Psychiatry on Verge of New World, Says NIMH Director

Credit: Mark Moran

It’s time to fundamentally re-think mental illness, said NIMH Director Thomas Insel, M.D., in a lecture at APA’s 2011 annual meeting in Honolulu. Insel delivered this year’s Frontiers of Science Lecture. Insel told psychiatrists at the meeting that psychiatric diagnosis today is made by observation of symptoms, detection of illness is late, prediction of illness is poor, etiology is unknown, and treatment is trial and error. There are no cures and no vaccines. But that will change. Psychiatric research today promises to produce a true science of the brain based on three core principles: 

• Mental disorders are brain disorders
• Mental disorders are developmental disorders
• Mental disorders result from complex genetic risk plus experiential factors.

“Rethinking mental illness means changing the emphasis so that you make sure the worst outcomes don’t happen,” he said. “We need to ask the question, How does variation in the genome lead to changes in particular neuronal circuits, which in turn bias the way an individual deals with emotional regulation?” With a true science of mental illness—from genes, to cells, to brain circuits, to behavior—psychiatrists will be able to better predict who is likely to develop a mental disorder and to intervene earlier. “Once that happens,” he said, “we will be in a different world.”