Influential psychiatrists last week called on the NHS to make a faux schizophrenia test available to patients and their families. The condition has never been demonstrated to be genetic, but it’s proving inconvenient to claim otherwise.
Someone you love is suffering emotionally. It is difficult to tell if they are losing touch with others’ reality. Would a diagnosis sooth or scare you? Perhaps it would depend on the label, or more specifically, your perception of it. Psychiatrists are confronted with this unknown every time they prepare to deliver a diagnosis. ‘Resistance’ to treatment, or other potential routes to recovery, can be frustrating for medics. It’s difficult to demonstrate that someone has schizophrenia – it’s not something that shows up in a scan or test tube.
"Schizophrenia has long been considered by BAME campaigners to be the 'most racialised' mental illness."
An elite band of doctors has now come up with a solution to their recurrent occupational hazard. They say a genetic test for schizophrenia should be made available on the NHS. “It can help people understand that they have an illness like any other, just like epilepsy or diabetes, and may also mean that they and their families are more comfortable with the idea of them taking medication,” Professor Kam Bhui explained in the respected British Journal of Psychiatry.
Professor Bhui edits the journal, published on behalf of the Royal College of Psychiatrists, and has long been an influential commentator. His latest suggestion has already been backed by his Queen Mary University colleagues Professor David Curtis and Dr Katherine Adlington. They say the NHS should make the test available “as a matter of urgency.”
There is just one small ethical problem. Schizophrenia has never been shown to be caused by genetics, either wholly or in part. The trio of psychiatrists appear comfortable in advocating that this moral inconvenience should not stand in the way of it being held up as an explainer to patients and families. “We can do a simple genetic test on a patient and, for example, tell them that they have a small piece of chromosome 22 missing and that this is probably the reason why they’ve developed schizophrenia,” Professor Curtis has excitedly argued.
This particular chromosome correlation has been observed in just one percent of patients with schizophrenia, and those without schizophrenia have also been seen to exhibit it, the Royal College of Psychiatrists has told Mental Health Today. Schizophrenia can not currently be genetically explained in the same way as, say, Down’s Syndrome can (where children are born with a third copy of chromosome 21).
If genetic testing becomes routine on all patients diagnosed with schizophrenia, then perhaps in time a commonality will be discovered. If patients are being given a false reason for taking a (currently hollow) test, does the end justify the means?
Let’s start by making a comparison with Down’s Syndrome once again. Since diagnostic testing has become more reliable and less invasive for pregnant mothers, abortions have increased. Parents should not be denied their reproductive rights of course, but campaigners living with the condition have expressed their fears at where that statistical trend will end up, or how such knowledge could be abused by eugenicists.
Just this month Japan agreed to pay compensation to thousands of individuals with mental health conditions, intellectual disabilities and physical disabilities who were sterilised over five decades until 1996. 25,000 people were sterilised under the so-called Eugenics Protection Law. Almost half gave their consent to the procedure.
Professor Peter Kinderman, a clinical psychologist, is dismayed at psychiatry’s latest approach to confronting conversations about schizophrenia. “Biological explanations of mental illness appear to offer people the suggestion that they are not to blame for their difficulties. But in truth the history of both psychology and psychiatry is littered with the debris of eugenics, where biological and genetic explanations are used as justification for harsh, discriminatory, and sometimes even lethal treatment,” he says. “Even if we did have a genetic test for so-called schizophrenia, we should be extremely reluctant to roll out its use. But in truth the notion is scientific fantasy anyway.”
Some may fall victim to double discrimination. Schizophrenia has long been considered by BAME campaigners to be the 'most racialised' mental illness. Black patients are up to 17 times more likely to receive a diagnosis than white patients, despite there being no biomarker for the condition. Last year an independent review looking into why ethnic minorities are also more likely to detained in hospital against their will was published. Racial bias was acknowledged as a factor by the report’s author.
BAME campaigner Suman Fernando, a former psychiatrist, argues patients should be given greater rights to challenge diagnoses, rather than misleading genetic tests. “It is extraordinary that this outdated view should be publicised at a time when the validity of ‘schizophrenia’ as a medical condition that is equivalent to ‘illness like any other illness’ is being questioned.”
Anne Cooke, editor of the British Psychological Society’s publication ‘Understanding Psychosis and Schizophrenia’ explains: “The terms schizophrenia and psychosis are words we use to describe various complex human experiences, for example believing things that other people find strange or hearing voices that other people can’t hear. The idea that these experiences are best thought of as an illness called schizophrenia, caused by a problem in the brain, is just one theory.”
Psychiatrists have been attempting to draw a straight line between genetics and mental illness for decades. Last month the BAFTA-nominated documentary Three Identical Strangers exposed the holes in various twin studies purporting to evidence that suffering is hereditary. Being permanently separated from your twin - for involuntary scientific analysis - is more of a risk factor than your parents’ state of mind, was one take home message. Distress can run in families, but in the sense that it is learned or absorbed, was the other.
The NHS has so far resisted the calls for a 'schizophrenia genetic test' to be added to its National Genomic Test Directory. Despite last week's intervention, some psychiatrists are pleased. King's College London Professor Sir Robin Murray, who sits on the Rethink Mental Illness clinical advisory panel, is among them. "Things may be very different in five years’ time, when we may have genetic predictors of drug response," he says. "But at present genetic testing is likely to be relevant for only a small proportion of patients, e.g. those with a diagnosis of schizophrenia and a learning disability together. Although it may be intellectually satisfying to find [a genetic difference], it’s unlikely to affect treatment."