Sunday, July 4, 2021

Science Plays the Long Game. But People Have Mental Health Issues Now.

When it came to judging government-funded research projects — a cleaner enterprise, presumably — I again asked the questions that people in crisis continually asked me. Is this study finding useful for my son, or my sister, in any way? Or, more generously, given the pace of research: Could this work potentially be useful to someone, at some point in their lifetime?

The answer, almost always, was no. Again, this is not to say that the tools and technical understanding of brain biology didn’t advance. It’s just that those advances didn’t have an impact on mental health care, one way or the other.

Don’t take my word for it. In his forthcoming book, “Recovery: Healing the Crisis of Care in American Mental Health,” Dr. Thomas Insel, former director of the National Institute of Mental Health, writes: “The scientific progress in our field was stunning, but while we studied the risk factors for suicide, the death rate had climbed 33 percent. While we identified the neuroanatomy of addiction, overdose deaths had increased by threefold. While we mapped the genes for schizophrenia, people with this disease were still chronically unemployed and dying 20 years early.”

And on it goes, to this day. Government agencies, like the National Institute on Drug Abuse and the National Institute of Mental Health, continue to double down, sinking enormous sums of taxpayer money into biological research aimed at someday finding a neural signature or “blood test” for psychiatric diagnoses that could be, maybe, one day in the future, useful — all while people are in crisis now.

I have written about some of these studies. For example, the National Institutes of Health is running a $300 million brain-imaging study of more than 10,000 young children with so many interacting variables of experience and development that it’s hard to discern what the study’s primary goals are. The agency also has a $50 million project underway to try to understand the myriad, cascading and partly random processes that occur during neural development, which could underlie some mental problems.

These kinds of big-science efforts are well-intended, but the payoffs are uncertain indeed. The late Scott Lilienfeld, a psychologist and skeptic of big-money brain research, had his own terminology for these kinds of projects. “They’re either fishing expeditions or Hail Marys,” he’d say. “Take your pick.” When people are drowning, they’re less interested in the genetics of respiration than in a life preserver.

In 1973, the prominent microbiologist Norton Zinder took over a committee reviewing grants by the National Cancer Institute to investigate viruses. He concluded the program had become a “gravy train” for a small group of favored scientists, and advised slashing their support in half. A hard, Zinder-like review of current behavioral science spending would, I suspect, result in equally heavy cuts.

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