The Myth of Normal 192

“My mind was flying high that day, courtesy of whatever witches’ brew of neurotransmitters God had programmed into my genes.” In truth, neither God nor genes have much to do with it. In her Touched with Fire, an equally poignant book, Jamison puts it more explicitly, asserting that “the genetic basis for manic-depressive illness is especially compelling, indeed almost incontrovertible.”[1] Twenty-five years on, we know that the hard, scientific evidence is not only not compelling; it is nearly nonexistent. The “almost incontrovertible” proof Dr. Jamison relied on is the literature on family histories, adoption, and twin studies, all of which are riddled with false assumptions.[*] The proof she alludes to for genetic causes is only “compelling” if one is already a believer: on the evidence itself, it is pure science fiction.[2] It is also inelegant: in my work with mental distress and addictions—including my own—I’ve always found more than enough in people’s personal histories to account for their psychic suffering, without superimposing a narrative dominated by genetic predetermination. The term “mental illness,” even as it describes real phenomena, focuses our attention centrally on brain physiology, analogous to how, say, anginal pain connotes a restriction of oxygen supply to the heart muscle, owing to narrowed cardiac arteries. It also implies that the problem necessarily falls within the domain of medicine. Despite whatever partial truths they contain, these assumptions are highly questionable and limit our understanding. Worse, they generate harm, both in the sense that they leave many people subjected to inappropriate treatments and in that they displace perspectives that could be far more complete, humane, and helpful. The biological determinism that governed Darrell Hammond’s physicians also placed his condition beyond his own agency to heal, thereby reinforcing the “You are the only one that has no power” story he spoke of. Such a view threatens to keep the sufferer largely in the position of passively receiving treatment, his symptoms ameliorated by medications to be ingested, in many cases, for a lifetime. In its predominantly biological approach, psychiatry commits the same error as other medical specialties: it takes complex processes intricately