Mar 22·edited Mar 22Liked by Awais Aftab

As someone who has no scientific training and is interested in the genetics of psychiatric conditions, I appreciate your clear writing on this subject. It’s a particularly confusing subject. I intend to read some of your earlier posts.

I do feel that you are missing something, though. Maybe MIA is going to extremes concerning genetics, but they’re only doing what psychiatrists have always done. You say MIA “offers overly simplistic answers to complex questions.” But that’s just what the earlier researchers did, referring to schizophrenia as if it were a “genetic disorder” and not being caused by many factors. Before that, many claimed that it was caused by bad mothering, and there was a backlash to that—mothers got angry!—so they switched to, no, it’s entirely a brain disease. Unfortunately, everyone—scientists too!—tends to cling to theories that focus on just one cause. I guess that’s changing in psychiatry, but it’s still got a long way to go.

You also say that MIA “presents the psychiatric profession as homogenous, corrupt, and self-serving.” I don’t think the profession is homogenous these days, rather in a state of confusion! but maybe that’s because it’s in a state of change, and maybe that’s good.

As for corrupt, do you really think psychiatrists are any less corrupt than anyone else? Is ‘corrupt’ the right word for a profession that has been influenced so much by the money of the pharmaceutical companies? Would you call Freud and all who followed him corrupt in denying the evidence of incest and claiming, without evidence, that very young children fantasize about sex with their parents? Seems corrupt to me. Psychiatry has a history of corruption, as MIA, among others, usefully points out.

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Thank you Zida!

Well, in that relevant passage about overly simplistic answers & presentation of psychiatric profession as homogeneous, corrupt, & self-serving etc, I’m talking generally about the populism aspect of antipsychiatry & not specifically about MIA, but yes, I do think a lot of it applies to MIA as well. The main thing I wanted to highlight was “distrust-the-experts” part of the dynamic.

Every clinical and scientific discipline has shortcomings. Psychiatry is no different. I do think there has been a strong reductionistic tendency in many segments of the discipline and I think public communication has relied heavily on overly simplistic buzzwords that have failed to convey the complexity of and uncertainty around the issues at hand. I do not think psychiatry is free from blame and I have written about it before. You are also right that we have a long way to go.

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Mar 25Liked by Awais Aftab

I think some common "pro-psychiatric" misconceptions about genetics that Awais fully agrees with are the following:

1. People think of "genes" and "the environment" like this:

"Oh, it's 70 % hereditary, so the genes did most of the work, meaning that the environment hardly affects anything."

You see this not just in psychiatric contexts, but also when people discuss obesity, for instance. You look at people who live in the same country in the same time period, and obesity comes out as having very high heritability. Then people think these results somehow contradict the fact that obesity rates have gone up and up over time. What is it, really? Is it genes or the environment? Or is it calories in-calories out (which people perceive of as a THIRD explanatory option)?

So many people have completely flawed understandings. They don't get that genes always express themselves in an environment, and that environmental influences always go through our bodies built by genes. They don't get that there may be all kinds of proximate causes in between "genes/environment" and "phenotype". So many "pro-psychiatric" or "pro medical model" discussions tend to be quite wrong-headed too.

2. With schizophrenia in particular, there's also this weird-ass idea that findings according to which it's equally common across the world (I'm spontaneously sceptical of the idea that we really have good data here - surely there are differences between cultures in how people get diagnosed?) constitute a strong argument for the thesis that it's "mostly genetic".

Some health problems can vary greatly in frequency across the globe, and still be inherited in a relatively simple manner, like sickle-cell anemia. It's also possible that something is global even if some external cause is important. Suppose, as an example, that smoking becomes super popular in Hollywood and then quickly gains popularity in most countries in our globalized and Hollywood-influenced world, and COPD becomes globally common as a result.

3. Finally, if we're discussing matters such as quality of life, there's a huge and important difference between being weird and neurodivergent but happy and functional on the one hand and being in deep distress and mentally ILL on the other. Even if we know quite a lot of genes that increase the probability that someone will be mentally WEIRD, external factors might be super important in steering them either to "weird and fine" or "weird and in horrible distress".

I think lots of people have come to view autism and ADHD as inherently neutral neurodivergencies that may or may not cause suffering and distress, but they think there's still a sharp line to be drawn between those neurodivergencies and horrible mental illnesses that are inherently distressful. But I also think it's clear that it's way messier and much more complicated than that.

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@Jeppsson, You might like Dennis Noble, the systems biologist claiming that genes are non-deterministic. He is commonly found on IAI disputing Dawkins and others.

