#thomas insel

[maaarine]

Ezra Klein: 

“We often seem to me to be optimized for people’s 20s. You move somewhere. You’re pursuing a job. Again, that’s not what everybody does.

But then, as your life changes and you need support, you have children, you have health problems, you age, you have mental health problems, all the things that make us interdependent on others, our lives are in places where we don’t have a lot of support for that. 

And our families are much smaller, and what we can ask of each other is somewhat less.

So you talk a lot throughout the book about isolation as a cause here, but you say that social isolation is the most under-discussed dimension of serious mental illness that there is. (…)”

—

Thomas Insel

“In an era where everybody is online and connected more than ever supposedly, there’s a greater sense of loneliness, which is different than being alone but a sense of loneliness. 

And you’re right. In the book I talk about how that is a feature of mental illness, which is one of the most disabling and difficult. 

And when you talk to people who recover they almost always start by telling you about a person who had their back, someone who they trusted who gave them hope.

And so in putting my vision about how to fix this problem together, I came up with those three Ps. 

It wasn’t my idea. It was the idea of a very wise street psychiatrist in L.A. who also was running the L.A. County Department of Mental Health, Jonathan Sherin who said, it’s really people, place and purpose. 

If you provide those, people will, in fact, recover.

So the first part of that, that social support, is, I think, entirely critical, and it’s a great place to start. 

And it could come from family. It could come from a peer who’s been down this road. It could come from a neighbor. There are all sorts of ways to make that happen.

And to build it into policy, it starts with things like having parental leave. It’s not in our value system, and I do think there’s a policy issue here that we ought to bring front and center. 

It’s one of the reasons why I said, the problem here is medical, but the solutions are social, they’re environmental. But they’re also political.”

Source: The Ezra Klein Show: A Top Mental Health Expert on Where America Went Wrong

[daviddobbs]

Smartphone psychiatry? How NIMH director Tom Insel turned from brain scanners to social tech

Smartphone psychiatry? How NIMH director Tom Insel turned from brain scanners to social tech

Thomas Insel, photo courtesy of The Atlantic.

Around this time, Insel told me recently, he’d just finished a talk describing the wonderful things the NIMH was discovering about the brain when a man in the audience said, “You don’t get it.”

“Excuse me?,” Insel said. “I don’t get what?”

“Our house is on fire,” the man said, “and you’re telling us about the chemistry of the paint. We need someone to…

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[crafalab]

Brainstorms: Are Psychiatric Disorders 'In the Brain'?

Photo by Brews ohare

Currently, there is a push to define mental disorders based on brain activity. The NIMH has initiated the RDoC project, designed to formulate these definitions based on neural and genetic traits. More on that here.

An fMRI study published this summer is among the first to investigate whether differences between mental disorders can be observed in the brain. The findings are impressive. Researchers could see clear differences in brain function when comparing patients with bipolar disorder and schizophrenia. They could also see many similarities when the disorders were compared in contrast with the control population. These were not the only remarkable findings - family members of people with these disorders showed subtle brain variations compared to controls, which resembled the brain functioning seen in the patient group. These family members do not have symptoms of mental disorders, and these neural events are considered variations of normal brain functioning. These findings suggest that continua of neural activity exist in the brain and people with disorders may simply be on the most extreme end of the spectrum. Here's a link to the abstract, for the curious. 

Tying these findings back to my interests: Culture may operate similarly. Variations in the brain exist between cultural contexts. More here. These variations appear to have been shaped by the social conventions and traditions that dominate specific cultures (see here) - possibly because of genes or possibly because of learning. The primary catalyst is currently subject for debate, though brain, genes, and social learning are indisputably intertwined. Researchers are currently investigating the role of culture in mental health, to determine whether culture-based variations in disorders are observable in the brain. More here. Such findings could potentially lead to an even more nuanced understanding of the continua between normal and disordered brain activity. Or, more plainly, there may be multiple continua at play.*

This is the flow of the current tide, anyway. It's worth mentioning that all of these fields are in the very (very, very) early stages of development. The future could bring contradictions and new directions, and probably will. I'll keep you posted.

*The position presented in this paragraph is summarized from "Traces of Culture" (Crafa & Nagel, in revision) - use of or reference to these ideas should be cited as follows: 

Crafa D, & Nagel S. (2013). Traces of culture: the feedback loop between brain, behavior, and disorder. Transcultural Psychiatry, in revision.

©Daina Crafa 2013

[crafalab]

Link to original article

(Image by U.S. Government)

This announcement comes with a critique of the DSM:

"While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."

In order to combat these concerns, the NIMH proposes a new system based on the state of the art in empirical research:

"NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system."

One potential concern with the RDoC is the possible neglect of qualitative data. As a research tool, it is intended to achieve greater external validity, which requires balanced insights into the patient. Considering data from mixed methods may be most effective for achieving this balance. However, it is still too soon to tell whether this will be an issue for the new system.

***It should be noted the RDoC is for research purposes only, and will not be used for medical diagnoses (yet, anyway).***

[meeshsbookmarks]

Toward a New Understanding of Mental Illness

[pejmanyousefzadeh]

In search of a better measurement of mental health.

[vicariouslyme]

TED Talk of the Day:

Mental health is increasingly becoming a more talked about issue.  But I still know very very little.  Due to our age behaviours signaling mental health become more apparent.  Thomas Insel gives a great talk suggesting that we are only intervening to these disorders once they become behaviours and what we should be doing is intervening when the brain start changing, at a much early age.  He discusses that the brain shows us a patterns during development that indicate a future mental disorder.  Very interesting TED Talk

[pas-daccord]

Thomas Insel: Toward a new understanding of mental illness.