The Dangers of Precision Medicine: Mental Health Is Not a Battlefield

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Precision medicine promises a new era of highly targeted treatments akin to precision strikes in warfare, aimed at ‘combating’ disease at the most individual, localised level. Hailed as the future of mental health care, it conjures images of medical interventions as carefully planned and executed military operations, striking with lethal accuracy at the heart of mental suffering while minimising collateral damage.

Yet, beneath this veneer of exactitude, precision mental health harbors myths and inherent dangers that undermine some of its promise. One of the most prevalent of these is that mental health is genetically determined and can be largely understood and treated by identifying specific genetic markers. Another is its emphasis on pharmacogenomics (how genes affect one’s response to drugs), which emphasises medication as the primary means of intervention.

Photo by A.T. Kingsmith

In areas like cancer and certain chronic diseases, where treatments and medications have been developed to target specific genetic mutations, precision medicine has shown promise. As Sally Satel points out, the precision model has been effective in treating cystic fibrosis because it located the single dominant gene mutation that drives the pathology and developed a medicative response, disarming the harmful product of that mutation. But what about the use of precision ‘targeting’ in other fields like psychiatry and psychology, where there is little evidence of causal genetic mutations to take aim at? How effective can a personalised approach to mental health be in a context wrought with widespread systemic deficiencies in access to basic care?

The promise of precision medicine is that it can safely mark and neutralise the underlying causes of mental suffering, giving diagnostic clarity and accuracy in a way that more generalised medicine cannot. What this metaphor of ‘combatting’ mental illness through precision strikes does is to reduce mental health to a series of targeted attacks on specific disorders. Sickness is thus understood not in psychological, social, or environmental terms, but in terms of biological markers and data points, mainly genetic predispositions and neurobiological characteristics, which are then taken to be the underlying causes of a person’s mental suffering.

Mental health is not a battlefield

The language used to describe suffering carries significant weight. For instance, the practice of characterising a patient as a ‘fighter’ battling a disease, or viewing an illness as an ‘enemy’, is deeply ingrained. This connection between mental health and the use of battlefield and warfare metaphors has meaningful implications for how people perceive and cope with mental health conditions, influencing how care goals are set and treatment plans are designed.

By blurring the lines between the literal and figurative, battlefield metaphors do more than explain similarities, they also construct them. As Dhruv Khullar observes, terms like ‘fighting’ or ‘battling’ tend to create a perception of health as adversarial, setting a confrontational tone. This framing can affect both the patient and the public’s understanding of suffering, often oversimplifying the complex nature of mental health conditions. As Khullar elaborates, this suggests a scenario where suffering can only have two perceived outcomes: victory or defeat.

Such a binary outlook adds further pressure to those suffering, making them feel as if they must constantly wage war against their conditions. What’s more, the notion of fighting a health condition implies that success depends on individual effort and resources, which can marginalise those with limited access to healthcare resources, including the uninsured or underinsured. New diagnoses or changes in regimens become retreats or advances, relapses and institutionalisation are battles lost, costly bills pilling up as the war rages on.

What these militarised metaphors do is amplify the threat in a certain way, superimposing a conflict narrative over a person’s lived experience of mental health. Illness is the enemy. Drugs are weapons on the battlefield of the body. Sufferers must soldier on, lest they be perceived as ‘not fighting hard enough’, which can further intensify stress and isolation. According to Peter Hodgkin, the operational logics of such ‘medicine is war’ metaphors are primarily centered around reinforcing the notion that ‘taking action’ is a virtue, viewing patients as passive, with doctors, diseases, and medical and technical ‘weapons’ as the main protagonists.

The idea of being in a constant battle is exhausting because it implies that health is a matter of personal effort while also relegating sufferers to a passive role in their mental health care. Feelings of failure or weakness become issues for anyone who does not experience their mental health in a narrow sense of triumph over the enemy within. The prevailing atmosphere of guilt, inadequacy, and self-blame that arises from this ‘war on mental health’ approach can exacerbate the challenges faced by those dealing with mental health conditions.

