The NIMH in 2017: Looking for Love in All the Wrong Places

Robert Nikkel, MSW
31
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It’s the beginning of a new year — and with Dr. Joshua Gordon’s ascension to the position of director at the National Institute of Mental Health, a new approach to research on mental health care.

Or not?

A quick history of the NIMH leadership over the past couple of years:  From 2002 to 2015 Dr. Tom Insel headed up this federal agency, and led the charge for finding the “real” cause of “mental illness.”  He has now moved on to Google Life Sciences (GLS) to help in their mission to develop “new technologies to transform healthcare, such as a contact lens with an embedded glucose monitor. The GLS mission is about creating technology that can help with earlier detection, better prevention, and more effective management of serious health conditions.  Insel’s stated intention in joining Google is “to explore how this mission can be applied to mental illness.”  Giving credit where it’s due, he did acknowledge that the chemical imbalance hypothesis wasn’t going anywhere. He was also critical of the process used in developing the latest edition of the Diagnostic and Statistical Manual DSM-5.

The official announcement of the new director’s appointment last July proudly proclaimed that Dr. Gordon and his colleagues at Columbia had been studying things such as “the role of the hippocampus, a brain structure known to be important for memory and emotional processes associated with anxiety and depression.”  Dr. Gordon’s research has also analyzed neural activity in mice who supposedly carry mutations “of relevance to psychiatric disease.” How these objects of study are analogous to mental disorders is not described, but the lab studied genetic models of “these diseases from an integrative neuroscience perspective, focused on understanding how a given disease mutation leads to a behavioral phenotype across multiple levels of analysis.” The press release lists several methods used — in vivo imaging, anesthetized and awake behavioral recordings, and optogenetics; using light to control neural activity. A gigantic leap is then made: that his research “has direct relevance to schizophrenia, anxiety disorders, and depression.”

As a former executive level director in state government, I recognize the talk — or at least the motivation behind the talk.  You want your new appointment to sound impressive: to the staff, to the public, and, most importantly, to the legislative bodies responsible every year or two for your budget.  It’s obvious that — except for a few — most Representatives and Senators are preoccupied with other, more important issues.  The few exceptions tend to be mental health professionals who are in Congress largely because they’ve been adept at getting corporate support of one kind or another.  They are hardly motivated to be on the cutting edge of unbiased research.  Using highly technical, complex, scientific, and hopeful language is enormously appealing.

And sometimes the officials actually begin to believe their own public relations mantras.   That’s almost more dangerous than using the talking points cynically.

So who is there to ask the question most unwanted in this environment: Is there any evidence that in the foreseeable future, anything will come of the scientific theories — and expenses — demanded of such technically sophisticated endeavors?  Has anything come of all the hype and hopes to date?  Is there such a huge gap between mice and men that a rat’s anxiety pales in any comparison to the complex causes and phenomenology of anxiety in humans?  Even if a connection could somehow be hypothesized, wouldn’t it be far more promising and timely to understand why abused kids or women are anxious and depressed?  Is the solution really “non-invasive” electrical stimulation or some other even more frightening intervention?

In his first Director’s message, which came out on January 4, Dr. Gordon uses as an example of where he’s going the research of one of his students into the “neural circuit we thought was critical for anxiety in mice.”  He praises her for taking on a project that he believed had no promise:

“Using a carefully engineered virus, she was able to direct an inhibitory opsin—a protein that responds to light by decreasing neural activity—to the connections between these brain regions. She then used light to activate the opsin and inhibit circuit activity, which reduced anxiety in the mice. Nancy’s next idea was to try stimulating those inputs in a specific pattern, to see if she could increase anxiety instead of decreasing it.”

