More than Nature: How we Lose Sight of the Importance of Nurturing
I have always loved biology. When I was first studying it in the ‘90s, I was fascinated by the human genome project and the possibility, seemingly within our grasp, of understanding genes and their role in our development. A lot has changed since then. I still love biology, but I have come to appreciate that genes are more than just light switches. Our experiences and environment play a profound role in shaping who we are and how we live.
I recently came across this article in the Harvard Review of Psychiatry. The authors take pains to show how media reporting of biological psychiatry often skews public perception too far in the direction of genes and biology. Of course, this does not negate the critical importance of genetic and biological research in psychiatry. However, it does alert us to the potential impact of seeing mental distress and disorder as the product of genes and biology.
Biogenetic Views are Attractive
Several factors may influence the public to view mental disorders as biogenetic in origin.
This research is highly publicized
Such research is often presented in a very optimistic frame
Biogenetic causes point toward psychopharmacological interventions
Medication may be easier to access than effective psychotherapy
This frame may divert attention away from psychological or sociological factors that play an important role but are painful or difficult to acknowledge
They appear less stigmatizing
I would like to discuss this last point a little further. Psychology and psychiatry are littered with theories that, to the modern reader, seem to blame patients (and their parents) for their troubles. Therapies that unduly saddle the patient with individual responsibility for their wellbeing fail to take history, community, and culture into account. In the extreme, these approaches can feel stigmatizing.
Additionally, a “born this way” narrative of mental illness can sidestep conversations that blame patients (or their parents) for their struggles. However, a strong biogenetic view of mental illness has its own drawbacks.
The Impact of a Biogenetic View
One of the more interesting segments of this article discusses the impact of a biogenetic view of mental disorders - one that sees them as largely the product of genes and biology. This appears to have several consequences including:
People see patients as less blameworthy, but also perceive them as more dangerous and are more pessimistic about the possibility of recovery.
This viewpoint reduces caregiver empathy for the patient.
Patients who adopt this viewpoint are more pessimistic about recovery.
This viewpoint overshadows psychotherapeutic and social supports that alleviate suffering
Adding the Psychosocial Perspective
Fortunately, we do not need to adopt a binary view of nature-nurture and decide that one (or the other) is most important. We can appreciate the ongoing rigorous research of biology and genetics while remembering that psyche, society, and the environment also play crucial roles. This may give us a lot more to think about, but it also gives us additional meaningful options for addressing human suffering. Here are a few suggestions to keep in mind:
Be discerning about media consumption - it is exciting to learn about the possibility of a new, helpful, treatment. When a headline captures your attention, use it as an opportunity to become curious and be careful not to assume that the study referenced will deliver the paradigm shift it promises.
Appreciate complexity - Studies often offer a slice of information. They may not take all relevant variables into account. What they say about groups is important to consider, but may not explain you, or the person you care about. Complexity is a feature, and it is inevitable. Appreciating this can help a person to make more informed decisions about what is needed now.
Explore social and psychological supports - if you, or someone you know, is experiencing a mental health illness, it is likely that biology plays role. While exploring options like medication, remember that other interventions - like supporting someone to build hobbies and reduce stress, or beginning psychotherapy - also have a significant impact.
