By Caplan, Arthur L.
The American Prospect , Vol. 19, No. 7
For too long, mental health has been a policy and ethical backwater. While mountains of articles have been written on the ethics of cloning human beings (hugely unlikely to happen anytime soon), the morality of using genetically engineered animals as sources of organs for transplants (ditto), and the moral defensibility of using treatments derived from embryonic stem-cell research to cure horrific diseases (a very long shot), hardly any literature exists on the ethics of current practices and policies in mental health.
All that is about to change. A technological revolution imminent in mental health will soon revolutionize how mental illness is widely perceived and elevate it to the forefront of health policy.
We have all heard, perhaps to the point of indifference, about the mapping of the human genome. With dramatic technological advances, we have jumped from having a rudimentary chromosomal map of our genes and those of other animals and plants to a finely tuned, high resolution blueprint of human DNA. Think of the transformation from a basic map of the world's continents and oceans to the ability to locate your own front yard through satellite imagery on Google Earth, and you'll begin to understand the enormity.
Most of the discussion about the benefits of mapping the human genome has focused on diagnosing physical disorders or the risk of acquiring them. Breast cancer, heart disease, deafness, cystic fibrosis, Fanconi's anemia, hemophilia, and similar maladies have been the poster children in the emerging era of precision genetic testing. But, as genomic knowledge expands and as more databases involving all aspects of the health of millions of people are correlated with an ever-increasing number of genes, mental illnesses will surely be the newest targets for genetic testing. This means that embryos, fetuses, children, and adults will soon be candidates for testing for a vast range of risks and predispositions: addiction, depression, anxiety, schizophrenia, phobias, paranoia, obsessive-compulsive disease, aggressive behavior, attention deficit disorders, and many other mental impairments. Doctors will soon be able to detect the risk of developing mental illnesses as accurately as they now detect many physical illnesses.
The expansion of genomics into mental health will bring much good in the form of prevention and early diagnosis. It will also bring much controversy. Among the many thorny questions to be answered: Should genetic testing for risks of developing mental diseases be entirely voluntary? How private should such tests be? How much counseling ought to accompany the tests, and who should do the counseling? How accurate must these tests be before being made available to doctors, employers, or to the public directly in home-test kits? And, critically, what exactly constitutes a "mental illness" for which testing would be worthwhile in the first place?
This is not the stuff of science fiction. At least one company, San Diego-based Psynomics, is offering a home-test kit for a gene associated with bipolar disease and depression. A buyer spits in a cup and sends the sample off to Psynomics for testing. It is not at all clear that the test is accurate enough to justify its widespread use. Nor are doctors ready to explain the results of the test to those who buy these kits. Nor is it clear how to protect someone from having their saliva taken and sent off without their permission--say by someone who swabs your mouth while you sleep or takes some of your DNA off a coffee cup or glass.
Right along with the explosion in knowledge about the genetic contribution to mental illness is another new and powerful, if less attention-grabbing, technology--neuroimaging. We have all seen the fascinating pictures of how our brains "light up" in response to certain stimuli or thought patterns. Scanning technologies far more powerful than the familiar CAT scan--tests like positron emission tomography, functional magnetic resonance imaging, multichannel electroencephalography, and near infrared spectroscopic imaging--already make it possible to "watch" neural activity in real time with impressive accuracy. …