May 9th, 2016
Modern genetics doesn’t forcibly sterilize people. But fashionable theories around it put us in boxes just as eugenics once did, harmfully ignoring cultural and social differences and individual change.
Adam Cohen’s book, Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck, chronicles the horrors of the eugenics movement. It focuses on the 1927 Supreme Court decision in Buck v. Bell, in which an 8-1 majority upheld forced sterilization. Oliver Wendell Holmes wrote in the decision: “It is better for the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.”
We all scorn eugenics today, recognizing its unscientific roots and its substitution of scientific terminology for prejudice. But we now kowtow to a virtually equivalent philosophy, one with no greater grounding in science—that is, the idea that mental illness and addiction are determined by our genes.
Of course, we don’t today allow forced sterilization based on genetics. But the implications of genetically-focused, biological psychiatry, for society and for individuals and families, are colossal.
Disbelief in Cultural and Social-Class Differences
Immigrants and poor people bore the brunt of eugenics and sterilization. Testifying against Buck, biologist Harry Laughlin submitted an affidavit to the court that she had a “record during life of immorality, prostitution, and untruthfulness” due to her belonging to “the shiftless, ignorant, and worthless class of anti-social whites of the South.” The same discounting of the impact of social forces was apparent in Laughlin’s sponsorship of legislation limiting immigration for Jews and other types who seemed distastefully unlike us.
What ignoramuses these leading scientists were, along with the unwashed masses who followed their legal and public health commandments! Our superior, evolved society now recognizes this as a facade for age-old bigotry. Of course, the Nazis’ endorsement of eugenics permanently killed the idea in the US. This anti-eugenics movement here was led by anthropologists Franz Boaz, Margaret Mead and Ruth Benedict, who emphasized instead that culture determines individual personality and outlook.
And yet, we don’t believe that today.
Instead, the American biological/genetic mental illness and addiction movement trawls the globe for signs that all people share the same DSM disorders. The most thoroughgoing treatment of how ubiquitous and misguided is this global assault on cultural differences is Ethan Watters’ remarkable Crazy Like Us: The Globalization of the American Psyche. As Watters has written: “We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.”
How crazy is that? The internationally biologized human psyche Watters describes is force-fed by the pharmaceutical industry, piggy-backing on American and international psychiatry, in every corner of the world, however ill the fit. In place of this homogenization, Watters argues, “researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places.”
But we move farther from this culturally aware alternative with every passing year. In 2001, the US Surgeon General’s office authored a supplement: “Culture Counts: The Influence of Culture and Society on Mental Health,” which “reveals the diverse effects of culture and society on mental health, mental illness, and mental health services.” No government office would issue such a declaration today (one that has been cited only once since then, according to the National Institutes of Health counter).
Watters notes that an “unfortunate relationship has popped up in numerous studies around the world. It turns out that those who adopted biomedical/genetic beliefs about mental disorders were the same people who wanted less contact with the mentally ill and thought of them as more dangerous and unpredictable.” Meanwhile, “the most perplexing finding in the cross-cultural study of mental illness: People with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations”—and this despite our advanced biomedical techniques!
A demonstration of cross-cultural imperialism regarding addiction was performed in 1999 by a committee of epidemiologists. The World Health Organization’s Cross-Cultural Applicability study was convened to judge the consistency of symptoms of alcohol dependence across cultures. Dividing symptoms of dependence into psychological and physical categories, they found, “Contrary to expectation, descriptions of physical dependence criteria appeared to vary across sites as much as the more subjective symptoms of psychological dependence.” Just as Watters describes with mental illness, the fundamental form that addiction takes, whether it occurs at all, is essentially determined by cultural factors.
Along with the denial of the impact of culture, how many times have we been lectured that addiction and mental illness don’t read income tax returns, that we are all equally susceptible to these maladies? But this isn’t true. Consider, as just one example, the undeniable data with the most prevalent form of drug addiction, smoking: “Today in Britain and the United States, smokers tend to be poor, less educated, or mentally ill.”
The struggle between biologic and social status factors is evident in efforts to explain all addictions. Maia Szalavitz, my fellow columnist for The Influence, has tried to tease out biological sources for addiction and mental disorders, problems she describes coping with herself in her brilliant new book, Unbroken Brain.
Elsewhere, however, Maia notes, “Addiction rates are higher in poor people—not because they are less moral or have greater access to drugs, but because they are more likely to experience childhood trauma, chronic stress, high school dropout, mental illness and unemployment, all of which raise the odds of getting and staying hooked.” Maia holds out the hope that big data assaults on mental illness and addiction will resolve these—see below for the chances of that.
Addiction therapist Adi Jaffe has described Carl Hart, Bruce Alexander and myself as “radical environmentalists,” by which he doesn’t mean that we blow up power plants. Rather, we three believe that addiction is culturally, situationally and experientially caused.
Bruce created the seminal Rat Park experiment, where animals previously habituated (“addicted”) to morphine solution simply switched to drinking water when allowed to roam free with other rats of both sexes.
Carl, another Influence columnist, makes clear—based on both his personal experience in Miami’s ghetto, and on his research showing that “addicts” can be dissuaded from taking methamphetamine by simply paying them enough—that drugs do not create drug addiction.
