March 28, 2008

It only took 50 years and many ruined lives for the truth to emerge

There was a story in the news today about a study to be published in the journal, Science which for the first time convincingly demonstrates that there are genetic factors associated with schizophrenia.

Schizophrenia Linked with Rare Often Unique Genetic Glitches

This story had particular resonance for me because my father was an influential Freudian psychologist whose career peaked in the 1950s. Many of his older psychiatrist friends had been students of Freud. So while I was growing up, I sat in on many a dinner table conversation between my father and his peers about schizophrenia and its causes.

My father's psychiatrist friends were powerful people in the psychiatric establishment in New York City. Often they'd brag about their celebrity clients. And they had no doubt at all about what caused schizophrenia: bad mothering.

The theories varied in details. Did a child become schizophrenic because they had what Bettelheim called a "refrigerator mother," or should the blame fall on the inconsistent mother who gave the child mixed messages? Others blamed the mother whose feminine sexual expression was too strong, but then, equal damage might have been done by the mother who confused her son about his gender identity by not being feminine enough.

All these theories had in common only this--that these influential doctors wrote and taught that the ultimate cause of schizophrenia was something the patient's mother had done wrong. And that these experts were utterly and irredeemably wrong.

But such was the power of these men within their profession that for decades they added an inconceivably cruel burden to the lives of the mothers whose lives were already hard enough, by telling them that their children's terrible untreatable mental condition was all their fault.

So you can imagine how I felt when I read that after years of futile searching for genetic causes of schizophrenia, scientists had been able to use new, sophisticated techniques of examining the genome to begin to identify some of the many different genetic flaws that interfere with the complex pathways involved in how the brain processes thought.

And that of course made me think of how another generation of powerful experts continue to increase the load of misery on another population whose condition is most certainly genetic in nature too: people with Type 2 diabetes.

Like schizophrenia, Type 2 diabetes is not one disorder, and it is not caused by one gene. Dozens of genes have been linked to the development of Type 2 diabetes--genes that affect insulin secretion, the function of mitochondria, and many other subtle factors. Only slowly is it starting to become clear that genetic flaws--inherited or induced by environmental toxins--disrupt glucose metabolism at any of a multitude of locations in the complex pathways involved and that without such a genetic flaw, no matter how fat or sedentary a person might be, they don't develop diabetes.

Don't expect the experts to change their tune on this, though. You'll still read diabetes "experts" pontificating that diabetes is "caused by obesity" and could be cured if people lost a couple pounds eating a low fat diet and got off their lazy butts and exercised.

In the case of psychiatry, my dad's friends never gave up their misguided theories. My dad died still convinced that Freud's toxic theories could explain anything that happened in the personality. But no one lives forever, and now he and his peers are all gone, replaced by a newer generation of psychiatrists who ditched Freud's toxic woman-hating theories in favor of drug treatments that, whatever their failings, could at least improve the lives of their patients.

We will probably have to wait for the current crop of experts to retire to see the same kind of change in public understanding of diabetes. One cannot help but hope that the diabetes experts continue to eat the low fat diets they are so enthusiastic about and maintain for themselves the A1cs they push on the public, to hasten the process.

But in fifty years the public will look with the same kind of horror on the doctors who blamed children and adults for causing their own Type 2 as they do on those toxic mother-hating theories.

I just hope I can hang on long enough to see it happen!


Anonymous said...

Don't expect the experts to change their tune on this, though. You'll still read diabetes "experts" pontificating that diabetes is "caused by obesity" and could be cured if people lost a couple pounds eating a low fat diet and got off their lazy butts and exercised.

The media often oversimplifies the message of knowledgeable, respected health and medical experts: disease is an interaction between genes and the environment. Just because someone is has genes that increase the risk of heart disease or diabetes doesn't mean that person will get these diseases prematurely or even at all. It is true that 20% of type II diabetics are not overweight. However, that is disproportionally lower than the general population. Moreover, those 20% may eat a high carb diet. The best evidence of the role of environment (diet, exercise) can be found in comparisons of diabetes rates between the Pimas of the southwest US and Mexico. Same genes, vastly different diabetes rates.

Diabetes rates among the elderly are high, aren't they? That means that even people not genetically predisposed to diabetes may get it eventually when their aging bodies can no longer counter the effects of an unhealthy diet and sedentary lifestyle.

Jenny said...


People develop diabetes as they get older, but it has nothing to do with the healthiness of their lifestyle.

My 92 year old mom, obese in her 50s, who never lifted anything heavier than a credit card and whose motto was, "Don't walk, take a cab" has a fasting blood sugar of 81 mg/dl.

As people age, the life-long stress on marginal beta cells starts to burn them out, and those with underlying predispositions will develop diabetes. So will those who have been exposed to critical amounts of things like pesticides and PCBs which damage genes too and also lead to people getting diabetes.

And I might also point out that I know quite a few low carbing slim Type 2 diabetics who are all QUITE diabetic, despite the diet. And the normal weight.

And finally, it is worth noting that the Pima diabetes is most definitely genetic in nature, confined to that ethnic group, grows out of their very short distance from a lifestyle with very limited food, and differs quite a lot in its characteristics from the kinds of diabetes found in European populations.

Anonymous said...