I don’t know about others but this stirs some pretty uncomfortable feelings in me. After all, nothing could go wrong with an engineered virus, right?  And I entertain some (I think reasonable) doubts about the likelihood that a “viral” approach is really the best approach to treating anxiety anyway, when we already know that intense anxiety is almost always related to an extreme physical or psychological threat to a human being.  Isn’t a real world immediate approach something more like an exploration of what that threat is all about, rather than assuming it’s really about neural connections?  Isn’t hoping for a neuroscience approach akin to denial and enabling?

I don’t doubt that there are biological, neurological, even neurochemical counterparts to our emotional and cognitive lives.  After all, we don’t need to buy into a complete split between these aspects of experience.  We are made up of both body and mind.  But what I question (and see no evidence of in this new/old NIMH approach) is that we already know a huge amount about what helps people, but where we have ended up, over decades, is in the illusory black hole of basic neuroscience research.

It’s an odd split that NIMH appears intent on maintaining: we’re not really minds or feelings, we’re neurochemical in nature and that is the way forward for improving mental health outcomes.  However, all the well-constructed research into outcomes clearly shows that biochemical solutions worsen outcomes, and that recovery and resilience come from shifting away from a drug treatment paradigm that is lucrative for the pharmaceutical industry, toward to a human relationship-oriented approach that profits individuals and society at large.

What helps more?  An unfounded belief that a neurochemical malfunction will lead to improved lives, or increasing solid human connections? Isn’t there far more promise in helping work through Adverse Childhood Experiences, or coming to terms with alcohol and street drug toxins, and on and on? The research and individual experience is pretty clear.

None of this is to say that drugs should never be used.  But that issue needs and deserves more examination. After all, even the Finnish Open Dialogue programs use drugs, but in smaller amounts than we do, for shorter periods, and only for some people.  Their approach accounts for the research that shows that since it’s impossible to know beforehand which people will benefit more from medication, and which from going through whatever it is they are going through, it’s better to wait. What they have demonstrated is that this restrained approach shows no evidence of worsened outcomes, as those who advocate for a one-size-(large)-fits-all approach to medication would have us believe, and in fact produces much better long-term outcomes across the spectrum of diagnoses and prognoses.

It may be that ultimately there are some people whose difficulties simply won’t respond to anything we have now, be it chemical or interpersonal.  I happen to believe that’s a relatively small number.  To be sure, there is a considerable amount of pain to be found in this small number of people, and in their families, and there will be many who do feel benefit in the short term as well as some who feel benefit in the long term. But basing on that minority the justification for leading (or forcing) a majority of people into treatments that — on average — will not help, and do — on average, in the long term — cause harm, amounts to injustice on a societal scale and a willful ignorance of the evidence. If NIMH and its supporters in Congress and the American Psychiatric Association could begin to open themselves to these current realities, we may gain a view toward a better understanding someday of some of the most difficult-to-help people.

Our problems are not all explained by looking in nerve synapses, hippocampi, or — God forbid — remedied by a manufactured virus. I think we need to ask the neurochemically-oriented crowd: could there be an acknowledgment of the vast body of research and knowledge that already exists linking mental health crises across the spectrum to readily observable traumas, that we already know how to treat, if we can only muster the will? Wouldn’t that be a better allocation of our resources?

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31 COMMENTS

  1. I glanced at the Jan 4 message of Dr. Joshua Gordon.
    These are people in lofty towers, I am a person on the ground.

    My introduction to psychiatry was waking tied to a bed in a most powerful thirst. I was refused water and tortured. I was not given legal council.

    Dr. Joshua Gordon is so far removed from reality (looking for mental illness in animals) that I would say he is “mentally ill”.

    People are locked up before they commit a crime, and not given legal representation is the reality.

    People are accused of being sick, then made sick by the jail (called a hospital) without due process and then by psychiatric drugs called ” medicines”. Withdrawal from the medicines is taken as “mental illness” returning the same way a drug addict goes into withdrawal when deprived of their drug.

    Dr. Joshua Gordon is continuing to look for the impossible paradox , the physical cause to mental illness. Which if proven would make the problem a neurological one and no longer to be treated by any psychiatrist.

