Here are two recent strands of thinking about genetics in clinical psychology: 1. Oliver James's (and others) bold position, that genetics play little or even no role in human psychology. Marcus Munafo has called this "genetic denialism" 2. The diffuse suggestion (one recent example here) that to pursue genetic research into mental health problems is related in some way to a eugenic agenda; to wit, that (i.e.) a genome wide association study looking at the diagnosis of schizophrenia may encourage us to think in quasi-fascistic ways. There are some good responses to the first of these strands, in Munafo's article (linked above), and in this piece by Kevin Mitchell at Wiring The Brain. Here, I want to address the second strand, which I will call genetic disavowalism.
The purpose of genetic disavowalism is pretty clear; to encourage us to think of genetic research and theories of genetic risk as inherently negatively morally valenced. This argument (to the extent that there is an argument; it is seldom made explicitly) is a little under-cooked to say the least. It is of course perfectly possible to acknowledge a genetic contribution to human behaviours and mental states without commencing some inexorable slide toward Nazi-ism. Does the genetic aetiology of Down Syndrome commit society to a re-run of the Nazi Aktion T4 programme? Clearly not. For one thing, a eugenic policy is a choice a government makes rather than a necessary consequence of a given set of scientific knowledge. For another, there is nothing to stop any government undertaking such a programme targetting people on the basis of behavioural or cognitive traits it doesn't like, but which are not genetically determined. Even if genetic theories about human behaviours and tendencies do incline some sorts of person towards ideas about eradicating those behaviours and tendencies (by "breeding them out" or what have you), there is no logical entailment, and we carry on with genetically inclined research because we wonder if there might be benefits to be derived from the knowledge.
Apart from all that, I think that genetic disavowalism has itself a moral problem to contend with; the denial of genetic privilege.
We are accustomed to thinking about privilege in terms of race, gender or social class. As a white man, for example, I have the privilege of not being looked on with suspicion in certain neighbourhoods, and I have the privilege of not feeling tense when groups of NYPD officers walk past me. It has come to be seen as crass and offensive to fail to acknowledge our privilege, especially when discussing race (see Peggy McIngtosh's essay on the invisble knapsack here), but the notion of privilege has been linked to mental health as well, by Martin Robbins here, and by me here.
When I first blogged about sane privilege, I was thinking in terms of the social position people have when they are viewed as less rational in virtue of their psychiatric status. When a person is considered deluded, their utterances become generally more suspect in the eyes of people around them They lose certain testimonial privileges (some of their statements about reality are taken less seriously). But privileges are also conferred on us by our genetic predispositions. This is most obviously the case in the way that skin colour or primary and secondary sexual characteristics are genetically determined facts about our appearance, but it presumably has cognitive implications too.
To the extent that IQ is genetically influenced, my course mates or colleagues with IQs two standard deviations above the mean have an advantage relative to me (with my quite middling IQ) in performance on exams or the production of research and logically sound clinical arguments. Equally, to the extent that my genetics plays a role in my tendency to not have debilitating emotional "highs" or feel my relationship with reality become terrifyingly fragmented, I have a sort of privilege conferred on me relative to people who are prone to such experiences. It is no good arguing that actually a tendency toward certain mental states is actually perfectly desirable, and should itself be considered a privilege. That may so for some people, but unless we want to deny that mental health problems are frequently extremely difficult to live with (and unless we want to throw out even the apparently politically neutral term "distress" to refer to such experiences), we have to acknowledge that is not the case for all.
Acknowledging cognitive genetic privilege need not entail acceptance of an illness account of mental health problems. Peter Kinderman has movingly written about his risk for a psychotic experience, given a possible personal high genetic loading for such an occurrence. At the same time, he resists the implication that this means he has a disorder or "attenuated syndrome". Even if you feel more inclined than Kinderman to describe such a genetic loading as predisposition toward illness, his is a perfectly consistent intellectual position.
Genetic influences on psychology have always been a controversial topic, and there is an easy tendency to accuse genetic researchers or thinkers of secretly holding eugenic aspirations. Perhaps some strains of genetic reasoning are infused with a negative moral valence (think of the pub bore who argues that women are genetically inferior), but to the best of our knowledge, genes make certain aspects of our lives more or less easy for us. They confer varying degrees of privilege. To ignore this is not only unrealistic, it is insensitive.
Dear Huw,
ReplyDeleteThank you for a thought-provoking post, as ever. Personally though, I would find it worrying if we started thinking in terms of ‘genetic privilege’. Leaving aside the difficulty of deciding which aspects of our individual psychology might be genetic (genes code for proteins, not experiences or behaviours) I have two main concerns.
Firstly, whilst of course there are genetic differences between us, and these differences may be indirectly reflected in our psychological characteristics, deciding which characteristics are good - an indication of genetic privilege - and which are bad - an indication of genetic underprivilege , presumably? - is a value judgement rather than a scientific one. I am reminded of the social model of disability which suggests that certain characteristics are only a problem if the environment is not organised to cater for them. Surely it’s the same with our psychological makeup? Accountants need different qualities from stand-up comics. Some people who hear voices value the experience, others find them very upsetting. Often what makes the difference is at least partly the attitude of the person’s loved ones and wider environment.*
Secondly, who makes that value judgement? Presumably those with most social power, who of course have their own priorities and ‘taken for granted’ assumptions, and are likely to value the characteristics of their own particular group. For example, powerful people in our own individualistic, male-dominated society tend to value competitiveness. It worries me when certain people decide that they are genetically superior to others – and to me the idea of ‘genetic privilege’ comes worryingly close to that. It has happened at various points in our history, and it doesn’t tend to end well.
