I was reading along in Dr. Makari’s Opinion piece in the New York Times when I got to the final paragraphs where he artfully articulated something I’ve been trying to say for a very long time:
New York Times – OpinionBy GEORGE MAKARINOV. 11, 2015…
Unfortunately, Dr. Kane’s study arrives alongside a troubling new reality. His project was made possible by funding from the National Institute of Mental Health before it implemented a controversial requirement: Since 2014, in order to receive the institute’s support, clinical researchers must explicitly focus on a target such as a biomarker or neural circuit. It is hard to imagine how Dr. Kane’s study [or one like it] would get funding today, since it does not do this. In fact, psychiatry at present has yet to adequately identify any specific biomarkers or circuits for its major illnesses.
Critics worry that this new stipulation will limit clinical studies and foster what has been all too familiar in psychiatry — unwarranted speculation aimed at prematurely reducing many layers of intersecting causality to one. If so, the institute will become the latest in a long, unhappy line of those who pressed for a simple solution to the Janus-faced problems of mind-brain illness. In the meantime, Dr. Kane’s study provides pragmatic clinicians with strong new evidence for an old idea: Individuals with mental illness should be fully engaged as beings whose rich psyches and ever-present social worlds are just as real as their brains.
I’ve been hard on Tom Insel and tried to say why every time I write about him, but I don’t ever feel like I get it said. But it’s simple. He thought he owned the NIMH and its directions. Last week in an interview, he blamed the NIMH’s inadequate analytic fire-power for not confirming his nebulous RDoC:
Five years ago, the NIMH launched a big project to transform diagnosis. But did we have the analytical firepower to do that? No. If anybody has it, companies like IBM, Apple or Google do – those kinds of high-powered tech engines…
Clinical Neuroscience, RDoC, Neural Circuits: These are some things he decided would lead us to the promised land, and so he made them preconditions for receiving NIMH grant money! No offense, but the Director of the NIMH is supposed to create an environment where our best and brightest researchers can pursue their ideas. It’s fine to keep them out of the stratosphere and insist that they propose projects that have some general value and realistic goals, but that’s not what Tom Insel did. He essentially told them what things he was interested in having them work on. Is the RDoC something of value? Who knows? Mainly because it doesn’t even exist. And would it transform diagnosis? Who knows? Again, because it doesn’t exist. And about those Neural Circuits, take a look at this earnest resident pretending to talk to a patient [the talk that matters…] about her Neural Circuits [instead of confronting her about her addictive behavior]:
Dr. Insel’s replacement will need to start by de-Inselizing the NIMH, and that’s going to be a big task. He micromanaged everything to follow his agendae. I wonder if it ever occurred to him that the reason that the NIMH didn’t give him what he wanted is that maybe it wasn’t there to find. He may have kept the researchers from spinning off and following some idiosyncratic path, but he did it by forcing them to follow his own idiosyncratic path.
I think he missed the point. Does he know who John Kane is? Anyone who is a psychopharmacologist looked at this study and said: “We just spent x million dollars to show that good clinical care trumps bad clinical care….so what? No news there.”
Dr. Insel doesn’t tell anyone that managed care companies fund 8 – 10 “med checks” per year and no comprehensive care for anyone with a serious mental illness. Dr. Insel doesn’t dictate that most inpatient psychiatric care these days is shuffling people in and out on the basis of whether they are “dangerous” or not so that managed care companies can optimize their profits on the DRG payments.
The blueprint for good comprehensive care for severe psychiatric disorders has been known since the 1970s with good recent work on the psychotherapy of severe psychiatric disorders that began in the 1990s. Getting that care funded and getting the care of people with severe psychiatric disorders on par with people with severe cardiac disorders has nothing to do with who heads the NIMH.
Well said. I’m reminded of the old joke about the drunk who looks for his lost keys under the lamppost “because the light is better there.” Dr. Insel and other neurobiology partisans look where our scientific tools provide the brightest light — functional imaging, genomics — regardless of whether answers are likely to be found there.
May be of interest:
https://www.washingtonpost.com/posteverything/wp/2015/11/11/the-va-treated-my-ptsd-all-wrong/
Insel is a pharmaceutical industry wet dream. He likes invasive surgeries and unproven mind controlling agents. His union with Google is place to like charges in a flammable environment. Time to ban psychiatry and its drugs? You bet.
One goes where the money (funding, grants etc) is. To do otherwise is research=suicide
As if right on cue, Dr. Insel writes in the Psychiatric Times all about the new and exciting development that water is wet:
http://www.psychiatrictimes.com/schizophrenia-0/new-hope-treating-psychosis
What we already have known since the fifties is exciting and new.
What we haven’t discovered yet is exciting and new.
It’s all exciting and new. Psychiatry is just like the Love Boat.