    The “normal” population is too stupid, too powerless, and needs psychiatry for psychiatry’s power to lock up that crazy person they don’t like.

    The only hope is those that pay for all this quackery are not happy with the results the psychiatrists produce, so stop paying.

  2. What are people looking for?

    In common with a lot of people, I found the Buddhist and CBT type approachs (within psychotherapy) to be very useful in my quest for Recovery, and Buddhism has been around for several thousand years.

    There are also lots of other safe and successful Approaches that lead to Full and Longterm Recovery.

    I think it might be a good idea to use what’s already available, safe and proven to work rather than waste time experimenting in dangerous areas.

    • But Fiachra, psychiatry and the drug companies can’t charge tons of money for the things that actually work safely for people!!! You need to get with the program!

      Seriously, I agree with you in that things like meditation and trying to live out the teachings of Buddhism on a daily basis are much more productive and helpful to me than anything that the “mental health” system wants to do to me.

      • Agreed. Psychiatry threw the book at me and had no intention of ever allowing me to recover – DID, GAD, ADHD, Panic Dis, C-PTSD, MDD, Bipolar 1,2, and 3, Borderline – they just kept applying diagnoses and giving drugs, no matter how inappropriate. (I’ll own being a difficult patient but there is nothing evidenced-based about the 10 psychiatric drugs I was on at one point.) I wanted to try DBT but there are no Medicare providers who offer it in my state, so I went straight to the source and took a class offered by a local Zen Buddhist sangha – the same branch of Buddhism that Marsha Linehan drew her work from. Daily meditation has absolutely changed my life. Coincidentally, I was able to go off ambien after ten years nightly use when I was diagnosed with sleep apnea and started cpap therapy. Amazing how being able to breathe when you’re sleeping will cure insomnia!

        But as you said, there is no profit in curing a psych patient.

  3. Psychiatric and neurological researchers will keep getting more of the same until they stop looking at human behavior and human relationships and start looking at how humans interact with information in order to predict what to do next. The most vitally important factor in mental health is how reliably and successfully a human is able to interact with information.

    Humans are born to eat, drink, be cared for, and care for other humans. These are givens. The only aspect of humanity not biologically predetermined is how a human will interact with information in a constantly changing environment and make predictions about what will happen next and what to do next. Relationships have no more or less importance than eating, drinking, sleeping, mating, breathing, etc. The element of most importance a human brings to any of his or her human activities is how she assesses the information surrounding the activities in order to make optimal predictions for what to do next.

    Because mental health is determined by a healthy relationship to information, mental health is not being adequately preserved or maintained by drugs OR therapeutic relationships. Creating the perfect sort of relationship with a therapist is no more the answer to mental illness than drugs are. They have both been hit or miss, last resort treatments.

    Admitting drugs as well as therapeutic relationships are inadequate solutions to mental illness is step one. Admitting the study of human behavior is not going to give us the answers we need for understanding mental illness is step two.

    Behavior is simply a reflection of what and how the brain is predicting. Behavior has no agency in and of itself. People don’t make behavioral choices, they make predictions for what to do next. And everyone predicts in a way that makes sense to them for the memory capacity they have, processing speed, visual and auditory acuity, depth perception, eye-hand coordination, spatial and numerical skills, speed, agility, etc.

    Comparing human behaviors up to a norm does nothing to help us understand mental health or mental illness. These comparisons help us understand typical sequential human development, but that is all. Trying to make someone with atypical sequential development behave like someone who is typical is a CAUSE of mental illness, not a remedy for it. We have classrooms full of children subjected to behaviorism and applied behavioral analysis (ABA) who will soon be mental illness statistics because behaviorism is so globally damaging to a child’s cognitive and physical development. Therapeutic relationships that stress ABA are torturous.

