Annalise M. Perricone

A Curtain of Clouds

Walk with me. Make sure you bring the rubber boots which I, as per usual, forgot on Monday.

It was a spectacularly beautiful day along the Columbia river, with cloudscapes encouraging all kinds of fantasies and re-interpretations. They also made you wonder what would appear if you lifted them. Were they hiding Mt. Hood, or Mt. St. Helens, or would a peek of Mt. Adams appear? Those speculations relied, of course, on the general knowledge that those mountains are situated in the approximate location you were staring at.

What happens when you lift clouds without having the faintest idea what the background will reveal? Pleasant surprise, useful information, or a wish they’d hung in the air forever given what you discover?

These thoughts were rumbling since I had just read a fascinating new paper by two Yale psychologists, Woo-Kyoung Ahn and Annalise Perricone. In essence their research looks at the consequences of providing genetic information to people, information concerned with their potential susceptibility to mental disorders like depression, Alzheimer’s disease, alcohol abuse or eating disorders. (I’m summarizing below.)

Would you like to receive that information? Hand it over, hey, all knowledge is good! Allows for personalized treatments, specific interventions! What could possibly go wrong?

A lot, as it turns out, and not always what you’d predict. Information can harm you, and curiously enough, both the kind of information that confirms genetic susceptibility to a disease or its opposite, the reassurance that you don’t have the genes that might contribute to a problem.

Let’s say you learn that you have an elevated genetic risk of living with depression. Would you change your behavior in ways that might affect the emergence or severity of the disease? As it turns out, people generally don’t. That failure to do so is closely connected to our general misunderstanding of how genes work: most of us think they are immutable, that we can’t change anything about their expression. “Genes are destiny,” is the assumption. This mistaken belief is called psychological essentialism, where genes are believed to provide the essence for the characteristics observed in a person. Take height, for example. People tie a person’s height to their genetic make-up – never mind that an environmental manipulation, the absence of presence of sufficient nutrition, can stunt growth in any given individual.

Now add prognostic pessimism, our general belief that mental disease is pretty resistant to treatment.

“The extent to which one believes that one’s mental disorder has a genetic origin is positively associated with the extent to which one believes that mental disorders are untreatable or inevitable . For instance, the more individuals with depression attribute their symptoms to genetic factors, the more pessimistic they are about their own prognoses.”

Once you’re in this loop – knowing you have an elevated genetic risk and doubting treatment efficacy, the clinical consequences are dire, since your negative expectations will affect the treatment course.

However, we are able to intervene if we teach people about the malleability of genes, and how genetic expression can be counteracted, even shut down, with environmental interventions. Learning about this, people actually become more optimistic about the prognosis. Lots of clinical programs now use that kind of education to help people understand that genes do not mean a certain destiny.

Unfortunately, even if we are able to help people look more confidently at a future where their genetic risk is not all that counts, we have so far no comparable mediations of how they look at the past. When people learn that they have a genetic predisposition for depression, for example, they start to interpret their experienced symptoms as much worse than they actually were. Study after study show memory distortions of the severity of symptoms once you learn about your genetic risk. That exaggerated belief, of course, affects one’s expectation in therapeutic efficacy, a self-fulfilling prophecy.

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What about learning that you do not have an elevated risk for a particular condition?

That, too, can produce harm. Let’s say you enjoy drinking, or eating, in ways that border on abuse, or so you fear. Receiving the results from your genetic test that you do not have an elevated risk for Alcohol Abuse Disorder or Eating Disorder can now become a risk factor, as you think you’ve been given green light to continue or even increase your behavior. The feedback affects your interpretation of the seriousness of the harm you might expose yourself to, a false reassurance that can have disastrous consequences.

Lifting the clouds of ignorance? Maybe not.

The birds didn’t care, one way or another. Flocks of snow geese huddled in great masses against the wind.