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Neurogenetic determinism and the new euphenics

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7174.1707 (Published 19 December 1998) Cite this as: BMJ 1998;317:1707

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Psychosocial and ethical issues in psychiatric genetics require informed and constructive debate

Debate about the ethical and psychosocial implications of advances in
understanding the genetic contribution to susceptibility to
neuropsychiatric disorders is essential. However, Steven Rose's article
"Neurogenetic determinism and the new euphenics"1 contains important
errors of fact, severely misrepresents current research and is neither
reasoned nor balanced.

This article makes some points with which we wholeheartedly agree,
including the importance of assuming personal responsibility for normal
behaviours and the fact that major medical advances bring with them major
ethical issues which require careful consideration. However, Rose launches
sweeping attacks on psychiatry and genetics that should not pass
unchallenged: He accuses researchers of simplistically assuming behaviours
are "genetically determined". In fact, most researchers in the field ,
ourselves included, are fully aware of the complexity of pathogenesis and
accept a model in which both genetic and non-genetic factors influence
disease susceptibility,2,3,4. Second, Rose makes the unfounded and frankly
disingenuous presumption that researchers seek to identify genes " ...
with a view to aborting fetuses which show the potential for such
undesirable characteristics or generating drugs which will alleviate the
condition, turn gays into straights, or radicals into conservatives". This
emotive statement both mis-represents and trivialises the aim of most
research which is to better define the pathophysiology of major
psychiatric disorders such as schizophrenia and bipolar disorder. Rose
gives the impression that this desirable end is a fortuitous by product of
research. In fact, it is the primary motivation. Third, Rose attacks
psychiatrists for creating illnesses where none exist. He offers Attention
Deficit Hyperactivity Disorder (ADHD) as an example that he claims "was
almost unknown in the UK a decade ago" and roundly berates psychiatrists
for prescribing the stimulant, methylphenidate as a treatment. "ADHD" may
be a new name but it describes a syndrome that has undergone almost a
century of study and refinement and is certainly not merely a label for
"naughty and disruptive" children5. Rose is wrong to claim that ADHD is
not a valid diagnosis and it seems both unsympathetic and arrogant to
maintain that sufferers should not have the opportunity to benefit from
potentially effective treatment.

Most researchers in psychiatric genetics readily accept the existence
of a complex interplay between genes and environment and roundly reject
the notion of "neurogenetic determinism". Their modest goal is to
contribute to improved understanding and treatment of the major
psychiatric illnesses that cause so much suffering to so many. It would be
helpful if Professor Rose stopped propounding his familiar but outdated
and tiresome anti-psychiatry, anti-genetic message and adopted a more
constructive and informed position. We need to work together to ensure the
opportunities provided by molecular genetics are used to the benefit of
our patients.
Conflict of interest: The authors are psychiatrists funded by the Wellcome
Trust to investigate molecular genetic contributions to the pathogenesis
of several psychiatric disorders including bipolar disorder, puerperal
psychosis and attention deficit hyperactivity disorder.

Professor Nick Craddock
Senior Research Fellow in Clinical Sciences,
Professor of Molecular Psychiatry and
Honorary Consultant Psychiatrist

Dr Ian R. Jones
Wellcome Trust Fellow in Mental Health
And Honorary Specialist Registrar in Psychiatry

Dr Lindsey Kent
Wellcome Trust Fellow in Mental Health
And Honorary Consultant Psychiatrist

References

1. Rose SPR. Neurogenetic determinism and the new euphenics. BMJ
1998; 317: 1707-8.

2. Craddock N, Owen MJ. Modern molecular genetic approaches to
psychiatric disease. British Medical Bulletin 1996; 52: 434-52.

3. Jones, I, Craddock N. The crisis in psychiatry. Lancet 1997; 349:
1550.

4. Jones, I, Craddock N. Ethical issues in genetics of mental
disorders. Lancet 1998; 352: 1778.

5. .Swanson JM, Sergeant JA, Taylor E, Sonuga-Barker EJS, Jensen PS,
Cantwell DP. Attention-deficit hyperactivity disorder and hyperkinetic
disorder. Lancet 1998; 351: 429-433.

Competing interests: No competing interests

21 January 1999
Nick Craddock
Wellcome Trust Senior Research Fellow in Clinical Sciences and Professor of Molecular Psychiatry
Ian Jones, Lindsey Kent
Division of Neuroscience, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham