Science, medicine, and the future. Behaviour and genes

Stigma of mental illness and ways of diminishing it

Stigma is defined as a sign of disgrace or discredit, which sets a person apart from others. The stigma of mental illness, although more often related to context than to a person's appearance, remains a powerful negative attribute in all social relations. Sociological interest in psychiatric stigma was given added vigour with the publication of Stigma – Notes on the Management of Spoiled Identity (Goffman, 1963). More recently, psychiatrists have begun to re-examine the consequences of stigma for their patients. In 1989, the American Psychiatric Association's annual meeting's theme ‘overcoming stigma’ was subsequently published as a collection of articles (Fink & Tasman, 1992), and last year saw the launch of the Royal College of Psychiatrists' five-year Changing Minds anti-stigma campaign.

The experience and consequences of people with mental health problems, the impact of stigma upon people with schizophrenia: a way forward

The aim of this literature review is to explore stigma as experienced by individuals with mental health problems, focusing primarily on schizophrenia. The concept of stigma has been examined. Service users' reports of their experiences of stigma have been outlined. The role of the media, public perceptions and the role of the nurses and mental health services have been discussed. Proposals have been suggested to address stigma.

Evolutionary, neurobiological, gene-based solution of the ideological “puzzle” of human altruism and cooperation

Despite hundreds of published articles about humankind's eusocial behaviours, most scholars still regard the origin of human altruism and cooperation as an enduring puzzle, because it seems incompatible with two central tenets of evolution, namely, the competition between individuals and the consequent selective advantages of selfish traits. This "puzzle", however, rather than being due to insurmountable scientific difficulties, is to be attributed to two powerful ideologies, which are politically opposite, but nevertheless concurred to prevent scholars from solving it. One ideology rejects the concept of genetic determinism, whereas the other dislikes the concept of group selection. As a consequence, these widespread ideologies, which are common in the scientific community, too, kept scholars from realising that the puzzle of human altruism and cooperation can only be solved by proposing a theoretical model that is based precisely on both genetic determinism and group selection. This model, which was never advanced in published papers, is presented here. This article also proposes to regard ancestral environments as determinants of human eusociality. By contrast, virtually all previous articles about it leave primitive habitats unmentioned. To support the hypothesis that human unselfish behaviours represent genetically conserved traits that evolved ancestrally, not products of cultural transmission, this paper also discusses six groups of arguments in the section "Genes versus culture". Finally, this article advances a purely genetic evolutionary explanation for the uniqueness of human eusociality, thereby challenging prevailing cultural explanations for the incomparably developed levels of cooperation in humankind, which are observed in no other social species.

Evolutionary, Biological Origins of Morality: Implications for Research with Human Embryonic Stem Cells

Medical research with human embryonic stem cells, despite its enormous potential to reduce human suffering, is banned in many countries and heavily restricted in others. "Moral reasons" are invoked to justify bans and restrictions on this promising research. Rather surprisingly, while those moral reasons have been extensively discussed and hotly debated in several papers, not a single article on the moral aspects of that research has attempted to answer this fundamental question: What is morality? Considering that a scientifically objective definition of morality is essential to determine whether those moral reasons are justified or groundless, this article focuses on the evolutionary origins of morality and its biological basis. Morality arose as a selectively advantageous product of evolution and preceded all religions and philosophies by millions of years. For the 99% of humankind's evolution, morality was axiomatically aimed at reducing the sufferings of the social members, because pains and afflictions, as expressions of diseases and impairments, tended to hasten the extinction of the small ancestral groups, which characteristically consisted of a few tens of members. Had the therapeutic use of human embryos been available in remote times, our ancestors would have deemed it unquestionably immoral to save amorphous and microscopic agglomerates of insensitive cells representing neither parental nor social investment, at the expense of the lives of the suffering members of their little communities. Unless we venture the untenable thesis that the unlikelihood of extinction of our immense societies entitles us to overturn the meaning of morality, we cannot but conclude that bans and restrictions on research with human embryonic stem cells are patently immoral.

Perinatal complications in children with attention-deficit hyperactivity disorder and their unaffected siblings

OBJECTIVES

Genetic and nonshared environmental factors (experienced by 1 family member to the exclusion of the others) have been strongly implicated in the causes of attention-deficit hyperactivity disorder (ADHD). Pregnancy, labour/delivery and neonatal complications (PLDNC) have often been associated with ADHD; however, no investigations aimed at delineating the shared or nonshared nature of these factors have been reported. We aimed to identify those elements of the PLDNC that are more likely to be of a nonshared nature.

METHODS

We used an intrafamily study design, comparing the history of PLDNC between children diagnosed with ADHD, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and their unaffected siblings. Children with ADHD were recruited from the outpatient, day-treatment program of the Child Psychiatry Department, Douglas Hospital, Montreal. The unaffected sibling closest in age to the child with ADHD was used as a control. The history of PLDNC was assessed using the Kinney Medical and Gynecological Questionnaire and the McNeil-Sjostrom Scale for both children with ADHD and their siblings. Seventy children with ADHD along with 50 of their unaffected siblings agreed to participate in the study. Child Behavior Checklist (CBCL), Continuous Performance Test (CPT) and Restricted Academic Situation Scale (RASS) scores were also used as measures of ADHD symptoms in children with ADHD.

RESULTS

The children with ADHD had significantly higher rates of neonatal complications compared with their unaffected siblings (F4,196 = 3.67, p < 0.006). Furthermore, neonatal complications in the children with ADHD were associated with worse CBCL total and externalizing scores and with poorer performance on the CPT.

CONCLUSIONS

These results suggest that neonatal complications are probably a nonshared environmental risk factor that may be pathogenic in children with ADHD.

Molecular genetics of attention-deficit hyperactivity disorder (ADHD): an update

Attention-deficit hyperactivity disorder (ADHD) is a heritable and behavioral condition of childhood, affecting 5-10% of school-age children worldwide. Affected patients exhibit various behavioral problems such as carelessness, restlessness, disobedience and failure to stay quiet in class. The etiology of ADHD is not known. However, family, twin and adoption studies have provided strong evidence for a genetic etiology of the disorder. A genome-wide scan has identified six chromosomal loci with LOD scores suggestive of linkage. Animal studies suggest the involvement of the brain dopamine pathway and its alteration in ADHD but there is no direct evidence to support this hypothesis. In addition, there are at least 20 candidate genes of small effect that have been studied but none of them appear to be the major gene causing ADHD. Medical intervention along with psychosocial therapy proved to be beneficial for controlling ADHD, although some undesirable side effects have been encountered during medical treatment. In the future, identification of environmental factors, study of additive gene effects and the interaction of genes and environmental factors may provide better insight into the pathophysiology of ADHD. This may lead to an effective new treatment strategy.

Metaphors in behavioral genetics

Behavioral geneticists sometimes use metaphors to describe the role of genes in human behavior. In this paper, five sample texts are analyzed: a popular book, a textbook, a scientific review article, and two original scientific articles representing different approaches in behavioral genetics. Metaphors are found in all the different kinds of sample texts, not only in the popular book and the textbook. This suggests that metaphors are used not only for rhetorical or pedagogical purposes but play a more fundamental role in scientific understanding. In the sample texts, the metaphors tend to be antideterministic, i.e., they do not imply genetic determinism but stress the interaction of multiple genes and multiple environmental factors. No conclusion can be drawn, however, as to whether antideterminism is representative of present-day behavioral geneticists in general. Certain historically important metaphors that may imply genetic determinism are qualified, avoided, or explicitly rejected. There are tensions between some of the metaphors, making them difficult to combine. All the metaphors that are used appear empirically apt, however sometimes only with certain qualifications.

Genetic discrimination and mental illness: a case report

With advances in genetic technology, there are increasing concerns about the way in which genetic information may be abused, particularly in people at increased genetic risk of developing certain disorders. In a recent case in Hong Kong, the court ruled that it was unlawful for the civil service to discriminate in employment, for the sake of public safety, against people with a family history of mental illness. The plaintiffs showed no signs of any mental health problems and no genetic testing was performed. This was the first case concerning genetic discrimination in common law jurisdictions, therefore the court's judgment has implications for how genetic discrimination cases may be considered in the future. The court considered it inappropriate to apply population statistics or lifetime risks to individuals while examining fitness for work. It recommended an individualised assessment of specific risks within the job, relative to other risks posed by that workplace.

The genetics of major depressive disorder

There is consistent evidence that major depression is familial and population-based twin studies as well as hospital register-based twin studies find substantial heritability. However, there is also a large proportion of variation in liability left to be explained by nongenetic factors. Although there seems little doubt that life events play a role in precipitating depression, studies that have attempted to examine familial liability along with social adversity find that environmental measures tend to be contaminated by genetic effects. Thus, the tendency to experience (or report) life events appears to be influenced by shared family environment, and for certain types of events there is a genetic component. The molecular genetic basis of liability to depression is an under-researched area, but some candidate gene studies show potentially promising results. Systematic mapping studies aiming to cover the entire genome are currently being launched.

The global burden of mental disorders

Recent data on the burden of mental disorders worldwide demonstrates a major public health problem that affects patients, society, and nations as a whole. Research must be done to find effective ways to deal with the increasing burden of mental disorders. Given the growing evidence that mental disorders are disorders of the brain and that they can be treated effectively with both psychosocial counseling and psychotropic medications, intervention packages could be developed to deal with the increasing burden. Such packages should be tested for real-world effectiveness and their cost-effectiveness should be demonstrated to guide policymakers to choose from among many other non-mental health interventions. The transportability and sustainability of intervention packages should be studied in public health research and a link between efficacy, effectiveness, cost-effectiveness, generalizability, and sustainability should be demonstrated. The World Health Organization's initiative on the World Mental Health 2000 Survey will provide the first basic epidemiologic data. Together with other data, the initiative will provide solid evidence for including mental disorders into essential treatment packages. In this way, parity can be achieved for mental disorders and mental health can be mainstreamed into health and public health practice.