In general, this article seems very well-supported, but some of the conclusions seem either too hasty or undersupported. In particular:
> From a structural perspective, it seems like a bad idea to give an NIH Institute Director the power to make radical changes in any one direction, turning the entirety of a given scientific field into his or her personal plaything.
The alternative suggested here seems to be ever-more layers of bureaucracy or more decentralized leadership. The tradeoff, of course, is that these sorts of government styles—which seem to be increasingly common in large institutions—dilutes responsibility and while promoting groupthink and increasing institutional inertia. An individual leader who is responsible for all decisions and actions, whether taken or not taken, does have advantages.
Insen had a plan, executed on it, was criticized for it, and has admitted at least some degree of error.
His mistake was obviously undesirable for NIMH. But we’re only seeing one side of the ledger here. When designing mass health systems, or public institutions in general, we have to weigh the risks of bad leadership against the risks of weak or no leadership.
I’d like to see the latter set of risks discussed more before people get too excited about changing structures in addition to leadership.
I don't think that's the only alternative. There is also ARPA-style funding, with multiple program managers making these kinds of decisions without encumbrance by bureaucracy, but also without creating a monoculture. It's the latter aspect that is really important for a healthy research organization.
That’s a very fair point. My main criticism is that the reformist sentiment near the end of the article, embodied in the text I quoted, seems to be too hasty to me.
It’s worth examining the pros and cons of other systems more deeply before deciding that the issue of a flawed administrator should be solved by systemic changes.
I think people are too quick to demand procedural reform when things go wrong, forgetting that government bureaucrats and officials are people too, and people who are willing and able to learn from their past mistakes without needing coercion.
Larger point taken, but if you're going to ding NIMH research for leaving out behavior, the self, society etc. in favor of genetics and imaging, why rag on the ABCD Consortium, which as you noted *does* include behavioral/social factors? You cite the 2021 NY Times op-ed by a mental health journalist formerly of Science, whose one reference to the study is his complaint that it involved *too many* behavioral/developmental variables. Looks like the researchers can't win!
If most functional mental illness is due to evolutionary mismatch, then we should be focused on addressing mismatch conditions, especially insofar as the genetics and neuroimaging approach has been largely a dead end.
Thank you for your article on NIMH. I look forward (I hope) to your book on NIH. I am a psychiatrist (I still treat patients) who was a Program Officer at NIMH when Dr Insel arrived. I was excited when Tom became Institute Director in 2002 - remembering his research on OCD during an earlier time as a Staff Fellow in Intramural NIMH (I was also an IRP Staff Fellow but several years after Tom). I left NIMH for NIA in 2009, disappointed w/ Tom's leadership & turning NIMH into the National Institute of Tom Insel.
I was previously in charge of the CATIE Program, 2 effectiveness trials comparing the new atypical antipsychotics (Zyprexa, Risperdal, Seroquel, Geodon) against each other in Alzheimer's & against an older antipsychotic, perphenazine, in schizophrenia. Tom tried to kill CATIE shortly after he arrived, since it was clinical research, but became more supportive once the trials garnered good press for NIMH (e.g., a NYTimes editorial).
NIMH's focus on genetics & neuroimaging actually began during Steve Hyman's tenure as director, before Tom. Steve killed most of the (then) existing biological psychiatry research but maintained focus on effectiveness & services research (he started CATIE) made possible by a doubling of NIH's budget by Clinton/Gore.
I remain at NIA & very much admire the NIA Director, Richard Hodes, since he pays attention to advice from Program scientists (e.g., me). Now is a very difficult time at NIH w/ all the changes made by the new administration. Nevertheless, we are making good progress on Alzheimer's
Szasz was right: the whole conceptualization of ‘mental illness’ is utterly absurd. Treating human behaviour as a disease and medicalizing it is an insult to our intelligence and a crime against our society. Insel was right to point out how there were zero biomarkers for any mental disorder, but the work needed to be done to exhaust the imaging and genetic angles. The effectiveness of CBT (basically Stoicism) in restoring emotional regulation may lead us in a new and fruitful direction.
