antipsychiatry. Although the result is as far from the origin as possible, the similarity between the two points of view is still apparent.

An atheist spends as much time and effort as a preacher thinking about God, only trying to prove His non-existence instead of existence. An antipsychiatrist still limits his thinking to the arguments of psychiatry, only trying to prove them wrong. And all of these people remain rigidly faithful to their points of view.

I don't know if psychiatry - in general - is good or bad. I think that psychiatry could be used to help people. I think it could be one of the most humane and rewarding professions. This is why I had become a psychiatrist (I wouldn't like to practice in the United States today, but that's another story). I am fascinated by the works of Jung, Assagioli, Laing and others who took the art of psychiatry one step further, from simply "fixing" people to fit the social average, to helping them achieve self-realization and spiritual growth.

This said, I can't help noticing that today psychiatry in America is practiced in a very strange fashion. It is no longer art, but science. It is not uncommon to meet a psychiatrist who knows a lot about biology and chemistry but has no idea how to talk to people. (You wouldn't go to a concert where the musicians know all about the physics of sound and theory of composition, but cannot actually play, would you? What if they had shown you their certificates?)

People are being lied to or confused on every step of the way. Every first-time patient that I saw at the hospital was convinced that since he had signed in voluntarily, he may leave at any moment - which was of course not the case. People are distracted from solving their real-life problems by the unnecessary talks of genetics and chemical imbalance. People are told that the prognosis of schizophrenia is better with drug treatment, but it is not proven. People are told that what matters is the symptoms, and not the cause of their depression, but it is ridiculous. They are told that modern drugs are safer than the older ones, but it is a lie. They are told that the drugs are scientifically proven to work, but it is a mystification.

At the same time, most of the doctors are very nice people, and they really believe that what they do is good. I don't know how that happens, but I see that for some reason many professionals have adopted rather simplistic and superficial views of human nature, reducing it to mere behavior, and refusing to understand its depths. I have seen psychiatrists making a diagnosis of schizophrenia and prescribing a drug to the patients complaining of hearing voices, without even so much as asking what those voices were saying. They are simply not interested - and with good reason: the drug that they prescribe will still be the same.

I am not even going to mention here the enormous financial pressures that psychiatry now has to endure. It is a subject for a long discussion.

To sum it all up: psychiatry in general is not good or bad per se, but at this point of its development in America it seems to be hurting more people than it helps, while proclaiming the opposite. Thus, although psychiatry may be helpful to some people, in dealing with it a healthy degree of skepticism and common sense needs to be maintained.