The March 3rd, 2016 edition of the Wall Street Journal featured an article by past President of the American Psychiatric Association (APA) Jeffrey Lieberman and his colleague, computational neuroscientist Ogi Ogas. The article was entitled “Genetics and Mental Illness—Let’s Not Get Carried Away.”1 Lieberman is the author of over 550 papers and articles published in the scientific literature, and has written and/or edited 16 books on mental disorders and psychiatry, including at least two dealing specifically with schizophrenia.
In their piece, the authors started by expressing the belief that a recent study identified a gene that causes schizophrenia, and then discussed whether it is desirable or possible to remove allegedly pathological genes in the interest of creating a future “mentally perfect society.” Portions of their article were adapted from their 2015 book Shrinks: The Untold Story of Psychiatry.2
I would like to comment on several points raised in this article:
- Lieberman and Ogas (“the authors”) discussed what they termed the recent “groundbreaking discovery” that a variation of the “C4” gene “clearly contributes to the development of schizophrenia.” At the same time, they recognized that previous psychiatric gene discovery claims were followed by subsequent research teams “quashing the claims.” Many critics believe that the C4 gene claim will also be “quashed.” The authors provided no reason for critics to move from their justified default position of extreme skepticism of all such claims. (See Noel Hunter’s 2016 MIA review of the C4 study.)
- The authors wrote that “we may one day be able to edit out the C4 gene from an embryo’s DNA.” The C4 gene’s two functions are “shaping the brain’s neural circuits during maturation” (the alleged schizophrenia-relevant function), and “contributing to immune-system protection against infections and toxins.” Although the authors believed that the “extremely daunting” task of editing out the C4 gene is “fraught with ethical pitfalls,” it would seem to create a set of medical pitfalls as well.
- The authors promoted a strong genetic (biological) determinist perspective. Because genetically oriented researchers often object to being called “genetic determinists,” I will quote Lieberman and Ogas directly: “What determines if you are mentally healthy is not necessarily what types of genes are in your DNA but how many or few copies of the genes you have.” This unsupported position only carries weight because, in a widely read and respected publication, two apparently authoritative authors state it as fact.
- The authors’ use of the term “fool’s gold” to describe decades of previous false positive gene discovery claims is fitting. Psychiatric molecular genetic researchers are like gold prospectors who have been panning unsuccessfully for genes in the stream of psychiatric genetics for decades—a stream that I argue contains nothing but genetic “fool’s gold.” They keep looking, however, because they have been “fooled” by relying on authoritative authors who have consistently misinterpreted the results of previous family, twin, and adoption studies in favor of genetics.
- The authors wrote that psychiatry and psychiatric genetics arrived at a “turning point” in 2003 with the introduction of a new genetic technique called “ROMA,” which they claimed has shown that “healthy and mentally ill individuals” vary in the “number of copies of various brain related genes” they possess. But in fact no gene discovery “turning point” occurred in 2003. This is seen in an official 2013 APA “DSM-5 Task Force” press release, in which Task Force Chair David Kupfer admitted that “we’re still waiting” for the discovery of “biological and genetic markers” for psychiatric disorders, a long-standing “promise” that “remains disappointingly distant.”3
- The authors claimed that psychiatric genetic researcher Seymour Kety’s “data” produced a “genetic riddle,” that the MZ (identical) twin of someone diagnosed with schizophrenia is “50% likely to develop the illness—not the 100% expected.” Kety is famous for the Danish schizophrenia adoption studies he and his colleagues performed in the 1960s-1990s (which I and others have shown were massively flawed on several critical dimensions), but he never published a schizophrenia twin study, nor did he publish any original schizophrenia twin data. Still, Kety’s non-existent schizophrenia twin study would have “expected” MZ concordance in the 40% range, which is the rough average of the 10 studies published between 1928 and 1970 (pairwise non-age-corrected MZ concordance rates ranged from 15% to 69% during this period).4 So even finding 50% MZ twin concordance would not have produced any new “genetic riddles.”
- Again referring to “Kety’s data,” Lieberman and Ogas wrote that “if both your parents had schizophrenia, you were only 50% likely to develop the illness.” Here they refer to so-called “dual mating” studies of the offspring of two parents diagnosed with schizophrenia. These studies have their own set of problem areas, and the rates are actually lower than 50%.5 But Kety never performed a dual mating study. Moreover, when discussing his work in Shrinks, the authors incorrectly described the groups that Kety and colleagues compared to arrive at their conclusions.6 (Similarly incorrect group comparison descriptions were made in works such as the 1995 edition of Maxmen and Ward’s Essential Psychopathology and its Treatment, and by Matt Ridley in The Agile Gene: How Nature Turns on Nurture.7) The authors also incorrectly wrote that Kety (and colleagues) “systematically tracked schizophrenia through tens of thousands of Danish families over many generations.” Such “tracking” was performed for a few hundred experimental (index) and control adoptees, and did not cover “many generations.” Lieberman and Ogas, like many previous textbook authors, seem unfamiliar with the original “evidence” that psychiatry ceaselessly puts forward as proof that its disorders are “highly heritable.”
