Often, when an area of knowledge is particularly complex, it is dominated by ideological tribalism. Very cohesive groups are formed, with great loyalty and enthusiasm of its members, charismatic leaders and a position that is self-satisfied with their own ideas and bellicose with those of others. Sounds very familiar to us, right? Since the Them/Us divide directly affects the mechanisms of empathy, this tribal behavior has moral implications and promotes the bilardist maxim “the enemy, not water” (this is wonderfully explained by Pablo Malo in his book The dangers of morality). Well, the study of Mental Healthat least throughout the 20th century and up to the present day, has been a clear example of this.
From the irruption and hegemony of psychoanalysis, the rise of behaviorism, the pendulum swing towards biologicism, to the appearance of antipsychiatry and other alternative movements, it is customary to consider the complex field of mental illness with earmuffs and resounding arguments, don’t go unless the other is partly right. We have witnessed fratricidal fights between Freud’s disciples, mutual disqualifications between behaviorists (those “mouse researchers, not people”) and psychodynamicists (“fraudulent, unscientific”), and fierce competition to see which psychotherapy works and which does not work for each diagnosis. , although they obviously share many common factors. But the quintessential tribal struggle, always tiresome on Twitter and some forums, is that of so-called “biologists” against those who argue that mental illness is purely social in nature.
Biologicism or biological determinism advocates that all psychological and psychopathological phenomena are due to innate hereditary differences. It’s a bizarre idea that sparked fascination in the 1980s, in the blinding light of new neuroimaging tests (with colors in the brain that seemed to indicate where the core of disease lay) and advances in knowledge of the human genome (that Rosetta stone that could decipher our complicated mental hieroglyphs). Nowadays, it is not seriously defended by anyone, because it is a very simple theory, reductionist and largely refuted by the data. What has persisted, curiously, is the term “biologist”, generally used to disqualify anyone who includes biological aspects in the explanatory equation of human behavior. A professor shows data at a conference which supports that the risk of having schizophrenia increases with more family history (1% in the general population, 2-4% with a relative in the second degree, 10% with a brother, etc.) and the buzz is already being heard in the room: biologist! Likewise, it happens if he mentions the effectiveness of the drug or expresses the desire to one day find biomarkers that will help us to individualize the treatment. The Biologist Tribe was disqualified decades ago and are in the doldrums, but what is clear is that the Anti-Biologist Tribe is sorely lacking.
The reality is that all this makes no sense, because there is an academic consensus to consider the gene-environment interaction as the basic element for understanding the development of psychopathology. It is known that serious mental disorders have a high heritability and a polygenic character, but that this predisposition interacts in a dynamic and complex way with many environmental factors, decisive for whether or not a person develops the clinical picture. In schizophrenia, for example, concordance between identical (monozygotic) twins is 45%, falling to 12% in dizygotic twins; genome-wide association studies indicate more than 100 genes and copy number variations associated with disease. But this translates into an evolution or not of the clinical picture depending on the interaction with proven risk factors: complications of pregnancy and childbirth, adverse and/or traumatic events in childhood, aggressive family functioning, drug use —especially cannabis, eye—, life in megalopolises, of low socio-economic status or belonging to segregated ethnic minorities. So it’s not a gene-environment dichotomy, it’s a dynamic interaction. Genetics modulates the susceptibility or probability of exposure to the risk factor, in the same way that the environmental factor produces objective epigenetic modifications. Sometimes one risk factor (childhood trauma) moderates the response to another factor (adult stress), and sometimes genetic aggregation (verified in family studies) and risk factors (the perfect storm , for example, a traumatized, socially marginalized immigrant, cannabis user) . Epidemiological studies that attempt to untangle these interactions are very difficult and expensive to conduct, as there can be decades of latency between the risk factor and the disease.
The group led by Dr. Celso Arango, of the Gregorio Marañón Hospital, analyzed the gene-environment interaction in several disorders. In a recent study discussed the role of loneliness and social isolation in the development of schizophrenia and their common genetic bases. This is an example of how genetics ends up dealing with sociological and ultimately subjective concepts (there is an unwanted and a voluntary loneliness, there is an experience of exclusion and another of indifference, under conditions similar objectives). Genetics allows us to interact with the environment and this interaction is subjective and sometimes elusive with objective measures, having to come into play disciplines that address the inner world of people. In the future, there will be more interdisciplinary projects that weave together the biological, psychological and social substrate of mental illness. The tribal wars will leave room for the constructive contribution of each discipline and each point of view. We urgently need geneticists with a background in sociology, psychotherapists with a background in physiology, mathematicians who understand the intricacies of the literature. And having gone beyond the biology-environment dichotomy, it will be inevitable to go beyond that of science and letters in the education of our adolescents. Martha Nussbaum oh Edgar Morin they have already underlined the critical role of the human sciences in our scientific (and civic) development. But the definitive dissolution of sterile dichotomies will occur when we have understood the meaning of the complementary contradiction, present in Heraclitus, Montaigne, Pascal, Spinoza, the Hegelian dialectic, Marx or Bohr. The harm is that it forces us to distrust our tribe, our guru, our complacent comfort, it forces us to relativize the hatred – that is to say the fear – that the Other arouses in us.
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