In the course of looking at some of the writing about the DSM-5, I was sent a recent speech by Dr. Tom Insel, Director of the NIMH [
class action in the air…] that began with one of his signature topics:
The field of mental health is on the cusp of a revolution, which is set to transform the diagnosis and treatment of mental illness and reverse the lack of major progress made in curbing associated ill health and death over the past 100 years, the director of the US National Institute of Mental Health, has claimed. “We are at an extraordinary moment when the entire scientific foundation for mental health is shifting, with the 20th century discipline of psychiatry becoming the 21st century discipline of clinical neuroscience.”
Insel’s repetative attempts to recreate psychiatry in his own image as "clinical neuroscience" is wearing thin with me and I hope others. The assertion that all mental illness is Brain Disease, eliminating the Mind from the equation, is certainly prevalent among many of his colleagues. But for those of us that think otherwise, having him preach that gospel from his pulpit as Director of the National Institute of Mental Health feels like an abuse of power.
He continues with his second signature maneuver – hyping speculative lines of research as the next future breakthroughs. This time it was neuroimaging brain circuitry, pre-psychotic intervention, and personalized medicine. In this case, they are "revolutionary" breakthroughs that will neutralize a century of failure. It’s his usual style with an added bit of melodrama.
But it was his signature ending that captured my attention [
the hell where youth and laughter go…]. I call it the World-Health-Organization-Public-Health plea for more biological research, so popular with many of our tainted psychopharmacologists [and their ghostwriters]:
Much more research into the biology of mental illness was needed, he said. The consequences of the “remarkable lack of progress” in tackling mental illness effectively were legion, he said. Depression alone was the number one source of disability, he said. “The rate of suicide is way way beyond the rate of homicide in most of the world. In the US, it’s double the rate of homicides and higher than road traffic accidents,” he commented, adding that suicide killed more soldiers in the US military than enemy combat…
The more I read that ending, the angrier it made me. So I drifted off into a brief review of the history of traumatic neurosis [
broad strokes 1…,
broad strokes 2…], a topic of my own long held interest, to see if it would calm me down and allow for a rational response to Dr. Insel. I try in this blog [sometimes unsuccessfully] to stay away from a direct focus on the Mind/Brain debate that rages in psychiatry. It’s not that I don’t have an opinion. I often do. But my biggest opinion is that it’s a false dichotomy. The Brain [neuroscience] is important in the study of mental illness. The Mind [separate from its obvious location in the Brain and reliance of brain function] is to me a legitimate and important part of the study of mental illness too. I believe the Mind can be a source of significant mental dysfunction and symptoms while the Brain remains totally normal. In fact I know that’s true.
One of the major ways we know that absolutely is through the topic at hand, Traumatic War Neurosis and Post-Traumatic Stress Disorder. World War I began with people believing that these were Brain diseases and ended with the clear conclusion that they were afflictions of the Mind [broad strokes 1…]. I’m aware of the various hypotheses and studies that there are sometimes biological abnormalities in Traumatic Neuroses, but they’re not etiologic. They’re suggestive at best, and could easily be secondary stress indicators [in my opinion, probably are stress indicators]. But war after war teaches us the same thing – anyone can develop PTSD under the right circumstances. And I likewise think I know why the military suicide rates in our recent wars is escalating [broad strokes 2…]. Prolonged combat exposure just causes such things. It’s "evidence-based." And our soldiers have had unprecedented prolongation of their combat exposure.
[beginning of rant] So when Tom Insel begins a speech trying to rebrand our specialty to fit his own preferred views of mental illness – Brain biology and clinical neuroscience; and then he makes a pitch for more research into the biology of mental illness; and he gives as a justification the high military suicide rate in a war where the preventive medicine strategies of the twentieth century have been ignored; using the illness that alerted us to the importance of the Mind in mental illness as his example; I find myself wanting to storm the NIMH and demand that the Directorship be passed on to someone who has at least read enough of the history of psychiatry to know when he’s saying something that’s colossally silly and uninformed.
Whether he could influence the political and military powers to change their redeployment policies is an unanswerable question, but he ought to try. The mental health consequences of prolonged combat is something we know for sure. We know it with more certainty than we know anything about neurotransmitters or brain circuitry. But I’m not even sure Tom Insel knows the story of traumatic war neurosis. He’s too preoccupied with neurobiology and his neurobiology friends to understand that the charge of the NIMH is Mental Health – right now. The preventive principles from our wartime history are ready for "translation" from the bench to the front lines – right now – just like they’ve been for the last eight plus years of war.
And he really ought to know his specialty well enough to pick some other examples for his World-Health-Organization-Public-Health pleas at the end of speeches to avoid sounding like a fool… [end of rant]
Eliminating the Mind from the equation could be expected of a physician (s) who don’t have a Mind himself (themselves) but a brain that has been operating under the influence of corrupting powers and coldly oblivious to the principles of medicine and the suffering of real people. Just for economic gains.
The NIMH Director seems not to have a Mind but appears to have kept a heart since he’s still pumping from his position of power and leadership. He would show that he has a true Heart by leaving the post and saving the truth face of the National Institute of Mental Health.
To him and his group of prevalent Mindless colleagues: If you “win†it is because you have enough brute power. But you will not convince. In order to convince it is necessary to persuade and to persuade you need something that you lack: reason and right in the struggle.
Shame, shame, shame. Cannot believe that someone at his level can suggest that the high suicide rate in today’s military could be assuaged with more “brain research”.
I think Insel should spend some time in a foxhole with rockets incoming all around him. Maybe then he will see the light.
Tom,
I was thinking the same thing. Or maybe treat some of those guys. From my experience, they’ll be glad to set him straight.
Great line of posts, as I’ve come to expect from reading this blog. A big thank you for the effort and the passion!
Well well well. Once again, the course of an entire profession is set to change thanks to the sway of a few powerful white guys. Isn’t it just great to know that future psych patients’ diagnoses and treatments have already been chosen by Insel and a few of his best buds?
Thank goodness Insel and co. have the patients’ best interests in mind!