Thomas Insel, Director of NIMH: Displayed a lack of understanding on his trip to Australia

In his post, on the road, 1 Boring Old Man talks about the purpose of Insel's trip to Australia.  As usual, a good read.  Mickey has a perspective that is informed by his training and professional experience as a psychiatrist and his observations are spot on:

"Back to the point, I’m all in favor of looking into the early detection of Schizophrenia and a carefully controlled search for genetic biomarkers in mental illness [neuroimaging? an interesting new telescope awaiting a Galileo]. But I think Dr. Insel is in Australia partly on his quest for something to keep his own dreams alive, dreams of coming breakthroughs in neuroscience, rather than because of a studied review of Dr. McGorry’s specific data or programs. "[the] Australian programs pioneered by Professor Pat McGorry were in the vanguard in the changing focus in mental health." I guess I’m accusing Dr. Insel of being more invested in a "vanguard in the changing focus in mental health" than in his job – creating an environment for creative and critical research.

"And then there’s, "…the term ‘mental illness’ might no longer be helpful in describing such conditions. These syndromes we call mental disorders are really just neural developmental disorders." Is Tom Insel the Director of the National Mental Health Institute? Or is he on a committee to turn all of psychiatry into his hoped-for "clinical neuroscience"? Does he really think that he can get away with this new version of the "chemical imbalance" theory of mental disorders – this time a "just neural developmental disorders" theory?

"At this point in our history, that statement is scientifically indefensible. Beyond that, it’s politically unwise in the face of the track record of the second generation antidepressants and antipsychotics and the widespread unholy union between some of his colleagues and the pharmaceutical industry. Tom Insel on the road is sounding more like an traveling tent evangelist these days than a Director of a National Mental Health Institute…"read

More on Insel's unsuitability from the summer of 2010 via Health Care Renewal:

a few excerpts:
"The NIMH Director, Thomas Insel, MD, is under siege for his problematic relationship with Charles Nemeroff. In his own defense, Insel placed a remarkable new post today on his official blog. It signals that Insel and NIMH just don’t understand the current controversy. Since the story appeared in The Chronicle of Higher Education 2 days ago, it has reverberated on Health Care Renewal, on Pharmalot, on University Diaries, on the Nature blog, on the Science blog, and on Drug Monkey, to name just a few. The authors on these sites have been uniformly critical of Insel and of NIMH, as have almost all the comments.

"What does Dr. Insel say in his defense today? Mainly, he demonstrates that he doesn’t get it. The very way in which he frames the issue tells us that. First he says it is about financial conflicts of interest. It isn’t. It is about the corruption of academic psychiatry. Financial conflicts of interest are just a part of that problem. Second, he says it is about whether the bad boys and girls in psychiatry were badder than those in other medical specialties. It isn’t. It never was. Third, he says he is surprised by criticism that he and NIMH have not taken firm action against the bad boys and girls, then he spends the rest of his column evading that issue. This degree of sophisticated indirection is achieved only in the highest echelons of bureaucracies.

"Instead of a frank discussion of the real issues, we get a self serving description of the ways in which NIMH has taken steps to preserve the integrity of the research that it funds (starting after the scandal about the bad boys and girls broke within the Senate Finance Committee in 2008 – a detail not included by Dr. Insel. Where were they before?). By the time one makes it through this glossed-up history and the new promissory notes, it is easy to lose sight of what provoked the controversy this week.

"It’s about the appearance of hypocrisy, with Insel assisting the compromised Nemeroff to land a new job at Miami while he is co-chairing a NIH effort to revise ethics guidelines." read

  picture from The Sydney Morning Herald article on Thomas Insel

Thomas Insel appears to be acting more like a political activist than a Director of the Nation's lead agency investigating the causes of and treatments for mental illness.  His activism appears to be an effort to validate the bio-medical paradigm of care for psychiatric diagnoses.  As the Director of the National Institutes of Mental Health, his job is not to stifle academic debate, or to arbitrarily direct scientific inquiry.

It is certainly not Thomas Insel's job to be a mouthpiece for the Pharmaceutical Industry; which necessitates ignoring the psycho-social cognitive/behavioral therapeutic treatments that effectively help people with a psychiatric diagnosis to fully recover; much less lobby for a neurobiological model of care as public policy!   The biomedical paradigm of care is not effective for far to many people in this county to be using it to the exclusion of other evidence-based and humane care---much less suggest it is the sole direction for valid scientific research for causes of and treatment for mental illness!  For this, hell I don't know what to call him---nothing nice comes to mind---for the Director in effect, to declare that genetic and biological mechanisms are the only explanations worthy of scientific research is irresponsible; it is not scientific---this need for so called experts to ignore the sociological and environmental etiology of anxiety and other types of distress, is suspect. In effect, it requires everyone to pretend that interpersonal and intrapersonal conflicts both whether 1:1, within families and within society don't really matter.  AS IF these conflicts are not causative and/or have  the potential to exacerbate a persons distress. It is simply ludicrous...

