As The Pendulum Swings

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As The Pendulum Swings

During the late 20th century the psychiatric community had a hard time getting their voices heard.  The work of a psychiatrist was hardly thought of as scientific and quantitative.  Ever since the beginning of the century when psychodynamic psychotherapy came on the scene the psychiatric community has tried to empower itself to move beyond “guesswork” and into the realm of validated scientific discipline when it comes to mental illness.  

Paul Meehl (3 January 1920 – 14 February 2003) was a clinical psychologist and Professor of Psychology at the University of Minnesota. A Review of General Psychology survey, published in 2002, ranked Meehl as the 74th most cited psychologist of the 20th century, in a tie with Eleanor J. Gibson.[1] Throughout his nearly 60-year career, Meehl made seminal contributions to psychology, including contributions on construct validity, schizophrenia etiology, behavioral assessment and prediction, and philosophy of science.) explains in his classic work “Why I Do Not Attend Case Conferences,” which spells out reasons why he felt psychiatric and psychodynamic case conferences at the time were not adequately rigorous (“reward everything—gold and garbage alike”).

Psychoneuroimmunologist who helped discover the opiate receptor, the cellular binding site for endorphins in the brain, Candace Pert said she is happy Psychology is “finally becoming scientific.”  Pert’s research into brain biochemistry contributed to a new understanding of relations between the mind and body.  Molecules of Emotion, Pert’s book demonstrates her perspective in this quote “Most psychologists treat the mind as disembodied, a phenomenon with little or no connection to the physical body . . . but the body and mind are not separate, and we cannot treat one without the other.”

Solid Science

Modern clinical neuroscience techniques throughout the past 30 years along with non-invasive brain stimulation and imaging, as well as a pointed focus of the psychiatric academic community to gain the industry’s respect, has catapulted itself into the “hard science” category.  

The new generation of psychiatric researchers has spawned from well-studied treatments, neuroscience, and researched coursework.  This has culminated in a whole new generation of psychiatric researchers who routinely investigate mental illnesses with modern clinical neuroscience tools.  Some researchers feel the psychiatric industry has strayed too far from the nest.  Citing the growing dependence on measures of physiology, along with the recent funding priorities of the NIMH (National Institute of Mental Health), which has a current budget of over $1.4 billion.  Although it should be mentioned that the majority of the psychiatric field has welcomed the transition over the years.  

It is not certain exactly how much of the funding from NIMH supports brain-based research, understanding the biological basis of mental disorders is a top priority for NIMH.  Describing molecules, cells, and neural circuits associated with complex behaviors and disorders, also identifying the genomic factors associated with mental illnesses.

The National Institute on Drug Abuse and the National Institute on Child Health and Development are also acutely focused on research into the biological basis of mental illness.

Qualms

New York Times Op-Ed contributor Dr. John C. Markowitz, a professor of clinical psychiatry at Columbia University and a research psychiatrist at the New York State Psychiatric Institute, wrote in “There’s Such a Thing as Too Much Neuroscience,” how diverting much of the NIMH budget away from clinical studies and into neuroscience research does little to help patients who are suffering from psychiatric illnesses.  Markowitz explains there is a shift from DSM toward “research domain criteria” (RDoC). Rather than focusing on DSM (Diagnostic and Statistical Mental Disorders), RDoC focuses on unitary constructs related to mental disorders.

The blow back against the modern prioritizing of this is mainly rooted in the human factor, that the biological process doesn’t recognize free will and human choices.  

Markowitz acknowledges that RDoC emphasizes understanding these clinically relevant constructs at various levels of analysis, including genes, molecules, cells, brain circuits, physiology, and behavior. He insists the progress of such multi-level approaches will likely not be borne for a decade or more, urging newly appointed director of the NIMH, Dr. Joshua Gordon, to prioritize clinical studies to “re-establish that balance” between neuroscience and clinical research.

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