Madness and Biotypes

There’s an interesting article in the most recent issue of the American Journal of Psychiatry. The study, Identification of Distinct Psychosis Biotypes Using Brain-Based Biomarkers, uses bio-markers to identify “three neurobiologically distinct psychosis biotypes.”

As the researchers explain, clinical diagnoses remain “the primary means for classifying psychoses despite considerable evidence that this method incompletely captures biologically meaningful differentiations.” The study aims to classify psychoses more rigorously and accurately by examining the underlying biological factors.

Researchers recruited individuals who had been diagnosed with some form of psychosis, as well as a comparative “healthy” population. They “collected a large panel of biomarkers of known relevance to psychosis and functional brain activity” and “refined a subset of the biomarker panel that differentiated people with psychosis from healthy persons.” Clustering the relevant biomarkers, researchers found three distinct biotypes (“biologically distinctive phenotypes”).

Interestingly, the three biotypes identified “did not respect clinical diagnosis boundaries.” That is: the biological expression of psychoses differed from their clinical diagnosis, highlighting the need to refine current diagnosis techniques.

However, the clusters did reveal a meaningful lens through which to view psychosis. For example, “the biotypes significantly differed in ratings on the Birchwood Social Functioning Scale, which assesses social engagement, psychosocial independence and competence, and occupational success; biotype 1 showed the most psychosocial impairment, and biotype 3 had the least impairment.”

Particularly interesting are the implications of this work:

The biotype outcome provides proof of concept that structural and functional brain biomarker measures can sort individuals with psychosis into groups that are neurobiologically
distinctive and appear biologically meaningful. These outcomes inspire specific theories that could be fruitfully investigated. First, biotypes 1 and 2 should be of greater interest in familial genetic investigations, while perhaps biotype 3 would bemore informative for explorations of environmental correlates of psychosis risk, spontaneous mutations, and/or epigenetic modifications.

This is fascinating research and certainly worthy of further study, but it also raises the haunting specter of modernity. As Gordon Finlayson describes in Habermas: A Very Short Introduction:

There is a sinister aspect to the assumption that science and rationality serve man’s underlying need to manipulate and control external nature: that domination and mastery are very close cousins of rationality. Not only science and technology, but rationality itself is implicated in domination.

James C. Scott emphasizes the difference between the dangerous ideology of “high modernism” and genuine scientific practice in his excellent book, Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed.

Unlike true scientific scholarship, high modernism was “a faith that borrowed, as it were, the legitimacy of science and technology. It was, accordingly, uncritical, unskeptical, and thus unscientifically optimist about the possibilities for the comprehensive planning of human settlement and production.”

In short, high modernism is the authoritarian imposition of a planned social order, designed by bureaucrats foolish enough fancy themselves as benevolent conquerors of nature.

To be clear, the study itself is not inherently high modernist. Better understanding and diagnosis of psychosis is a worthy scientific goal. But you’ll forgive me if I’m somewhat weary of the profession which considered homosexuality a mental ailment until the 1970s. Social understandings of “mental health” have long been propped up by the scientific understanding of the day – with the currently scientific research miraculously changing to validate social norms.

Michel Foucault perhaps best documents this phenomenon in Madness and Civilization, a brilliant historical account of “madness” as a social construct which shifts to fit the norms of the day.

Perhaps this seems unlikely in our modern world – surely our modern scientific understanding of biology far out shines the dark, half-science of the middle ages. Finding biological underpinnings of madness, biotypes that reveal psychosis, seems, on its face, reassuring: madness can be rationally explained.

Yet it is exactly that reassurance which ought to give us pause. Perhaps we have only found what we wanted to find – irrefutable proof that the mad are somehow different than the healthy, that there is something fundamentally, biologically, different about “them.” And, of course, it’s the implied outcome which should surely give us pause – if we can define the root of their madness, we can at last fix these poor, broken souls.


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