Myself and colleagues (various research nonprofits) too find problems with the genetics argument from an applied level. Of what clinical, ethical, or social value is it to invoke a genetics argument to a service user or even the public, regardless of it's truthiness? We have never found one. Instead we often find ourselves agreeing with people like Noel Hunter. To paraphrase, it is but "a 'metaphoric blame-game' wherein people no longer need to be concerned about their own behaviors, but rather blame generations prior for passing down bad genes due to their (or other society's) problematic behaviors and lifestyles". Indeed, it seems to fit in quite well with the anti-free will agenda throughout neurosciences: "Free will can't be real, so no one is responsible for anything whatsoever! Now give us more money for this next gen MRI machine!"

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Haha, I'm a philosopher who started my career writing about free will, though now I focus on philosophy of psychiatry and philosophy of madness. And empirical scientists who wanna discuss free will are often SO bad. #notallempiricalscientists , of course, and #notallneuroscientists. But way too many believe that they don't need to know any philosophy, because empirical science is better than philosophy. They don't even understand that those are different subject matters, concerned with different types of questions. They believe that philosophers do the same thing as empirical scientists, only rely on armchair speculation instead of empirics, and therefore worse. And then they plow ahead and do philosophy too without realizing that this is what they're doing, and predictably, the results are awful.

But it's interesting you're talking about the "blame game", because moral philosophers are traditionally fond of drawing these strict lines between actual moral blame and merely causal responsibility attributions. And then they'll insist that those are completely different, and telling someone they have "bad genes" is squarely in the latter, supposedly far less loaded, camp. I think this is wrong-headed and comes from the fact that philosophy is so dominated by quite privileged people. But yeah, future work is coming on this.

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Mar 22Liked by Awais Aftab

Thank you very much for this thorough critique of Whitaker’s misleading pronouncements about the genetics of schizophrenia—his latest salvo in the anti-psychiatry campaign he and his MIA army have been waging for some time. I am not qualified to evaluate the complexities of the genetics or the statistical arguments. But I have observed the damage that the anti-medical view of mental illness can do. Of course questions of etiology are infinitely complicated (and not resolvable in my lifetime). These are not just academic questions, however. “Have a better childhood” or “wait for a society to be more humanely organized” don’t cut it as solutions faced with acute mental suffering. The consequences of accepting Whitaker’s anti-medical propaganda can be dire. He positions himself in part as a crusader against the greed of Big Pharma, but he too has a dog in the fight. I don’t claim to know his motives, but Whitaker's livelihood is dependent on promoting his own ideological position. He is a journalist and the exposé is his bread and butter: An important function, but not when the baby goes the way of the bathwater and no realistic alternative is on offer.

Perhaps it is human nature to take a dim view of doctors—like undertakers, they inhabit a realm we would all rather avoid. They become associated with illness and pain and so end up being blamed for its existence.

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Mar 22Liked by Awais Aftab

Thank you for putting the work into refuting disinformation from MIA. “The amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it.” - Alberto Brandolini.

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Mar 24Liked by Awais Aftab

This is an excellent, and helpful, review of MIA. Thank you Awais :).

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Just read Aftab piece on JAMA v MIA on ‘genetics’. Far too much for proper argument here but It would be good if there was some humility. The most sophisticated writers know that they are struggling in the dark in this domain. There are trillions of synaptic connections in the human brain and gene/SNP expressions and connections are highly malleable or plastic. Nearly everyone has not got too far beyond the” P=G x E” formulation and the aspects of ‘E’ that have been ‘studied’ are predictable and they are political – cannabis use, in utero insults, obstetric complications etc. Probably the only non ‘biologically oriented aspects of ‘E’ that have been examined are urbanicity especially ethnic density. In the domain of ‘heritability’ so-called, for example, regression models, correlations and other ‘elemental’ ones fail to recognise that the brain, body and world are integrally connected and can’t be reduced to ‘components’. MIA and JAMA equally “don’t know what they don’t know” and to position JAMA as the ‘experts’ and MIA as ‘populists’ (not of the positive kind) is not a scientific argument as Awais Aftab well knows. It is simply spin to invoke the Trumps, Bolsonaros, Erdogans etc of this world here and if Aftab doesn’t like ‘connotations’ he should just think about what’s implied by this term ‘populism’. It is far too serious for a start. I am a novice in this domain and claim just the ‘ordinary public interest’ Aftab worries about. I just suggest reading Thomas Osborne and Nikolas Rose forthcoming book The Future of Humanity: Being Human in a Post-Human World.


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