- By guest author Dr. Eve Sounder, a Learned Warthog
- Professor of Social Suidae-Zoosemiotics
- Author of Let’s All Root For One Another: Individual and Group Benefits of Reciprocal Rhizophagy in Phacochoerus africanus (Poster Presentation, 1972)
As a social suidae-zoosemioticist I spend most of my time out on the veldt. The last time I gave NIMH any thought was when Dr. Tom Insel was brought in as director. I remember the press release emphasizing his leadership and vision. I remember thinking they must need money.
Is vision communicable? In 2015 it looks like the whole institute is having visions and speaking in tongues. Thirteen years of Insel’s vision and an antipsychotic is the top grossing drug in America. It’s time to offer Astro Boy early retirement and find out what can be salvaged.
[Ed: Dr. Insel announced on September 15 that he is leaving NIMH as soon as he possibly can, presumably before he is obligated to issue another joint press release with Jeffrey Lieberman. Sources say he’s not over the DSM-5/RDoC abasement, and we aren’t either. ]
I emailed Dr. Insel earlier today to see if he had time for coffee with an old colleague. (He and I overlapped at Yerkes). I heard back right away, from an auto-responder that said he was out of the office and advised that I check out his blog. So we–the blog and I–had a little chat. My contributions are in red. Everything else came from the man in charge of NIMH’s $1.5 billion annual budget, Tom Insel.
NIMH Director’s Blog • Training for the Future
by Dr. Tom Insel and Dr. Evie, a Warthog
May 15, 2015
A lot has been written about the gap between modern neuroscience and contemporary psychiatry, sometimes caricatured as mindless neuroscience versus brainless psychiatry.
Not looking good.
Patients and families will need the field to overcome this gap if the power of modern neuroscience is to improve outcomes for people with autism or other serious mental illnesses. [ 😫😩😫 ]
Nice try, but your boss, Dr. Francis Collins, already played the gap card, attempting to deflect questions about The White House BRAIN Initiative. His gap was between what we want to do in brain research and the technologies available to make exploration possible. Not to put too fine a point on it, but my mother had a gap between her top incisors, and she got it fixed.
How do we bridge this gap?
Ordinarily someone calls for an end to interdisciplinary squabbles, nothing happens, and everyone forgets about it.
To some extent, this problem is resolving itself.
Ah, that’s a new one. Is this a good time to ask why you haven’t followed up on the 1983 study in which you found d-amphetamine highly effective against OCD?
Every year more neuroscientists choose to train in psychiatry. The psychiatric residency program at Yale received applications from 60 M.D.-Ph.D. students this year, for only 16 positions. Other psychiatry programs also reported a spike in the number of Ph.D. neuroscientists who applied for post-graduate training after completing medical school.
You’re realizing you have nothing to say and 500 words to not say it in? Seriously, get on the bandwagon and look for a new indication for Dexedrine™. They still make it.
Until recently these young physician-scientists often discovered that their residency training was completely disconnected from their rigorous scientific background. Psychiatry training comprised required instruction on psychodynamic theory, psychopharmacology, and psychotherapy but little that linked to their interests in brain circuits or brain function.
Because little that concerns psychiatry links to brain-anything. You’re thinking of neurology. Go back and put that in.
Faculty taught largely what they were taught twenty years ago. There were exceptions—NIMH supports several residency programs to offer research tracks for a few residents to pursue science during their clinical training years but for most young psychiatrists, training in 2015 is hardly different from training in 1995.
That’s what drug reps are for.
A small band of psychiatrists who are involved in residency training, led by David Ross at Yale, Melissa Arbuckle at Columbia, and Michael Travis at Pittsburgh, set out to change this with the creation of the National Neuroscience Curriculum Initiative (NNCI). This online set of teaching modules is grounded in principles of adult learning and innovative teaching methods. Take a look at http://www.nncionline.org.
On QVC last week.
You can see the case conferences, experiential learning modules, and a course on neuroscience in the media that the NNCI uses as a toolkit to help residents navigate the new world of brain science.
I thought this was going to be about helping people with serious mental illness.
Why would residents want to know about modern clinical neuroscience?
Totally. There are very few useful neuroscience-based diagnostic tests or treatments.
After all, there are very few useful neuroscience-based diagnostic tests or treatments.
What Dr. Ross and his colleagues discovered was a hunger for the information from modern brain science.
Did you just say hunger for and brain in the same sentence?
At the annual meeting of residency training directors, the NNCI workshop has been a standing room only event for the past two years/Over 200 individuals from around the country have signed up to be part of the NNCI “learning collaborative,” a group that helps test and develop teaching materials, and more than 25 residency programs have incorporated NNCI material into their training.
I’ll be sure to tell all my friends. (What?)
It’s true that most of the neuroscience and genomics findings are not yet actionable for psychiatry.
Further studies are needed.
No one doubts that the brain is the organ of affect and behavior, but no one can point to a biomarker that is essential for clinical practice.
Maybe it’s time for some doubt. James-Lange is back, you know.
In the short-run, we may do much more to bend the curve on suicide mortality by changing public policy (such as through restricting access to means) rather than finding a biomarker for suicidality.
