Siddhartha Mukherjee tackles mental illness with The Gene

by Aarathi Prasad

The morning I met Siddhartha Mukherjee, he had run most of the way from his room at the magnificent St Pancras Renaissance Hotel—as soon as he realised that his cab would not get the better of London’s rush-hour traffic. “You haven’t even broken a sweat,” I joke. “I have. I’m sweating,” he insists. But Mukherjee is impossibly calm and disarmingly kind, the qualities that likely marked him for success when he left Delhi for Oxford at age 17. He became a Rhodes Scholar and completed his PhD before going on to receive a medical degree at Harvard University. His first book, The Emperor Of All Maladies, won the Pulitzer Prize for non-fiction in 2011 and introduced us to a consummate wordsmith, one who can present cutting-edge science and complex ideas through a riveting narrative. 

The physician and cancer researcher lives in New York with his wife, artist Sarah Sze, and their two young daughters, and family forms the emotional core of his new book, The Gene: An Intimate History. More than scientific or historical, this book is intimate. “The book covers so much ground,” says Mukherjee. “It ranges from my very personal history all the way to the future of the way we understand race and sexuality and gender. Every different chapter brought in a new surprise, like a change in the weather. There were chapters in the book where the weather turns wintery, there were chapters where it turns summery; there is humour, and then that goes away and is replaced by something very dark. Macabre, even.”

I felt a little voyeuristic reading The Gene. You have to read on, you want to know more, because of the very personal family stories he lays wide open. These are stories of his father’s brothers and his own first cousin suffering possibly the most stigmatising of conditions anywhere in the world: mental illness. And in India, as I realised over the last year when I spent time exploring the landscape of psychiatry for my book, In The Bonesetter’s Waiting Room, Mukherjee’s discussion of both mental illness and genetics doesn’t come a moment too soon. We spoke about the story behind this epic, erudite, moving, and very personal account of the mental illness that runs in his family.

Aarathi Prasad: I loved reading the stories of your grandmother, who moved to Kolkata during the Partition, and about her difficulties raising her children there. You describe how some of them have serious, very frightening mental illnesses.
Siddhartha Mukherjee: Well, The Gene came out in a very personal way. I felt it was a book that had to be written, about how we imagine inheritance, heredity and family, in the future. We are at this striking moment in history, when all of a sudden, genes have become understood in a way they were not 10 years ago. We can change the human genome with the kind of dexterity that we did not possess earlier. That’s part of the reason it had to be written down. For as long as I can remember, I’ve thought that the history of mental illness in our family had a multigenerational component. It was something that I feared as I was growing up, and [there was] a moment in my childhood when that fear became even more visceral. I had the typical storms of adolescence. There was very little psychiatry in India, so my father dragged me to a general doctor, and in the end, nothing came of it, but that fear was very much part of my childhood.

AP: How did your family in India deal with the mental illness?
SM: I think that my family had no vocabulary to comprehend it. Obviously, the Partition was such a huge event in their lives. Giving up your home, the moving, the moral tragedy—everything was explained in terms of that trauma. 

AP: But when your cousins, who didn’t experience Partition, also developed mental illness, did your family suspect it might be genetic?
SM: Post 1947, Kolkata was a transformed city. And that a transformed city would give rise to children with trauma was not surprising at all to my parents. We are always looking to tie our own lives with our experiences to try to explain ourselves. I do think that illness, including mental illness, is not just genetic. It might well need triggers and environmental influences to unveil or release itself. Or maybe, chance. And at least in my grandmother’s typography, those elements—chance, triggers, environment—reigned large. She didn’t have the vocabulary of heredity and genetics to talk about it. Perhaps because she was too afraid or ashamed of it; that was certainly the nature of that conversation.

AP: Why, then, did you choose to work with cancer and not mental illness?
SM: Maybe I was too scared. I don’t know, I’ve thought about it a lot. And then I was just drawn more and more to my work in cancer.

AP: What genetic or environmental triggers do you think caused the mental illness in your family?
SM: We will never know. I have not tested myself because I do not believe that the testing will reveal anything at this point. Maybe in the distant future.

AP: In which case, what do you say about the idea some people have, that a person with mental illness, like bipolar disorder, ought to consider not procreating?
SM: You know, this is a eugenic argument that I don’t buy. Anytime someone says ‘ought to’, they should reconsider what they are saying ‘ought to’ about. It’s a very personal choice. Bipolar disorder is a complex disorder involving multiple genes, gene-environment interaction and chance. Although there is a hereditary component to it, it’s not like there’s one gene governing a certain type of mental illness.

AP: So parents can’t be certain that they will pass it on?
SM: Yes. But more importantly, what I am saying is that extraordinary eugenic statements need to judged with extraordinary amounts of skepticism. And these are decisions that I think we are going to face more and more as a society and as genetics moves forward. What will happen in the distant future is that we will understand the genome, but it won’t be a one-to-one understanding. The genome won’t be a report card in which, you know, you get an A– for this disease and a B+ for that disease. I think what will happen is that the genome will be read in terms of probabilities. If it is a report card, it will be only in the sense that we will be able to predict propensities and probabilities. And the question is, what will we do with that information? 

AP: Do you think mental illness will lose this fog of misunderstanding?
SM: We are still trying to understand it: what it means, how it lies within the bounds of what we consider normal and where it departs from them. It is not so simple. For most mental illnesses there’s usually no diagnostic test—you can’t take a blood test, for example, for schizophrenia. Even the testing and the understanding of it is subjective, based on an assessment done by a psychiatrist. There’s a long way to go. But right now, we are trying to understand how genes, environments and chance precipitate all kinds of illness, including mental illness. This has already changed how we imagine ourselves and our futures.

AP: Do you think we could lose a little of the variety of what makes us ‘us’ if we could write out mental illness? You quote a conversation with a psychiatrist who muses if a little psychosis might be good for us.
SM: There’s the anecdotal stuff in culture of a link between mental variation and creativity. It’s very poorly understood and very poorly studied. That quote gets to the idea that in psychiatry it’s very hard to say what good and bad is. Psychiatrists are trying to figure out how to attach value—moral value—to your particular behaviours. Are they adaptive? Are they a response to something? Are they causing pathology? Given my own family’s history, that’s a question that I keep coming back to.

AP: Do you worry about the family history affecting your children?
SM: I fear it less and less every year. You know, that’s the wonderful thing about genes: as they get mixed and matched, they change. And that’s an arrangement we should celebrate more than rue. 

The Gene: An Intimate History (Penguin Random House) is out now

Photograph: Keiran Perry