This article had too much speculation about implications and not enough talk about plans for replication to my liking. And Dr. Insel’s blog was more in the range of the charge of the light brigade than the kind of strategizing we need from the NIMH about how to validate and proceed with the new science of genomics.
PsychiatricNewsby Jun YanOctober 09, 2013
As scientists scan and analyze thousands of DNA samples from patients, a picture of the “genetic architecture” of schizophrenia finally begins to emerge. Recent genomic discoveries are converging on several heritable risks that contribute to the development of schizophrenia. One such discovery arises from a new genomewide association study [GWAS] that identified 22 chromosomal regions with genetic variations that are linked to schizophrenia. Thirteen of these regions had not been identified before, while the rest confirmed findings of previous studies. The multinational study, including researchers and funding from the United States, Sweden, and the Netherlands, was published online August 25 in Nature Genetics.“The results of this mega-collaborative study by Sullivan and colleagues paint an even more complex mosaic than was previously appreciated,” APA President Jeffrey Lieberman, M.D., told Psychiatric News. “If confirmed, they will have a game-changing effect on our understanding of the genetics of mental illness.” He pointed out that the magnitude of SNPs estimated for schizophrenia, and possibly other mental disorders, could be larger than other complex-trait diseases, such as type 2 diabetes, coronary artery disease, and rheumatoid arthritis. “This is the genetic equivalent of death by a thousand cuts and shifts the focus from the rare mutations and CNVs that had previously been thought to be the predominant genetic mechanisms conferring disease risk.” Lieberman, who also is chair of psychiatry at Columbia University and director of the New York State Psychiatric Institute, agreed that the identified risk loci offer targets for new treatment development.
[Lieberman’s comments start at 3:00]
It has been five years since Senator Grassley and Paul Thacker investigated the KOL layer of psychiatry. Since then, this kind of exaggerated, staged rhetoric has looked like the grandstanding it really is. Since then, there have been a raft of hefty settlements against the pharmaceutical industry for deceptive and criminal practices – AKA big-time exaggerations [a sad tale…] many having to do with psychiatric drugs and the misbehavior of highly placed psychiatrists. And yet exaggeration and salesmanship persist as dominant themes in organized and academic psychiatry – our public voice.
This is a time for something else, a time of paradigm exhaustion, a time for realigned priorities. The mental health parity reform offers us a chance to break free from this exaggerated medicalized psychiatry and restore some balance to the care of the sick – the traditional role of physicians. Future advances in genomics and neuroscience will certainly be welcomed when they come, but in the meantime, Dr. Lieberman would be well advised to take a walk down the street from those labs in the New York Psychiatric Institute and Columbia into Harlem, to take a stroll under the nearby George Washington Bridge, to have a look at the New York jails and prisons, to visit the inadequate remnants of a long neglected community mental health initiative – the worlds where the severely mentally ill spend their lives right now. And it’s a time to cry foul about the too-long-ignored prohibitive restrictions placed on psychiatrists by Managed Care that reinforce such a monocular view of mental illness. It’s a time to rein in the exaggerations rather than join in the fun.
Lieberman appears to subscribe to the “spokesperson” leadership model, interpreting his role as APA president is to be the public voice of biomedicine psychiatry
Exactly!
Schizophrenia is genetic the way that everything is genetic — usually, with genetic factors so complex, and so modified by life experience, they cannot be predictive — if they could be identified.
An excerpt from this article I love
Kaufman looked first to see whether the kids’ mental health tracked their SERT variants. It did: The kids with the short variant suffered twice as many mental-health problems as those with the long variant. The double whammy of abuse plus short SERT seemed to be too much.
Then Kaufman laid both the kids’ depression scores and their SERT variants across the kids’ levels of “social support.” In this case, Kaufman narrowly defined social support as contact at least monthly with a trusted adult figure outside the home. Extraordinarily, for the kids who had it, this single, modest, closely defined social connection erased about 80 percent of the combined risk of the short SERT variant and the abuse. It came close to inoculating kids against both an established genetic vulnerability and horrid abuse.
