I am interested in the history of the pro psychiatry and anti psychiatry movements and the arguments concerning mental illness as brain disease versus mental illness as a metaphorical illness.

Has the recent mapping of the human genome contributed to a resolution to that debate?

-- John Hedlin (jhedlin@shaw.ca), September 26, 2002

Answers

I don't know that there is a definitive answer to this, or that the answer to it would resolve the question of the literality of the term "mental illness". However, it is my understanding that genetic markers have been found for increased likelihood of one's suffering from major depressioin and of becoming schizophrenic. I'm sorry I cannot give more exact information. You should probably try a more medically- or genetically-oriented forum.

-- Christopher Green (christo@yorku.ca), September 28, 2002.

Hi John, I am not aware of anyone actually documenting the history of the anti- psychiatry and pro-psychiatry movements. However, the history of psychiatry is often written along these two divisional perspectives, even though both claim to be historically accurate and objective. The polemics between the two are often passionate, fierce and accusatorial, especially within the ant-psychiatry movement and its allegations towards orthodox (mainstream) psychiatry for present and historical abuse towards the mentally ill. Although the anti- psychiatry movement has been accused of historical revisionism, the pro-psychiatry movement has equally been accused of revisionism with its historical accounts of the progression of its discipline and treatments. It’s up to you to decide who is correct, or whether to adopt an interactional historical perspective. You should first start by writing to the Citizens Commission on Human Rights, 27 Carlton Street, Suite 304, Toronto, Ontario, M5B 1L2 and ask for their publication: Psychiatry: A Human Rights Abuse and Global Failure. This way you can keep abreast of the historical and emerging views of the anti-psychiatry movement and get a better understanding of mental illness as a metaphorical illness (after all, they claim Thomas Szaz and R.D Laing as founding members). Then, for the opposite (biological – brain disease perspective), you should definitely read Shorter’s (1997) A history of psychiatry. New York: Wiley. As for the human genome project shedding light on this debate – unfortunately the answer is not yet and most likely not for quite a while. No genetic markers for Schizophrenia or Bipolar disorder have been found (See the chapter: The mark of madness in R. Walter Heinrich’s (2001) In search of Madness: Schizophrenia and neuroscience, New York, Oxford University Press). Neither is the answer going to be found along the lines of a Mendelian genetic model (dominant – recessive genes) as has been found for Huntington’s disease. For example, the genetic concordance rate for identical twins with schizophrenia is only 48% (not the expected 100%). Therefore, some other biological or environmental elements (whether perinatal/ obstetrical complications, psychological stresses or viral contagions) might also be implicated as predisposing factors. However, one possible genetic lead for solving the enigma of Schizophrenia and Bipolar disorder was discovered through the use of fluorescent in-situ hybridzation to locate an interstitial deletion at chromosome 22q 11.2 which appears to be a common replication error during karyokinesis (mitosis) within humans. It’s characterized by a variable phenotype that includes palatal abnormalities, characteristic facial features, congenital heart and other birth defects - all noticable features in a small percentage of Emil Kraepelins (1971[1919]) descriptions of schizophrenics and majority of Thomas Cloustans (1888) "adolescent insanity". Approximately 2% of all schizophrenics have this deletion and over 25% of adult patients with the deletion develop psychotic disorders – implicating an interaction of multiple genes. A very few but progressive researchers have even contemplated the implication of multiple genes through a genetic or chromosomal virus. I am particularly partial to this view and feel it has biological merits that go well beyond the scope of any discussion appropriate for this forum. In any case, whether the study of genetics and the genome project will settle the debate between mental illness as a disease or metaphor is superfluous. For quite a while now, the debate has only existed in the historiography of Psychiatry – so it’s definitely the place to search for possible answers, instead of waiting for the “promissory note” of the genome project to settle the issue – once and for all!!!

All the best in your research endeavors,

-- Pete Economou (peteecon@yorku.ca), September 29, 2002.

There was an article in SCIENCE this summer that looked at Schizophrenia and 2 other "illnesses." They hypothesize a multifactoral causation. It interests me too, because it has implications for "regular" illnesses. Sorry I'm not citing the SCIENCE article.

-- Marie Missie (mariemissie@hotmail.com), October 02, 2002.