- Lieberman and Ogas also repeated the common yet incorrect claim that, compared to the general population expectation, Kety found a 10-fold increase of “schizophrenia” among the family members of people diagnosed with schizophrenia. Elevated rates claimed by Kety and colleagues were based on the after-the-fact expansion of the schizophrenia concept to include so-called “schizophrenia spectrum disorders.” David Rosenthal, Kety’s closest collaborator, stated that Kety and colleagues “broaden[ed] the concept of schizophrenic disorder as widely as it may have ever been reasonably conceived before.”8 Kety would not have found statistically significant results without this maneuver. The 1968 Kety-led study found zero cases of chronic schizophrenia among the 65 identified first-degree biological relatives of the index adoptees, and the 1971 Rosenthal-led study found that only 1 of the 76 adopted-away biological offspring of a parent diagnosed with a schizophrenia spectrum disorder had received a hospital diagnosis of chronic schizophrenia. Had the researchers decided to count only these chronic cases—as schizophrenia was defined in Denmark—they would have been forced to conclude that schizophrenia has no genetic component. (For more on the Danish adoption studies, see my January 18th, 2016 MIA posting.)
- According to Lieberman and Ogas, “environmental factors likely play a role” in causing schizophrenia. But the role of environmental factors is not only likely; it is certain because MZ concordance rates are well below 100%. If genes were the only factor, MZ concordance would approach 100%.
- The authors wrote, “By 1960, nearly 60,000 Americans had been sterilized in a government-sanctioned effort to eradicate mental illness,” a practice they correctly viewed as “appalling.” This practice was supported not only by political leaders, but by leaders in science and psychiatry as well. The further post-World War II turn against eugenic theories and practices in the 1960s and 70s was due mainly to social struggle and social enlightenment on a massive scale, not because psychiatry was pushing for it.
- For example, in the 1938 edition of his Manual of Psychiatry and Mental Hygiene, American psychiatric investigator and twin researcher Aaron Rosanoff supported eugenics and forced sterilization. Although he recognized that “social and economic factors” are “of quite overwhelming importance” in producing “antisocial behavior,” be believed that in many cases, “permanent segregation and, possibly, sterilization will have to be arranged, for the double reason of protection of society and eugenic effect” (italics in original).9 Rosanoff supported eugenic measures and forced sterilization for other psychiatric conditions.10 Between 1944 and 1965, an annual eugenics- and forced sterilization-friendly “Review of Psychiatric Progress: Heredity and Eugenics” appeared in the American Journal of Psychiatry.11 Even Abraham Myerson, the most prominent psychiatrist critic of eugenic theories and practices during the interwar period, supported forced sterilization in certain cases.12
- In Germany, “Munich School” psychiatrists such as Ernst Rüdin, Hans Luxenburger, Bruno Schulz, and many others helped promote and carry out the Nazi regime’s 1933 sterilization law, which resulted in the forcible sterilization of roughly 400,000 Germans between 1934 and 1939, primarily on the basis of being labeled “feeble-minded” or “schizophrenic.” About 6,000 people died as a direct result of the surgical procedure.13 Tens of thousands of people were killed in the subsequent “euthanasia” program, which Rüdin was involved in.14 Lieberman and Ogas did not mention the complicity of Rüdin, German psychiatric genetics, or German psychiatry in their article, nor did they mention it in Shrinks.
- The authors closed with a neutral reference to “Galton’s dream” of achieving a “mentally perfect society.” The 19th century British statistician Francis Galton was the founder of the eugenics movement, and his “dream” was to use selective breeding to prevent what he saw as the future hereditary “degeneration” of the human race. However, eugenic theories and practices in psychiatry and psychology were (and are) based on an utterly false set of premises about genetics, the environment, psychiatric disorders and psychological characteristics, and human beings in general.15
- Lieberman and Ogas believe that genes are the main cause of mental disorders, which implies that there is little need to change political policies and social conditions to improve people’s psychological well-being. Many critics, on the other hand, argue that the causes of human psychological distress and dysfunction lie outside of the body, and this is where social and scientific attention must be focused.16 A really “groundbreaking” event would be the publication by the Wall Street Journal of an op-ed piece whose authors argue that social policy changes, which would include significantly reducing economic inequality, would significantly improve people’s psychological well-being, and would greatly reduce the prevalence of psychiatric disorders.
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- Lieberman, J., & Ogas, O., (2016, March 3rd), Genetics and Mental Illness—Let’s Not Get Carried Away, Wall Street Journal.
- Lieberman, J., & Ogas, O., (2015), Shrinks: The Untold Story of Psychiatry, New York, NY: Little Brown.