    Comparing each individual’s predictions and predictive processes up to their OWN cognitive, sensory, and physical skill sets will give us information about how human’s with different sensory, cognitive, and physical capacities interact successfully or unsuccessfully with information. The most important aspect of humans to study is how they interact with information.

    Inhibition of how one is capable of understanding and managing information is what causes humans to react and/or adapt in ways that look to an outsider like mental illness. When you receive negative consequences for making predictions and decisions in the ways that make sense to you, you are put in the most debilitating double bind a human can be in. You must respond and adapt to survive this untenable situation.

    Mental illnesses are often biologically crucial survival responses and adaptations to having one’s interpretive and predictive mechanisms inhibited in any way. Understanding why a person who appears mentally ill is interacting with information the way he is, you will discover how he has been inhibited from optimally managing information in the ways that make the most sense to him.

    Trauma has been a scapegoat for causing mental illness when trauma is much easier to recover from than information management inhibition.

    Therapeutic relationships have been held up as the best option for mental illness recovery when therapists are often causing more problems than they are solving. Therapists also often give misinformation about how thoughts, emotions, and behaviors integrate.

    No professionals are yet talking about how each human brain must optimally interact with information in order to optimize his or her predictions and decisions in order to optimally maintain mental equilibrium. Humans don’t need therapists to rescue or empathize with them. They need biologically accurate information for how to understand and properly care for their personalized and highly customized brain mechanics.

    A person who has been severely inhibited in how they are allowed to manage information can certainly benefit from a therapist if that is his only option. If the inhibited person can be given biologically accurate information about how to restore his thought processes back to how they were intended to be exercised, it will help him even more.

    The above ideas are hypotheses born out of my own observations and research, therefore they are not yet scientific facts or theories but ideas still in the hypothesis stage.

  4. The official announcement of the new director’s appointment last July proudly proclaimed that Dr. Gordon and his colleagues at Columbia had been studying things such as “the role of the hippocampus, a brain structure known to be important for memory and emotional processes associated with anxiety and depression.”

    OK so obviously the Mengelian approach is scheduled to continue. No corporate academic studies of “the role of capitalism, alienated lifestyles and enforced conformity in emotional processes associated with anxiety and depression.”

    The message is clear — eat shit AND LIKE IT or we have some neurotoxins for you.

    Arguing with these people on their own level is best left to people like Bob W who do it very well; most of us should not waste our precious time on this, as the reality is that they ARE NOT INTERESTED in what “makes sense”; their primary goal is to perpetuate repression in the guise of medicine.

    • Old head: I was Psychiatrically incarcerated in 1989 and made the mistake of abrupt withdrawal of Lithium in 1990. I have led a relatively normal life since then as a substitute teacher and youth worker.
      However, last summer, I was hauled into HR because
      some students said I was acting “irratically.” talk about the lunatics running the asylum! I was requested to get a Pschiatric med check in order to return to work-I got the run around from the behavior health people. Showing up at the crack of dawn on the psychiatrist’s doorstep really got their attention. Thanks to the crisis worker, I beat their attempt to incarcerate me, but still had to appear at the Magistrate because the shrink filed papers for a restraining order, which the deputies tried to serve me while I was on vacation. Any how, I showed up at the courthouse to straighten things out, because I wasn’t keen on the deputies showing up at my house a second time-I was escorted out of the courthouse by five deputees for using my teachers’s voice. The next day, the magistrate ruled that the restraining order be mutual. But now I have the nuisance problem of having to go to a new Pschiatrist every six weeks or so.

  5. ‘“We have cured cancer in mice for decades—and it simply didn’t work in humans.”[1] Even chimpanzees, our closest genetic relatives, do not accurately predict results in humans—of the more than 80 HIV vaccines that have proven safe and efficacious in chimpanzees (as well as other nonhuman primates), all have failed to protect or prove safe in humans in nearly 200 human clinical trials, with one actually increasing a human’s chance of HIV infection.’ http://www.neavs.org/research/limitations

    If this is the case for physical illnesses, then what does it say about psychological problems?

