“The Genetic Limp” – Confusing Genetics and Modelling in Mental Health Problems

April 24th, 2011

An elderly therapist once observed the situation whereby the young son of one of her clients walked with a limp, evidently having copied his father. The father had an injury that resulted in limping, but the young boy had no such injury; he just had the role model of what a man was and this was one aspect he learned. We know that children copy others (swearing, hitting, throwing a tantrum when upset etc) and so it is not such a stretch to understand that the son could copy the limp.

In mental health services when staff assess new clients they often enquire if anyone else in their family has a psychiatric disorder. It is common to hear staff comment that a person’s problem must be genetic…because of other family members having similar problems.

We all try to make sense of our world and so it is understandable staff may conclude there is such a link. However, is it accurate? Where is the evidence? And is it helpful?

Is it accurate?

Why would staff speculate that the person’s difficulty is genetic? This comes from a tradition of thinking that psychiatric disorders are genetic. There is a history of thinking that psychiatric disorders are ‘illnesses,’ (meaning biological ailments) and if a genetic cause could be established, there would finally be a conclusion to the debate; however to date there is no proof.

The ‘evidence’ that is collected, that other family members (parents, siblings, uncles, cousins) have similar problems is taken to be significant. However, why is this ‘evidence’ not assumed to be proof that the client has modelled their family’s limited coping skills? We can accept that the young child above could copy his father’s limp, but why not conclude, “The limp must be genetic?” We are looking at a correlation in both instances, but with the child one would conclude modelling as the cause, and with psychiatric disorders some people think genetics.

Some assume that the genetics of ‘mental illness’ such as schizophrenia are proven. More likely the evidence supports the view that ‘nurture’ is responsible, not ‘nature.’ One interesting fact I read is that where a child grows up with a parent diagnosed with schizophrenia, the child has three times a greater risk than if neither parent has that diagnosis. (Ref p17-18, Ch 1 Biological Psychiatry: Science or Pseudoscience? in “Pseudoscience in Biological Psychiatry: Blaming the Body” by Colin A. Ross & Alvin Pam – John Wiley & Sons, N.Y. 1995.)

Why would one not conclude that parenting is the key factor? Most likely where families have relatives with similar problems, they share limitations in the way they manage life challenges – these can easily be learned (eg avoiding conflict rather than discussing issues, using drugs or alcohol, giving up in the face of difficulties rather than persevering.)

Statistically the expectancy rate for a child with one parent diagnosed with schizophrenia is 12%. This is far lower than predicted by Mendalian ratios – for a ‘dominant’ gene one would predict 50% of children who have a first degree relative (eg parent); for a ‘recessive’ gene one would expect 25%.

And if both parents had the diagnosis, one would expect 50% for a ‘dominant’ gene and 100% for a ‘recessive’ gene. This is nowhere near the 36% incidence found by researchers. (Reference – same as above.)

There are many discrepancies between what would be predicted by genetic theories and what is found. (For a detailed critique see Ch 1 Biological Psychiatry: Science or Pseudoscience? in “Pseudoscience in Biological Psychiatry: Blaming the Body” by Colin A. Ross & Alvin Pam – John Wiley & Sons, N.Y. 1995.)

Those who hold to genetic explanations seem to want to prove a theory, contrary to the evidence. Even the often mysterious symptoms of psychosis in adolescents and young adult children can often be explained when one understands the particular family context. (See “Leaving Home: The Therapy of Disturbed Young People,” by Jay Haley – Brunner/Mazel, N.Y., Second Edition, 1997. See also my essay on this site, There’s an Underlying Biological Illness.)

Is it helpful to believe ‘mental illness’ is genetic?

If the cause of ‘mental illness’ was clearly established as a brain problem, it would be assigned to Neurologists, which is the medical speciality that deals with brain problems. And if the genetics were clearly demonstrable, then it would be well publicised by the mass media. Neither has happened. That ‘mental illness’ has a biological cause is debatable, and clear genetic proof will likely never happen. So in the absence of proof should the suggestion of a genetic cause (and its implied life long existence) be mentioned? Does it not invite despair for clients and families? And does it not invite staff to notice similarities (difficulties) when it may be more helpful to notice and highlight differences (surprise achievements/exceptions?)

A colleague told me he can clearly remember one particular young man in an inpatient setting who suicided after being given what he termed, “the questionable diagnosis of schizophrenia,” and then told it was a lifelong illness. He had previously shared his future life plans with my colleague, which presumably now seemed unattainable. How much do labelling and the genetic explanation contribute to the high suicide rate for those diagnosed with major psychiatric disorders?

I asked above whether the genetic explanation is useful? My answer is, “No.” Shall we stop? I hope so.

(The end.)


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