Starting with results of the Nazi elimination of diagnosed schizophrenics, Levine re-examines the evidence for the heritability of mental illness and offers some suggestions about Western civilization and our shared humanity.
If a nation murdered and sterilized an estimated 73 percent to 100 percent of its diagnosed schizophrenics, yet a generation later that nation had a higher rate of incidence of new cases of schizophrenia than did surrounding nations, shouldn't we have questions about the claim by the mental health establishment that schizophrenia is highly heritable?
Moreover, since people diagnosed with schizophrenia and other "seriously disabling mental disorders," like bipolar and major depression, have markedly lower reproductive rates compared with the general population, but the prevalence of these disorders throughout the industrialized world has increased, shouldn't we also be asking questions about heritability?
When we begin to question, we discover that (1) scientifically flawed research has been used to promote ideas around mental illness and its heritability, and (2) instead of focusing on nature vs. nurture causes of mental illness, it's time to consider whether certain phenomena are really symptoms of pathology, or instead are inextricable aspects of our humanity.
However, with the pharmaceutical industry's antipsychotic drug bonanza now more than $18 billion annually in the US (orchestrated primarily by increasingly pathologizing behaviors), and with financial dependency on pharmaceutical companies by the psychiatric establishment, including by the American Psychiatric Association (publishers of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatric diagnostic bible), it is increasingly unlikely that truths about normality, pathology and heritability will get out to the general public.
Results of the Nazis' Attempt to Eradicate Schizophrenia
The genocide of 6 million Jews by the German Third Reich is widely known; but less publicized is the Nazis' attempt to eradicate other groups, including the Romani, homosexuals, the physically deformed, the developmentally disabled - and people diagnosed with psychiatric disorders. This has been documented my many researchers, including Benno Muller-Hill in Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Others in Germany, 1933-1945 and Robert Proctor in Racial Hygiene: Medicine Under the Nazis.
In Nazi Germany, influential promoters of the theory that schizophrenia and other mental illnesses are inherited included psychiatrists Ernst Rüdin and Franz Kallmann. Rüdin was the director of the Genealogical-Demographic Department of the German Institute for Psychiatric Research in Munich, and his research was actually supported by the Rockefeller Foundation. Rüdin believed schizophrenia is caused by a recessive gene, and advocated that mentally ill individuals should not have children. In 1933, Rüdin was a major force behind the passage of Germany's first compulsory sterilization law.
Franz Kallmann, a student of Rüdin, was a Berlin psychiatrist who researched schizophrenia in twins. Kallmann argued for compulsory sterilization - not only for schizophrenics, but also for their relatives identified as non-affected carriers. In 1936, Kallmann immigrated to the United States, where he continued his twin research and later became one of the founders of the American Society of Human Genetics.
Ridding society of burdensome individuals was much of what the "eugenics movement" was about, and this movement was a significant force in the United States and Great Britain. By 1928, 21 states in the US had compulsory sterilization laws, most targeting "lunatics" (as the mentally ill were commonly called). While the United States and Great Britain were most responsible for igniting the eugenics movement, it was Nazi Germany, with both massive sterilization and murder (called "euthanasia" by the Nazis), which acted most decisively to accomplish its goals. So, how did it work out?
Schizophrenia Bulletin in 2010 ("Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia") reported that an estimated 73 percent to 100 percent of individuals with schizophrenia living in Nazi Germany were sterilized or killed. This psychiatric genocide obviously resulted in a lower prevalence of schizophrenia in Germany immediately after 1945, but not for long.
A generation after the fall of the Third Reich, Schizophrenia Bulletin noted "the incidence of schizophrenia in Germany were unexpectedly high." And today, the prevalence of schizophrenia is virtually the same in Germany as it is for other nations in Europe and North America.
Schizophrenia Bulletin detailed the work of Heinz Häfner at the University of Heidelberg. Häfner reported that in Mannheim, Germany for each year from 1974 to 1980, new incidents of schizophrenia ranged from 48 to 67 per 100,000, averaging 59 per 100,000. Häfner compared the rate of new incidence of schizophrenia in Mannheim with 11 studies in the Netherlands, Italy, Denmark, Norway, Iceland, the United Kingdom, the United States and Australia. The non-German locations averaged 24 per 100,000, less than half the incidence rate for Mannheim. Another study done in Bavaria, Germany in 1974-1975, reported an annual incidence rate of 48 per 100,000, double the incidence of non-German locations. Today, the World Health Organization reports the prevalence of schizophrenia in Germany is virtually the same as it is for other European and North American nations.
Ironically, the lead author of that 2010 Schizophrenia Bulletin article, E. Fuller Torrey, is perhaps America's most well-known psychiatrist advocating that schizophrenia and serious mental illnesses are caused primarily by biological factors. Yet, even Torrey rejects the idea that schizophrenia is "a simple Mendelian inherited disease in which a single gene, or small number of genes, is sufficient to cause the disease."
