Mental healthDaniel R. Weinberger
Senior investigator, US National Institute of Mental Health
The search over the past decade for genes behind mental illness has led to the realization that mental disorders are not discrete conditions with specific causes. Rather, they are the result of interactions between risk factors that affect development; psychiatric symptoms can arise from many causes and are more interrelated than current disease models allow. By 2020, this insight, which has been slow to take hold, will have transformed how doctors understand and treat psychiatric conditions.
Finding specific genes for mental illness now seems a pipe dream. A more realistic endeavour for the next ten years is to look for genes that code for basic cellular and brain functions that modulate our responses to the environment and that come together in particular ways in individuals at increased risk. Many hundreds of genes may contribute to raised vulnerability, and such defects may affect brain development and function independently of any specific psychiatric diagnosis. There is no straight road to psychiatric illness, but a highly diverse network of developmental pathways.
This approach will lead to diagnosis and treatment based on a proper grasp of the underlying biology, rather than on an interpretation of symptoms. Psychiatric research is poised to realize Sigmund Freud's dream of a biological psychology, but it will require new applications of old thinking (see also page 9).
Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Tuesday, January 12, 2010
Danny Weinberger: Mental Health in 2020
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can we set the couch on fire now/?
Nope. :) It's genes, its temperament, it's environment, some forms may be virally triggered, etc. But how we think, and how we act affect not simply how we feel in the short term, but the structure and growth of brain cells. Therapy can change the structure of the brain. We are animals with minds, spirits, ideals and understanding that can make it possible for us to do the impossible. Biology is destiny and one can achieve somewhat better living thru chemistry, but what makes a life worth living? Not "health" but meaning. Not cure but healing and hope. We discover these thru relationships and thru hard work on ourselves to improve ourselves. For some it's found in loving families. For others by belonging to a faith community, for others what the Brits call their "mates" (buddies, posse, group). For others a shrink who helps them wrestle thru their sufferings and grow strong and insightful enough to be brave and productive anyway. It is hubris to think anyone can cure or prevent mental illness, because many of the conditions that afflict us actually benefit the population under certain conditions.
Enough. The short form: good therapy heals.
"No biological etiology has been proven for any
psychiatric disorder in spite of decades of
research. ... Don't accept the myth that we
can make an 'accurate diagnosis.' ... Neither
should you believe that your problems are due
solely to a 'chemical imbalance.'"
– Edward Drummond, M.D.
Associate Medical Director
Seacoast Mental Health Center, Portsmouth, NH
re: dinah's comment . . .Billy Joel song We Didn't Start the Fire is going through my head, now, thanks
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