Or, to phrase it as Cole might, the lack of a reliable connection harmed the kids almost as much as abuse did. Their isolation wielded enough power to raise the question of what’s really most toxic in such situations. Most of the psychiatric literature essentially views bad experiences—extreme stress, abuse, violence—as toxins, and “risk genes” as quasi-immunological weaknesses that let the toxins poison us. And abuse is clearly toxic. Yet if social connection can almost completely protect us against the well-known effects of severe abuse, isn’t the isolation almost as toxic as the beatings.
http://www.psmag.com/health/the-social-life-of-genes-64616/
In the following TED talk by John Cacioppo
http://www.youtube.com/watch?v=_0hxl03JoA0
he says, that “To grow to adulthood for a social species— including humans— is not to become autonomous and solitary; it is to become the one on whom others can depend.”
and
“Not long ago we thought of genes as the keyboard on which life’s songs played out what this research suggest is that if the genes are the keys on the piano, then the environment, including your social environment is the pianist, influencing which keys are turned on and off.”
We are social animals. Infants who are not touched die. Infants who are not reliably cared for might never develop a conscience. Loneliness shortens lives more than smoking does. It should be evident that even if you are convinced that mental illness is completely physical, that it would follow that mental health would deteriorate in a body that was dying of loneliness.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000316
The Lieberman’s of the world, by dismissing the impacts of social connections and disconnections, appear not to be studying humans, or are thinking like sociopaths themselves. That this is being aimed at children is horrendous.
For the most part, if someone believes, thinks, is sure that drugs work for them, then they should have that option while being fully informed. Clinicians should report all suspected side effects and changes in drug effects when new taken with an additional drug in order to help to provide that informed consent. If someone is psychotic and dangerous in the Charles Manson vein, then people are going to have to drug them for others’ protection.
But we really need to stop pushing this “brain disease” model as if it were actually a scientific theory, rule out other physical causes for psychiatric symptoms, address personal and social issues, and address psychological states and cognition for an extended period of time before resorting to a label. The APA and the AMA has plenty of power to lobby to have the insurance companies and the government pay for services without having to label the patient.
Wooden men being turned into “real” scientists are doing irreparable damage.
Wiley,
One of the sad pieces of this story to me is that American psychiatry had a father and a mother – Adolf Meyers and his wife Mary Potter Brooks – now largely forgotten. They worked together to take extensive case histories along with home observations. While Meyers introduced Freud’s psychoanalysis and Kraepelin’s nosology to America, he had arguments with both approaches. His own work was published simply as The Commonsense Psychiatry. Rather than devise specific theories, he developed an approach – the Bio·Psycho·Social model [Psychobiology] – by which he meant “look at all aspects of a person’s life” – and that’s what good clinicians do no matter what their discipline.
I think that’s right on, jamzo.
Dr. Lieberman is horrible, to point at brain volume loss induced by medication and say that’s its the ‘disease’ – and to imply Schizophrenia is genetically hereditary!
(What a load of INTENTIONAL disinformation)
http://www.ncbi.nlm.nih.gov/pubmed/19445674
I think someday I might start a public petition to submit to the APA t tell Dr. Lieberman to stop lying in public.
I was just a the Institute of Psychiatry Services meeting. It was pretty demoralizing. Psychiatry is working hard to maintain some role with the shifting sands of health care reform and it is an inconvenient time to admit all that we do not know.
But there is actually some wonderful work going on down the street from Dr. Lieberman’s office. It is called Parachue NYC. It involves peers and northern European influenced dialogic practice. There are good humble people working very hard in that city. I also heard the Medical Director of the Philadelphia Dept of Mental Health speak and he was truly inspiring. There is so much good that can be done and we do not need to wait until we have figured out the workings of the brain to start doing this.
That’s good news, Sandra. Thanks.
Sandra, how can we clone you? That would be a worthy NIMH project.