Pulling at the Roots: Broadening Our Perspective on Mental Disorder Aetiology

At a global level, our understanding of mental illness has unparalleled potential for breakthroughs given recent advances in genomics, neuroimaging, and the cognitive, affective, and social neurosciences. The emergence of high-throughput and low-cost genomic technologies, and the convergence of a number of new genomic approaches with systems biology approaches and with neuroimaging data, in the context of large-scale studies, has paved the way for more computationally based neuroscience that will arguably enable us to bridge the knowledge gap between causation and psychopathology. Major initiatives such as the European Union-funded Human Brain project and the USA-funded BRAIN (Brain Research through Advancing Innovative Neurotechnologies) project are focusing efforts onmultilevel integration of brain neuronal networks and connections, using intensive computing, in an endeavour to create the next generation of brain tools that will inform a deeper understanding of the brain (Kandel et al. 2013). In the future, these tools are likely to have profound therapeutic and preventive applications. With these promising advances there has, paradoxically, been a fair amount of frustration voiced in the Global Mental Health Community by researchers and clinicians alike. These frustrations concern the application and potential uses of such tools that extend to the: (i) relatively slow pace of progress in completely unravelling the complex aetiology of mental disorders; (ii) absence of reproducible, diseasespecific biomarkers; (iii) wide chasm between clinical diagnosis and molecular and brain neuroscience; (iv) relatively poor integration between brain neuroscience and social and cultural variables; and (v) lack of recent treatment breakthroughs against the backdrop of a high global burden of psychiatric morbidity (Krystal & State, 2014). But in addition, these frustrations reflect the distance such tools are from much of the developing world and from much of the social, psychological, and cultural aetiologies of which they are a part and whose understanding has also been impoverished by being primarily studied in only some populations and in only certain parts of the world. For mental health researchers and clinicians working in lowand middle-income countries, scientific discovery and innovation is further hampered by lack of access to key technological platforms (e.g. epigenomics, proteomics, metabolomics, and neuroimaging facilities) and limited armamentarium of effective pharmacological, psychological, and social treatments. Nonetheless they have the potential to uniquely add to a global understanding of aetiology by markedly expanding the populations, contexts, and opportunities for study. Psychosocial models of risk and causality in mental illness are as important as, and complementary to, biological frameworks. At a global level these advances, therefore, underscore the need to pay even more attention to other factors, and other needs (e.g. socioeconomic deprivation, race/ethnicity/cultural issues, migratory stress, food security, and economic growth) that may contribute to disparities in mental health care use and treatment outcomes (Chiao & Blizinsky, 2013). * Address for correspondence: Soraya Seedat, Department of Psychiatry, Stellenbosch University, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa. (Email: sseedat@sun.ac.za, SSEEDAT@sun.ac.za)