To become effective, psychiatry has to give away descriptive diagnosis (see Elephantanopia series). It has to find causes. Far easier said than done. The causes of mental disorder are more elusive than those of physical illness. The March 2012 issue of the British Journal of Psychiatry touches on some complexities that make the task so difficult. Genetically inherited temperament seems an obvious cause of mental illness. To take one example, the callous-unemotional trait at first sight seems the obvious cause of antisocial behaviour and psychopathy, but proves not so. Those who study the trait find no significant association with conduct disorder in childhood (Kumsta et al., 2012*) or antisocial behaviour in adult life (Viding & McCrory 2012).
The ambiguity of words misleads the reasoning about the connection. What seems callous need not arise out of an insensitive and cruel disregard for others. The capacity to cut off emotional reaction has virtue in a poker game or in coping with an emergency. It can save a life or the group in an emergency. The trauma of childhood maltreatment produces the frightening potential of the callous antisocial. Even previously deprived children brought up in a supportive family do not inevitably become psychopaths. Viding and McCrory ask why even bother to measure the trait in children?
Mark R. Dadds traces the connection between genes and psychopathy to a failure of the child to make eye contact with parents. The failure has a gender bias handed down the male side of the family (Dadds et al., 2012). Of course antisocial disorder has the same gender bias. The families that prevent the pathological outcome could well have found the way to break the connection. Observations in psychology and psychiatry, management, Toastmasters and snake charmers recognise the power of eye contact. Hopefully, Dadds and his associates have found for at least some possessing the inherited trait a means to prevent it from progressing to antisocial behaviour.