Directing NIMH: Morphing Materialist Madmen

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A sample of what NIMH is funding these days: pulsing lights that control mice whose “hopelessly entwined neurons” are infected by tracer-laden viruses…

NIMH announced its new director earlier this year. He seems to be the love child of a couple of older gents in his profession. We can expect the usual: announcements of non-breakthroughs sporadically, waiting for progress in plugged drug-development pipelines usually, and watching while rivers of cash roar past always. NIMH is still pushing RDoC, the New Coke of psychiatry paradigms, which should yield several promising-yet-ultimately-fizzling biomarkers of schizophrenia per year, more certainty that autism isn’t caused by anything, and the discovery that there aren’t just four kinds of depression, as a recent fMRI study showed, but 16, maybe 32. And genomes, many genomes, each one as significant as lipstick on a collar, but ultimately as informative as the red-faced man wearing the stained shirt. We’ll be that much healthier for knowing about them, though. So yes, it’s bad, and here’s some news that means it could be very bad.
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He’s from Columbia! Sure, the psychiatry department associated with their teaching hospital is top-ranked for research funding by US News and World Report, but that just means they don’t care about patients. Notable Columbia professors are Joe Biederman and Jeff Lieberman, whose reputations precede them, but here’s a refresher: Biederman is the famous child-drugger and Lieberman is the famous whiner. And, like Tom Insel, the new director spent some formative years at UC San Francisco. I don’t know what that means per se, but it probably means he has bats in his belfry, like Insel. So what can we expect from Dr. Joshua Gordon, spiritual spawn of Jeffrey Lieberman and Tom Insel, the new BMOC at NIMH, ready, ripped and roaring to implement RDoC? NIMH says…

“. . . he employs a range of systems neuroscience techniques, including in vivo imaging, anesthetized and awake behavioral recordings, and optogenetics, which is the use of light to control neural activity.”

At last, a humanist. [J/K]

“His research has direct relevance to schizophrenia, anxiety disorders, and depression.”

It has direct relevance to life in the real world, they mean. But “direct?” Could anything be less direct than infecting neurons with a virus that makes them light sensitive and then sending light pulses to engender a fear response? Saying “boo!” is a little more direct than that.

What an un-encouraging choice he was…like rolling Lieberman and Insel into a ball, pounding it flat, cutting out a man shape, and looking to that for the secret of human happiness. Actually that’s not much more stupid than looking to Tom Insel. In fact, I think we should stick with a loser. The safest bet would be to let Insel direct NIMH while he’s too busy at Verily to think about it. We don’t even have to tell him.

What, you might want to ask, is actually wrong with Dr. Gordon, the new head of the National Institute of Mental Health? Oh, nothing. He seems like a good guy. He doesn’t cheat on his wife and he takes an active role in not raising the kids. It’s his research that’s problematic. He’s looking for factors…underlying the symptoms…associated with…mental illness.

I can tell you right now, that’s going to take a long time, and lots of billions of dollars. First he has to get a bead on the symptoms, which barely differentiate the supposed illnesses. Then, onto the factors that underlie the symptoms. I mean you could just ask the person with the symptoms, as in “Hey you! Why so blue?” and “Dammit, man, why do you always act crazy?” Nope, you have to scan them, zap them, draw blood, sample brain tissue, hook up electrodes, inject chemicals, induce coma and exacerbate psychosis if you really want to know what’s going on with someone who isn’t acting right. Dr. Gordon is nothing if not fond of probes, so I predict a trouble-free, yet pointless, tenure. After all,

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.

That’s some mission. Prevention, recovery and cure are a long way off, so they’ve really only charged themselves with: transforming the understanding of mental illnesses, and transforming the treatment of mental illnesses. The understanding and treatment of so-called “mental illness” have been transformed many times, but illness of the mental variety is still with us. I guess they’re thinking this time will be different. This time, they have fMRI, and RDoC and JoGord. I’m sure he settle in quickly and get to work interpreting that vague mission any way he likes, and hundreds of thousands of mice will cower in corners for the great good of humanity.

What if NIMH’s mission were, well, what you thought it might be? Something like: “To discover the conditions under which human beings flourish in all our uniqueness and develop ways to relieve distress according to the wishes of the distressed.” Then who would run NIMH? Maybe Mehmet Oz,

The challenge awaits. During Tom Insel’s lengthy reign, spanning 2002 to 2015, no biomarkers were found and absolutely nothing of use to you and me came of NIMH’s labors. Insel admitted as much before bolting off to Google, shouting back over his shoulder that his failure was NIMH’s fault for not having big enough computers. He forget that it was his fault, after 13 years of annual budgets ranging from $1B to $1.5B, that NIMH still can’t compute itself out of a paper bag.

Do the Liebermans, Insels, and Gordons ever consider that there aren’t any biomarkers of mental illness to be found, which would explain why they haven’t found any? When something physical is found to underlie mood or behavioral problems, they stops being psychiatric and starts being neurological.

