NIMH · Atonement

In his blog post entitled AtonementThomas Insel, MD, Director of the National Institute of Mental Health (NIMH), calls for humility:

So this year on Mental Illness Awareness Week, my call is for humility. We need to be aware that mental disorders are immensely complex—too complex for scientists, clinicians, patients, or families to solve alone. Prevention, recovery, and cure—the NIMH vision—need a collective effort. Beyond the day—or week—of atonement, we need a massive campaign to transform diagnosis and treatment.

http://www.nimh.nih.gov/about/director/2014/atonement.shtml

Below I directly quote his very moving and thoughtful piece in its entirety.

Thank you, Dr. Insel.


Director’s Blog: NIMH · Atonement
By Thomas Insel on October 8, 2014

One of my first meetings when I arrived at NIMH 12 years ago was with board members of the National Alliance on Mental Illness (NAMI). I asked them how NIMH could be helpful. One board member’s request was especially memorable. “Declare a day of atonement,” she suggested. When I saw this same board member last month at the annual NAMI meeting, we both recalled that 2002 meeting with a touch of regret. I wished I had had a better response to her request. And, as she said to me last month, “I wished I had asked for a week.”

As it turns out, Mental Illness Awareness Week this year began with Yom Kippur, the Jewish Day of Atonement. Which begs the question: what do we (in the mental health community) need to atone for? There are so many answers. For some, it may be the culture of blame and shame perpetuated for years by clinicians who explained all mental illness as being caused by trauma and evil parents. For others, it may be the singular reliance on medication and modifying behavior rather than holistic care and the provision of skills. Others will name the paternalistic structure of mental health care, which can undermine rather than empower individuals and their families. The list goes on. Maybe it would take a week, not just a day, to capture the many complaints.

My own favorite atonement issue for Mental Illness Awareness Week this year is the lack of humility in our field. Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods. Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science. That is, so much of mental health care is based on faith and intuition, not science and evidence. On the plus side, we put a premium on listening and compassion. We help people to change through understanding. But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.

On the research side, it’s easy to lose humility. The pace of discovery in genomics and neuroscience is ever more rapid—this week’s Nobel Prize in Physiology or Medicine is a good example of how neuroscience is revealing the fundamentals of brain activity—in this case describing the brain’s “GPS” network. Advances in systems neuroscience, from dissecting circuits to human brain imaging, are unequivocally stunning. But, and this is a humbling caveat, we simply have not been able to translate this revolution in neuroscience to diagnostics or therapeutics for people with mental disorders.

Why the disconnect? Translation takes time. Translation requires replication, regulation, and ultimately reimbursement. Fundamentally, translation is really difficult. For instance, we have thousands of neuroimaging studies but none that has delivered a clinically useful biomarker. For NIMH this is a humbling realization—we still lack biomarkers to identify who should get which treatment. We still lack effective treatments for many aspects of mental illness.

So this year on Mental Illness Awareness Week, my call is for humility. We need to be aware that mental disorders are immensely complex—too complex for scientists, clinicians, patients, or families to solve alone. Prevention, recovery, and cure—the NIMH vision—need a collective effort. Beyond the day—or week—of atonement, we need a massive campaign to transform diagnosis and treatment.

http://www.nimh.nih.gov/about/director/2014/atonement.shtml

14 thoughts on “NIMH · Atonement

  1. Dani October 12, 2014 / 8:06 am

    What a great re-post, Kitt. And this:

    “My own favorite atonement issue for Mental Illness Awareness Week this year is the lack of humility in our field. Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods.”

    Well said and well written.
    Thank you for sharing.

    With blessings,
    Dani

    Liked by 1 person

  2. Sandy Sue October 12, 2014 / 6:40 am

    Glad he’s one of the old, white guys in charge, but not enough think like he does.

    Liked by 1 person

    • Kitt O'Malley October 12, 2014 / 5:15 pm

      Unfortunately not everyone is as enlightened, but the tide is changing.

      Like

    • Kitt O'Malley October 12, 2014 / 5:15 pm

      You are welcome, Sheri. Humility and atonement are so important.

      Like

  3. Tertia October 11, 2014 / 8:07 pm

    Loved that–and I’m thinking of you, Kitt. I’m excited to hear about your continued explorations into advocacy. Part of me gets frustrated that my current circumstances don’t allow me to commit to very much, but I did attend a volunteer training for one of my old programs this week. Hope you’re having a good weekend!

    Liked by 1 person

    • Kitt O'Malley October 14, 2014 / 8:45 am

      Congratulations on the volunteer training. The experience did overstimulate me. Have had trouble slowing down and turning off since then. Resorted to taking clonazepam to fall asleep, which I try to avoid.

      Like

  4. mihrank October 11, 2014 / 5:00 pm

    Kitt – I am glad you had a great experience – You were in my prayers. I hope California will provide service and support. This message strong to be aware and wish always the best!

    Liked by 1 person

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