{"id":22521,"date":"2012-04-22T13:35:45","date_gmt":"2012-04-22T17:35:45","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=22521"},"modified":"2012-04-22T13:35:45","modified_gmt":"2012-04-22T17:35:45","slug":"the-first-lemming","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/04\/22\/the-first-lemming\/","title":{"rendered":"the first Lemming&#8230;"},"content":{"rendered":"\n<ul>\n<div>06\/03\/2011&nbsp;&nbsp;&nbsp;&nbsp;<a href=\"http:\/\/www.nimh.nih.gov\/about\/director\/2011\/psychiatry-where-are-we-going.shtml\" target=\"_blank\"><u><strong><font color=\"#200020\">Psychiatry: Where are we going?<\/font><\/strong><\/u><\/a><\/div>\n<div>04\/20\/2012&nbsp;&nbsp;&nbsp;&nbsp;<a href=\"http:\/\/www.nimh.nih.gov\/about\/director\/2012\/the-future-of-psychiatry-clinical-neuroscience.shtml\" target=\"_blank\"><u><strong><font color=\"#200020\">The Future of Psychiatry (= Clinical Neuroscience)<\/font><\/strong><\/u><\/a><\/div>\n<\/ul>\n<hr width=\"84%\" size=\"1\" \/>\n<div align=\"justify\">Having noticed last night that Dr. Tom Insel, Director of the NIMH, had reproduced last year&#8217;s post-APA blog post this year a couple of weeks before the APA Meeting, I went to bed. This morning, I had a spontaneous wakening thought. What the hell is the NIMH Director doing, pontificating about the direction of Psychiatry as a specialty? Is that in his job description? He does that kind of thing so often that I guess we&#8217;re used to it, but is that really kosher, directing the show? Is that what <strong><font color=\"#200020\"><em>Director<\/em> of the National Institute of Mental Health<\/font><\/strong>&quot; means? that he chooses our <em>direction<\/em>?<\/div>\n<hr width=\"84%\" size=\"1\" \/>\n<ul>\n<div align=\"justify\">11\/02\/2005&nbsp;&nbsp;&nbsp;<a target=\"_blank\" href=\"http:\/\/www.medicine.mcgill.ca\/oslerweb\/InselQuirion2005.pdf\"><u><strong><font color=\"#200020\">Psychiatry as a Clinical Neuroscience Discipline<\/font><\/strong><\/u><\/a><\/div>\n<\/ul>\n<hr width=\"84%\" size=\"1\" \/>\n<div align=\"justify\">The Clinical Neuroscience thing seemed to start with his publication [above] in the JAMA [also as a <a href=\"http:\/\/www.nimh.nih.gov\/about\/director\/publications\/psychiatry-as-a-clinical-neuroscience-discipline.shtml\" target=\"_blank\"><u><strong><font color=\"#200020\">Director&#8217;s Blog<\/font><\/strong><\/u><\/a>]. And when he was apparently called to task, he published his resolution of the argument as a blog post:<\/div>\n<blockquote>\n<div align=\"center\"><u><strong><a href=\"http:\/\/www.nimh.nih.gov\/about\/director\/2012\/balancing-immediate-needs-with-future-innovation.shtml\" target=\"_blank\"><font color=\"#200020\">Balancing Immediate Needs with Future Innovation<\/font><\/a><\/strong><\/u><br \/>         01\/06\/2012<\/div>\n<p>         <\/p>\n<div align=\"justify\"><sup>NIMH, like all Institutes at NIH, has an advisory council that meets three times each year. The National Advisory Mental Health Council (NAMHC)  is a distinguished group of scientists, advocates, clinicians, and  policy experts. Each of our meetings includes a closed session to review  individual grants considered for funding and a session open to the  public that engages this diverse group in discussions about the larger  issues that guide NIMH funding. At last week&rsquo;s session, we heard a  recurrent tension around one such larger issue. Some members of Council  bear witness to the poor quality of care, the unmet medical need, and  the diminishing investments by states on behalf of people with mental  disorders. They reasonably ask, &ldquo;How are we ensuring that the science  that NIMH has produced is implemented where the need is greatest?&rdquo;&#8230;<\/sup><\/div>\n<\/blockquote>\n<div>His conclusion was clear:<\/div>\n<blockquote>\n<div align=\"justify\"><sup>Let us hope we don&rsquo;t short-change our grandchildren, sixty years from  today, by failing to invest in the long-term promise of more effective  diagnostics and therapeutics for mental disorders.