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Post-psychiatry

December 22, 2006

The triumph of the reductionism of the Greeks is a pyrrhic victory: We have succeeded in reducing all of ordinary physical behavior to a simple, correct Theory of Everything only to discover that it has revealed exactly nothing about many things of great importance. R.B. Laughlin and D. Pines

As stated earlier, contemporary psychiatry seeks fulfillment of its reductionist and essentialist goals through genetics. However the first era of genetics, the identification of individual (and groups of) genes and their individual roles, is nearly over. Its reign has yielded minimal results for biological psychiatry. On the horizon is Functional Genomics, the study of how genes interact with each other and their environment, over time. Functional genomics not only identifies the biological task of a given gene, but it identifies how and in what conditions it is activated. Furthermore, functional genomics recognizes that genes do different things under different conditions, and consequently understands that genetic destinies are at least co-authored by environment.
Ironically, functional genomics is an intrinsically non-essentialist, non-reductionist science. After decades of reductionism “medical research is entering the era of synthesis” it is time to explore “interactions between subsets of possible genetic and environmental agents as causations in particular contexts indexed by time and space.” Functional genomics is interested in how genes interact over time, in response to cellular conditions. This approach inherently acknowledges exogenous environment and culture, opening the door for acknowledgement of the role of factors such as psychogenic ‘triggers’. Additionally, functional genomics defies the traditional diagnostic framework. Rather than further delineating mental illnesses into distinct diseases with unique molecular mechanisms, functional genomic approaches will blur and even disintegrate distinctions between diseases with related disease processes. Illness will be understood as being on a spectrum of human conditions rather than grouped into distinct categories that must be explained by common origins. Rather than attempting to prioritize contributing factors to make a global model for mental illness, models will necessarily be personalized. Already these shifts in understanding are beginning to permeate our culture: in the last two years, three popular science books have been published highlighting the role of mental illness in creativity, entrepreneurship, and human evolution.
Undermining and eliminating the essentialist and reductionist tendencies of psychiatry will have two effects. First, it will lead to the personalization of medical care. The disintegration of diagnostic classifications will lead to treatment strategies fitted to individual patients rather than to global models of disease. This trend will also allow for reconciliation with anti-psychiatry as the personalization of medical care will grant more user choice: eliminating the urgency of many of anti-psychiatry’s protests against psychopharmaceuticals. The dissolution of broad diagnostic criteria will render obsolete the criticisms about the insolvency of psychiatry’s diagnostic system.
Cardiovascular disease is an example of a somatic illness that has already gone through this transformation. The term cardiovascular disease only has meaning in a personal context. Cardiologist Charles Sing indicates that cardiovascular disease “develops as a consequence of interactions between the ‘initial’ conditions, coded in the genotype, and exposures to environmental agents indexed by time and space.” The causes of cardiovascular disease include diet, exercise levels, daily stress, lipid profiles, high blood pressure, poor heart function and many others. Nobody suggests that any of those is contributing factors are inherently more important than any others; these factors are prioritized only to the degree in which they are present in any given patient. Also, few people would argue that they are free of cardiovascular disease; it is understood as a dynamic health condition that should be managed throughout life. Similarly, I suspect that post-psychiatry will adopt treatments strategies incorporating psychopharmaceutical correction of irregular brain function combined with cognitive therapy aimed at assisting individuals in normal construction of the ‘architecture of their mind.’

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