1 Boring Old Man

I should’ve just let things lie with my last post – stuck with my bit of sarcasm and moved on. Instead, I clicked on the link that lead to Fusion‘s interview of Dr. Insel, and it wound me up all over again. I’ve characterized Dr. Insel as a breakthrough·freak…– moving from one shiny object to another without every landing on something that endures, chasing whatever rainbows are on the horizon. Early in his time at the NIMH, I suppose he could get away with that occupying himself with his Clinical Neuroscience fantasies, following the pop-science concepts of the day – evidence-based medicine, translational medicine, personalized medicine, proteionomics, neuroimaging, etc. and riding on the back of the matriculation of various medication trials started by Steven Hyman, his predecessor. His blogs and speeches were like the article below, filled with future breakthroughs just around the corner. And then there was the parallel DSM-5 initiative, funded in part by the NIMH, holding symposia with the same future-think  aiming to transform psychiatric diagnosis by linking clinical syndromes to biological markers.

Why America’s top mental health doctor is moving to Google

FUSION

by Casey Tolan

October 26, 2015

After 13 years as the director of the National Institute for Mental Health, Dr. Thomas Insel is starting a new job next week. But it’s not a job you might expect for a respected neurologist and psychologist: Insel will be working at Google, as a leader of the Google Life Sciences division, an independent company under the tech giant’s Alphabet umbrella.

Insel is moving from the government to Silicon Valley, he told me last week, because he sees the tech sector as the answer to detecting, diagnosing, and treating mental illness. “Technology can have greater impact on mental healthcare than on the care for heart disease, diabetes, cancer or other diseases,” he said in an interview at Chicago Ideas Week. “It could transform this area in the next five years.”

At the national institute, Insel prioritized funding for research of the most severe mental illnesses, like schizophrenia. He was previously the director of the Center for Behavioral Neuroscience at Emory University, where he studied how brain chemicals affect behavior like infidelity and parental attachment.

The details of his new job description are still under wraps. “I don’t know what I’m going to be doing, and I think they don’t either,” he said. “They’re an amazingly secretive company.” But he said it was an offer he “couldn’t refuse.” He sees potential in using Google’s analytics and data-mining tools to pilot new research on mental health.

Right now, he said, America’s system of treating mental illness is “dysfunctional.” He’s disappointed at the high levels of people who don’t get treatment and his failure during his time at the national institute at driving down suicide rates. “We’re not seeing any reduction in mortality in terms of suicide because we’re not giving people the care that they need,” he said. “We would never allow this to happen for cancer, for heart disease, for diabetes.”

He imagines creating “sensors that give you very objective measures of your behavior.” “We do that already for how many steps you’ve had and your activity,” he said, pointing to the Fitbit strapped to his wrist, “but this would be doing it for mood, for cognition, for anxiety. It’s really actually very doable.” The sensors would measure sleep, movement, and have you take clinical tests in order to measure mental health. Other tools could analyze someone’s language use for early signs of psychosis.

Technology can also be used to treat mental health as well as help detect symptoms. Insel cited the success of companies like Big White Wall, a startup in the United Kingdom. Members post anonymously about their struggles with depression, anxiety, or other mental health concerns, take clinical tests online, and videochat with therapists. It’s been supported by the National Health Service and has made therapy available to people who might never have had it before.

“This is really potentially transformative,” Insel said. Some research has shown that “giving that treatment online is as effective as face-to-face treatment, and in some cases better, because there are so many people with these disorders who will not come in for treatment.” Other research projects have used digital avatars as stand-ins for human therapists: A potentially life-saving innovation would be making it possible for people to get online therapy right when they’re having a crisis, even if that’s in the middle of the night.

“So much of what we’ve done in the mental healthcare system is you have a bad night, you make it through till morning and you call and they say, ‘We’ll give you an appointment in two weeks.’ That’s just not how you treat these disorders,” Insel said. Innovations like these are the future of mental health, he said—a future he hopes to keep pursuing at Google.

Beyond that, this kind of promo-talk has characterized his blogs and speeches throughout his tenure. Phrases like “potentially transformative” dot every interview and they might as well retire the word "innovation" with him as he has worn it out [along with "novel"]. It’s hard to understand why he has the longest time in grade of any NIMH Director unless the gift of spin has become a requirement for the job.