  6. Since HIV is basically a monkey virus — possibly genetically engineered itself — it makes sense that monkeys would have a stronger immunity.

    Somewhat off-topic but there is evidence that tens of millions of polio vaccines were contaminated with simian viruses in the 50’s. I don’t know why more boomers aren’t on this when contemplating the many toxicities associated with cancers.

        • I’ll board this hijacked train.

          “Some evidence suggests that receipt of SV-40 contaminated polio vaccine may increase risk of cancer…”

          Good old SMR: “Suggests-May-Risk.” It means there’s a relationship, period.

          Any studies showing that it reduces the risk? Didn’t think so. I believe they would say so: “In fact, some evidence suggests that being shot up with monkey-AIDS-causing-virus actually may reduce your risk of cancer…”

          In the (presumed, but wrongly, perhaps) absence of studies revealing a negative relationship, findings would would necessarily average out to a positive relationship. The basic statistic calculated to determine a relationship between two measurements or yes/no outcomes is a number between -1 and +1. When more of X is associated with more of Y, it’s a number between 0 and +1. When more of X is associated with less of Y, it will be a number between -1 and 0. If all you have are findings of a positive relationship or of no relationship, the average will be above 0: a positive relationship. It cannot be 0.

          “…the majority of studies … have shown no *causal* relationship between receipt of SV40-contaminated polio vaccine and cancer.” [asterisk-emphasis added]

          But have the majority of studies found a relationship, despite no proof of causality? Sounds like a possibility. How would you prove causality other than in an experiment that cannot legally be conducted? So, another way of saying the above would be “the best evidence we have so far…” because correlational evidence is as good as it is going to get.

          If being injected with monkey-AIDS-causing-virus increases the odds you’ll get cancer, either the shot causes it, or something correlated with the shot causes it. (Getting cancer later can’t cause you to have got the shot earlier.) I’d like to hear some ideas on what was correlated with getting a polio vaccine in the US in 1960, other than being born.

          This isn’t about the wisdom of being vaccinated against polio; it’s about word use. Any government I fund is obligated to tell the truth clearly. Ours doesn’t.

          • Correlation is not causality, but it’s nice to be told about it. Then again the information is useless unless it’s reported, and I never read about any of this in the paper.

            My comment about monkeys and HIV was not directly related to the polio issue, btw.

  7. Amazing:

    “Dr. Gordon’s research has also analyzed neural activity in mice who supposedly carry mutations “of relevance to psychiatric disease… the lab studied genetic models of “these diseases from an integrative neuroscience perspective, focused on understanding how a given disease mutation leads to a behavioral phenotype across multiple levels of analysis… A gigantic leap is then made: that his research “has direct relevance to schizophrenia, anxiety disorders, and depression.”

    What a joke! It’s the tried-and-true NIMH formula: You assume the existence of a valid illness called schizophrenia, and then you look at cute white mice and speculate what they might tell you about the disease in humans. What bullshit!!!

    Even when leading NIMH officials and past DSM heads said that these categories (“generalized anxiety disorder, major depression, schizophrenia”) lack validity and usefulness for research, they just go back to doing the same thing. It’s the definition of insanity: doing the same thing over and over again and hoping for a different outcome. That is what research psychiatrists do.

    I have to wonder how research psychiatrists keep coming up with this stuff. You would think they were trying to be funny on purpose. But the amazing thing is they don’t even do it on purpose. That is the biggest incongruity: research psychiatrists are dead serious about their diagnostic labels and really want to be looked up to as prestigious researchers, and they don’t even realize what ineffective and out of touch they appear to people looking at severe distress from other perspectives outside the field.

