Can Psychiatry be Misused Again

The Human Genome Project was completed in 2003. While the medical community is still digesting the results, some questions are already emerging: Are psychiatrists prepared to discuss with patients and families the genetic aspect of mental illness (1)? Since genetic testing reflects probabilities and risk factors for mental illness, are patients and families able to understand that genes do not cause diseases or symptoms, but rather “conspire” with the environment to bias the individual toward a syndrome or symptom? Is the data relevant enough to be communicated even in the absence of adequate treatments? Do the offspring of mentally ill patients have the right to know the results of their genetic testing? What about the right not to know if they choose so? Can insurers or employers misuse genetic information? Are we headed toward a twenty-first century neo-eugenics? Historic View of Psychiatry Historically, psychiatry was frequently misused for political or economic gain. Science of eugenics emerged at the beginning of last century (2). It stated that the genetic pool of the population could be improved by limiting the reproductive rights and even survival of the “unfit” individuals. Psychiatrists played a crucial role in the eugenic movement in Nazi Germany. In September 1939, Hitler signed a document called “The Law for the Prevention of Offspring with Hereditary Diseases.” This law specified three actions to prevent the perpetuation of hereditary diseases in the German population: mental retardation, schizophrenia, and alcoholism. These actions were: Forced sterilization of “unfit” population. Children with deformities and other hereditary disorders were reported to a central registry from where a committee of academics decided who would be killed. “Action T4” was a program that targeted adult psychiatric patients for extermination (3). This euthanasia program entailed killing of patients by gas in special hospitals in the years 1939–1941, and in psychiatric hospitals in the years 1942–1945. In this latter period, patients were killed with lethal injections and through the introduction of a starvation diet. It is interesting that the elite of German psychiatry such as university professors and hospital directors decided whether a given patient would meet the criteria for the euthanasia program (3, 4). These criteria were met by individuals who: Had specific mental disorders and were unable to work, or Could carry out purely mechanical tasks, or Had continuously spent at least 5 years in an asylum, or Were kept under custody as criminally insane, or did not possess German citizenship, or Were not of the German or similar races (5, 6). American eugenics Prior to World War I eugenics was widely accepted in the U.S. academic community. The American eugenics movement was rooted in the biological determinist ideas of Sir Francis Galton. Galton coined the term “eugenics” in 1883. The essence of the concept was described in his book “Hereditary Genius,” published in 1869. Galton believed that through selective breeding human species should direct its own evolution. Others who followed Galton in principle pursued a difference approach, advocating involuntary sterilization and restrictive laws for marriage and immigration, a program often labeled “negative eugenics.” Focusing first on the mentally ill and mentally handicapped, negative eugenics expanded to embrace notions of racial inferiority (7). In 1927, the U.S. Supreme Court had empowered the states to determine who should and should not be permitted to reproduce. From this point on eugenics was enforced by state laws. These family laws prohibited the marriage of “lunatics,” “imbeciles,” “epileptics,” the “insane,” and the “weak minded.” Some of these laws lingered in different states of the union in one way or another until 1980s (8, 9). Between 1907 and 1940 a total of 18,552 insane individuals were sterilized in the United States. Half of the procedures were done in California where the superintendent of the Stockton State hospital believed that marriage licenses in the general population should not be given to anyone with “a taint of insanity in his or her family” unless the person had first undergone sterilization (10). Psychiatry's desire for greater respectability in the medical profession made eugenic “science” attractive. Nathan Hale wrote in “Freud and the Americans”: “Logically, only eugenics programs could halt the apparently mounting incidence of insanity.” Barbara Sicherman, in “The Quest for Mental Health in America: 1880–1917” similarly observed that “most psychiatrists were greatly interested in the scientific study of eugenics” (10).