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The annual congress in Berlin next month will be a meeting of firsts. It will be held in a spanking new building and it is our first meeting in the German capital. We have also inaugurated a first public education day designed to illustrate how neuroscience is informing our understanding and treatment of psychiatric disorder. We hope that this will be successful and replicable before all future congresses.
I believe 2014 saw a land mark event for research in psychiatry, which we can all enjoy and take inspiration from. It was the publication in July of the latest GWA update showing about 100 genes that we can say with statistical confidence are associated with schizophrenia. This did not represent in itself a new idea or a new discovery. We knew, didn’t we?, that schizophrenia is a genetic disease because of the different concordance of identical and non-identical twins. In fact, it is the culmination of one of the most boring fishing expeditions ever devised. However, it turns out there were fish.
The results illustrate the inescapable statistical law that demands very large numbers for statistical confidence and the ugly fact that power is related to the square root of sample size. And it shows that cooperation, between groups, across borders, can be the right thing to do, although the field was slow to learn that. But none of this breaks new ground: clinical trialists discovered large numbers over three decades ago.
No, the land mark is the proof that the diagnosis of schizophrenia has a biological basis. Neuroscientists may be surprised by just how much opposition there still exists to this idea. For example, the impending publication of DSM-5 last year provoked the following outburst in the Guardian newspaper in May 2013:
Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP's statement, said it was unhelpful to see mental health issues as illnesses with biological causes.
Under the byline, ‘British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness’, she claimed to represent the Clinical Section of the British Psychological Society (their consensus statement was actually a lot more sensible).
The idea that schizophrenia is a myth rather than an illness was first widely promoted by Thomas Szaz and it has simply proved too alternative to go away - an idea that would not die. So, Nosferatu-like, no metaphorical stake or garlic has been quite strong enough to banish it from the minds of some members of the Clinical Section of the British Psychological Society. However, Szaz was very clear that schizophrenia was not an illness because there was no demonstrable biological association. While his conclusion was always spurious, it was at least falsifiable and now has been falsified.
The other promise of landmark change is that the schizophrenia finding is first past the post only because it has attracted the largest sample size. The many genetic associations of bipolar disorder are also likely to be published soon and will show us how Kraepelin’s diseases really are related at the level of the genome. The rest of psychiatry will gradually be mapped out in the same way. Since I have always seen bipolar disorder as the paradigm disorder of psychiatry on the basis of its phenomenology – where every psychiatric syndrome comes together – personally I can’t wait to see the answers. Once we have them, it is not overstating the facts to say a new era begins.
I look forward to seeing you in Berlin.
Guy Goodwin
ECNP President
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