[author's note: This is a repost of a blog I wrote last month on my old blog]


An article was published today on msnbc.com about the development of a DNA blood test that could detect bi-polar disorder.

http://www.msnbc.msn.com/id/23337532/

The article raised the issue of the ethics behind having such a blood test, specifically the ability to discover someone's mental state. I find this to be a very curious question, and it brought to mind two different stories that have insight into this article, the film Gattaca and the novel Erehwon.

The fear that people can find out information about you from your DNA is the central theme of Gattaca. In the near future, individuals are screened for genetic disorders and it is used to determine what employment opportunities are available. An otherwise healthy young man who has a heart condition cheats the system to become an astronaut.

Now, Gattica does make the point that scanning for DNA is illegal, but everyone does it anyway. With the HIPAA regulations that are in place, there seems to be a similar concern in the article. While this concern is not isolated to just bi-polar or other mental disorders, it does seem to be exacerbated by the social bias against mental illness.

Erewhon specifically highlights the societal bias against mental disorders, specifically by reversing the societal bias to be against physical disorders in the mythical country of Erewhon. In Erewhon, if someone caught a cold, they would call in depressed to work. The author's hope, it is assumed, that by highlighting this difference in societal response, individuals would not be as likely to hide their mental issues and would seek treatment. Now that the mental diseases, such as bi-polar disorder, are being linked to physical causes, one can only hope that the stigma surrounding them might be lessened.

My own opinion, however, is that it isn't the detection or determination of a cause of a mental disorder that will make it more acceptable in society, but rather the treatment of said disorder. Mental disorders are frightening for many reasons, one of which being the lack of control. Hopefully, with the better ability to diagnose the disease, a better treatment can be found. Where it gets complicated is the thus far poor differentiation of disorders in psychiatry. Where bi-polar stops and depression, or anxiety, or other disorders begin is very undefined. Perhaps, what will come out of this test is a re-classification of these disorders that is separate from the symptoms.

I'd like to say that society will evolve into being as tolerant of mental illness as it is of physical illness, but sadly, that wouldn't even be saying that much. Given the AIDS scare of the 1980's as well as the increasing fear of getting sick at all (anti-bacterial soap, anyone?), I don't see society as likely to become calmer until there are more effective treatments.

Also, it is necessary to point out that just because someone has the genes for the disorder, it does not mean they will automatically have this disorder. The expression of the genes is influenced by many factors, including other parts of the genome and various environmental factors. While some genes work as an on..off switch, many others only indicate a tendency. Many of the studiers around genetic disposition for cancer have shown that there are a whole host of factors involved. So, as they continue to develop this blood test, I hope this issue will be explored more fully.

Of course, any talk of genetic markers for diseases can quickly delve into the murky ethical waters of genetic engineering. That I will save for another post, or for when I've had a couple of beers with one or more of you at the bar.