BBRF Head Responds to New York Times on Psychiatric Research Comments

So wrote psychiatrist Jeffrey Borenstein, M.D., in a letter to the editor published December 2, 2018, in the New York Times. Borenstein, who is the president and CEO of the Brain and Behavior Research Foundation (BBRF), a member of the APA Assembly Executive Committee, and editor in chief of Psychiatric News, was responding on his own behalf to an article in the Times about modern psychiatric research. The Times article, appearing November 19, 2018, was a broad overview outlining the historical difficulty of understanding mental illness and finding treatments for it.

“Nothing humbles history’s great thinkers more quickly than reading their declarations on the causes of madness,” the story began. The article underscored some positive new directions in research—particularly the need for researchers to partner with patient groups. But the Times article also lamented what it called the “futility” of modern biological research, saying, “Despite billions of dollars in research funding, and thousands of journal articles, biological psychiatry has given doctors and patients little of practical value, never mind a cause or a cure.”

Borenstein took exception. The Times, he wrote “is correct in pointing out the need for new treatments but is wrong to say that billions in research funding have given doctors ‘little of practical value’.

“Recent advances in treatment include transcranial magnetic stimulation for depression and other conditions; early diagnosis and intervention for schizophrenia, including cognitive remediation; and the potential effectiveness of rapid-acting antidepressants, which are being studied,” Borenstein wrote.

“Regarding prevention, researchers are looking at the use of nutritional supplements during pregnancy to decrease the risk of the child’s developing schizophrenia and other illnesses. In addition, new technologies like optogenetics are helping scientists better understand the brain. … We need more investment in brain research to find the causes and develop cures and methods of prevention for psychiatric illnesses.”

In comments to Psychiatric News, Borenstein urged other psychiatrists to push back when necessary to defend the profession and patients. “It’s enormously important for all of us to speak up and provide our perspective,” he said.

Carol A. Bernstein, M.D., chair of APA’s Council on Communications and a professor of psychiatry and neurology at NYU Langone Medical Center, commented to Psychiatric News that the expectations for psychiatry—as expressed in public forums and in lay media—may be inflated, and its putative “failures” often exaggerated.

Much remains unknown about many common general medical conditions, she said. “The truth is that psychiatric conditions have more in common with the rest of medicine, with the possible exception of something like infectious diseases, when a specific virus or bacteria is identified as the causative factor. Most diseases and conditions have multiple etiologies and are the result of the interaction between biopsychological and genetic predispositions and their interaction with the environment.”

She echoed Borenstein’s comment about the complexity of the brain. “Disorders of the mind and brain impact the essence of what we understand to be human—how we think and feel. And we have so much more to learn.”

Bernstein, a former APA president, said that psychiatrists don’t need to publish letters in the Times to make a difference. “There are few people fortunate enough to get a letter in the Times,” she said, “but no one should underestimate the real significance of an individual’s capacity to speak up and make a difference. Talking with friends, family, and colleagues; having a voice in social media; even speaking at your child’s PTA meeting—all of these areas, while not as sensational as publishing something in the national media or being on TV, are critically important.”

Bernstein said staff in the APA Division of Communications are available to help APA members who want to make their voices heard in the public sphere. “I do believe that in the end, we change public opinion at the grass-roots level,” she said. “We can help our friends, our neighbors, and our colleagues understand that mental illness is as treatable as anything else in medicine.” ■