The pandemic highlighted critical flaws in our country’s approach to mental health. What should we do to correct course?
-19 pandemic eases, a mental-health crisis still has us in its grip. My fellow-psychiatrists and I continue to be flooded with referrals, desperate calls, emergencies, and relapses—likely the consequences of years of isolation and grinding anxiety, loss, school disruption, and who knows what kinds of viral assaults on the brain. Preliminary studies report elevated rates of suicide, anxiety and depression, addiction, developmental delay, and psychiatric E.R. visits.
So I should have been prepared to have my head spin when I interviewed clinicians, historians, and prominent leaders in the field about our capacity to respond to a post-Diagnostic and Statistical Manual of Mental Disorders All these changes were accompanied by publicity campaigns attacking stigma. Mental disorders, we were reminded on billboards and in commercials, were no different from diabetes or any other illness. This work paid off. Today, princes, athletes, senators, and celebrities no longer hide their psychic struggles.
There’s an underlying reason for all this zigzagging. Picture an archer’s target; at the bull’s-eye, place the most basic of possible causes for mental illness—say, genes. Huntington’s chorea, a fatal disease that affects cognition and movement, is solely genetic: it sits wholly at the center of the target.
, or self-harm in adolescents—but, to maximize your chances of being funded, your study had to incorporate a measurable characteristic, such as a gene or neural circuit, that reflected an underlying biological process. In a 2013talk, Insel, standing before mesmerizing brain scans and images of neurons, assured his audience that new knowledge based on this approach—he had previously called it “clinical neuroscience”—would soon sweep away two centuries of psychiatry.
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