<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I&#8217;m not mounting an argument against neuroscience here. I think, instead, I&#8217;m realizing why Tom Insel grates on my nerves every time he opens his mouth. He has a fixed idea about Psychiatry, Research, and how things are supposed to go &#8211; and that set of ideas drives everything he says and does. The two blog posts on top are supposed to be addressing the problem that US medical students aren&#8217;t choosing Psychiatry as a specialty and programs are filling with Foreign Medical Graduates [if they can]. In the first article [last year], he points out:<\/div>\n<ul>\n<div align=\"justify\"><sup>Traditionally,   psychiatry has been  the medical  discipline that cultivates a rich   relationship with  patients,  countering suffering with empathy and   understanding. But a  recent  article in the New York Times reported that   only 11% of  psychiatrists  perform psychotherapy and described a   psychiatrist who  ran his  office &ldquo;like a bus station,&rdquo; seeing so many   patients for 5 -10  minute  medication checks that he had to train himself   not to listen  to his  patient&rsquo;s problems.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">&#8230; that psychiatrists are now seen as pill pushers who have no involvement with their patients. His solution?<\/div>\n<ul>\n<div align=\"justify\"><sup>NIMH has been running an annual &ldquo;Brain Camp&rdquo; for select psychiatry residents to give them a crash course in the most recent findings from cognitive science, neuroscience, and genetics. The residents we see at Brain Camp bring new perspectives.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">&#8230; the MD\/PhD group that came to his NIMH <strong><font color=\"#200020\">Brain Camp<\/font><\/strong>. In the second article [this week], Psychiatry as a specialty choice continues to decline. His solution?<\/div>\n<ul>\n<div align=\"justify\"><sup>This year, 11 of the 17 psychiatric residents at Brain Camp were MD-PhDs. Many had been neuroscience majors in college, had published high impact papers in medical school, and were continuing to do research during their clinical training. Prior to residency, all 17 were medical students who had been at the top of their class and could have gone into any specialty&#8230;<\/p>\n<p>    This year Brain Camp was largely focused on neuromodulation&mdash;using cognitive training and repetitive transcranial magnetic stimulation (rTMS) &mdash; to alter symptoms of depression and anxiety by modulating specific brain circuits. For this new generation, psychiatry already is clinical neuroscience. So maybe there is an identity crisis for psychiatry in the U.S. as well as the U.K. But the U.S. version seems filled with hope and excitement, with many of the best and brightest now deciding that they can bring new approaches to help people challenged by mental illness&#8230;<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">&#8230; it&#8217;s <strong><font color=\"#200020\">Brain Camp<\/font><\/strong> again [all six of the ones who might practice]. That&#8217;s his solution [and I hope the six are independently wealthy, because they&#8217;re only going to be paid &quot;<em>for 5 -10  minute  medication checks<\/em>&quot;]. And I doubt that &quot;<em>using cognitive training and repetitive transcranial magnetic  stimulation (rTMS) &mdash; to alter symptoms of depression and anxiety by  modulating specific brain circuits<\/em>&quot; is going to make much of a dent in what psychiatrists do and how they are seen in the real world. Leadership means something more than being the first Lemming in a stampede&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>06\/03\/2011&nbsp;&nbsp;&nbsp;&nbsp;Psychiatry: Where are we going? 04\/20\/2012&nbsp;&nbsp;&nbsp;&nbsp;The Future of Psychiatry (= Clinical Neuroscience) Having noticed last night that Dr. Tom Insel, Director of the NIMH, had reproduced last year&#8217;s post-APA blog post this year a couple of weeks before the APA Meeting, I went to bed. This morning, I had a spontaneous wakening thought. What the [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-22521","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22521","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=22521"}],"version-history":[{"count":15,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22521\/revisions"}],"predecessor-version":[{"id":22536,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22521\/revisions\/22536"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=22521"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=22521"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=22521"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}