The Dangers of Genetic determinism
As the date of the completion of the human genome project is advancing with accelerating speed, it is time to reflect upon the practical and logical limits to our understanding of human behaviour in terms of biology. In so doing it might be well to remember that for every complex problem, there is a simple, easy to understand, but incorrect answer.
The human genome project is likely to present a very detailed genetic blueprint of the species homo sapiens in the year 2003, at the latest. This will provide information at the molecular level of the human being and tell us much about the genetic bases of many diseases and human traits, with huge consequences for medical practice and with enormous social consequences. One day, in the not too distant future, it may be possible to provide each newborn child with a genetic identity card. But would such a card tell us all about the medical future of child and about his height and his future character and intelligence?
If we look back over past millennia the human mind and human behaviour have been explained using different models. Plato placed the soul and human reason above and beyond the body, while still capable of influencing it. Aristotle described the soul as the vital principle of living things. He also distinguished between a hierarchy of souls, the human soul being highest up on the scale, and possessing the vegetative and appetitive powers and potentials of the lower souls in addition to its own specific power, namely reason. He placed all the powers and aspects of the human soul in the body, except reason, which, unlike the other perishable powers, he regarded as the immortal aspect of the human soul. Few psychologists or philosophers today seek to explain human rationality and human behaviour by reference to the soul. It is too elusive an entity.
But we still speak of rational and appetitive aspects of behaviour. While reason has often been placed at a separate plane, the desires, appetites and needs have often been associated with the body. For example, the enlightenment philosopher Immanuel Kant, claimed a total freedom of the mind insofar as the rational aspect of it was concerned, and claimed that the realm of morals was that of free and rational agents. Desires, on the other hand, he saw as enslaving the human will.
Other more materialist theories dating from the last century have favoured the view that human behaviour is determined by economic or biological conditions. The birth of modern medicine and genetics, in particular, has favoured the search for immanent biological causes of human behavior.
Indeed, the enormous progress in genetics in the century, has led to what the Nuffield Council of Bioethics describes as geneticisation. This is in its latest publication, Mental Disorders and Genetics: The Ethical Context (London 1998, para. 1.5). Geneticisation is the latest theory of biological determinism. The symptom of geneticisation is the belief that our genes determine nearly everything about us as individual human persons. This belief underlies claims to the effect that alcoholism and traits such as novelty seeking are genetically, rather than socially based.
As the Council warns, the tendency to geneticise can led to an underestimation of the importance of other kinds of explanation for human illnesses and different kinds of behaviour. This could have the result that the traditional emphasis on the importance of good parenting may become less important, and genetic quality in reproduction more so (Ibid.). It could also result in a failure to support education and other non-medical ways of assisting those who may be regarded as mentally disturbed. The Nuffield Council is dissociating itself from geneticisation, warning that it risks undermining moral responsibility and social solidarity.
But it has already taken hold of our minds, and with increasing knowledge about our genes and with the list of prenatally testable conditions growing longer and longer, there will no doubt be an increasing demand for so-called designer babies, who have been selected with a view to avoiding medically and socially undesirable traits, such as Down syndrome or dwarfism and even cleft palate, as well as late onset diseases such as Huntingtons disease and breast cancer. Many people have warned that this kind of testing and selecting will have socially undesirable consequences for people with disabilities and lead to their sigmatisation and to discrimination directed both a the affected individuals themselves and at their parents.
Soon it may even be possible to attempt genetic alterations to avoid certain medically undesirable traits and to enhance certain socially desirable traits. Gene therapy could lead to further discrimination. For it may not be available except to a select few, perhaps those who can pay for it out of their own pocket. Moreover, in the case of enhancement treatment (to improve, for example, hearing or physical strength) it may lead to discrimination by those who have been subjected to it against those who have not. It could, as suggested by some authors on the subject, lead to two kinds of people, the enhanced and the not enhanced.
Some would argue that prenatal diagnosis and selection has not led to discrimination. There may be some truth in that. Today much is done to make life easier for the physically disabled. For examples, theatres and other public buildings are being adjusted so as to accommodate people in wheel-chairs. While prenatal diagnosis is used as a tool for avoiding the birth of physically impaired children, an attempt is often made to help and to avoid offending the physically disabled.
