New Scientist
Psychiatry needs its Higgs boson moment
* 29 April 2013 by _Nick Craddock_
(http://www.newscientist.com/search?rbauthors=Nick+Craddock)
Fighting the scourge of mental illness means giving psychiatry the kind of
boost that physics got from the Higgs hunt
PSYCHIATRISTS and other mental health practitioners are nothing if not
pragmatic, using the best available evidence to guide diagnoses and
treatments. But not since Freud's pseudoscientific theories early last century
has
psychiatry claimed any broad theoretical basis for making sense of our normal
and abnormal feelings, thinking and social behaviours – the complexities
at the heart of being human.
In fact, the international classifications used to diagnose mental
disorders are descriptive and explicitly "atheoretical" – to acknowledge our
limited understanding and the need for empirical evidence rather than fanciful
theory.
While this is a necessary stage in the development of a complex field and
intellectually attractive to some, there is a need to create a coherent
scientific narrative and a more theoretical foundation for psychiatry. This
may seem like a challenge too far for many, and it has undoubtedly been an
impediment to recruiting enough of the best minds.
That matters for everyone. Mental ill health accounts for some 15 per cent
of the disease burden in developed countries – and people who are
seriously mentally ill typically die 20 years earlier than would otherwise be
expected. Globally, by 2020, the WHO expects depression to come second only to
heart disease as a cause of lost years of health. For that to improve,
psychiatry must be able to recruit the very best.
Recently, some colleagues and I launched a report, Strengthening Academic
Psychiatry in the UK, and found ourselves justifying how psychiatry had
acquired – and was still struggling to shrug off – the label of a "vulnerable
academic discipline". There were particular concerns about a fall in
academic recruitment and unfilled academic posts.
Compare this with a field like physics. At just one frontier, it has a
standard model that describes particles, Higgs field theory, the search for
the Higgs boson and the Large Hadron Collider. These constitute a clear
narrative: there is a global collaborative search for a "missing" particle
based
on fundamental theory, using a large and expensive piece of equipment that
allows experimental testing of this and other predictions. This heady mix
understandably makes physics a popular career choice.
Psychiatry, on the other hand, started the new millennium a few hundred
years behind physics. But the decade that followed saw radical change, and
set the stage for an intense period of catch-up. It is not fanciful to
describe what will happen as the equivalent of some 200 to 300 years of
progress
being compressed into 20 to 30 years. This corresponds to the period of
greatest productivity in a scientist or clinician's career, so someone
starting
research now stands to make great headway.
If such a speedy catch-up seems like an extravagant claim, consider that
the scientific kit and culture of "big science" are now sufficiently
developed to deliver unprecedented insights into the neuroscience of mental
illness. Key tools include molecular genetics, neuro-imaging and artificial
intelligence.
We are already seeing research into the neuroscience of decision-making
and social behaviours such as neuro-economics, which models choice behaviour
mathematically. And enormous advances are being made in understanding the
molecular genetics of major disorders such as schizophrenia, bipolar
disorder and depression.
For centuries, we have known that susceptibility to psychiatric illness
can be inherited. In the past five years, studies of tens of thousands of
people are beginning to pin down some of the genes and biochemical pathways
involved.
Take voltage-gated calcium channels. They were initially implicated in
bipolar disorder in 2008, but have subsequently been linked to other
psychiatric disorders. This was not a pathway that researchers had considered.
It
is, however, well understood when it comes to heart disorders.
That fact immediately opens up new ways of using existing knowledge and
drugs. Crucially, too, this kind of exciting research may help us understand
why we quite often see people who are both mentally and physically ill. In
the calcium channel example, it may help explain why we often see patients
with both heart disease and mood disorders.
Another tantalising finding is the involvement of the major
histocompatibility complex – a key part of the immune system – in influencing
how
susceptible people are to mental illness. Together with research into other
immune-related genes in diseases such as Alzheimer's, the idea that immune
processes are involved in some psychiatric phenotypes is looking ever more
solid.
Powerful advances are also being made in using computer networks to model
neuron biology and to build complex neuronal networks, which should produce
interesting emergent properties. The European Union's €1.1 billion Human
Brain Project, for example, aims to understand the brain as a single system,
integrating multiple levels of organisation – surely a key step towards
preventing or curing psychiatric diseases.
One of the biggest challenges will be to unite these disparate
methodologies to tease apart the normal and abnormal working of the brain in
schizophrenia, bipolar disorder, depression, and the like, diseases that
devastate
the lives of so many and are so often associated with early death.
So, in 2013, psychiatry has powerful scientific tools and a developing
narrative that already points to strong theoretical bases. Yet, in the UK
research into mental illness has stalled at around 5 per cent of the annual
medical research budget, and the picture is similar in other rich countries.
That will have to change – and governments and funders are starting to see
this. The door is open: all that is needed is for more of the best to come
in and find out just how hot psychiatry really is.
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