Genetic determinism and biological fatalism

The allure of precision medicine lies in its promise to pinpoint the genetic causes of mental conditions and tailor treatments accordingly. The quest for identifying genetic biomarkers in schizophrenia exemplifies the pitfalls and limits of this approach. This search, deeply rooted in 19th century concepts of eugenics, assumes a simplistic causation model where genetics are seen as the primary determinant of complex mental health conditions and outcomes. As a result, it not only overlooks the nuanced interplay of environmental and social factors but also imposes stigmatising narratives around ‘deviant’ genes and bodies.

In a 2016 study published in Nature, researchers proposed some potential biological origins of schizophrenia, receiving widespread coverage with headlines indicating significant breakthroughs in understanding the condition. However, as Noel Hunter points out, the study’s actual impact and findings were far less profound than suggested by the media. Rather than a decisive step forward in the precision targeting of specific ‘irregular’ genes, the actual content of the study highlighted the need for a more nuanced, comprehensive approach to understanding and treating the complex, multi-factorial nature of mental health conditions like schizophrenia.

By framing studies like this as breakthroughs without adequately discussing its limitations or the complexity of schizophrenia, the media perpetuates a misleading narrative that mirrors the genetic determinism of precision medicine in mental health diagnostics and treatment. This reductionist framing is further intensified by current trends in pharmacogenomics, which presume that a person’s response to psychiatric medication can be finely tuned based on their genetic makeup. Exposing patients to a range of side effects, some of which can be severe and long-lasting, this approach often leads to a trial-and-error method of prescribing high-dose medications or a cocktail of drugs, hoping to hit that elusive genetic target.

Describing drugs as a ‘weapons’ or ‘magic bullets’ encourages more aggressive treatment strategies. It also normalises an entirely data-driven healthcare landscape, where the complexity of mental health is reduced to a series of inputs and outputs—cause-and-effect relationships determined largely by genetics. Bolstered by the aggressive marketing of pharmaceuticals as precise tools targeting specific genetic markers, pharmacogenomics risks fuelling a cycle of dependency just as debilitating as the mental health conditions they aim to treat.

Moreover, the emphasis on genetic determinism in precision mental health perpetuates a sort of biological fatalism. Sufferers and their families are left with the impression that mental health conditions are predetermined and unchangeable, locked in one’s genetic code. This narrative diminishes the role of social support systems, and reifies societal misconceptions about ‘mental deviance’, further alienating those who suffer from these conditions.

Mental health as a garden

Couched in a technical, deterministic, confrontational mode of thinking about mental health that implies a battle against an internal enemy, precision medicine neglects the complex reality of mental health conditions, which are deeply embedded in personal histories, socio-cultural contexts, and lived experiences. This neglect is symptomatic of the market-driven nature of precision mental health care.

As I highlight in a previous piece on ‘high-functioning anxiety’, mental health diagnostics and treatment in a capitalist system operate within a framework that prioritizes efficiency, competition, and profit. Combat metaphors like ‘fighting illness’ align well with this ethos because they portray health as a battle to be won, emphasising individual responsibility and resilience. At the same time, the heavy reliance on data-driven solutions and pharmacological interventions in precision medicine renders sufferers as passive recipients of care dependent on medical technologies and drugs to wage their internal war.

James Tabery’s work in Tyranny of the Gene uses a historical perspective to shed light on how we got into this paradox. By examining the competition between genetic and environmental research at the National Institutes of Health since the late 1990s, Tabery highlights how precision care’s fundamental approach can be misleading and distracts from more impactful research into how factors such as racism and socio-economic conditions affect mental health. In doing so, it often diverts resources away from basic care to access, broadening and legitimating health disparities framed across a binary of winning or losing.

Ultimately, any metaphor—combat or otherwise—is not inherently good or bad. They serve as a means through which to express and understand suffering within a given social context. If the metaphor of precision imposes damaging language and practices on patients and practitioners, then there’s a pressing need to reframe and reimagine our understanding of mental health care beyond the narrow confines of this battlefield.

Rather than a war to be fought within individuals, we should envision mental health as a garden to be carefully nurtured. In this ‘garden’ model, mental health is seen as a collective, dynamic cultivation process. Here, environmental influences, social connections, and personal factors interact synergistically, much like the roots, soil, and water in a thriving garden. The emphasis shifts from targeting isolated genes to nurturing the complete well-being of individuals within their environments.