Addiction is instead caused by people’s environmental and situational motivations, which frequently change. This truth—and its denial—is evident in the genetic idea that mental illness and addiction are permanent, which answers the question Szalavitz poses in her cogent piece: “Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied?”
The reason, Maia, is widespread belief in biological, genetic causation—along with trauma theory. (If addiction-causing trauma is permanent, how can people overcome addiction?)
The Reification of Biological Conceptions
Today, people widely, but vaguely, assume that addiction and mental illness have been shown to be genetically based. The reverse is true.
In, 2003, scientists completed compiling the three billion letters of genetic code that comprise the human genome. The initial Human Genome Project (HGP) cost $1 billion, an amount that has been matched and exceeded several times over in research on the genome conducted since then. Many people assumed that having our DNA coding read meant the end of mental illness and addiction.
To our disappointment, the reverse has been true, for both addiction and mental illness. Remarkably little useful therapy has been developed due to the completion of the genome map. And this has been, by far, most evident with addiction and mental disorders.
Prior to HGP, periodic announcements were made of the discovery of a gene for this or that mental disorder—depression, bipolar, schizophrenia. And then? Disappointment.
The gene for alcoholism is a case in point. In 1990, Ken Blum and Ernest Noble identified the alcoholism gene as a variant of the D2 dopamine receptor gene in the prestigious Journal of the American Medical Association.
Neither of the researchers was a geneticist (Blum is a pharmacologist, Noble a psychiatrist). Actual genetic epidemiologists pursue two paths. One is tracing a family where a disorder occurs frequently, and seeing which gene differs in those in the family line who do, or do not, manifest the disorder. The second is to conduct a general population study to find people who display a disorder, and see how their genetic make-up differs from the general population.
Blum and Noble instead studied 35 males who died from alcoholism, and generalized from this small group’s genetic differences to a general population. But, unfamiliar with the population’s origins (it turned out that they were largely African American), their group’s genetic distinctiveness was due to traits found more commonly in this racial group.
This problem invalidated the Blum-Noble research from the start, as I noted at the time in The Atlantic. Then, too, researchers (none actual geneticists) proposed a dizzying array of potential genetic sources for alcoholism, each one independent from, and often contradictory to, the other! I wrote too about this cacophony, this time in the Journal of Studies on Alcohol.
The Blum-Noble “discovery” actually marked the end of the search for individual genes that cause mental disorders or addiction. Now 25 years old, the dopamine receptor gene allele that supposedly caused alcoholism—and then was claimed to cause addiction in general—has turned out to be useless. (Have you ever heard that someone was diagnosed as being alcoholic because they carried the A1 allele of the dopamine D2 receptor gene?)
In the area of mental disorders, research teams search for clumps of DNA that are in common associated with the total range of disorders, including autism, ADHD, depression, schizophrenia and bipolar disorder. According to Jordan Smoller, a coordinator of this research, “these genetic associations individually can account for only a small amount of risk for mental illness, making them insufficient for predictive or diagnostic usefulness by themselves.”
That specific genes can account for mental illness or addiction was actually, amazingly, disproved by the HGP. The first major surprise to arise from mapping the genome was the discovery of how little of DNA comprised actual genes—fewer than 25,000 were identified, a figure remarkably lower than the 70,000 or more genes researchers expected to find. This number was rather uncomfortably close to the number of genes found in even the lowest life forms—that is, what puts us on top of the evolutionary ladder is not individual genes.
Read more from The Influence:
As I describe in Recover!, the vast majority of DNA on our chromosomes is not organized as specific genes. Much of this DNA (referred to as “switches”) is now understood to catalyze processes that then proceed to different genetic outcomes. As Dr. Bradley Bernstein, an Encode (one subtask of HGP) researcher at Massachusetts General Hospital, commented, “The system, though, is stunningly complex, with many redundancies. Just the idea of so many switches was almost incomprehensible.”
The implications of this degree of complexity are still incomprehensible. Not only do such switches impact the course of genetic development (ontology), but the form and expression of genes are influenced by such random events as the mingling of DNA across the chromosomes, along with such seemingly casual influences as temperature and light during gestation.
All together, the picture of the genome that has emerged is one of a seething mass of activity, of change, often unpredictable, and of interactions between different components of the genome and the genome and its environment.
The ideal image many people had of the genome as a straightforward template that maps out human beings in a predictable way was, and is, a fantasy. And this is nowhere more evident than in the case of human personality traits and mental illness. There simply are no bright neon signs in all of that DNA blaring: “introverted/extroverted,” let alone “schizophrenic,” “autistic,” “bipolar,” “addict,” et al.
According to the CDC: “Scientists believe that many mental disorders result from the complex interplay of multiple genes with diverse environmental factors.”
True, but meaningless. And addiction—with all the individualism and changeability noted by Influence writers Maia Szalavitz and Meghan Ralston, two people with direct experience—epitomizes the now-definitive practical uselessness of genetic models in our field.
Stanton Peele is a columnist for The Influence. His latest book, with Ilse Thompson, is Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life. He has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His website is Peele.net. Dr. Peele has won career achievement awards from the Rutgers Center of Alcohol Studies and the Drug Policy Alliance. He is currently working on his memoir. You can follow him on Twitter: @speele5.