Man vs the Mad gene - Siddhartha Mukherjee's account of a global problem
That smallest unit of heredity which doesn't care about our happiness or unhappiness. About our health or well-being. About our freedoms. About our choices. About us.
But it faithfully passes on from generation to generation - the good, the bad and the ugly of the gene pool. While the good doesn't hurt, there is plenty of bad and ugly - that kills. Literally.
Cancer cells being the worst hand-me-downs. Mental illnesses such as schizophrenia and bipolar disorders are hardly family treasures to be proud of. But genes are the only true legacies that we inherit for free, without an ounce of favouritism, without the fights in courts and without a care.
There's no escape. Not from the carcinogens. Not from heart diseases. Not from obesity. Not from madness. Even if we decide to screen ourselves twice a year. Or are screened before our births. There is no stopping the genes.
And that's what had Siddhartha Mukherjee, a cancer geneticist and stem cell biologist, worried for over forty years. Worried about the schizophrenic genes of his paternal uncle and cousin showing up in him. Or being passed on to his two daughters.
Mukherjee started to delve into a futuristic world where we could order genes, manipulate them, have a manifesto in place or at least a hitchhiker's guide for a post-genomic world. The result is his newest book "The Gene".
But the bad news is that such a world may never be. As Mukherjee's opening quote in the book by Philip Larkin, reads:
They fuck you up, your mum and dad.
They may not mean to, but they do.
They fill you with the faults they had
And add some extra, just for you.
The Mad Genes
When Mukherjee's cousin Moni turned, 40, he was diagnosed with schizophrenia and sent to a "lunatic home". Mukherjee's father is yet to accept Moni's diagnosis. He once visited the institution unannounced hoping to see a transformed Moni.
But then Moni isn't the only member of his family who has been diagnosed with madness.
"Madness, it turns out, has been among the Mukherjees for at least two generations, and at least part of my father's reluctance to accept Moni's diagnosis lies in my father's grim recognition that some kernel of the illness may be buried, like toxic waste, in himself," Mukherkee writes in "The Gene".
Mukherjee's uncle Rajesh died prematurely when he was only 22. Rajesh was the best of the brothers, a genius of sorts, who had successfully stepped into his father's shoes at the age of 12 following his premature death. But in the summer of 1946 he began to behave oddly: good news triggered outbursts of joy and bad news plunged him into inconsolable desolation.
The extreme mood swings from "rage to grandiosity", the fits of energy, the séance sessions, the graveyard meetings at night were noticed by the family. Officially, Rajesh died of pneumonia. Unofficially, it was his madness that consumed him.
The diagnosis came much later when Mukherjee was in medical school and realised that his uncle was likely in the throes of an acute manic phase.
Then there was Jagu, another of Mukherjee's uncles, who looked like a "Bengali Jim Morrison", and whose mind was also "crumbling".
In Jagu's case the signs showed up early. Voices in his head told him what to do. "He often spoke to himself, with a particular obsession of reciting made-up train schedules ('Shimla to Howrah by Kalka mail, then transfer at Howrah to Shri Jagannath Express to Puri')".
In the 1970s Jagu was diagnosed with schizophrenia. But Jagu continued to live at home guarded by his mother. When Jagu was restless or consumed by his fears and fantasies, she put him to bed like a child, with her hand on his forehead. When she died he vanished to live with a religious sect until his death.
Triggers & Instigators
Mukherjee's parents believed that the psychic trauma of their sons was a result of the Partition of East Pakistan, which both their sons had witnessed.
The illness manifested differently in both the sons. While Rajesh wandered the city at night, Jagu stayed inside his room staring blankly at the world outside.
The trigger was beyond comprehension for Moni. He was not a "child of Partition" and had had a secure childhood. Yet he was responding to the "inner voices" that commanded him to piss in a public park or flirt with a girl. He was sent to an "institution".
"Psychiatrists discourage the use of the archaic phrase 'mental asylum' - but for Moni, the description had come to be chillingly accurate: this was the one place that offered him the shelter and safety that had been missing from his life. He was a bird that had voluntarily caged itself," writes Mukherjee.
There was an episode in Mukherjee's life too - and his parents dragged him to the doctor who had diagnosed Jagu. Because Mukherjee had stopped speaking to his parents and had refused to do homework. On top of that his ageing grandmother insisted on calling him "Rajesh".
When he met his wife Sarah he decided to tell her about the mad genes in the family.
"I told her about the splintered minds of my cousin and two uncles. It was only fair to a future partner that I should come with a letter of warning," he writes.
Normal vs Abnormal
Mukjherjee's parents continued to be in denial but it was hard for him to not think about the "hereditary component" - the gene or a set of genes - that had consumed three people in his family.
Two studies that he chanced upon confirmed his suspicion on the role of genes in transmitting mental illness. The studies pointed at a genetic link between bipolar disease and schizophrenia crisscrossing generations.
While the studies provided him a "strange solace", they provoked a volley of new questions.
- If Moni's illness was genetic, then why had his father and sister been spared?
- What triggers had unveiled these predispositions?
- How much of Jagu's or Moni's illnesses arose from 'nature' (i.e, genes predisposed to mental illness) versus 'nurture' (environmental triggers such as upheaval, discord, and trauma)?
- Might my father carry the susceptibility?
- Was I a carrier as well?
- What if I could know the precise nature of this genetic flaw?
- Would I test myself, or my two daughters?
- Would I inform them of the results?
- What if only one of them turned out to carry that mark?"
A Dangerous Idea
The gene is the smallest, the most fundamental and the least divisible unit of a larger form that holds our lives in its fist. Mukherjee calls it the most powerful and dangerous idea in the history of science.
He offers an analogy to make the readers understand the importance of this smallest unit.
"You can only decipher the meaning of a sentence by deciphering every individual word - yet a sentence carries more meaning than any of the individual words. And so it is with genes. An organism is much more than its genes, of course, but to understand an organism, you must first understand its genes," he writes.
We've come a long way since Dutch biologist Hugo de Vries encountered the concept of the gene in the 1890s. We can alter genes and change their functions. We can now "read" and "write" human genomes.
"This transition - from explanation to manipulation - is precisely what makes the field of genetics resonate far beyond the realms of science," writes Mukherjee.
And embedded in the history of the gene is "the quest for eternal youth, the Faustian myth of abrupt reversal of fortune, and our own century's flirtation with the perfectibility of man" and our "desire to decipher our manual of instructions".
An Intimate History
"The Gene" runs into 600 pages. Enough reason to give it a miss. And there's the presumption that it's a heavy-duty science read which most people have no aptitude or appetite for.
But Pulitzer award-winning Mukherjee has beautifully woven the story of the gene against the backdrop of mad genes in his family. That pulls the reader in. Next, without intimidation or the air of a genius scientist - which is what he is - he breaks up the gene for the uninitiated and how it affects our lives, our destinies.
The stories of his two uncles and his cousin are touching. It is difficult to resist the urge to check our own family histories. Or ponder over what lies in store for us, given the stressful times we live in. Will we see a future when "inner voices" will command us to do certain things?
The perception of "normal" and "abnormal" changes after reading this book. Mukherjee's uncle Rajesh was an exceptionally bright person, but also bipolar. He died right after his accentuated celebrations of his spectacular exam results in college.
There are stories within stories. Such as of Mukherjee's cousin Moni, who decided to stay on at the "institution" because he had nowhere else to go. Of Mukherjee's father, who has been a witness to the mad genes in the family, but continues to live in denial.
What is worrisome though is, despite the strides science has made, we have no control - yet - over our genes. And our destinies. Que sera, sera. Whatever will be, will be.
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