This holistic approach recognizes the intricate interplay of elements that contribute to mental wellness and underscores the importance of comprehensive, preventative care. Such a model requires substantial investment in community-based mental health initiatives, bolstering social support networks, and tackling systemic issues such as poverty, inequality, and social injustice. It also means empowering individual sufferers to play a more engaged, participatory role as active gardeners of their mental landscape.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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22 COMMENTS

  1. Another description of the problem is ‘reductionistic thinking’ – the cognitive biases we tend to default to – what one attends to and sees, what cognitive framework and narrative one has to articulate this. The wider issue is the operationalisation and commodification of phenomena, both natural and human kinds, the measurement mania, the managerial mentality, that is a feature of the neoliberal ideological framework and what follows is the ‘cookbook’ approach where this dogma is further enshrined in ‘treatment guidelines’ – encouraging practicing medicine by numbers. The person is not seen or attended to, instead the person is reduced to a ‘lesion’, the biomarker, the measurement taken etc, and responded to accordingly. This is McMedicine.

    It is possible to use so-called’ precision medicine to inform one’s humanistic engagement with the person and their contexts.

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    • As a Homeopath we treat such patients with great success..individualised treatment is the go….if a bank robbery takes place with 10 customers involved the resulting trauma can produce 10 different symptoms which we individualise and treat successfully…no side effects…

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  2. Good info. To have. Question, since all bipolar 1 meds don’t actually work well or at all, there is no meds,, no effective therapy available affordable I’ve found out in Phoenix, AZ. So, with no working meds, no affordable therapy, I suggest maybe make a safe working med. And until then give back the 4 msg of Klonopin for patients who don’t abuse them so they can live a life worth living and longer. Still searching for that doctor

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  3. The use of genetic testing is expected to reduce the extent of over treatment with antipsychotics on a patient by patient basis. At the moment we are essentially guessing what would work for someone and causing a lot of side effects. Knowledge of receptor patterns and which antipsychotic will fill these correctly, at which likely dose and over what expected amount of time would leave a lot more room for your desired holistic approach when possible.

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    • I don’t see how more genetic testing is required to recognize how ludicrous the current prescribing is. People who are not psychotic are put on antipsychotics (people with bipolar diagnoses, borderline diagnoses, depression, people with dementia, people in nursing homes, children) and even people who are experiencing a psychotic episode get put on APs and left on them indefinitely, almost always without informed consent or support in dealing with devastating “side effects” and almost always without a plan for coming off the drugs.

      The author’s desired holistic approach is desired by most patients and psychiatric survivors, who deserve the chance to live a full life and not be disabled by neurotoxins. After 4 decades of the current prescribing system (since the “atypical anti psychotics” came on the market) we are physically and spiritually ill and shouldn’t have to wait for more genetic testing for drastic changes to be made. These drugs are neurotoxins with debilitating effects.

      The money should be spent on basic needs, the prevention and treatment of trauma, and consensual treatments/community supports.

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    • The stated approach is discrimination genocide against a targeted person before its even conceived. I’d like to say forgive them for they know not what they do but I can’t. It’s too personal. Medical ethics leaves alot to be desired in breaches of 53 nuremberg and the ongoing torture of those malpractice victims soo easily coined mentally ill after the fact after the malpractice to commit genocide and sterilization eugenics in sanitized society of carbon copy workers for the state and call it humanity…don’t forget the God gene now how personal is that

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  4. To me, precision medicine sounds like a logical extension of the dominant ideology about treating “mental illness”. Western medicine has always been focused on killing things (bacteria, infections, cancers, viruses). I think most psychiatrists, and many therapists, view treatment as killing the piece of the person that they think is causing the “mental illness”. They wanted me to stop thinking about suicide without asking whether the part of me that gave rise to suicidal thoughts had some value. They put people on anti-psychotics with the aim of making them stop thinking the thoughts that they see as a problem. If that means stopping most of the thoughts/creativity, they see that as a fair trade. With ECT they are literally killing brain cells, killing memories.

    Many patients who spend long enough in the system, unless they are exceedingly fortunate, begin to sense that mental health treatment is very much a battlefield. We know that in certain instances, police will be involved. We know that sometimes you need to lie to get out of “prison”. We feel it in our bodies when the drugs kill off sensations and emotions.