However, the situation is not quite so good in the case of those with psychiatric illness. Recently, The Lancet (26 September 1998, Vol. 352, No 9133, pages 1049-1060), devoted several articles to the issue of stimatisation of mental illness. As one author wrote, The diagnosis of mental illness is not a welcome label associated with access to treatment, and so perhaps improved prognosis, but can instead prove an added burden linked with job loss, relationship breakdown, and social rejection (Astrid James, The Lancet, 26 September 1998, page 1048). The diagnosis of mental illness is often hushed up and talked about in whispers. Those affected by mental disorders often experience shame. Often their relatives do so too.
This is not surprising, for in our society we ascribe a high value to human autonomy and the ability to take care ourselves as individuals while integrating in society. But, as the Nuffield Council report points out mental disorders frequently disrupt cognitive processes and capacities for social interaction (para. 1.24). Indeed, they affect both emotive and rational capacities and so affect personal integrity and the ability to relate to others and to form personal relationships and take up employment.
Hence, for those who believe in genetic determinism, mental illness must come high up on the list of conditions that should be eliminated if it were possible to modify peoples genetic make-up. But how realistic would that project be? And, also, how dangerous would it be?
A comparison between phrenology and genetic determinism
In a paper published in last summers issue of the American journal, Perspectives in Biology and Medicine (Vol. 41, No. 4, pages 491-503), the author Sherry Lyons, talks about the parallels between phrenology and modern-day genetic determinism, including the belief that we may be able to change our nature by means of gene manipulation.
Phrenology, the theory that later developed into simple craniology, was popular in the first part of the last century. It was a materialist theory, according to which mental processes have an identifiable physical basis. The proponents of this theory spoke of mental organs, which they usually located in the brain. Though, one article written on the subject in 1825 suggested that the musical faculty was located in the foot rather than the brain (Bently, The phrenological organ of tune, in The Art of Improving the Voice and the Ear, London 1825). This was on the basis of the evidence provided by the fact that musicians often keep time and rhythm by beating the foot.
Not only did the phrenologists explain human character and mental capacities in terms of biology, but that they also claimed that mental traits were hereditary. As Sherry Lyons, notes, the Viennese physician Franz Joseph Gall, one of the main advocates of phrenology, challenged the theory of the English philosopher John Locke, according to which the human mind starts as a tabula rasa, which is then filled and shaped by empirical experience. To Galls mind mental traits, as based on physical traits, were hereditary just like other physical traits. It may be added that phrenology is also at odds with a rationalist enlightenment theory of the mind such as that of Immanuel Kant, on whose voluntarist-cum-rationalist understanding the human mind transcends the realm of biology and physics, especially insofar as it enters the moral sphere of autonomous and rational agents.
However, it was not because of its incompatibility with certain philosophical theories of mind and epistemology that the prenologiocal theory eventually fell out of fashion.. The theory folded because it has not proved possible to find cerebral organs that can be correlated with different kinds of personality traits, such as novelty seeking, aggressiveness or anxiousness or with behaviour related to, for example, sexual orientation or various types of addiction. To say this is not to deny that certain parts of the brain can be associated with certain abilities such as linguistic abilities, with the functions related to various kinds of perception and motor abilities.
Today, then, the identification of particular organs and parts of the brain as places associated with particular mental character traits and thus behaviour is generally deemed less plausible, even if it is recognised that certain brain lesions may be correlated with certain physical disabilities and mental impairments. As for, the thesis of craniology, in terms of which the shape of skull tells us about the mental characteristics of the person, is has been discredited not only scientifically but also because it has been used for racist ends.
Yet, the phrenologist theory managed to become quite popular. Why? Spurzheim, the most renowned pupil and follower of Gall, wrote a much read work called The Constitution of Man, which was quite popular in Victorian England. It stated that some people were inherently or naturally superior to others. But, although it promoted the idea that there will always be a hierarchical arrangement in human society, it did not promote the idea that individuals belonging to the so-called higher classes were necessarily better endowed intellectually than those belonging to the lower ones. Instead it proclaimed that those who possessed inherent capacities could advance and make their way up in society, even if they set out from a disadvantageous starting point. This was is some ways an optimistic theory coloured by a belief in inherent human powers.
In many respects the same kind of optimism marks present-day ideas based on genetic determinism. Is this optimism warranted? Is it dangerous?
