Within the psy- disciplines, Foucauldian discourse analysis has shown that those who exercise power in defining psychological experiences seek to maintain existing power hierarchies through this labeling. In that way, it is a fitting method to examine how the use of specific language constructs reality for individuals and society as a whole. Currently, the use of the word "triggered" has proliferated beyond the common mental health usage to refer to posttraumatic stress disorder or a re-experiencing symptom of a trauma. In (...) this qualitative investigation, we analyze "triggered" experiences written about in participants' vignettes to explore how using the word "triggered" does something in terms of power, hierarchy, and expression of vulnerability for individuals, and how this is impacted by the way they position themselves and others in speaking about their experiences. We understand the experience of being "triggered" to be constructed differently depending on the source of the trigger. The difference is particularly salient for those who use "triggered" to refer to a microaggression as opposed to those who are referring to a sexual assault. We discuss the tension between supporting a psychiatric status quo regarding trauma and the subversion of this status quo via the expanded use of the word "triggered.". (shrink)

Turkheimer and Greer’s article “Spit for Science and the Limits of Applied Psychiatric Genetics” (2024) offers a devastating critique of the state of psychiatric genetics, using Spit for Science (S4S) as a case study. I have read the paper many times in the process of writing this commentary, and each time I am left inarticulate. Nonetheless, I hope that my comments, from the point of view of a practitioner who operates at the intersection of clinical psychiatry, psychiatric science, and philosophy (...) of psychiatry, will be of some value to the discussion. I have no substantial disagreements with Turkheimer and Greer. The main point I wish to convey is that there is reason to hope that findings from genetic research... Read More. (shrink)

The pstchologist Danielle Dick and psychiatrist Kenneth Kendler (DK) began an ongoing study in 2011 called Spit for Science (S4S) in which they obtained saliva as a peripheral source of DNA along with assessment of detailed self-report information on alcohol and other substance use, selected personality traits, and psychosocial history about the students entering a large university (Dick et al., 2014). They hoped to identify the genes underlying the heritability of alcohol use and related behaviors to inform students about their (...) individual risk, and thereby to promote increased self-awareness and health. The students were highly cooperative volunteers, and many peer-reviewed research papers have been published from... Read More. (shrink)

In their paper “Spit for Science and the Limits of Applied Psychiatric Genetics,” Turkheimer and Rodock Greer use results from the Spit for Science (S4S) project to argue that the idea of psychiatric genetics1 yielding actionable results is a folly. Although there is much about which Turkheimer and I agree (I took my first psychology class from him 30 years ago), we fundamentally disagree about the outlook of psychiatric genetics. His paper suggests that our differing conclusions arise from the authors (...) misunderstanding the nature of the S4S project and a difference in our views on the broader purpose of psychiatric genetics.It is the characterization of S4S as a “program of research” that is the foundation for the... Read More. (shrink)

Here we articulate a negative answer to Turkheimer and Greer’s question: “Is it possible to envision a genetically informed program that ethically intervenes on campus drinking?” (Turkheimer & Greer, 2024). However, first, we note that the authors cover an immense amount of ground in their paper. They lend insight into how psychiatric genetics, at its very core, is conducted through their detailed examination of a large body of work in one specific area of this large field. A main result of (...) this is to explain the gulf between results and conclusions, work that provides an invaluable service not just to various areas in philosophy and bioethics, but that are deserving of readership by a very wide audience. This gulf... Read More. (shrink)