Ignoring these issues, also lets everybody on the planet off the hook.  A decision to research only genetic, neuro-biological brain-based etiology as the primary cause for symptoms is short-sighted. It ignores what we know about the impact of various environmental factors, and the brains neuroplasticity. Pharmacological treatments are never going to "effectively treat" the problems humanity has due to sociological, environmental, and political environmental factors. These inter- and intra- personal conflicts, can not be controlled for, they can only be masked by pharmacological "treatment." The only effective way to really "treat" the symptoms is to treat one another better.

Thomas Inel is apparently attempting to enlist political support for 'Staying the Course.' Insel claims, "I think we have come through an era of blame and shame which this new approach hopefully will get us away from.  I am not sure it was helpful to anyone," It was what it was Tommy because of the neurobiological lie NIMH sold along with NAMI and other "advocacy" groups funded by BigPharma benefactors.

I think that Thomas Insel should: 

It is an attempt to validate belief in the notion that mental illnesses are diseases, and to prey on the hopes firm believers in the disease hypothesis, have.  Usually it is desperate parents who dismiss the idea that without evidence, is not a valid claim; in large part because so-called experts like Thomas Insel continue to state it as if it is. Some people, not only parents, do not want to examine why, they do not think, or would even consider it possible that what we do as parents, friends and neighbors--how we talk to, look at, involve, exclude, and even our posture and tone of voice does have an effect, even a lasting impact on one another.  This effect, and the impact we have on others plays a significant role in the level of dysfunction, and in the chances for recovery people with a psychiatric diagnosis have.

I am not a parent who buys into the biological explanation; I do not dismiss it out of hand either.  I do not believe it could possibly be the only cause or explanation for why a person is given any psychiatric diagnosis.  I also do not dismiss the value of continued research, I know it's needed.  This is not an either or situation, since it has not been established that psychiatric diagnoses are due to biological causes.  I resent Thomas Insel pretending that this is in fact the case, then determining the bulk of our efforts---and tax dollars funding should be invested at the expense of other avenues of research. I personally am insulted that the Director of NIMH is attempting to convince the American people to "Stay the Course;" you know, the illegal marketing and unethical research and development course.

This is, IMO, Thomas Insel's desperate attempt to save a sinking ship...In spite of  decades long devotion to the biochemical and neuro-biological hypothesis, to date, there has been no definitive evidence found to validate it; so it is not even a theory yet!  To date, no definitive evidence or 'proof' has been found that a genetic, or neuro-biological disease or defect causes any psychiatric diagnosis; this does not necessarily mean we should stop looking.  It is shortsighted and foolish to not aggressively pursue other avenues of research into the causes and treatments for psychiatric diagnoses.  How can it be reasonably assumed, (or Scientific at all?!) that a yet to be identified genetic or neuo-biological process definitively causes any psychiatric diagnosis, much less all of them?    

The fact is, Thomas Insel, the Director of the NIMH, is a Scientist and a 'doctor,' and he should know better.  It is disingenuous and not at all believable for Insel to claim that his chosen course is based on Scientific reasoning. For Insel to repeatedly be quoted stating such bullshit, performing his "Staying  the Course" political lobbying, as if it's The Holy Grail of Mental Health Research; is evidence to me that he should be fired. Insel is the Director of a Federal Research Institute devoted to scientific inquiry who appears to have little understanding of what the difference between what a hypothesis and a theory is. I say this because he has repeatedly in effect, stated that a particular hypotheses, is an established scientific fact, a medical certainty. This is dangerous, unethical and most importantly, it is not the type of conduct that is  serving the interests of the American people. It begs the question, whose interests does Thomas Insel serve?

I am speaking as a mother, who is painfully aware this miscreant is not serving the interests of people like my son---who is a victim of this BULLSHIT belief system, that Thomas Insel is peddling as science and medicine. I've said it before, and I'm saying it again: Insel does not appear to be academically qualified, and he certainly does not have the ethical integrity required to be a doctor; much less the integrity needed in a person chosen to be the Director of National Institutes of Mental Health and now NCATS...

Separating Facts From Propaganda Alliance of Human Research Protection

hat tip: Mickey
parts of this post were first published on October 12, 2011 with a different title