There are always exceptions, Jenny. Your mom probably has great longevity genes, just like the relatives on my mother's side of the family. The longest living person in the world smoked, but that doesn't disprove that smoking causes lung cancer, COPD, and other diseases.

That thin people, even low-carb thin people, get diabetes does not disprove a causal link between weight, diet, and physical activity and diabetes. Those three factors alone cannot make one diabetic, but they can hasten the onset of diabetes in genetically susceptible people.

As for the "low-carbing, slim diabetics," I'm curious to know if these people had been low-carbing and slim for their whole lives before developing diabetes. If so, that suggests there are some people are genetically doomed to diabetes in the way that people with hypercholestemia cannot avoid heart disease or people with high risk cancer genes have preventive mastectomies.

Jenny said...

People who are curious can check out just a small amount of the research pointing to strong genetic components in the development of diabetes at:

There is new data along these lines coming out every month.

Anna said...


I've never run into anyone with any blood glucose abnormality who wasn't a consumer of fairly high carb intake for a significant length of time, regardless of weight status. In some cases, they mistakenly think that a lot of carbs are good for their condition, especially if they were diagnosed hypoglycemic (my retirement age neighbor, could never work because of her hypoglycemic condition (?), nibbles on carbs all day, has a pronounced apple shape, and has had at least one heart attack. She can't imagine that nibbling carbs all her adult life could be problematic, since her hypoglycemic condition "requires" her to consume carbs to keep her BG up enough (sigh).

In other cases, most people just people learned to eat carbs while growing up. In American society, people eating a fairly high amount of carbs is pretty much the default, especially in the recent decades with the low fat emphasis; far less people eat LC naturally (don't eat sugar or starch foods) without a conscious effort to do so (though I know a few with just natural inclinations to LC and none of them are overweight or have glucose issues).

Anonymous, so I am one of those "those people" who *used* to eat lots of carbs, but have a glucose regulation problem now despite not being overweight. I'm not diabetic yet, prediabetic would be the best description. I'm not sure I would use the term thin, but I'm not overweight, but I will start to gain weight if I don't stay on a LC diet.

I was too thin and ate anything I wanted to ( until the age 29, after a couple years really doing a good job of following the advice of the day to reduce saturated fat & meat, increase complex carbs (especially whole grains) & polyunsaturated fats. In one year I went from my usual too-boyish figure to having curves (from about 106 to 125 - I'm 5'4"). It was easy to write that new pounds off to a less active job change, age, etc. I never imagined it could be from the "healthy" carbs I was consuming a la Jane Brody. I also had some minor, but annoying issues cropping up then that I now recognize as glucose issues-adult acne, yeast infections, gingivitis, etc.

At age 36 I was 131 pounds, and pregnant. Halfway through, I was diagnosed with gestational diabetes, well controlled with LC diet for the remainder of the pregnancy. *After* I finished breast feeding, I was at a nice 125 pounds or so again, but then I gained about 20 pounds over a few years; I had gone back to a high carb diet, complete with homemade bread daily from my new bread machine and frequent home made pizza & pasta. Four years ago I stumbled back on low carb to lose that 20 pounds (high point at 140 lbs at 5'4" and I have stuck with it and maintained a good "mid-normal" weight ever since, in the low to mid 120s. But I now know my glucose regulation is not working normally so I have to stay on LC to keep normal BG and weight.

So if my experience is typical, I think that most "thin diabetic" types do eat a fair amount of carbs before the glucose issues are detected. I think when one is thin it might even take longer to detect the problem, because doctors are focussed on obesity as a risk factor for diabetes. In my case, I had to prove to my doctor that I needed another GTT, even with a gestational diabetes history and my reports that a glucose meter showed abnormal post meal levels with high carb foods.

Dallee said...

Dear Jenny,

I don't know if you've followed the historical explorations of Freud's "conversion hysteria" position, so I'll share three book titles -- all are currently listed on if anyone would like to take a peek.

The Assault on Truth: Freud's Suppression of the Seduction Theory by Jeffrey Moussaieff Masson -- great reviews -- explores Freud's initial belief in his patient's accounts of sexual abuse (Freud had had much experience during his training at the Paris Morgue with young female victims of abuse), and his revision of his views after he was professionally rejected by his male colleagues.

Denial of Death (Paperback)
by Ernest Becker
-- 1974 Pulitzer Price winner by a brilliant existential philosopher, containing much material about Freud's reaction to male disapproval, including documented reports of fainting. Beautifully written, touching upon many themes other than Freud.

In the Freud Archives by Janet Malcolm -- an account of Masson's connection with the Freud Archives, not always favorable to Masson.

But, to return to your basic point, I believe you are entirely correct on the mixture of genes, what we have come to know as "life-style" factors, and influences still being identified (such as the correlation with a mother having gestational diabetes). And, as is clear from your Blood Sugar 101 and Low Carb web pages, for us diabetics, our best hope arises from accepting our diagnoses and working to keep blood glucose within normal ranges.

Thank you for all your posts.

Tracy said...

Hi Jenny,

I know schitzophrenia isn't your area of focus, but your post reminded me that there is a link, at least in some people, between this condition and gluten intolerance/celiac disease. It never ceases to amaze me how many ills are related, in some way, to nutrition (or to poor nutrition/unsuitable foods turning certain genes on that would not have been triggered otherwise)