Low Reproductive Rates, but Rising Population
A large number of studies confirm the commonsense expectation of a markedly lower reproductive rate in those diagnosed with schizophrenia, depression and bipolar disorder as compared with the general population.
In Behavioral and Brain Sciences in 2006 (Resolving the Paradox of Common, Harmful, Heritable Mental Disorders), Matthew C. Keller and Geoffrey Miller document that in the majority of 14 studies on "schizophrenia" and "psychosis," reproductive rates were less than 50 percent of the general population.
Keller and Miller also document reproductive rates from five studies on bipolar and affective disorders, including depression. Study results show these populations also have much lower reproductive rates than the general population: 70 percent; 50 to 62 percent; 47 to 89 percent; and 66 percent respectively.
From an evolutionary-biological perspective, this lower reproductive rate should ultimately decrease the rate of schizophrenia, bipolar disorder and depression, yet the rate of this population has actually increased. Robert Whitaker in Anatomy of an Epidemic documents that the mental illness disability rate in 2007 (1 in every 76 Americans) had more than doubled from 1987 (1 in every 184 Americans). Examining other statistics besides disability, Whitaker concludes that the rate of the US mentally ill population appears to have grown since 1955. And the World Health Organization in 1999, ranked depression as the world's most devastating illness, projecting depression would climb to second place by 2020.
So, if serious and disabling mental illnesses such as schizophrenia, depression and bipolar are highly heritable, wouldn't the sterilization and murder of such people, in addition to their markedly lower reproductive rates diminish their prevalence, not increase it?
Yet, the National Institute of Mental Health (NIMH) and the rest of the mental health establishment insist that schizophrenia is highly heritable. NIMH states that an identical twin of a person with schizophrenia has a 40 to 65 percent chance of developing the disorder. So, what about all those twin studies that the psychiatry establishment tells us prove that schizophrenia is highly heritable?
In twin studies, heritability is a statistic routinely found by comparing identical twins (monozygotic twins) to same-sex, non-identical/fraternal twins (dizygotic twins) with the intent of teasing out environmental influences.
However, we now know that one major problem with comparing identical twins to fraternal twins to tease out environmental influences is that it's incorrect to assume that there is an equivalent environmental influence on identical twins and fraternal twins, and so it is incorrect to assume that differences between them can be attributable to genetics.
Specifically, Not in Our Genes, authored by biologists R. C. Lewontin and Steven Rose and psychologist Leon Kamin, reports how identical twins - as compared to same-sex fraternal twins - are often treated more similarly by parents, peers and teachers; have more similar friends; do more similar things; and spend more time with one another. In one study, 40 percent of identical twins reported that they usually studied together, compared to only 15 percent of fraternal same-sex twins.
According to psychiatrist Don Jackson's The Etiology of Schizophrenia, not only does the unique psychological bond of identical twins contribute to their higher concordance rate for schizophrenia on the basis of mutual association, the nature of the identical twinship might itself create conditions leading to the identity problems often experienced by people diagnosed with schizophrenia.
There are many other twin study research problems, according to The Etiology of Schizophrenia and Not in Our Genes, as well as psychologist Jay Joseph's The Gene Illusion. For example, Franz Kallmann's 1938 high concordance rates of mental illness for identical twins have not been replicated, and in recent twin studies with more modest concordance rates, the diagnosis of schizophrenia is unreliable (see Herb Kutchins and Stuart A. Kirk's Making Us Crazy for the unreliability of psychiatric diagnoses). Compounding normal psychiatric diagnosis reliability research problems, in many of these twin studies, researchers making diagnoses were not "blind" (in the fashion of proper "double-blind" scientific studies), resulting in potential bias.
What about studies of twins reared apart? There are very few of these kinds of studies, and much of what the general public has heard has been anecdotal. As Joseph in The Gene Illusion points out, "Most pairs come to the attention of researchers and journalists because of their similarities.... Stories of similar reared-apart twins are news because they are interesting and compelling; stories about dissimilar twins are not."
There are a handful of systematic twins reared apart (TRA) studies, the most well known being the 1990 "Sources of Human Psychological Differences: Minnesota Study of Twins Reared Apart" by Thomas J. Bouchard. However, Joseph found important research problems with this most famous TRA study. Of perhaps greatest importance, Joseph points out, most labeled as "identical twins raised apart" don't actually deserve the status of being called "raised apart," since most pairs had significant contact with each other. These studies are confounded by the fact that, besides sharing the same prenatal environment, the twins typically spent time together in the same family environment (averaging more than five years together prior to separation), were aware of each other's existence when studied, and often had regular contact over a long period of time.
Joseph points out there are many environmental (non-genetic) factors shared by identical twins labeled as "raised apart" that would lead them to resemble each other more than two randomly selected members of the world's population. In addition to sharing the same prenatal environment and an average of five years together in the same family environment, they were likely to elicit more similar treatment because they have the same appearance, almost always the same ethnicity and are usually raised in the same socioeconomic class and culture. Also, while Bouchard examined IQ, personality variables and social attitudes, he did not specifically examine mental illnesses (as it is difficult enough to find identical twins reared apart - Bouchard was only able to find 100 - making it exceedingly difficult to find enough identical twins reared apart who had been diagnosed with mental illness).
