Genetic science has progressed rapidly in the last 20 years. I am not an expert in genetics, so I will not try to explain how this has been accomplished or what specifically has been accomplished. Suffice it to say, it is brilliant and fascinating.
The idea of “messing” with genes can be scary. Hollywood loves this topic because most of their imaginary outcomes do not go well and make for stories that are as disturbing as they are compelling (See: “The Fly”). Despite our fears, we must come to terms with the fact that the field of medical genetics is here.
The human genome has been mapped and we have the ability to explore what kinds of diseases and illnesses we are prone to have. Additionally, in certain illnesses, which medications we may have adverse reactions to, or may or may not respond to.
Genes are blue prints of proteins. Proteins are the building blocks of who we are physically and mentally. Genes are specific sections of DNA, made up from “base” pairs, which are molecules that write the “code” for genes. Two strands of genetic material bind together by the base pairs and that forms the double helix design of DNA.
There are about 3 billion base pairs that spiral into DNA. The DNA is stored in chromosomes in the nucleus of every cell. The reason for pairs of strands, I believe, is that when cells split to replicate, this ensures that each cell gets identical copies of DNA. It is estimated that 99% of base pairs are the same in all of us; it is the additional 1% of DNA that makes us all so different in the inside and out.
The study of genetics and risks for medical illness is broad and has many applications. This is not yet the case for the field of psychiatry. For example, Dr. Phelps (Psychiatric Times February 2015), reports that studies show there are at least 266 genes involved in the development of Bipolar Mood Disorder. In a nut-shell, this means there are many path-ways to the development of a mood disorder, some more associated than others, but in the end, impossible to find a true genetic causation at this point.
This concept underscores what makes treating mental illness so complex. We have no x-rays, no blood tests, no specific genetic markers that help us diagnose mental illness. We rely on relationships, history taking, ongoing evaluation of patterns of behavior. Complicating this approach is the fact that psychiatric illness results in thinking and behavior changes. These are things that we naturally assume we can simply change by changing a mind-set. Contrast that to another systemic illness such as heart failure. For that, there are many tests that prove the changes are not “voluntary”, and that help is needed to restore physiologic balance. More tests can be done to assure the balance is being reached.
Despite the perceived lack of science in psychiatry, there is science. Psychiatric treatment is about treating a biologic system. That system is the nervous system. This is a complex system that drives autonomic functions, movement, behavior, thought, and feeling. If we consistently feel wrong or bad, that means there is a problem with that system.
Although causal genetic markers for mental illness remain elusive, there are still genetic applications for treating mental illness. There is “pharmaco-genetics”, not discussed in this article. There is also the field of “epigenetics”.
Epigenetics is “the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.” In other words, production from certain genes can be turned on or off by environmental or physiological influence. If a person has a gene that can cause a variant protein that can cause mental illness, stressors like physical abuse or substance abuse may cause that variant to be expressed.
There are also protective factors of genetic expression. An example is maternal love. A study from 2004 showed that the quality of a rat mother’s care significantly affects how its offspring behave in adulthood; rat pups that had been repeatedly groomed by their mothers during the first week of life were subsequently better at coping with stressful situations than pups who received little or no contact. (Reported by Bell, C, “The Telegraph”, October 16, 2013).
Applying this relatively new science to psychiatry, a focus for people with “toxic” stress in their lives is to help figure out how to better manage that or, if possible eliminate it. If a person is staying up until 3am to binge watch reality TV or play video games, educate on how those habits could alter certain genetic expression. Focus on how substance abuse can do the same. With that, we can educate on how medication treatments will likely be less effective in scenarios with toxic stress.
People with mental illness, in other words, a nervous system dysfunction or imbalance, can get better. This is accomplished with therapy, with medications as needed, with direct attention to changing life-style, and with work on eliminating certain stressors if possible, and with managing the basic stress that life can bring.
You’ve heard the line: “I’d rather have a bottle in front of me than a frontal lobotomy.” Perhaps we should update that to something like, “I’d rather handle my genetic biology than rely on winning the genetic lottery”.