Wednesday, June 9, 2010

der Insel

There is a flurry of recent blogsphere posts about the conflict of interest relationship between Dr. Thomas Insel, Director of NIMH and Dr. Charles Nemeroff, University of Miami, formerly of Emory University. I did a previous post in May where I voice my complaints about the NIMH's focus on future magic bullets.

In Dr. Insel's own words (I painted in my own highlights):

We must address mental illnesses, from autism to schizophrenia, as developmental brain disorders with genetic and environmental factors leading to altered circuits and altered behavior. Today’s state-of-the-art biology, neuroscience, imaging, and genomics are yielding new approaches to understanding mental illnesses, supplementing our psychological explanations. Understanding the causes and nature of malfunctioning brain circuits in mental disorders may make earlier diagnosis possible. Interventions could then be tailored to address the underlying causes directly and quickly, changing the trajectory of these illnesses, as we have done in ischemic heart disease and some forms of cancer. For serious mental illness, this is a new vision for prevention, based on understanding individual risk and developing innovative treatments to preempt disability.

I highlighted the word "supplementing" because here he is being disingenous. If anything, it's the other way around. Psychological explanations for mental illness have been ignored by the brain biochemistry model. Dr. Insel believes mental illness is a brain disease.

Where Dr. Insel is not even bothering to look:

The placebo effect
Non-drug alternative therapies
What actually works for people
Orthomolecular therapy
Family therapies

He promotes the diseased brain version of mental health disorders because that's where the money is today and will continue to be if the NIMH gets its way. If big money were in alternative therapies, Dr. Insel might be its public face, but it's doubtful it would be him. If the NIMH were to look seriously into these matters, the way it stands now it would become a rump organization with a small office and skeleton staff in some industrial park or run-down storefront. He otherwise would have to go back to being a psychiatrist who makes a comfortable, but by no means lavish living by listening to patients. There is already competition in this area from psychologists. The 1950s is beginning to look like the Gilded Age for psychiatry. The big money is over for psychiatry if it abandons its disease mantra. Dr. Insel would be paid less than most of the people he went to medical school with and there would be no flying around the world giving keynote addresses.

The collapse of the biochemical model is looming. The NIMH has aligned itself with the pharmaceutical industrial complex which is beginning to show signs of unravelling from within. If the machinery collapses it will be thanks to bloggers, certain politicians, patients' rights groups, investigative journalists, and lawsuits. The monopoly on information has been challenged by the internet and it's looking unlikely that the diseased brain model can be sustained. Its end will be like the demise of the Soviet Union back in 1989 which had been building slowly for a long time and took everybody's breath away with the speed of its collapse.

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