Yet, biological psychiatrists such as Torrey continue to maintain that serious mental illnesses such as schizophrenia are biological. Torrey argues:
The cause of schizophrenia involves dozens, and perhaps hundreds, of genes and includes common variants such as single nucleotide polymorphisms or less common variants such as copy number variations. Such variants may be carried by large numbers of people, most of whom never develop schizophrenia. It is possible that such genetic variations may cause disease only if they are activated by life experiences such as perinatal hypoxia, nutritional deficiency, infections or other environmental factors.
Schizophrenia and Western Civilization
What causes schizophrenia? The surprising answer that biological psychiatrist E. Fuller Torrey argues for in his book Schizophrenia and Civilization is Western civilization. Torrey concludes, "Between 1828 and 1960, almost all observers who looked for psychosis or schizophrenia in technologically undeveloped areas of the world agreed that it was uncommon." Torrey writes, "There was a steady stream of studies from African countries noting the relative infrequency of schizophrenia," and he offers other evidence for his thesis from the South Pacific, Tibet, Australian aborigines, and indigenous peoples in Brazil. And Torrey's own 1973 New Guinea study shows contact with Western civilization is highly correlated with schizophrenia.
For the biological psychiatrist Torrey, what's problematic about Western civilization is something biological. He writes, "Viruses in particular should be suspect as possible agents."
However, what appears to be most problematic about Western civilization - in contrast to many societies with little or no schizophrenia - is Western civilization's discomfort around people who display certain behaviors outside of ordinary experience. This discomfort results in objectification, coercion and other forms of violence - emotional and physical.
The behaviors that characterize people diagnosed with schizophrenia (delusions, hallucinations and disorganized speech) are certainly outside most people's ordinary experience. And in Western civilization, unlike other civilizations with little or no schizophrenia, there is a strong tendency to label behaviors outside ordinary experience as pathological and to attempt to forcibly control these behaviors. That's why homosexuality was an official American Psychiatric Association mental illness until the 1970s for which "treatments" were administered - this before psychiatry and society began to become more comfortable with homosexuality.
Does Hearing Voices Make One Mentally Ill?
Psychiatrist Dan Fisher, director of the National Empowerment Center, was diagnosed with schizophrenia and hospitalized on three occasions, but has long recovered primarily with peer support, and he today rejects the term schizophrenia in favor of the non-disease term "lived experience." Dutch psychiatrist Marius Romme also believes that schizophrenia is a harmful concept, and that hearing voices and other so-called "symptoms" of schizophrenia are not evidence of an illness.
In 2011, Behavioral Healthcare ("So, What's Wrong with Hearing Voices?") described the work of a growing international organization, the Hearing Voices Network (HVN), developed around work by Marius Romme and voice hearer Patsy Hage. HVN has grown to encompass hundreds of chapters worldwide. The group's mission is to nonjudgmentally gather and share information among those who hear voices or experience other extreme phenomena.
Two "voice hearers" who had been previously diagnosed with serious mental illness (and who also prefer the term "lived experience") are Daniel Hazen, now executive director of Voices of the Heart, Inc. and Oryx Cohen, now the Technical Assistance Director for the National Empowerment Center. Both Hazen and Cohen believe what was helpful for them was to "de-pathologize" experiences like hearing voices (see Cohen and other voice hearers talk about their experiences in trailer for the movie Healing Voices).
Cohen notes that phenomena psychiatry proclaims as symptoms of psychosis are actually reported by 1 in 10 people at some point in their lives, making an individual's likelihood of experiencing them "about as common as being left-handed." Cohen adds that it is not uncommon for people after the death of a loved one to hear that voice again, and adds that for many of these hearers, "that voice is experienced as a very reassuring thing." However, vulnerable people who experience such phenomena can become dangers to themselves and create havoc for others when they have become terrified. And being told that such phenomena are evidence of a disease can be extremely frightening. But bolstered by security and support from other voice hearers, Cohen says, "The hearer can come to the conclusion that he or she does not have to listen to the voice."
Learning to live with voices, but not being enslaved by them, is actually the strategy used by Nobel Prize-winning mathematician John Nash that helped him to return to functioning after being diagnosed with schizophrenia for many years. Nash, made famous by the film A Beautiful Mind, is glad the movie gave families of those diagnosed with schizophrenia hope of recovery; but he is troubled by many inaccuracies in the movie, including its claim that medication was important to his recovery, when in fact he rejected medication (see interview with Nash).
If we accept that hearing voices is not evidence of illness, but actually within the normal range of human experience, then, just as in the case of homosexuality, depression and life-sacrificing altruism, neither genocide nor lower reproductive rates will affect its prevalence.
In other words, if phenomena are inextricably part of our humanity, to eliminate such phenomena, all human beings must be eliminated.