Is psychiatry approaching a 'tipping point'?
The BBC's Newsnight this week declared that psychiatry is approaching a 'mental health revolution'. Finally, it announced jubilantly, the physical basis of mental disorders will be laid bare, and psychiatry will become 'just another brand of the physical sciences, like cardiology'. I quote:
Professor Tom Insel, director of the $1.5bn National Institute of Mental Health in the United States, told Newsnight there is a profound change taking place, and science and technology is key to that change: "We are really facing a tipping point here with research in mental illness. We have gone through a revolution in how we can look at the brain. We can begin to understand which circuits are involved, and how the brain is wired. We have never had a full wiring diagram of the human brain. We are getting that now."
What this means, scientists say, is that mental health is rapidly becoming a field of medicine just like any other. If something goes wrong, clinicians will apply a battery of tests, make a diagnosis and decide on the best treatment for an individual.
Prof Insel told us that until recently, research in mental health was dominated by a decades old, and pretty haphazard approach. Drugs which happened to work in some patients were subject to scrutiny, to try to establish why they worked. There just were not the tools available to look at the fundamental mechanisms involved.
Scientists are mapping the brain in ever greater detail
His peers in the UK agree. Professor Shitij Kapur, Dean of the Institute of Psychiatry at King's College London, explained:
"Up until now our approach to mental disorders has been very much at a surface level. A psychiatrist or a psychologist will talk to you and try and understand your problems very deeply, but largely based on what you say and what your family members say about your condition they will have to make up their mind about the diagnosis.
"There was no aid from clinical tests - lab tests or blood tests - that have been there for last 50 years in other aspects of medicine. So this is our first opportunity to take psychiatric diagnosis from the descriptive, to in some sense based on their deeper biology."
Technologies such as brain scans and rapid genetic analysis have changed everything. At last, those treating mental disorders have the tools they need to apply a more systematic approach, and it's already changing they way patients are treated.
In groundbreaking research seen by Newsnight, a London team taught computer software to recognise patterns in brain images. Those patterns predict which patients will go on to develop the most serious forms of psychosis.
Dr Paola Dazzan from King's College London carried out this research, at professor Kapur's institute: "When people come to us with the first episode of psychosis we can already distinguish the people who will do better than from the people who will have a more severe type of illness course. And this will allow us to start thinking of using a different treatment for these different groups of people".
Professor Neil Craddock believes research such as his will force a major change, not just in the way patients are treated, but in helping to remove the stigma that still goes with mental illness.
"People view mental illness as being somehow different from physical illness. In truth, the only difference is that we understand less about the workings of the brain, and we don't have laboratory tests that can back up diagnoses. What I foresee over the next generation is psychiatry becoming like cardiology and other medical specialities, where we have a range of tests - imaging tests of the way the brain functions, blood tests to know about susceptibility factors, other sorts of psychological tests. That will really help direct us to the diagnosis, and crucially - enable us to know how to help people."
This sounds positive - who wouldn't want more effective help to be given to people with chronic mental illnesses like bipolar disorder and schizophrenia. It would be exciting to see this new research.
But before we get too carried away - this is not the first time psychiatry has said it's on the verge of a 'tipping point'. It's been saying that ever since it came into existence, over a century ago. Each new advance has been greeted with enormous hype - trepanning! lobotomy! electro-shock therapy! anti-psychotic drugs! - before the slow research afterwards reveals that things are not quite so rosy.
Here's one key reason psychiatry is different from cardiology, and why it makes my heart sink somewhat when a scientist says they're the same. The psyche, unlike the heart, is not an automatic machine. It possesses reason and consciousness. What that means is that our beliefs and attitudes play a role in our mental health and mental illness, and therefore we have a measure of autonomy and self-direction. That's the case even for psychotic illnesses like schizophrenia - where scientists have discovered that a great difference is made by the person's attitude to the voices in their head.
Psychiatrists are so embarrassed at how little advance they have made over the last century, and so keen to join the ranks of the more credible sciences (like cardiology), that they cannot wait to show that the mind is a machine just like the heart or the lungs or the nervous system. And of course they always couch that professional eagerness in terms of compassion for the ill - wouldn't it be great if we could just solve all mental problems with a pill, or an injection?
Yes, in some cases, it would be great. But don't be too eager to mechanize the mind. Don't ignore the role of ideas, beliefs, attitudes, and the meaning we give to our experience. Otherwise psychiatry is just going to make the same mistakes, and cause the same human suffering, as it has done repeatedly over the last century. Please respect the fact that we are persons, not puppets.
(By the way, I got this cartoon above from Facebook - does anyone know who did it so I can make proper attribution?)