The Medicalization of Sin

Marilyn vos Savant, who holds the world record for "highest recorded IQ," answers a reader's question in her "Ask Marilyn" column in this week's issue of Parade Magazine,

Why do you doubt the idea that certain people are genetically prone to alcoholism?

- J.T., New York, N.Y.

One reason is that alcohol doesn't exist in nature. Instead, alcohol is a creation of mankind: Our genes don't know about it. Another reason is that about 80% of alcoholics are male. Yet no one suggests that problem genes are sex-linked, such as male-pattern baldness. So I am concerned that, in an effort to remove the stigma of alcoholism from individuals and to blame their genes instead, we are stigmatizing whole families and ethnic groups. In my opinion, that's far worse.

I'm not knowledgeable enough to judge her factual claims, but I find her argument plausible, and if true, devastating to the "scientific" claims of the modern puritanical movement.

This strategy of using pseudoscience to justify religiously motivated prohibitions against sin has been around for over a century and a half:

1843 ? The Ruthenian physician Heinrich Kaan publishes his study "Psychopathia sexualis", in which sins of the flesh are reinterpreted as diseases of the mind. Following this initiative, other physicians and psychiatrists also begin to use medieval theological terms of disapproval like "deviation", "aberration", and "perversion". Originally, these had referred to "false" religious beliefs or heresy; now they begin to turn into (pseudo) medical concepts. The whole process is known in cultural history as the ?medicalization of sin?.

- Erotica Bibliophile - A Chronology of People (1800 - 1935)

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Imagine: the world's highest

Imagine: the world's highest IQ and her name is "Savant."

I can't understand the

I can't understand the savant's commentary but I've mostly interpreted alcohol abuse as a culturally inherited preponderance or, in the case of when it is newly introduced to a culture: moreso fascination with its effects; it has been popular through the ages. . . and although abuse of alcohol can be ruinous -- like anything else there are two sides to the coin and there might be some enjoyment found there whereas those of moderation might not have access too. . .

On your blog you say, Well,

On your blog you say,

    Well, I don't see the logic to that statement. The "alcohol" gene could have evolved in relation to something else--like dark fingernails, or long toes, for instance.

As I said, I'm no expert, but from the little evolutionary biology I do know, this doesn't seem plausible. It is certainly possible that such a gene exists and was inherited over thousands of years for no apparent reason (perhaps because it was linked to another, more useful gene). But there is no reason to believe that this is more probable than not. Also, if we assume that there have been a number of medical studies looking for other phenotypes in common among alcoholics, and none have been found, we might be less likely to believe that one will be found. Of course, this may not be the case, but it does give us reason to doubt.

And speaking of probabilities, I too wonder: what are the odds that the world's highest IQ has the name of Savant?

Speaking as a former

Speaking as a former molecular biologist, I can attest to what Buster is saying.

The problem with concieving of things as "the X gene" or "the Y gene" is that folk start to think that here is a gene that is designed with X or Y purpose in mind.

The problem is most genes aren't/weren't designed at all (if you accept evolution). The theory popular back when I was in the Genetics dept at UGA was that gene evolution occurs through gene duplication and mutation of the extra gene. When a new environmental effect appears and can "act" upon the new gene, a new function may appear (a previously neutral mutation is revealed to be positive in a new circumstance).

Thus it is at least possible that there does exist a "gene" who's function is revealed only when exposed to alcohol.

But that's just a simplistic way to look at it. Another way is to think about a legitimate biochemical pathway that has multiple proteins that can have multiple structures. ONe can imagine a particular structure or arrangement that reacts to alcohol in a way that causes dependence. If men are more likely to be alcoholics, one might think that the pathway is related to male hormones, for example, and look there.

Finally, the idea that alcohol doesn't exist in nature is poppycock. Fruits ferment as a part of the rotting process. But more fundamentally, alcohol is a common byproduct of many biochemical reactions. Yeast use the alcohol route for anaerobic respiration. Alcohols get formed all the time. Knowing this about human/animal biochemistry would at least grant the possibility of a natural, inherited system that is susceptible to alcohol that can lead to addiction.

Brian, I'm familiar with


I'm familiar with your criticisms, but what I think is at issue here is that unless the "alcohol gene" (or combination of genes that lead to the same effect) is somehow connected with other phenotypes that would be naturally selected for (in the same way that genes which make Africans susceptable to Sickle Cell disease also make them resistant to malaria), it seems unlikely that it would have been passed down over thousands of years. And if there is a link between alcoholism and some beneficial phenotype, why have we not discovered this phenotype common to alcoholics?

Of course I'm not positing any "design," as that is contrary to the concept of natural selection.

Finally, the idea that alcohol doesn't exist in nature is poppycock.

I actually thought of mentioning this same criticism when I was making my original post, but I'm not entirely sure if that kind of fermentation is related to the type of alcoholism in question. It could be, which is why I acknowledged that I'm not knowledgeable enough to judge her factual claims, but it doesn't seem likely.

I should probably stick to economics, where I have a comparative advantage, and avoid biology, where I do not.

It doesnt have to be linked

It doesnt have to be linked to a beneficial phenotype (ala Sickle Cell anemia), it could simply be a by-product of a vital pathway. Like a security flaw in Windows or something. ^_^

IN other words, the propensity to become an alcoholic (genetically) may be the function of a completely unrelated pathway/system that IS selected for, but you'd never notice it if you took the sickle-cell approach.

I live alongside an

I live alongside an abandoned orchard where fruit ferments in vast quantities. You should see the drunken robins killing themselves against my picture windows every spring. Flying under the influence: it's deadly. Ms. Savant is no savant about alcohol.

Moreover there are demonstrable differences in alcohol metabolism, both among individuals and ethnic groups. People who metabolize alcohol very well or very poorly are disproportionately apt to become addicted. The frequency of alcoholism in given populations roughly tracks the length of time that alcohol has been a part of local cultures. One can infer that a propensity to abuse the substance diminishes over thousands of years, possibly for evolutionary reasons.

The Church of Alcoholics

The Church of Alcoholics Anonymous are absolutely committed to the idea that alcoholism is the fault of *anything* but the alcoholic, and the idea that it might be genetic fits into their dogma wonderfully. It's voodoo pharmacology as religion.

The problem with determinism

The problem with determinism is that Humans are self-aware, which means that we're ultimately indeterminant (except for the mentally insane). Genetics or no, I can't accept a position that lets people off the hook for the choices they make with the equivalent of "the devil made me do it".

Being self aware means being able to alter one's circumstances (because one is aware of what is going on). Whether that alteration comes from force of individual will or by getting others to intervene on your behalf is immaterial. But it is never a case where you're some sort of robot, passively following your genetic program.