Anne
* See our paper on this: Jackson, L., Hayward, M. & Cooke, A. (2011) Developing Positive Relationships with Voices: A Preliminary Grounded Theory Study. International Journal of Social Psychiatry. September; vol. 57, 5: pp. 487-495
Thanks Anne,
ReplyDeleteThis is a nice comment to get to reply to because there are ways in which I straightforwardly mostly agree with you, but nonetheless think that the concern I raise in the post remains essentially right as well.
First up, I agree, let's leave out the *fact of the matter* about any given trait and to what extent it is contributed to by genetic factors or not (and of course genes will only account for some part of the variance in many cases). We only have to agree that genes are playing a role in some of our thoughts/behaviours for now, and then we could get up a good debate about *which* behaviours some other time.
So here's where you're dead right; privilege is an inherently value-laden notion. It is also a fluid notion, because what we regard as conferring privilege will change across time and place. So for example, there is a certain amount of privilege to be had in being (i.e.) an emotionally sensitive male in a caring profession in 2016, whereas there might be very little for the same person in a trench in WW1.
But this fact is true also in domains where we already feel quite at home talking about privilege. Race for example. We don't need to claim that it is inherently *better* or *preferable* to be white to talk about white privilege, we just need to agree that all things being equal, it is a damn sight *easier* to be white, at least in much of Europe and the US. Well the same goes (I claim) for various forms of mental health difficulty. It is *easier* not to have periodic psychotic breakdowns, or strong swings in mood, or strong behavioural compulsions, and therein lies the privilege.
Now the reason I mention Peter's Discursive article (and I could also nod to Steve Silberman's Neurotribes and the neurodiversity movement here), is that we can accept that a behaviour or predisposition is somewhat genetically mediated, and still decide A) to not label it as illness, and B) to value it more highly in society at large. If enough of that sort of work is done, we might theoretically put an end to quite a lot of privilege differential (and see the fascinating article in The Economist recently about trying to value people with Autism in terms of their occupational skills for more of that). In my view this may be possible for some sorts of phenomena, and not for others. I don't know if we can really get to a stage when we can straightforwardly value the fact (assuming we can agree that it is a fact) that some people are more disposed toward paralysing forms of misery than others (though we may value the people themselves very highly indeed).
In short, I agree that *genetic privilege* should be kept distinct from *genetic superiority*. Just as race or gender privilege should be kept distinct from any notion of race or gender superiority, but I maintain it is a useful lens for thinking about genetic differences between people.
Thanks for the reference and as ever for the opportunity to debate :-)
Dear Huw,
ReplyDeleteThis issue has been continuing to bother me and I think I’ve worked out why. I think that whatever you personally mean by it, for me the phrase ‘genetic privilege’ sounds too close to ‘genetic superiority’. Privilege is a social issue, not a biological one. Of course particular biological characteristics confer certain social advantages in particular situations. For example, in a patriarchal society I may be disadvantaged in many situations compared to you by dint of being female, but explaining that by saying that you are ‘genetically privileged’ would come too close for comfort – for me at any rate – to saying that men are genetically superior to women. So we need to make society less patriarchal, not start talking about ‘female genetic underprivilege’. Similarly, you talk about some people being ‘disposed towards paralysing forms of misery’. Surely the predisposition is not to misery but to certain experiences that may *or may not* lead to misery depending in large part on our social environment. For example, many of the interviewees in the study I cited were happy that they heard voices , either because the experience was valued within their social environment, or because they had been successful in finding one where it was. I worry that the idea of ‘genetic privilege’ could become another currency with which powerful people can maintain their power by defining their own characteristics as the desirable ones, and pathologising others.
Anne
Thanks Anne, I see two arguments here. I have sympathy with both, but I think one of them holds more persuasive force than the other.
ReplyDeleteArgument one: "privilege" sounds too much like "superiority". I understand that concern, and I think I see why they feel associated. But if we take it seriously, it seems to apply to *any* discussion of privilege, and runs the risk of accusing people of invoking i.e. *white superiority* when they are intending to discuss white privilege. Unless you mean it's never appropriate to discuss privilege, I think that's not an argument that has much application in this domain.
Argument two however *does* persuade me that the application of the idea of privilege to psychiatric genetics could be shaky. You say privilege is a social issue, not a biological one. I agree; privilege is not accorded to people in response to facts about their genome but in response to facts about their social presentation. Even where the genome straightforwardly influences social presentation (in some secondary sexual characteristics for example), the broader, visible facts are the mediating component. So your argument does make me reluctant to talk of "genetic privilege".
I will be interested, nonetheless, to see how much traction the idea of privilege will gain in mental health. Talk of "cognitive privilege" or "neurotypical privilege" might get closer to the issue I was groping toward? As a final thought, I want to address your evident unease and see if I can alleviate it to some degree. Imagine if we all agreed to dispense completely with any form of pathologising terminology ("illness", "disease" etc.), and instead spoke solely in terms of privilege. Such a little linguistic habit might be expected to have a positive impact, reminding people that the issue is not one of *absolute* health or wellness, but of the extent to which society makes life more or less easy for different people with different experiences. That more relativist view seems quite close to the position of Understanding Psychosis for example.
Thanks for the reference btw, I really enjoyed the paper!