- American Psychiatric Association (2013, May 3rd), Chair of DSM-5 Task Force Discusses Future of Mental Health Research; Statement by David Kupfer, M.D., American Psychiatric Association [Press release].
- Joseph, J., (2013), “‘Schizophrenia’ and Heredity: Why the Emperor (Still) Has No Genes,” in J. Read & J. Dillon (Eds.), Models of Madness: Psychological, Social and Biological Approaches to Psychosis (2nd ed.; pp. 72-89), London: Routledge.
- Joseph, J., (2006), The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes, New York: Algora, Chapter 7, pp., 125-127.
- In their book Shrinks: The Untold Story of Psychiatry, Lieberman and Ogas described Kety’s adoption study comparison groups and conclusions as follows:
“To settle the question of schizophrenia’s genetic basis, Kety started a new study. He identified individuals with schizophrenia who had been adopted at birth and examined the rates of schizophrenia among both adoptive and biological relatives. He found higher rates of schizophrenia in the biological relatives, but not in the adoptive families….These findings demonstrated that schizophrenia was at least partially due to one’s genetic endowment…”
This is an incorrect description of the groups that Kety and colleagues actually compared. In their major publications, these researchers based their conclusions on diagnostic comparisons between their index biological relative group versus their control biological relative group, not between their index biological versus index adoptive relatives.Key and colleagues wrote in 1976 that comparisons “between adoptive and biological relatives” are “inappropriate,” and Kety wrote in 1983 that conclusions drawn from “improper” comparisons between index biological versus index adoptive relatives are “fallacious.” In a yet another 1983 publication, Kety wrote,
“We anticipated that there would be differences between adoptive and biological relatives in age, socioeconomic status, life style, and other variables. For that reason we planned not to make comparisons between these two groups of relatives but, instead, as described fully in the original publications and outlined above, to compare each group with their respective controls in evaluating separately the significance of genetic or family- related environmental factors.”
Kety, S. S., (1983), Mental Illness in the Biological and Adoptive Relatives of Schizophrenia Adoptees: Findings Relevant to Genetic and Environmental Factors in Etiology, American Journal of Psychiatry, 140, 720-727, p. 721; Kety, S. S., (1983), Dr. Kety Responds [Letter to the Editor], American Journal of Psychiatry, 140, 964.
Kety et al., (1976), Studies Based on a Total Sample of Adopted Individuals and their Relatives: Why They Were Necessary, What They Demonstrated and Failed to Demonstrate, Schizophrenia Bulletin, 2, 413-427, p. 420; 5
- Maxmen, J. S., & Ward, N. G., (1995), Essential Psychopathology and its Treatment (2nd ed., revised for DSM- IV), New York: W. W. Norton, pp. 70-71; Ridley, M., (2004), The Agile Gene: How Nature Turns on Nurture [Originally published as Nature via Nurture], New York: Perennial, pp. 105-106. For more on textbooks’ misreporting of schizophrenia adoption research, see Joseph, 2006, Chapter 5.
- Rosenthal, D., (1975b), “The Spectrum Concept in Schizophrenic and Manic-Depressive Disorders,” in D. Freedman (Ed.), Biology of the Major Psychoses (pp. 19-25), New York: Raven Press, p. 19.
- Rosanoff, A. J., (1938), Manual of Psychiatry and Mental Hygiene (7th ed., rewritten and enlarged), New York: John Wiley & Sons, pp. 641-642.
- Rosanoff, 1938, pp. 759-761.
- For example, see Kallmann, F. J., (1952), Review of Psychiatric Progress 1951: Heredity and Eugenics, American Journal of Psychiatry, 108, 500-503.
- Myerson, A., (1925), The Inheritance of Mental Diseases, Baltimore: Williams & Wilkins, p. 320.
- Schneider, F., (2011), Psychiatry under National Socialism: Remembrance and Responsibility, European Archives of Psychiatry and Clinical Neuroscience, 261, Supplement 2, S111-118.
- Joseph, J., & Wetzel, N., (2013), Ernst Rüdin: Hitler’s Racial Hygiene Mastermind, Journal of the History of Biology, 46, 1-30.
- Joseph, J., (2004), The Gene Illusion: Genetic Research in Psychiatry and Psychology under the Microscope, New York: Algora; Joseph, 2006; Joseph, J., (2015), The Trouble with Twin Studies: A Reassessment of Twin Research in the Social and Behavioral Sciences, New York: Routledge.
- Read, J., (2013a), “Childhood Adversity and Psychosis,” in J. Read & J. Dillon (Eds.), Models of Madness: Psychological, Social and Biological Approaches to Psychosis (2nd ed.; pp. 249-275), London: Routledge; Read, J., (2013c), “Psychosis, Poverty, and Ethnicity,” in J. Read & J. Dillon (Eds.), Models of Madness (2nd ed.; pp. 191-209), London: Routledge.