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Wednesday, 20 December, 2000, 10:21 GMT
Nature versus nurture?
Scientists are predicting huge breakthroughs in the treatment of mental illness as a result of the imminent cracking of the human genetic code.
They believe they will soon be able to identify the genes which cause many mental health problems, such as schizophrenia, with the result that new drugs can be developed.
In a recent article in the British Medical Journal, Peter McGuffin of the Institute of Psychiatry in London, and Neilson Martin from the University of Wales College of Medicine, predicted genetic advances would lead to better treatments for mental illness and eliminate discrimination.
They believe research already shows responses to some anti-psychotic drugs is influenced by genes.
But campaigners warn that science may not hold all the answers.
The argument about whether mental illness is caused by nature or nurture is one that has raged for years, with consequent splits between those who believe counselling and therapy rather than drugs or operations are the solution.
As mental illness emerged from the asylums into the community in the1950s and 60s, there was a big growth in the nurture side of the argument due to the work of psychoanalysts such as RD Laing.
Many argued that the family as at the root of mental disorder.
Much was made of the so-called double bind theory for schizophrenia which suggested that children who often received contradictory messages from their parents were more likely to develop the illness.
But many now believe that the theory has not been substantiated by scientific studies.
It has also been highly controversial and made parents feel they are to blame for their child's illness.
In a paper for the International Congress of Psychology, Mathijs Koopmans of City University in New York states: "There is a very persistent misconception that models connecting family processes to schizophrenic symptomatology in effect blame the parents for their children's ills, rather than recognising the potential of such models to empower parents and caretakers to modify their interactive patterns to better accommodate the identified patient, and perhaps even prevent dysfunctional patterns of interaction from occurring in the first place."
Mr Koopmans argues that more research is needed to either prove or disprove the double bind argument.
Dr Demitri Papalos of the Albert Einstein College of Medicine in New York says acceptance of the role of genetics in mental illness has come gradually because of resistance from psychiatrists and behavioural scientists.
But while he believes genetics has an effect, he says studies on twins suggest that nurture also plays a role in schizophrenia.
One study showed about a third of twins raised separately did not both develop schizophrenia, suggesting that, if there is a genetic trait for the illness, environmental factors may trigger it.
However, research shows that a child whose parent has schizophrenia may be up to 10 times more likely to suffer a mental illness than average.
Scientists, for example, have suggested that children whose mothers have eating disorders are more likely to develop the problem themselves.
But eating disorder experts warn that it is unclear if the link between parent and child is because children have learnt the behaviour or are genetically predisposed to it.
Health campaigners also state that higher levels of schizophrenia among black people suggest social pressures play a significant role in mental illness.
Dr Papalos argues that the rise of antidepressants and other mental health drugs has stimulated interest in the medical model of mental illness.
But many patients suffer relapse after being given medication and he believes environmental factors may play a role.
He says there has been little research into whether giving patients and their families more information about their illness helps them to take their medication and prevents relapse once they have been released from hospital.
He believes the balance has shifted too much towards the medical treatment of mental illness in recent years.
"Simply relegating these disorders to the realm of physiological disturbances that require medical treatment alone is a serious clinical oversight and a gross scientific presumption, similar to earlier psychological oversimplifications and prejudices that compounded the difficulties that have inhibited the development of multidimensional treatment approaches," he says in a recent paper.
Mental health charity Mind also believes too much emphasis has been placed on the medical model in recent years.
It says this has led to "an epidemic in overprescribing of anti-depressants".
A spokeswoman said mental illness was "very rarely" caused solely by biological factors.
"It is often caused by a combination of factors and can be triggered by events in a person's life," she stated.
Mind wants people to be given a choice over the treatment they can have.
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