Exploring and Exploiting Genetic Risk for Psychiatric Disorders Edited by Joshua A. Gordon and Elisabeth B. Binder. MIT Press. 2023. £35.67 (pb). 340 pp. ISBN: 978-0262547383

The past decade has seen a rising tide of research in genomics, including psychiatric genomics, ferrying hope within the scientific community of the imminence of genomic medicine and genomic psychiatry. Among clinicians, although this frisson is shared by some, there is perhaps also some weariness and cynicism regarding the promise of genomics to deliver the much-needed disruption in our understanding, diagnosis and management of mental health problems. The rapid pace of knowledge accrual on the one hand and the lag in translational impact on the other is such that by the end of this decade we will either see the current period as a watershed moment or a receding tide.

This edited volume grew out of an Ernst Strüngmann Forum whose overarching aim was to build a much-needed roadmap from contemporary psychiatric genetics research to the clinic via neurobiology. The contributing authors are familiar names, world leaders in the field of psychiatric genetics, whose deliberations have coalesced into a hilltop view of the current state of this rapidly evolving field.

The book is organised around four concepts: gene discovery, common genetic variation, rare genetic variation and clinical utility (including ethical concerns). Cross-cutting themes were the need to go beyond binary diagnostics in search of deeper, developmental and translatable phenotypes; attempts to find convergence between rare and common genetic variation; and importantly, the need for diversity. In all of science, here is a field that cannot thrive without diversity – of researchers and research participants – and this is echoed in chapter after chapter.

Authors address the thorny question of clinical impact, foregrounding the low-hanging fruit of polygenic scores. The chapters by Naomi Wray and Jordan Smoller are particularly insightful; clinicians will benefit from perusing the latter's use cases, focused on predicting risk and prognosis, and reducing diagnostic uncertainty. The authors, however, remain circumspect about the extensive work that still needs to be done before any of this can be rolled out in clinics. With the exception of the rather long-winded and repetitive chapter on counselling (which could probably have been embedded in Chapter 12), the book provides a good distillate of the state of knowledge in the field, its challenges and future promise.

The nature–nurture debate has surely long been put to bed. Nevertheless, conversations about genetics must foreground the importance of avoiding a naive genetic determinism, reductionism or even essentialism – it is to the authors’ credit that they maintain a holistic perspective. Human behaviour is far more complex than DNA, and the art and craft of psychiatry will always rely on more than our understanding of genetics and biology, even at its most sophisticated. If anything, the convergence of genetics, neuroscience and artificial intelligence should make us think harder about what remains – the things that make us human, including our stories, which cannot be captured by science. In Greek mythology, Psyche is depicted as a beautiful being with butterfly wings – a delicate, mutable object of desire.