by Thomas R. Insel, MD and Remi Quirion, Ph.D, FRSC, CQJAMA. 2005 294:2221–2224.
One of the fundamental insights emerging from contemporary neuroscience is that mental illnesses are brain disorders. In contrast to classic neurological illnesses that involve discrete brain lesions, mental disorders need to be addressed as disorders of distributed brain systems with symptoms forged by developmental and social experiences. While genomics will be important for revealing risk, and cellular neuroscience should provide targets for novel treatments for these disorders, it is most likely that the tools of systems neuroscience will yield the biomarkers needed to revolutionize psychiatric diagnosis and treatment. This essay considers the discoveries that will be necessary over the next two decades to translate the promise of modern neuroscience into strategies for prevention and cures of mental disorders. To deliver on this spectacular new potential, clinical neuroscience must be integrated into the discipline of psychiatry, thereby transforming current psychiatric training, tools, and practices.
Parenthetically, I resent the Director of the NIMH thinking that it is in his job description to point the directions for clinical psychiatry. After leaving his own residency about the same time I did, he went to the NIMH Intramural Research program where he stayed until his position was eliminated. He then went to the Yerkes Primate Center as director [1994-1999] where he wasn’t reappointed followed by a move to direct the Center for Behavioral Neuroscience in Atlanta – finally returning to the NIMH as Director in 2002. He has never practiced clinical psychiatry, in either the public or private sector. He hasn’t even been actively part of an academic department where training is going on. So I also question his weighing in on how residents should be trained for the same reasons. What does he know about clinical psychiatry? about training residents? He’s a lab guy, and an ideological lab guy at that. It feels like he’s trying to create a psychiatry that fits what he sees in the mirror.