As we blog on, the British Journal of Psychiatry redeems itself. Its second issue for 2012 provides in editorial and original research papers a peek into a future that puts aside descriptive diagnosis for solutions that connect mental states to causes.
The first general population study of the most readily evident cause of mental disorder, the maltreatment of children, did not appear until 2004. Its recency illustrates how little psychiatry has done to explore the causes of mental illness. The data confirm what the community has long known, the crippling mental effect of abuse, but until the current decade largely ignored. Child abuse in conjunction with genetic predisposition can not only lead to psychosis, but shape its delusions and hallucinations. Maltreatment and psychosis even have a common pathophysiology.
The findings about the far more common neuroses and addictions take us further. They dismiss the traditional descriptive diagnoses of the neuroses. Child abuse does not channel its ill effects into their pigeon holes, but into the simple division of internalising or externalising disorders determined by genetics. The survey found that physical abuse of boys brings about the externalising disorders of antisocial and aggressive behaviour in the men they become, but of girls results in the internalising states of depression and anxiety. Another paper finds a correspondence of externalising disorder and a particular gene that produces monomamine oxidase A in males. In those, who have a relative deficiency of the gene, maltreatment results in a greater degree of antisocial behaviour.
Hopefully the mapping of causal effects will in time, perhaps soon, dispose of descriptive diagnosis and render the elephantanopia of psychiatrists irrelevant and harmless.