Intrinsically linked to the idea of genetic determinism are eugenic aspirations, aspirations to improve mankind. Such aspirations may not only be linked to race or to physical attributes but also to mental attributes. We well know the dangers of eugenics as it has been implemented this century. Most of us shudder at the thought of the Third Reich. But apparently it is easy to overlook that still today eugenics is practiced, even if differently. Indeed, despite the enormous difference and its moral implications, now as then eugenics is practiced by means of selection, that is to say by way of weeding out individuals with medically or socially undesirable characteristics. To be precise, presently prenatal diagnosis is our main means of making sure that some individuals do pass on their genetic heritage to future generations.
But, strangely enough, the Nuffield Council voices the view that that the present use of genetic testing for reproductive choice in the UK cannot be regarded as eugenic (para. 5.54). This is at the same time as it makes the observation that about 13% of British obstetricians questioned feel that the state should not be expected to pay for the specialised care of a child with a severe handicap where the parents have declined the offer of prenatal diagnosis of the handicap. The kind of attitude inherent in this statement is clearly eugenic. It reflects the view that the state has a right to discriminate on grounds of physical or mental attributes regarded as physically or socially disabling.
The charge that prenatal diagnosis is inherently eugenic is further substantiated by the fact that if you ask women about their experiences when pregnant, you will find that mothers over 35 are made to feel that it would be irresponsible to decline the offer to have an amniocenteses to avoid the birth of a Down syndrome baby.
And it is not just the members of the medical and nursing professions who reflect eugenic attitudes, parents too do so. Our society does so. Hence, pregnant mothers or parents themselves often put pressure on the medical profession to do all in their power to ensure the birth of a baby free from genetic disease. The availability of prenatal diagnosis as a means of avoiding the births of handicapped babies has raised the demands and expectations among patients as well as among doctors. It has made doctors put pressure on patients and patients put pressure on doctors. Effectively, there is a two-way demand for eugenics, which goes to prove how deeply influenced we are by the ideology of eugenics.
Our eugenic aspirations for our children will no doubt be further heightened when gene therapy becomes a reality. Not only will the new gene technologies or DNA techniques serve as tools for the cure of cancers and various acquired illnesses, but people are hoping that they may be able to manipulate genes linked with shyness, homosexuality, alcoholism, novelty seeking and aggressiveness and so on.
Aspirations such as these, raise the question whether the idea of genetic determinism, especially in regard to mental characteristics, is as vain as the theory phrenology?
We know that there are genes that are straight forwardly linked with physical illness such as cystic fibrosis and thalassaemia. It could well be, and it is to be hoped, that our new DNA technologies may help us to find ways of curing or alleviating the symptoms of single-gene diseases such as these. The new DNA technologies may also help us to find cures or treatment for multi-factorial diseases such a heart disease, the development of which depend not only on our genes but also on environmental conditions, including life-style. Many mental conditions too may be amenable to gene therapy. Even if we reject the theory of prenology, we must admit and accept that many mental conditions do actually have a physical basis. Among the conditions of this kind is Huntingtons disease which is a condition linked to a single gene and which might therefore be amenable to cure or treatment with the help of the new DNA technologies.
This being said, most mental characteristics may not be of this nature. In regard to human behaviour, the situation is even more complicated. For individual actions, as opposed to habits, depend not only on biological nature and social nurture but also very much on situational circumstances.
As regard mental illness, the Nuffield Council remarks that, few mental disorders show such simple patterns of inheritance as Huntingtons disease (para. 3.6). If this statement is true in the case of mental illness, then it is no doubt even more true in the case of other mental characteristics and types of behaviour. The Council notes that many common mental disorders may be multifactorial and linked to many genes as well as to environmental conditions.
More subtly, it also comments that it might be methodologically wrong to treat genetic and environmental causes as independent factors. In the more complex mental disorders, genetic and environmental factors interact (para. 3.18). For example, it is observed that genetic differences between individuals affect whether particular events have a traumatic effect on them (Ibid.).
To this kind of skepticism about genetic determinism, I wish to add other reasons for being skeptic about attempts to link mental attributes with particular genes and attempts to alter human character and intellectual abilities by means of gene therapy manipulations.
Character traits and many so-called mental illnesses may depend not only on genes and what we usually describe as environmental conditions, including life-style, upbringing and social conditions, but may also depend on our own interpretation of and attitudes towards the phenomena in question. For example, different cultures may take different views of people who show a certain aggressiveness or introvertedness. Certain character traits may be encouraged in certain cultures and discouraged in others. For example what is seen as mad rather than heroic in one society may be differently regarded another. To take a concrete example showing cultural difference, the Chinese are very respectful of social orderliness and would regard as antisocial and even mad what in Western society may be regarded as a minor traffic disturbance.
