From Molecule to Mind: Genetics, Genomics, and Psychiatry

It is probable that in April of 1953 very few psychiatrists took note of a 1-page paper in Nature written by James Watson and Francis Crick. Nor have most of you probably read this classic in the history of science before today, although the enormous attention created by the sequencing of the human genome has certainly placed genetics and genomics on the radar screen for all of us. This issue of the Journal is designed both to commemorate and honor the “double helix discovery” and to prepare psychiatrists for the “genomic era” that will unfold during the 21st century.

We have reprinted the original Nature paper for all to read. We are honored to have commentaries by James Watson, by Marshall Nirenberg (Nobel recipient in 1968 for discovering that RNA is used for protein synthesis), and by Thomas Insel and Francis Collins, the Directors of NIMH and the National Human Genome Research Institute, respectively. We also have four highly educational overview articles by distinguished authors on endophenotypes, animal models, microarrays, and on general strategies for identifying the genetic mechanisms of mental illnesses. Some of you may be shaking your heads and wondering if all this “technical stuff” really has anything to do with psychiatry, or if it will change your daily practice in any way. Believe me—it will. The question is not a matter of “if” but “when?” So right now is the time to start educating yourself about it, if you haven’t already. The genomic era has implications for all of us, whatever our intellectual and philosophical approach to psychiatry and whatever mix of patients we treat.

If the past is any predictor of the future, then I would infer that we cannot come close to imagining how much the genomic revolution will change psychiatry during the next 50 years. As overviewed by Merikangas, the genetic contributions to major mental illnesses have been well-recognized for more than a century. Increasingly, the genetic contributions to other human traits and variations are also being studied and documented, as demonstrated by the article on shyness in this issue. It will take time and a great deal of work, but over the coming decades we are certain to learn much more about the movement from molecules to minds—how our genes contribute to who and what each of us is, and how and why some of us move from the normal continuum into a state of pathology.

As a psychiatrist who has struggled to help people with serious mental illnesses for 30 years, I welcome the era of the genome with great hope. The “genomic era” is about much more than “finding genes.” It is about understanding how they get turned on, or turned off. It is about examining the complex interactions between genes and the huge array of nongenetic factors that influence their effects. It is about our capacity as scientists and clinicians to improve diagnosis, treatment, and, ultimately, prevention. The tools described in this issue will gradually and steadily be used to identify new ways that we can intervene and prevent or ways that we can treat more effectively and intelligently. During the 21st century, a story whose plot we do not yet know will certainly unfold. Whatever its specific content, it will be about how we can move from studying and understanding molecules to studying and understanding the human mind. During this journey from molecule to mind, we will discover many ways to ameliorate and perhaps prevent some of the untold human suffering caused by mental illnesses. Prepare yourselves to understand this journey by studying this issue of The American Journal of Psychiatry!