Those darned neurologists…they get all the good diseases. The headshrinkers are left with moth-eaten, unmanageable diagnoses. They can’t control the symptoms of these imaginary mental illnesses, so they give themselves over to controlling their patients instead. Chemical kosh, libido lidocaine, neurotoxic neuroleptic: just shut them the hell up and call it a cure. They talk about mental health problems, but what they mean are human being problems. Individuals who are distressed, whom others find distressing, are deemed mentally sick. Attempts are made to stop the distressingness, and that’s called treatment. The patient’s complaints about the treatment being worse than the supposed sickness be damned. That’s called side effects and side effects are mostly not serious, transient, or phantom, conjured by too much internet research.

Of course there are people whose minds generate voices that they hear as if someone were speaking. Because their experiences are qualitatively different from most people’s, they are said to have physiological brain disorders, but nothing out of the ordinary in their physiology has been found. However, common non-biological factors have been found: traumatic life experiences, and amenability to intensive, long-term psychodynamic talk therapy, which heals around 80 percent of so-called schizophrenics. This suggests that the experiences of people diagnosed with schizophrenia are not so wholly other. Their symptoms seem not to be on a continuum with the symptoms of other psychiatric diagnoses, but what does that mean? Most people have heard at least one voice, often while falling asleep. One voice, fifty voices…there’s your continuum. True, there is much written about “schizophrenia” and enlarged ventricles, which is a foolish euphemism for reduced brain tissue, the thing no one wants to talk about. It would mean that shrinks who prescribe antipsychotic drugs really are headshrinkers. Evidence that reduction in brain tissue is caused by antipsychotic drugs and isn’t a natural feature of the brains of those diagnosed with schizophrenia, can be found here in NIH-funded research, here in an unfortunate experiment exploiting rhesus macaques, and here and here , in Italy and the Netherlands, exploiting Italian and Dutch human beings.

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I think we can all agree that rhesus macaques, Michael Bublé, and Golden Earring deserve better.

Biopsychiatry is going nowhere. Why shouldn’t it? The only incentive for researchers is the next grant from people who are even less in touch with reality than the researchers themselves. We might see something worthwhile coming out of NIMH if it were run like a business, with bonuses paid when suicides and hospitalizations decrease, and changes in leadership when they rise or remain high. Meanwhile, we’ll have to make do with NIMH’s agenda. Here’s a sample of what’s gone down in Bethesda in recent decades:

Tapping Crowd-Sourced Data Unearths a Trove of Depression Genes (2016)
Get used to this kind of thing, and fear it.  Sure, they start with something innocuous like depression, which is so non-stigmatized that hardly a day goes by that you don’t hear some one say “I’m depressed.” But just wait until it’s schizophrenia or “the warrior gene.” And they’re not doing this just see if they can. The data will be used for something.

Normal human shyness is not being confused with the psychiatric anxiety disorder known as social phobia, according to an NIMH survey (2011)
Glad we got that sorted out. Just don’t tell me what it cost. I’ll blow a gasket.

Imaging Identifies Brain Regions and Chemicals Underlying Mood Disorders; May Lead to Better Treatments (2008)
That was 8 years ago.

Human Brain Appears “Hard-Wired” for Hierarchy (2008)
Therefore, those who don’t love living at the bottom of an immutable power pyramid have faulty wiring? Hmmm. Can we expect a new disorder in DSM-6, “Governance-Resistance Disorder,” first identified in Paris in the 1940s by German researchers?

How Schizophrenia Develops: Major Clues Discovered (2007)
Major, major clues…9 years ago.

Drops in SSRI prescription rates may coincide with increases in youth suicides (2007)
Except they didn’t. Prescribing and suicide have risen in lock-step ever since.

Manic Phase of Bipolar Disorder Benefits from Breast Cancer Medication (2007)
That went over like a lead balloon. Tamoxifen’s patent expired in 2002, the year Abilify was launched (and akathisia became a thing).

tamoxifen

Although Abilify is off patent and generics cost less, connoisseurs with health insurance prefer the original, price tag and all.

In case you’ve been mocking the tin-foil-hatters for voicing their worst fears about the destructive mental-healthing of America’s children, check out NIMH’s news feed:

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Mind you, there are 30 clinical trials listed for adults and only 16 for children, a reassuring sign. Less reassuring is that in the 30 studies described on the adult page, the word “brain” appears 84 times, while for the 16 studies on the child page, it’s used 71 times, which is 63% more often. Unfettered biopsych to be inflicted on tenuous little beings who cannot decide for themselves whether they want to take brain-changing drugs for their personal problems, or be left alone to cry it out with a stuffed animal.

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“Stuffies” make good listeners. They don’t mind having their eyes pulled out or their feet stuffed in their mouths, which is why babies prefer them to NIMH scientists.

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We can hope that someone at NIMH accidentally discovers a cure for something mental. Viagra was an accident, after all. It was meant as a drug to treat hypertension and angina, but ended up causing those cardiovascular conditions in the partners re-invigorated Viagra-takers.

Joshua Gordon, MD, the fate of a miserable nation is in your soft indoor hands. Look around you and admit mental health research is a morass. If Americans knew you will be modeling policy on what your predecessor Tom Insel did, or what your former Columbia colleague Jeffrey Lieberman says you should do, they would beg you to cast aside those old determinists.

I’m sure you voted for Hillary Clinton, but I’m still going to suggest the following way to think about your job. Ask yourself a simple question: What would Trump do? Chances are he’d fire Insel if Insel hadn’t already split. He’d give you a year to produce something of value to the public. You were hired five months ago, so get crackin’.

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