In The Genes or
Just Full of Beans?
Until pretty recently, most people presumed that variations in
matters of mind and mood were merely personality differences. Now neuroscience is showing
us how much of what we feel and do is tied to brain biology, and the Diagnosing &
Statistical Manual (DSM) is beginning to bulge with clinical names for problems we used to
think of simply as character traits.
Funny how that works: When we don't know where it comes from or
how to treat it, we call it "just" personality. But once we see links to biology
of the brain, particularly when we have some medication to offer, then we give it a
medical name and say "woops, wrong-o, it was biological after all."
The underlying mechanism, whatever it was, didn't change in the
interim. All that changed was our view of the problem.
Biological Buttons: The truth is, of course,
every thought we think and every action we take involves neurochemicals flowing and
synapses firing; everything is biological at some level, whether that biological button
was pushed by something genetic, something emotional, something that someone else did, or
bits and blends of all the above.
But in matters of mind, we have kept behavior and biology separate
until and unless we think we there might be a way to deal with it medically. Doctors tell
patients "it's all in your head" and send them home (or to therapy) unless
there's a pill to try, at which point it may be "legitimized" as something more
than flawed character.
Why do we set up these logic boxes that perpetuate an illusion we
understand more than we do about behavioral cause and effect ?
I imagine it's partly because we need to to sort matters in our
own heads and make an effort to strategize, based on what we think has gone wrong. It's
also because mental health pros need their dividing lines to diagnose and prescribe.
But it's also because we want something -- or someone -- to fault.
We'd rather be wrong, than say we don't know, as fault-finding implies it can be
Paradoxical Benefit: Historically, in times gone
by, there might have been a paradoxical benefit to the blinders that kept behavior
separate from biology.
Until we had a biological clue, there wasn't much else to do . The
only things we could hope might change were our actions and attitudes. Being told it's
"all in your head" may not have been all bad back when bootstraps were, in fact,
about the only tools. Unless persuaded you had no choice but to help yourself, you
probably wouldn't be helped at all.
But today decisions about the links between behavior and biology
have a great deal to do with which kinds of help we are given. The more
"physical" a problem seems to be, the more we are inclined to see a
"disability" deserving of aid rather than blame.
Deciding whether an unruly child has something wrong in his genes
or is just full of beans and then faulting him or his parenting, may determine whether
he's scolded and flunked or offered remedial ed. Deciding if bad behavior has a biological
cause may also determine if an adult is sent to a doctor or loses his job.
These questions have become even more thorny since the ADA
(Americans with Disabilities Act) now mandates a "free and appropriate
education" (FAPE) for all children with handicaps. The same law requires employers to
make accomodations for challenged adults.
So biology versus behavior is not just a moral judgement these
days, it's become a political hot potato, too.
Adding dimensionality: The idea that all behavior
has some kind of biological tie is a mixed message to many ears, no matter how literally
true it may be.
Some hear that message as forgiveness and hope. Others hear it as
failure. Many hear it as evasion, an invitation to duck and run from responsibility. Still
others worry we're well on our way down a slippery slope towards the day when we'll all
take mind-tuning meds and become a society full of blissed-out Prozac poppers.
What's usually missing from such debates is a sense of context and
degree, a willingness to see things spectrally, in shades of gray, instead of black and
white, or what is sometimes called "dimensionality."
Despite their biological ties and their clinical names, mental
conditions are not diseases you "catch" that you then either "have" or
don't. Behavioral traits, which evolve over time, are the sum of biology and experience
blended together, not one or the other alone. Those elements combine in degrees, which
means, among other things, the effects of the same biology will vary depending on the rest
of a person's qualities and how well that whole package fits in with his or her
We already have a more "dimensional" view of some mental
problems, such as depression. We grant that some are born predisposed to the blues, while
others are shocked or stressed into it. We also grant while some may need that Prozac for
the rest of their lives, others may only need it from time to time to balance a temporary
"neurochemical deficit," while many others will never need a prescription at
all, effecting that neurochemical shift by changing behavior instead.
When it comes to depression, most see that pills are far from the
only choice on the wellness menu; there are many types of therapies and therapists, as
well as scores of self-help books and support groups. Last but not least, we've also
removed at least some of the shame that used to attach to admitting you had any such
"weakness," making it a little less tough to seek help and get it.
But we have a long way to go before most "mental
conditions" are viewed in a dimensional way. About most matters of mind even mental
health pros are often still being pretty binary*.
Which leads to a query especially apt in this venue: How severe do
attention differences need to be before we say they also are more than "just"