The mental health crisis in the country is “not a research problem, it’s an implementation problem,” he said. Good treatments for serious illnesses such as schizophrenia and bipolar disorder already exist, he says, and service provision is not the responsibility of NIMH scientists.
“It has nothing to do with what they do,” he said. “He asks for French food from an Italian restaurant.”
However, his comments angered the agency he ran.
In an interview, Dr. Gordon, current director of NIMH, said that Dr. Insel did not acknowledge “some of the really great things that have been done at NIMH” during his tenure, or “the tremendous work that we continue to do in research that have short-term implications for mental health care.”
He gave examples of two new treatments developed from neurobiological research: ketamine treatment-resistant depression and brexanolone for postpartum depression. He said the NIMH also funded research that led to therapies being used today, such as a large-scale study that established the effectiveness of integrated services for people experiencing their first episode of psychosis.
As for major breakthroughs, he said, they take decades to materialize. Dr. Gordon was in graduate school when scientists cloned the Huntington’s disease gene, and it’s only now, three decades later, that work has led to effective new treatments. It would be “bravado” to envisage revolutionary treatments in the short term, he said.
Definitive treatments for autism, bipolar disorder and schizophrenia based on genetics “are unlikely to be successful in the next five or ten years,” he said. But researchers have identified hundreds of relevant genes and are “beginning to understand the function of these genes in the context of the brain,” which he says could provide a path to better treatments.
Maybe it’s the same bravado? he said. “I don’t use a date.”
As for Dr. Inzel, he now sees himself in a different role, not unlike Al Gore, who, after serving as a senator and vice president, reinvented himself as a climate change truth teller.