Neuroscience: Why we cannot explain psychopathology based only on genes

This is a simple article to explain highly complex subjects: neuroscience, psychopathology and genetics. The question is, why, despite decades of progressive molecular biological research, we cannot exclusively answer psychopathology / mental disorders not caused entirely by organic conditions, by looking at genes alone. Although there are numerous twin studies for mental disorder, the results are inconclusive.

The diagram below describes the simplistic idea to a comprehensive concept of genetics linking to mental disorder (psychopathology).


It would have been easy if we could identify a gene for each disorder, as in (a). With issues of the psyche, it is much more complex. The nature of genes is that genes switch on and off, and what gets transcribed from genes into proteins are very dependent on the environment in which the individual lives in and the experiences (consequence of time / relationships / fate).

The image below describes how the environment / perceptions and social interactions affect gene expression and the condition of the neurocircuits in the brain.


The graphic below explains how multiple experiences and the type of life experiences affect gene expression and hence the severity of a psychological symptom.

The diagram below further illustrates the effects of stress on gene expression leading to neurological consequences that lead to setting up of psychiatric disorders.


The image below shows that the genotype (and hence the quality of certain essential proteins) plays a role in susceptibility to disorder.  No man is created equal, in other words.

Which genes are responsible for what disorder? The diagram below is an illustration that disorders are complex and involve the expression of different genes.  These genes affect different biochemical pathways. In order to put a finger on which pathway leads to what consequence is complex and may not hold true for all persons suffering the same symptoms.

That said, the type of genetic make-up leads to susceptibility to a disorder. This is because the proteins that are involved in neuro circuitry, may differ in structure in different individuals (are polymorphic) even if these have the same function. The polymorphism explains why some people are more likely to get the disorder. The graphic below also explains to us that environmental factors play important role.

The diagram below repeats the same message as the previous diagram.

In conclusion, genes are simply there to be coded. The coding, however does not tell us a whole lot about the individual because the expression of the genes are regulated. Not all genes are expressed at all times, and how they are regulated is dependent on the experience of the individual’s environment / social situation and structure / family history, health, etc. Furthermore psychopathology is very complex, and in the molecular sense involves complicated biochemical pathways which are constantly being regulated. It is however true that some people are predisposed to certain conditions, however the severity of the symptoms (or if there are symptoms at all) is dependent on the environment.

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Pinel 1754-1826 on Treatment of Illness from “Moral Causes”

Out of the era of the post French Revolution, we learn about Philippe Pinel (1754–1826), one of the founding fathers of what would later become psychiatry and psychopathology.

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“Pinel is important because of his method: he was the founder of the clinic, that is to say, of the determined and systematic approach through which mental illness acquired its distinctive status, institutions, and treatment.

With regard to theory, he took a rather peculiar stance: he remained skeptical of any form of theory that, as far as he was concerned, moved too rapidly away from observation. Hence one cannot talk about Pinelian theory. Rather, he proposed a pragmatic approach, a form of know-how (savoir-faire) that enters history under the name of the “moral treatment” (traitement moral). This approach accords with his views on etiology. (Verhaeghe, 2008. p 93)”

He distinguishes between three groups of pathogenic factors / causes of illnesses:

  • • Physical causes (trauma, organic diseases);
  • • Hereditary causes (debility);
  • • Moral causes.

Deeming the first two practically incurable, he concentrates on the third group, which can be inferred to as describing psychological pathology. His ensuing treatment model recalls the Hippocratic idea of illness, in which illness is the body’s healthy defensive reaction to an imbalance, and whose normal result is health. This is not unlike much of the philosophy of traditional medicine which we also embrace today.

It is clear that such a conception of illness has important repercussions for the way the person who was then called the “alienist” responds. Pinel sums this up in three basic rules:

  • • He has to wait;
  • • He has to avoid any intervention that disturbs the natural course of the illness (because its ultimate goal is health);
  • • He must help the illness progress.

It is precisely this last that constitutes the “moral treatment.”

This principle of “waiting” instead of leaping immediately into trying to “cure” or “treat” or solve a problem” or to “eliminate the pain”, with regards to working with mental issues was also clear in the decades prior to Pinel. The creation of the 18 century Magazin by Moritz, das Erfahrungsseelenskunde, centered also around the same premise of observing without premature judgment, or looking for explanation. Moritz also wrote about the need for “moral doctors” to work with individuals seen as societal deviants.

This is also in line with the principles of the Paradoxical theory of Change in Gestalt Therapy, written by Arnold Beisser in the 1970s.

With regards to psychological health and working with patients with psychological and psychosomatic issues, this attitude of being patient, of observing and understanding the client’s symptoms, and allowing the client to understand his/her situation in order to support the change process, without premature intervention is crucial for therapeutic change in psychotherapy.

The magic pill that solves the problems immediately, does no magic in helping the client work through with the goal of dealing permanently to alleviate the symptoms of depression, anxiety and other inter- and intra-personal issues.

Bibliography

Verhaeghe, P. (2008). On being normal and other disorders: A manual for clinical psychodiagnostics. Karnac Books.