Is psychiatry on the right track? A statement from Tom Insel

In 2015, the news that Tom Insel, the then director of the American National Institute of Mental Health, leaves the agency and moves to Google, has triggered considerable discussions not only among American psychiatrists, but also internationally. After only 1 ½ years at Verily (formerly Google Life Sciences, a branch of Google, now Alphabet, which has committed itself to the overcoming of the most common diseases) Insel leaves the company now and moves to the Californian startup Mindstrong.

At both Verily and Mindstrong, Insel has set himself the task of describing mental disorders by a “digital phenotype”. The exact background of his move is beautifully illustrated in a recent article in the American magazine “Wired”. However, the words with which Insel justifies his departure from the NIMH in 2015 seem very remarkable to me:

„I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.“

A sobering but honest record. The last years of Insel’s work at the NIMH centered on the search for biomarkers for mental disorders. It is closely linked to the promotion of a new, biologically based classification system for psychological disorders (Research Domain Criteria, RDoC), which is supposed to replace the phenomenologically oriented classification of the DSM-5 (see also my recently published video on Psychiatric Classification – in German language). While the international academic – especially the German – psychiatry is enthusiastically following this path, its protagonist already seems to say goodbye to it. I personally consider the RDoC system to be a reductionist approach that does not appropriately describe the specificity of mental illness. I am currently preparing a publication on this topic. I honestly doubt that the “digital signature” of mental disorders will be more successful than genetic or biological biomarkers with regard to the improvement of long-term outcomes of these frequent, but so complex, disorders.

This post is also available in: German

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