The Riggs Blog

Empathy Matters Throughout Medicine, But Nowhere More Than in Psychiatry.

By Eric M. Plakun, M.D., DLFAPA, FACPsych

Margaret Parish’s blog posting reminds me why I chose the Columbia College of Physicians and Surgeons. Torn between interests in medicine and literature as an undergrad premed, I was drawn to P&S because an early twentieth century task force under the leadership of then P&S leader Aura Severinghaus had concluded that the best premedical curriculum for future physicians was not as a science major, but focused on the humanities, with the necessary science courses included along the way. This idea spoke to me then; and now science is providing evidence for part of how this then revolutionary idea was right. Empathy matters throughout medicine, but nowhere more than in psychiatry. 

In another “Back to the Future” moment, molecular genetic research is showing how much more environmental factors, like relationships, matter than geneticists had initially guessed. And, it turns out, relationship experiences matter partly because good ones help gene expression in positive ways, and bad ones in negative ways (Caspi et al., 2003, Belsky et al., 2009). Our colleague in the UK, Jeremy Holmes (2013), who plans a Riggs visit next spring, has captured this nicely in his equation reminiscent of Einstein’s revolutionary one about the relationship between matter and energy. Holmes writes:

Phe = G x E²

Holmes argues that the individual’s phenotype (Phe), that is, how they are in the world, including character and other psychiatric disorders from which they suffer, is a function of genetic endowment or genotype (G), but also much more powerfully of environmental factors (Hence E for environment is squared). Explicating this stance, Holmes summarizes evidence that both the early developmental environment (one E) and, independently, the current environment with its relationships and experiences (the other E) have powerful influences on how genes are expressed. This makes psychotherapy and other psychosocial treatment biological treatments that modify genes as people in treatment change and take charge of their lives.

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