Dr Tineke Broer reviews Michael Arribas-Ayllon, Andrew Bartlett, and Jamie Lewis’ Psychiatric Genetics: From Hereditary Madness to Big Biology (Routledge, 2019).
Michael Arribas-Ayllon, Andrew Bartlett, and Jamie Lewis present an erudite and informative “ethnographic” study of one UK centre (‘the Centre’) involved in psychiatric genetic studies. They carefully trace the changes in psychiatric genetics, both from a historical point of view and in a contemporary context, arguing that psychiatric genetics has become, as the title already suggests, “Big Biology”. In many ways, this book can be seen as a traditional STS laboratory ethnography, albeit now in a time where a single laboratory needs to be part of a collaborative (the Psychiatric Genetics Consortium) in order to survive. Two of the key questions in the book, then, are “how does a politics of scale operate in contemporary psychiatric genetics?” and, as outlined later, how has this politics of scale “changed the social and epistemic organization of a single institution?” (p. 217). In contrast to ‘Big Physics’ for instance, where scale is visible in “centralized facilities” containing “concentrations of expensive equipment” (p. 5), scale in the biomedical sciences “has come to denote the distributed management of scientific sites, the outsourcing of key components of production, and their less visible research practices that include a wide variety of expertise” (p. 5, emphasis in original).
The authors deliberately refer to their study “as ‘ethnographic’ rather than ‘ethnography’ because the former implies intermittent access to cultural domains of science through observation, description and interviews, rather than a sustained period of immersion” (p. 12-13). Throughout the book, they helpfully draw on Hacking’s concept of “styles of reasoning”. Styles of reasoning here are not taking place ‘in the head’; rather, they are “social practices”, “practical and theoretical activities of getting at the truth” (p. 6). For instance, in one of the historical chapters, they show how a gradual transition from “Library Medicine to Bedside Medicine”, as two distinct styles of reasoning, enabled a move away from theoretical concepts and reasoning to using the patient as a “patron” in empirically examining family histories (p. 23). In the early 1900s, “Hospital Medicine”, as explained in chapter 2, allowed for a larger number of cases, and this became combined with “Laboratory Medicine”, so that “an ensemble of researchers and methodological techniques [was formed] around patient populations” (p. 53), drawing too on emerging statistical techniques. Through engaging with a wealth of (historic) literature, the authors thus present a brilliant genealogy of how psychiatric genetics and its focus on large cohorts were born. This coincided with, or indeed enabled, a move from the concept of ‘hereditary’ where “a germ of disintegration passed from one generation to another” (p. 21), to the inclusion of “latent causes” and “irregular transmission” across generations (p. 23), through to a model of “polygenic liability” (p. 38).
In the contemporary chapters, they provide a careful analysis of what the scaling up of psychiatric genetics does within one particular centre. Except for the PIs who can attract funding to their name and can claim the ‘best’ position on publications, most of the people working in the Centre seem to be the “stand-ins” of Big Biology (p. 226). These people are in many ways “immobile” and ‘invisible’, despite being key drivers of the knowledge production (p. 227). Moreover, the authors show how a laboratory style of reasoning, in the era of Big Biology, largely gives way to a statistical style of reasoning, because it is necessary for survival to outsource the ‘wet’ labour of molecular biology such as extracting DNA, done in labs rather than on computers, to larger laboratories that form part of the consortium. The authors suggest that “the move to ‘Big Biology’ in psychiatric genetics is concomitant with a network of production in which bioinformatics [i.e. applying “statistical methods to produce biological knowledge” (p. 123)] plays a central role.” (p. 121, emphasis in original) Yet, for many biologists, bioinformatics is seen as merely a “service”, similar to technicians, analysing “other people’s data” (p. 135). In other words, “while in post-[Human Genome Project (HGP)] Big Biology bioinformatics is epistemically central, it is often institutionally peripheral” (p. 137). The authors make such points without ever falling back to easy criticisms regarding responsibility and determinism; indeed, their sociological analysis is nuanced and does justice to the complexities of scientific practices and disciplines.
Another interesting actor in this ‘network of production’, as they refer to the consortium of Big Biology with a reference to Latour (1987), is that of the fieldworker. Mostly young female psychology graduates, they spent a few years at the centre (though mostly by being ‘on the road’) collecting stories and blood of participants who have a history of mental illness. While the analysis of their affective labour is engaging, here one of the downsides of the book becomes apparent as well. It would have been of added value to also show the affective labour of fieldworkers rather than to merely present fieldworkers’ own accounts. Observations of fieldworkers at work would have allowed the authors, for instance, to analyse how fieldworkers managed to efficiently get through the interview while being sympathetic to participants, or how they deal with difficult and emotionally challenging questions and situations. Perhaps the authors did not have ethical permission to conduct these types of observations, but then an explanation or justification of this would have been useful. Consequently, they make such affective labour of fieldworkers visible only as invisible. Moreover, their own ethical, logistical, and indeed affective labour when doing ethnography remains mostly invisible too.
Even in chapter 7, on the publics of psychiatric genetics, notes from fieldwork are lacking, despite having done this fieldwork. Lewis was involved in some of the public engagement events and materials, which would have been a great basis for a more participatory observation including a discussion of the role of social scientists in such public engagement activities. Yet the only real “ethnographic” mention in this was that he had been told that one of the scientists nearly had a “heart attack” upon hearing about “a proposed event involving visual artists” (p. 177). They relegate to a footnote an explanation of how such art-based events are feared to co-align with public perceptions of psychiatry as ‘soft’, an image that psychiatrists themselves are keen to move away from (p. 189). Including more field notes, and not just in the introduction and conclusion as they have, would have significantly strengthened the analysis, especially those analyses that engage explicitly with the social and affective organization of knowledge production and the consequences for individual scientists and fieldworkers.
In conclusion, this is a highly engaging and readable ethnographic study of psychiatric genetics both then and now, providing a thorough analysis of written and spoken accounts of scientists to investigate how the field of psychiatric genetics evolved and became stabilized, and with what social and epistemic consequences. While this could have been mostly a contemporary ethnographic study, the authors are acutely attuned to historical literature and practices, and with much nuanced attention to the changes over time in the social practices of science. Their article, co-written with Katie Featherstone, ‘Complexity and accountability: The witches’ brew of psychiatric genetics’, which formed the basis for chapter 3 in the book, was already an article I have gone back to time and again for its inspiring analysis of scientific rhetoric and the material and temporary consequences of such rhetorical strategies, and Psychiatric Genetics will also be a pleasure to re-read and re-engage with. I would highly recommend the book to STS scholars, sociologists of medicine and of psychiatry, as well as to psychiatrists and genetic researchers interested in a sociological and generous take on their disciplinary practices.
Latour B (1987) Science in Action: How to Follow Scientists and Engineers through Society. Cambridge, MA: Harvard University Press.
Tineke Broer is Assistant Professor at the Tilburg Institute for Law, Technology, and Society at Tilburg University, the Netherlands. Their research interests are across the sociology of science and the sociology of mental health and illness, with a predominant focus on new technologies in and for mental health. Previously, Tineke was a Research Fellow at the University of Edinburgh.