The fairly recent explosion of genetic research, suggesting a real quest for genes in psychiatric diseases, didn’t result in the discovery of a gene as an ultimate determinant of psychiatric illness. Up to date, convincing evidence for a monogenetic cause is lacking. There is no strong evidence from candidate gene research or genome-wide studies. Genetic research for determining genetic and environmental causes, include clinical, behavioural and molecular biological methods and assays. New techniques like transcriptomics and proteomics examine gene products, whose expression is influenced by both genetic and environmental factors, and can contribute to identification of both causes of disease.

However, the conclusion thus far is that all genetic factors only contribute with environmental factors to a multifactorial inheritance. This weak genetic power is illustrated by the liability threshold model that can be conceived as an epigenetic challenge.

This paper is all about practical consequences for caregiver and patient. As the interplay of genetics and environment can be considered as cause of psychiatric diseases, ultimately the ethical responsibility for individual and society seems inevitable. What is the dilemma, put forward by the’real’ genetic portfolio on the human subject? How man should act in dialogue with its genes? How human behaviour can influence genetic expression in a well-tuned manner? What is the relation between prenatal genetic design and postnatal ethic demands? This neodarwinistic reflection focuses also on the antero- and retrograde aspects in human development. Finally, how can practical wisdom help us in the quest for a well-tuned epigenetic attitude?