The Gateless Gate

What causes mental illnesses like schizophrenia and autism? We have long known that both tend to run in families and that if one of two identical twins has such a disorder, there is a much higher than average probability that the other will too. Autism is sometimes associated with genetic syndromes, such as Rett, Down, and Turner's, Phenylketonuria, and Tuberous Sclerosis. The clearest single-gene cause of autism spectrum disorder (ASD) is Fragile X syndrome, with a wide range of severity in symptoms and 25-47 per cent of affected males meeting the criteria for autism. But neither autism nor schizophrenia obeys classical Mendelian laws of inheritance in the way that Cystic Fibrosis or some types of colour blindness do.

However, there is also good evidence for social, environmental causes of mental illnesses. Studies of the Dutch wartime famine and of the Chinese famine of 1959–61 reported increased incidence of schizophrenia among children born just after the events. And a study of 2 million Swedish children born between 1963 and 1983 revealed a significant link between schizophrenia and poverty in childhood. Those with 4 out of 5 measured indicators of hardship had an almost 3-fold greater risk of schizophrenia than those with none. Where ASD is concerned, the exponential increase in diagnoses since the 1980s has prompted some to suggest environmental or social causes: most controversially, childhood vaccines like MMR. Autism can certainly result from ethanol or valproic acid poisoning during the mother's pregnancy, and in the 1964 rubella epidemic in the USA, the rate of incidence of autism exceeded 7 per cent at a time when the normal rate of diagnosis was not much more than a tenth of one per cent. ASD can also be caused by thalidomide, where it affects about 5 per cent of those with birth defects attributable to this cause.