Eugen Bleuler introduced the concept of double bookkeeping in schizophrenia to describe the tendency for people who experience delusions to simultaneously be convinced of the delusional content and yet to act as if the delusion(s) was untrue/irrelevant or be unbothered by discrepancies. We open the question of whether there exists a double reality in individuals with addiction and whether double bookkeeping can be applied to addiction. While double bookkeeping has primarily been explored in schizophrenia, this concept may hold promise in (...) elucidating insight deficits in individuals with substance use disorders. We propose two forms of addiction double bookkeeping: 1) Partial compartmentalization: individuals demonstrate some awareness of the deleterious consequences of drug use, but continue to engage in addictive behaviors; and 2) Total compartmentalization: individuals who act as if the negative consequences of addiction do not exist, reflecting a more generalized and deeper lack of awareness into their own actions. We propose that a basic alteration in the individual’s sense of self occurs in addiction double bookkeeping as it does in schizophrenic double bookkeeping. We describe the proposed double reality in addiction from first-person and third-person perspectives, accounting for their differences. Three clinical exemplar cases are presented, and conceptual implications are explored. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities relating to drugs, drug (...) paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply _what_ affordances are experienced as salient, but also the _way_ in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved,” dominant concern, there is a risk that the _shape_ of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Turkheimer and Greer (2024) (henceforth “T&G”) make some fair points about problems in the scientific profession, including the regrettable tendency to promise practical applications of research that then never materialize. However, T&G’s sustained critique of a body of work associated with one particular researcher to make these general points struck us as uncharitable. More pressingly, we feel that the far-reaching conclusions that T&G attempt to draw from the results they review from the Spit for Science (S4S) cohort are unjustified and (...) risk misleading readers that psychiatric and behavioral genetics is in a parlous state.T&G state that S4S “produced a clear answer to the question it was designed to address,”... Read More. (shrink)

Theorists commonly maintain that addiction involves compulsion or diminished self-control. Some enactivist theorists have conceptualized this disruption to autonomous agency in terms of embodied habits that become overly rigid, so that an agent enacts this pattern of behavior even in circumstances that call for the activation of a very different set of habits. What is more, because addiction crowds out other goals and priorities, agents may become more one-dimensional and begin to lose a hold on values and commitments that are (...) important to them. Rather than engaging in self-regulation to balance competing priorities and gain a better understanding of how different aspects of their identity relate to one another, agent’s lives become dominated by addictive behavior. I argue that enactivist notions of _habit_ and _self-equilibration_ can help to make sense of how the disruptions to autonomous agency characteristic of addiction are linked to diminished self-insight. (shrink)

Back in 2011, I wrote a paper for the Journal of Bioethical Inquiry, an Australian journal, for a special issue dedicated to ethical issues associated with psychiatric genetics research. The editor was particularly excited by the recent findings of the 5-HTT allele in psychiatric illness. I had different ideas about what I wanted to write about, and the editor, Michael Robertson, graciously considered them and ultimately published the paper. At the time I was interested in the colossal investment of National (...) Institutes of Mental Health (NIMH) research dollars in psychiatric genetic research; at the time I was troubled at the lack of on-the-ground clinical implications of this research investment, and figured an... Read More. (shrink)

The research program Spit For Science was launched at Virginia Commonwealth University (VCU) in 2011. Since then, more than 10,000 freshmen have been enrolled in the program, filling out extensive questionnaires about their drinking, general substance use, and related behaviors, and also contributing saliva for genotyping. The goals of the program, as initially stated by the investigators, were to find the genes underlying the heritability of alcohol use and related behaviors, and in addition to put genetic knowledge to work in (...) ways that might aid university administrators and mental health professionals in the prevention and treatment of substance abuse. We review every empirical paper involving genetic data that has emerged from the program, and reach a surprising conclusion: the study has never identified a single genetic effect of more than trivial magnitude. Although the quantitative results of the studies were reported transparently, the theoretical ramifications of the negligible results have never been acknowledged. To the contrary, most of the papers ignore the tiny effects, reaching optimistic conclusions about the prospects for future genetic explanations of alcohol use. We explore the implications of these results for the broader prospects of applied psychiatric genetics. (shrink)

We are grateful for the opportunity to respond to such a varied and challenging set of commentaries. They range from highly supportive to quite disputatious; we will repay the supportive ones ironically, by discussing them only briefly. That will allow us to expand a bit on the more difficult comments, and of course the thoughtful reply from Dr. Dick.Knox, Allen, and Downes imagine a world in which effective polygenic scores for alcohol use exist and conclude that even then there would (...) be no way to use them ethically. We agree, for the most part, but there are several distinctions to consider. The first is among physical, medical, psychiatric, and normal-range behavioral phenotypes. Effective polygenic scores exist... Read More. (shrink)