Because of such cultural differences, the way people look upon those who manifest certain character traits or mental characteristics may itself alter the attitude of the individuals and the further development of their character or illness. Without denying the existence or reality of mental illnesses such as schizophrenia and maniac-depression, it may be argued that to some extent concepts of mental normality and excellence are social or cultural constructs. Who is seen as normal or excellent varies to some extent from society to society, which in turn affects the social response to different mental qualities and kinds of behaviour as well as the agents own attitudes to themselves and those around them.
Thus, as argued in one of the articles in the issue of The Lancet devoting attention to the stigmatisation of mental illness, there is evidence that popular understanding of mental illness, and thus the social response, may determine the prognosis of severe mental illness, independently of medical treatment (Roland Littlewood, pages 1056-1057). Referring to a report by the World Health Organisation (World Health Organisation) International Pilot Study of Schizophrenia and the Determinants of Outcome study) the author, Roland Littlewood, claims that it is generally accepted that schizophrenia has a better prognosis in the developing world than in the developed world (Ibid.).
Differences such as these, Littlewoods argues, can be attributed to different attitudes to, for example, social and personal responsibility and varying concepts of gender roles. In the industrialized capitalist world, fostering values of individual initiative and self-support, there is less tolerance of those who have difficulties in assuming responsibility for themselves, than in non-industrialised societies. Inaddition, the social rejection and isolation often suffered, and aggravating the situation of the schizophrenic person in western society, is not helped by the nuclear family system. It is harder for the small nuclear family to accommodate the dependent or different than it is for an extended family where there are many people around to share the burden of support. Littlewood also observes that symptom patterns typical of the medical concepts of acute psychosis, mental handicap, personality disorder, or neurosis may be understood in a variety of ways--as moral choices, antisocial behaviour, physical or psychological illness, or simply as points on a spectrum of possible everyday action and experience (Ibid.).
Since, then, classifications, attitudes and judgments made in regard to human behaviour are linked to culture and social interaction, it is arguably not methodologically possible to reduce all human character and behaviour to genes. In particular, individual actions will always be interpreted and judged in different ways depending on the social context. This means that human actions will always be subject to interpretations and judgments relating to different kinds of human inter-action and discourse. To be precise, human actions are subject to moral, legal and historical judgments as well as to psychological, sociological, and anthropological explanations or explanations in terms of genes or brain activity.
Of course, these different modes of discourse and explanations may not be totally independent of one another. For example, legal or moral judgment may be withheld when the agents behaviour or action is thought to be unfree. And the behaviour of those considered mentally unwell is often thought of as unfree because it is thought of as determined by underlying causes not within the agents control. In the case of illnesses such as Huntingtons disease, or Alzheimers the underlying cause may be thought to be biological, and in regard to Huntingtons certainly biological with a genetic basis.
But, as we have seen, there are various reasons for not thinking of and judging all mental traits or kinds of behaviour and certainly not every individual action as if they were determined or programmed, and, in particular, not as if they were biologically determined or programmed.
And even if we were to think that character traits were largely inherited and even if we were to think that behaviour linked to character traits such as extrovertness or novelty seeking were largely inherited, we would not necessarily suspend moral or legal judgment in the case of agents displaying such characteristics. Why should we? Even if there were genetic causes for certain character traits (and there no doubt are), that would not mean that the carriers of these traits are unfree in any sense that warrants the suspension of moral or legal judgment.
We live together in a complex web of moral and social demands and expectations. The way we describe human actions and evaluate them by reference to this normative system is irreducible. This mode of discourse cannot be translated into the language of biology. Nor can it be replaced by the language of biology. Though, as we seen, it may be affected by the language of biology, in the sense that biological explanations of human actions will sometimes, but not always, influence our moral judgments.
We may explain the human being at different levels and by references to different models, such as the physiological, the molecular, the psychological, the historical, the economical, the sociological and the theological, but we must remember that each model has its own rules, logic and classifications. It is a vain quest to seek to reduce one discourse to another or to replace it by another. This is why, genetic reductionism, and so genetic determinism, deserves the same fate as phrenology.
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