    People talk about wanting to write online reviews about places where they’ve been harmed, but they are aware of the possibility of retaliation.

    This sounds like more of the same ideology, unless I’m missing something.

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  5. It feels like a battlefield. This author has strong opinions, with great emotion and I don’t find it super helpful or indicative of how I feel. In one statement it says it should take certain things into consideration then says the opposite later. That’s only my perception. I’m continually disappointed at these articles but like learning new things. I’ll keep reading but it would be great if the author relaxed a bit. Us crazies know that acting that way doesn’t get your point across better.

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  6. “The allure of precision medicine lies in its promise to pinpoint the genetic causes of mental conditions and tailor treatments accordingly”

    To me, after being experimented on for 35+ years with a cascade of drugs prescribed by doctors who couldn’t even be bothered to take my weight into account when determining dosage (one Dr prescribed 20 different drugs over a 6 year period, at the end of which I learned, he’d kept NO records), this screams: stay away from psychiatry at all costs. Whoever is in charge of the research trends is either completely out of touch with reality or entirely corrupt.

    They can’t face the fact that their billions of dollars of genetic research has led nowhere, or the money is so good that it doesn’t matter.

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    • Yes, and most of society goes along with it. If dogs or cats were treated the way psych patients are treated, people would be marching in the streets.

      Most people just lie to themselves/stay ignorant and say things like “Thank God it isn’t like it used to be, when people were kept in asylums and subjected to inhumane treatments. Thank God everything they do now is based on science and patients are protected!”

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  7. Look in the DSM and see how related ANY disorder is to genetics – very small correlation in a few cases. Big problem is no one knows how the brain works properly. therefore there is no way to know what physical vector a disease or disorder takes because we don’t know how the brain works. We don’t have that level of detail. Most mental health issues are relational and environmental even when there is physical trauma. This is a farce to create a false solution to attract popular support because people believe science knows more about the brain than we actually do. We know some real things about Altzheimers and other dementias. But we can’t cure it. no one knows how to cure any of them. So we don’t know who’s on the battlefield nor even where in the body the battlefield exists. And it isn’t a battle, it is really a coming together and making whole.

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    • Similar to the author, it strike me as strange/bizarre/inappropriate/reductionist… that the concept of war is used so often when used to address human issues. How successful have the “wars” on poverty, want, drugs, waste and others actually been? In the article, Launching the ‘War on Mental Illness’, J Licinio & M-L Wong, in Molecular Psychiatry volume 19, pages1–5 (2014), the authors advocate for another war, “It is unquestionable that a ‘‘War on Mental Illness’ is necessary, timely, and technically feasible.” But they don’t seem to realize that wars are made against people with devastating consequences.

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  8. I wish I had the time to point out every single thing scientifically wrong with this article and the harm this perpetuates against mental health but I don’t.

    This author has a PhD in Political Economy so theyre not really a reliable source of information regarding pharmacogentic testing(which is literally meant to help limit trial and error of medications). This author also managed to forgot about the most important thing for mental health… AUTONOMY.

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    • Patient autonomy? Maybe some patients are privileged to have autonomy while the rest of us are subject to coercion and force.

      I experienced 40 years of trial and error. As a result I’ve spent the last five years mostly bedridden. But they still pour money into looking for genetic solutions to problems no one has ever substantiated are genetic.

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      • I know me too I’ve been bedridden now 5 years under to walk since 86 more than 2 blocks now not at all. Misogynist medical intrusive invasive and brutal force and coercion by denial of fundamental human civil constitutional rights they invalidate discredit their victims never take responsibility. I hope things are better for you heaven awaits you, believe.

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  9. Beautiful use of words. Einstein stated the last frontier was the human mind and the violence and hatred malice of medine towards this marginalized group even historically is outrageous…the experimentation and crime, genocide in ww2 and the centuries upon centuries of victimization hear can be heard thank you again medicine has and wll never conquer the source and the true mechanism of the human mind in which the spirit of man and his very soul resides and moves. Unless a danger to self and or others and meets the burden of proof society should accept others for who they are vive la difference.

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