Prominent behavior geneticists have made a case for “precision education”, using polygenic scores to come up with personalized “education plans” for each child, an advanced form of tracking.
"But, genomic evidence suggests that ADHD and depression are extremes of normal spectra of behavior (externalizing and internalizing, respectively). The use of substances to alleviate symptoms may be advised when these conditions become detrimental. But it might be wise to reconsider defining depression as a discrete category of clinical significance."
This is almost certainly correct, but with a caveat. When we talk about "depression", we can mean many things, as there are many varieties of human unhappiness. I agree that what most people call ordinary depression is basically on the spectrum of ordinary human misery, and most "depressed" people these days are using medical language to describe fairly normal, albeit painful and unpleasant, life problems. For many of them, prescription medication is marginally helpful at best.
But severe depression, or melancholic depression, or whatever you want to call the depression that renders someone totally non-functional for weeks or months on end, sometimes leading to catatonia, psychotic depression, etc is clearly an illness.
Brief example: I treated an older gentleman who was admitted to the psychiatric unit for depression. He had no history of psychiatric problems at all. Over the past year or so he had been becoming increasing depressed for no apparent reason. By the time he was admitted, he thought he was actively dying, or possibly already dead because he didn't think he had a pulse. He was convinced he had murdered members of his family and committed all sorts of heinous crimes. None of this was true or course. We treated him with electroconvulsive therapy (ECT), and he rapidly improved and was discharged to get back to his life.
It will also be welcome when psychiatry is developed enough to start looking at diseases from a causal perspective rather than a symptom-syndrome one. But for all its inadequacies, the DSM isn't a totally useless book. Paraphrasing from psychiatrist Kenneth Kendler, here is one example of how to usefully think about the DSM in clinical practice:
If someone comes to the ER with crushing left sided chest pain, certain EKG changes, and elevated troponin levels, we can tell them they are having a heart attack. Of course "what a heart attack is" is not those EKG changes, chest pain, and changes in blood levels. Those are indexes of the illness such that, if they are present, we can say the illness is present.
The DSM works in a similar way. If you ask "what is major depression", we wouldn't say it is literally low mood, sleep and appetite changes, low energy, etc. Those are indexes of depression just like the EKG in a heart attack.
The DSM remains agnostic on causes, which is probably a wise thing ultimately since we don't know what the causes are. But eventually we will, and the DSM will either incorporate this or will cease to be relevant.
"But, genomic evidence suggests that ADHD and depression are extremes of normal spectra of behavior (externalizing and internalizing, respectively). The use of substances to alleviate symptoms may be advised when these conditions become detrimental. But it might be wise to reconsider defining depression as a discrete category of clinical significance."
This is almost certainly correct, but with a caveat. When we talk about "depression", we can mean many things, as there are many varieties of human unhappiness. I agree that what most people call ordinary depression is basically on the spectrum of ordinary human misery, and most "depressed" people these days are using medical language to describe fairly normal, albeit painful and unpleasant, life problems. For many of them, prescription medication is marginally helpful at best.
But severe depression, or melancholic depression, or whatever you want to call the depression that renders someone totally non-functional for weeks or months on end, sometimes leading to catatonia, psychotic depression, etc is clearly an illness.
Brief example: I treated an older gentleman who was admitted to the psychiatric unit for depression. He had no history of psychiatric problems at all. Over the past year or so he had been becoming increasing depressed for no apparent reason. By the time he was admitted, he thought he was actively dying, or possibly already dead because he didn't think he had a pulse. He was convinced he had murdered members of his family and committed all sorts of heinous crimes. None of this was true or course. We treated him with electroconvulsive therapy (ECT), and he rapidly improved and was discharged to get back to his life.
It will also be welcome when psychiatry is developed enough to start looking at diseases from a causal perspective rather than a symptom-syndrome one. But for all its inadequacies, the DSM isn't a totally useless book. Paraphrasing from psychiatrist Kenneth Kendler, here is one example of how to usefully think about the DSM in clinical practice:
If someone comes to the ER with crushing left sided chest pain, certain EKG changes, and elevated troponin levels, we can tell them they are having a heart attack. Of course "what a heart attack is" is not those EKG changes, chest pain, and changes in blood levels. Those are indexes of the illness such that, if they are present, we can say the illness is present.
The DSM works in a similar way. If you ask "what is major depression", we wouldn't say it is literally low mood, sleep and appetite changes, low energy, etc. Those are indexes of depression just like the EKG in a heart attack.
The DSM remains agnostic on causes, which is probably a wise thing ultimately since we don't know what the causes are. But eventually we will, and the DSM will either incorporate this or will cease to be relevant.
Great stuff, thanks for posting.
Superb comment.
Parents want the best for their children. I think many progressives will be totally willing to use PGT-P if they are already undergoing IVF.
This is a great post. Thanks for writing.