  8. Change of the guard, more of the same. You know what to expect from the NIMH. I applaud your effort to change the NIMH, but when it comes to the need for such change, you’ve only touched on the tip of the iceberg. So much is wrong with the way they are approaching matters I don’t know where to start. Everybody is so bio bio bio, even when they’re bio psycho social. The NIMH has consistently displayed its own type of bias. Had they another Loren Mosher to give the sack to, don’t you know, he’d get the sack.

  9. A virus to cure anxiety!!!!!!!!! When will these idiots realize that we cannot take away our survival technique!!! The fight and flight response is the cause of anxiety. We have this built in us to survive. The brain would certainly fight back at such an assault to it, in what form who knows but I very much doubt it would be any good for us.

    • Robert Sapolsky, a Stanford neurobiologist, was last seen “working on a modified virus that could carry engineered ‘neuroprotective’ genes deep into the brain to neutralise the rogue [stress] hormones before they can cause damage. The virus is now shown to work on rats…”

      The modified virus is herpes. Volunteers?

      I thought his lunacy was worth mentioning because of a column he wrote right after the Germanwings antidepressant-induced atrocity. It ran in major newspapers across the country. The gist was: “get treatment because depression kills.” He mentioned “schizophrenics” along the way. His thoughts on those diagnosed with schizophrenia?

      “…the vast majority of schizophrenics are dangerous only insofar as they break the hearts of loved ones watching the tragedy of a wasted life.”

      The unfortunate thing is that Sapolsky is not just respected, he’s generally revered. For those uncertain about how to revere him, he provides the model by revering himself.

  10. Pseudoscience:
    1 – Hostile to criticism, rather than embracing criticism as a mechanism of self-correction

    2 – Works backward from desired results through motivated reasoning
    3 – Cherry picks evidence
    4 – Relies on low grade evidence when it supports their belief, but will dismiss rigorous evidence if it is inconvenient.
    5 – Core principles untested or unproven, often based on single case or anecdote
    6 – Utilizes vague, imprecise, or ambiguous terminology, often to mimic technical jargon
    7 – Has the trappings of science, but lacks the true methods of science .
    
8 – Invokes conspiracy arguments to explain lack of mainstream acceptance (Galileo syndrome)
    9 – Lacks caution and humility by making grandiose claims from flimsy evidence
    10 – Practitioners often lack proper training and present that as a virtue as it makes them more ‘open’
    `Insanity is doing the same thing over and over again and expecting different results.’
    All of the above as usual – the old saying “Psychiatry is to medicine as astrology is to astronomy” but the astonomers know the difference, psychiatrists still fool themselves. I can imagine the lovely group w*nks they enjoy when they discuss all this – it’s a bit pornographic really. I’ll *** yours, then you can *** mine – luvly! I wouldnt care about all this except for the money. It should be going somewhere where some actual good will come from it. Let them w*nk all they like but not on taxpayer’s money.

  11. 8. Invokes conspiracy arguments to explain lack of mainstream acceptance (Galileo syndrome) – “It’s the Scientologists, the Anti-psychiatrists, the Media who are responsible for our lack of respect by the rest of the medical profession and the public.”
    10. Practitioners often lack proper training and present that as a virtue as it makes them more ‘open’ – I agree, the being more `open’ doesn’t cut it, but these are people who postulate all kinds of detailed neurological terminology as involved in behaviour that leaves the real experts, shaking their heads. When I showed the neurologist who confirmed that my cerebral atrophy was very likely due to ECT a psychiatrist’s study published in an in-house magazine, he was totally perplexed. It was `confusing’ he said. When I told him that psychiatrists used cingulotomy (lobotomy with a new name) to control/alter behaviour, he was horrified. “That’s to control epilepsy, and only as a last resort!” he said. They are not highly trained in neurology and they are not trained in psychotherapy and learn little about sociology or normal human behaviour, so the claim of being a broad bio-psycho-social discipline is rubbish. Have a look at the article on this site called `Healing Madness’ to see what is really going on.