Psychiatric Genomics and Mental Health Treatment: Setting the Ethical Agenda

Abstract

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health.

Beneficial and detrimental effects of genetic explanations for addiction

“…For example, these conceptual frameworks may engender genetic essentialism —the misguided view that DNA contains the biological, largely immutable “essence” of a disorder, inevitably consigning people with certain genes to the fate of developing a particular health problem (Dar-Nimrod & Heine, 2011; Haslam, 2011). Although the essentialist view that addiction results deterministically from genes may deflect individual blame by countering the notion that people with addictions are simply choosing freely to engage in problematic behaviors, it may also promote the notion that people with genetically caused disorders lack agency or control over their behavior, and are thus helpless against their symptoms (Dar-Nimrod, Zuckerman, & Duberstein, 2013; Kong, Dunn, & Parker, 2017; Meurk et al, 2016). …”

Ethical Implications of Mental Health Stigma: Primary Health Care Providers’ Perspectives

“…Jordan has been a refugee hosting country for many years including large influxes of Iraqis and now Syrians, which requests to the Health Sector Working Group to conduct research studies, that are frequent and often based on the needs/interests of researchers and not on research gaps identified by operational agencies (Campbell et al, 2015;Kong, Dunn, & Parker, 2017;Shen et al, 2017;Vaz & Srinivasan, 2014). Furthermore, to date, there have been few measures beyond standard ethical review procedures to ensure that specific protection or ethical concerns relating to people with mental health problems or refugees are considered in planning and conducting and reporting research.…”

The ethics of global psychiatric genomics: Multilayered challenges to integrating genomics in global mental health and disability—A position paper of the Oxford Global Initiative in Neuropsychiatric GenEthics (NeuroGenE)

“…As laudable as this aim is, how its goals and aspirations are to succeed in the global context is a significant concern for two reasons: first, psychiatric genomics will not be practically applicable if there is little engagement with a range of ethical issues that are raised in this approach; second, there is a risk that ethical violations could occur in research and application if these issues are not examined carefully. The ethics of psychiatric genomics from local and global perspectives has garnered little systematic attention thus far (Kong, Dunn, & Parker, ), though increased ethical attention on the implications of psychiatric genomics in the American context has been particularly welcome in current projects funded by the National Human Genome Research Institute's Ethical, Legal and Social Implications (ELSI) Research Program.…”