Pigs will fly before Americans give up their guns. I saw that on Twitter.
But in the long-run, and we need a long-run strategy, policy will hit a wall and we will need better diagnostics and therapeutics.
Were you even awake when wrote that?
This is what you meant:
There’s no strategy, short-, medium- or long-run; gun-grabbing is going to “hit a wall” which is a nice way of saying “start a civil war,” and we will have to actually learn something at some point so A) you won’t have to blither on like this and B) much suffering will be relieved. I know A and B sound like the same thing but they weren’t supposed to.
That is where this new initiative can make a difference.
Sodium Pentothal does make a difference. Start writing this again with 100mg chugging its way up your neck and it might be worth reading.
The research of 2015 suggests that the clinician of 2025 and certainly the clinician of 2035 will need to know about cortical dynamics, neural networks, and genomic variation.
At least it suggests something.
I have a suggestion, too: You guys should agree to use one buzzword at a time. In a few years, when cortical dynamics has gone nowhere, you can whip out neural networks and keep the ball rolling. And so on.
Those entering the field today will need to know how to think about the brain […]
Tell them to refresh RetractionWatch.com a few times a day. It’s a news feed for research with “the brain” in the abstract.
[…] and how to critique brain science.
A document shredder is how to critique brain science.
By changing the training of the next generation, we not only prepare for the future, we create it.
That’s from the Best Buy employee manual.
Was that it?
That was not at all encouraging. “No one doubts?”
“No one doubts that the brain is the organ of affect and behavior.”
I do. The brain he’s talking about is confined to the skull; affect and behavior require a body. He thinks it’s all in our heads? More likely, “the brain” inhabits the entire body. His statement was an assumption he’s never questioned. It indicates that he’s about as scientific as DSM-5. (Meant to sting.) It also indicates that he hasn’t stubbed his big toe lately. That sh*t will change your life for a least few minutes, but it doesn’t mean the foot is the organ of affect and behavior. It means you should watch where you’re going.
(Say, doc–the Cochrane Group says antidepressants are a bit problematic. They noted that short-term use of psychostimulants reduces symptoms of depression, and suggest further study.)
READINGS OF SOME INTEREST
Jim Coyne warming up • NIMH Biomarker Porn: Depression, Daughters, and Telomeres Part 1 http://blogs.plos.org/mindthebrain/2015/01/21/nimh-biomarker-porn-depression-daughters-telomeres-part-1/
Jim Coyne finishing the job • Biomarker Porn: From Bad Science to Press Release to Praise by NIMH Director Part 2 http://blogs.plos.org/mindthebrain/2015/01/29/biomarker-porn-bad-science-stanford-u-press-release-praise-nimh-director/
Letter to Baltimore Sun from an impoverished self-described mentally ill man : http://articles.baltimoresun.com/2013-08-05/news/bs-ed-nih-20130805_1_longevity-gap-social-science-research-funding-nih
Contents of the above-linked letter:
Regarding Sandra Hofferth’s recent column on funding for the National Institutes of Health, I agree that “closing the longevity gap depends on behavioral and social science research” (“Budget cuts and the politics of research,” July 15).However, Ms. Hofferth is merely talking about the longevity gap, whereas I am living in it, and I believe people like her and the researchers at NIH are the source of the problem rather than the solution.
As a taxpayer and a mentally ill individual, I cannot support her requests for additional funding for “behavioral and social sciences.” It is simply a waste of money and it saps valuable resources out of the economy into programs that falsely raise peoples’ hopes and foment an elitist class of academics who exploit human misery for financial gain without directly taking responsibility for delivery of real-world solutions.
[…T] he gap between the real world and the world of NIMH researchers and staff is too wide, and there is a quality control crisis in public mental health, not a funding crisis as many would like us to believe.
I sat down and wrote a description of my own experiences and the breakdown in the role of the mental health profession, and I submitted it to NIMH after President Barack Obama called for a national conversation on mental health in June.
Someone needs to tell President Obama that it is a one way conversation — I talk and the National Institute of Mental Health ignores me — kind of like a session with a psychiatrist at a community mental health center.
Does the president want a “national conversation?” I say the time is now and the place is here.
Sam Mela, Gainesville, Ga.
It’s a crying shame that the letter-writer is afflicted with the belief that he’s sick in the head. I wonder where he got that idea.
- Bye for now!
[Ed.: About Insel’s departure:If pinching yourself isn’t doing the trick, we recommend the MIT Tech Review’s interview. Dr. S. liked it because the first thing he said was “In the future.”]
[Note: The DSM-5/RDoC Insel-Lieberman press release could only have been devised to assuage Lieberman’s inevitable conniptions subsequent to the Insel blog post that famously announced there’d be no NIMH funding for research on mental health unless a component of the project sought evidence of observable, measurable physical phenomena, whether molecular, genomic, or morphological, that could advance diagnosis, etiology, or treatment. It was a kicking-to-the-curb of a book some psychiatrists call their specialization’s bible. Not long after, the storied joint release was issued. If only it hadn’t been. Think of the letters Lieberman would have written and the vlogs he would have recorded. -Nelllie]