{"id":40528,"date":"2013-10-06T11:38:54","date_gmt":"2013-10-06T15:38:54","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=40528"},"modified":"2013-10-06T11:38:54","modified_gmt":"2013-10-06T15:38:54","slug":"same-old-banners","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/10\/06\/same-old-banners\/","title":{"rendered":"the same old banners…"},"content":{"rendered":"
Functional magnetic resonance imaging or functional MRI [fMRI] is a functional neuroimaging procedure using MRI technology that measures brain activity by detecting associated changes in blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area of the brain is in use, blood flow to that region also increases. The primary form of fMRI uses the Blood-oxygen-level dependent [BOLD] contrast, discovered by Seiji Ogawa…<\/font><\/sup><\/div>\n
Functional magnetic resonance imaging<\/font><\/a>, Wikipedia<\/font><\/sup><\/div>\n
The Human Genome Project was declared complete in April 2003. An initial rough draft of the human genome was available in June 2000 and by February 2001 a working draft had been completed and published followed by the final sequencing mapping of the human genome on April 14, 2003…<\/font><\/sup><\/div>\n
The Human Genome Project<\/font><\/a>, Wikipedia<\/font><\/sup><\/div>\n

In the waning decades of the last century, no psychiatric lecturer worth his\/her salt failed to include some version of the slide on the right at some point in every presentation. The labels may have varied [catecholamines, dopamine, serotonin], but the slide was eternal. It was the era of the neurotransmitters. At the time, I called it the NIMH Memorial Neuron, joking, "don’t leave home without it."<\/p>\n

The 90s were declared the Decade of the Brain, but I think of it as the Serotonin years because that seemed to be what everyone talked about – SSRIs and SNRIs. And if there was a must-have slide for the 90s, it would have to be one of the ubiquitous clinical trial graphs – just fill in any drug in the one below right:<\/p>\n

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Then halfway through the 90s, along came the Atypical Antipsychotics picking up where the SSRIs\/SNRIs left off. The pipeline was flowing on into the early 2000s:<\/p>\n

 <\/p>\n

The point of this little review is that something happened in the early 2000s that had a profound impact on the decade. Buoyed by the seemingly endless flow of new drugs, the non-invasive fMRI neuroimaging technique of Ogawa <\/font>[BOLD], the completion of the human genome project, and who-knows-whatever-else along the way – what had been previously vague speculative biological hypotheses were elevated to the level of basic truths awaiting confirmation – and the march towards proof was underway. There were two official channels available for such a move: the National Institute of Health [NIMH] and the American Psychiatric Association [APA].<\/p>\n

In 2002, Tom Insel<\/a> became the surprise choice for Director of the NIMH. By 2005, he made the direction of his NIMH very clear in an article, Psychiatry as a Clinical Neuroscience Discipline<\/a>:<\/div>\n
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In this commentary, we argue that psychiatry’s impact on public health will require that mental disorders be understood and treated as brain disorders. In the past, mental disorders were defined by the absence of a so-called organic lesion. Mental disorders became neurological disorders at the moment a lesion was found. With the advent of functional neuroimaging, patterns of regional brain activity associated with normal and pathological mental experience can be visualized, including detection of abnormal activity in brain circuits in the absence of an identifiable structural lesion. If mental disorders are brain disorders, then the basic sciences of psychiatry must include neuroscience and genomics and the training of psychiatrists in the future needs to be profoundly different from what it has been in the past.<\/em><\/div>\n<\/blockquote>\n
In that article, he mapped out the future of psychiatry<\/strike> clinical neuroscience with a twenty year plan: <\/div>\n
<\/div>\n
Also in 2002, the APA published a book by the people chosen to lead the coming revision of the Diagnostic and Statistical Manual of Mental Disorders [DSM] entitled A Research Agenda for DSM-V<\/a>. – another version of the map that would lead us into the future:<\/div>\n
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It is our hope and expectation that through advances in animal models, genetics, neuroimaging, and postmortem investigations psychiatry will ultimately have a diagnostic system based on etiology and pathophysiology. Such a system should result in reliable and valid diagnosis, more specific and effective treatments, and therapeutic strategies to delay and even prevent the development of psychiatric disorders.<\/div>\n<\/blockquote>\n
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This pair of initiatives [NIMH’s clinical neuroscience and APA’s DSM-5] were both presumptuous and risky: presumptuous because their biological hypotheses were still speculative even after the Decade of the Brain; and risky because they were betting on success with an exposed hand [I put a red line on Insel’s map to mark the present]. Neither gambit paid off. So we enter the fourth decade of the modern era absent the kind of proof both of these initiatives promised for current directions<\/em>. <\/p>\n

There’s nothing at all wrong with academic scientists dreaming and speculating about the future. In fact, that’s what they’re paid for. For that matter, there’s nothing wrong with a professional organization involving itself in the broad directions<\/em> of the profession it represents. But in this case, there’s something out of alignment in both aspects of the process. Both the academic and professional arms felt a pressing need to define the causes [and treatment] of illnesses within the domain of psychiatry – the mental illnesses – following their current trajectory. I would propose that in both cases, they are not leading but following. And what they’re following are the definitions of what is "illness" and what is "medical" handed out by the Insurance Industry and the Pharmaceutical Industry. It’s time for some major soul-searching, not plunging ahead into a fourth decade with the same old banners…<\/div>\n","protected":false},"excerpt":{"rendered":"

Functional magnetic resonance imaging or functional MRI [fMRI] is a functional neuroimaging procedure using MRI technology that measures brain activity by detecting associated changes in blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area of the brain is in use, blood flow to that […]<\/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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-40528","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40528","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=40528"}],"version-history":[{"count":43,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40528\/revisions"}],"predecessor-version":[{"id":40571,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40528\/revisions\/40571"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=40528"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=40528"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=40528"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}