Your example of neglected research is Kristina Olson - someone who studies implicit bias (a discredited concept) to bolster the idea of “gender-affirming care” (another discredited concept)! Maybe better at least to focus on real science, even if it doesn’t lead to immediate treatments.
I had similar concerns to you, so I looked her up, and you’re mischaracterizing her researcg and the current state of her field.
Kristina Olson doesn’t study implicit bias. She has used implicit association tests (IAT) to study how strongly respondents feel about their own gender identity. I share your skepticism about this methodology, but unlike implicit bias, it does appear to pass basic replication tests, and is not truly “discredited.”
Similarly, while gender-affirming care has its criticisms, calling it “discredited” is allowing politics to do your science for you—which is obviously bad epistemology. Ironically, that’s exactly what you’re accusing Olson of.
It’s reasonable to ask whether the NIMH should be funding studies using methodology heavily involving IAT, but the issues of IAT would not be addressed by adding an MRI scanner. Whatever you think of Olson’s research, the way the NIMH wanted her to change her research to make it eligible for their grants was farcical.
In general, this article seems very well-supported, but some of the conclusions seem either too hasty or undersupported. In particular:
> From a structural perspective, it seems like a bad idea to give an NIH Institute Director the power to make radical changes in any one direction, turning the entirety of a given scientific field into his or her personal plaything.
The alternative suggested here seems to be ever-more layers of bureaucracy or more decentralized leadership. The tradeoff, of course, is that these sorts of government styles—which seem to be increasingly common in large institutions—dilutes responsibility and while promoting groupthink and increasing institutional inertia. An individual leader who is responsible for all decisions and actions, whether taken or not taken, does have advantages.
Insen had a plan, executed on it, was criticized for it, and has admitted at least some degree of error.
His mistake was obviously undesirable for NIMH. But we’re only seeing one side of the ledger here. When designing mass health systems, or public institutions in general, we have to weigh the risks of bad leadership against the risks of weak or no leadership.
I’d like to see the latter set of risks discussed more before people get too excited about changing structures in addition to leadership.
I don't think that's the only alternative. There is also ARPA-style funding, with multiple program managers making these kinds of decisions without encumbrance by bureaucracy, but also without creating a monoculture. It's the latter aspect that is really important for a healthy research organization.
That’s a very fair point. My main criticism is that the reformist sentiment near the end of the article, embodied in the text I quoted, seems to be too hasty to me.
It’s worth examining the pros and cons of other systems more deeply before deciding that the issue of a flawed administrator should be solved by systemic changes.
I think people are too quick to demand procedural reform when things go wrong, forgetting that government bureaucrats and officials are people too, and people who are willing and able to learn from their past mistakes without needing coercion.
Larger point taken, but if you're going to ding NIMH research for leaving out behavior, the self, society etc. in favor of genetics and imaging, why rag on the ABCD Consortium, which as you noted *does* include behavioral/social factors? You cite the 2021 NY Times op-ed by a mental health journalist formerly of Science, whose one reference to the study is his complaint that it involved *too many* behavioral/developmental variables. Looks like the researchers can't win!
If most functional mental illness is due to evolutionary mismatch, then we should be focused on addressing mismatch conditions, especially insofar as the genetics and neuroimaging approach has been largely a dead end.
How much time do kids spend actively interacting with people online: e.g. gaming with pals?
Psychology is just the philosophy of man. It isn’t a health discipline at all.
Thank you for your article on NIMH. I look forward (I hope) to your book on NIH. I am a psychiatrist (I still treat patients) who was a Program Officer at NIMH when Dr Insel arrived. I was excited when Tom became Institute Director in 2002 - remembering his research on OCD during an earlier time as a Staff Fellow in Intramural NIMH (I was also an IRP Staff Fellow but several years after Tom). I left NIMH for NIA in 2009, disappointed w/ Tom's leadership & turning NIMH into the National Institute of Tom Insel.
I was previously in charge of the CATIE Program, 2 effectiveness trials comparing the new atypical antipsychotics (Zyprexa, Risperdal, Seroquel, Geodon) against each other in Alzheimer's & against an older antipsychotic, perphenazine, in schizophrenia. Tom tried to kill CATIE shortly after he arrived, since it was clinical research, but became more supportive once the trials garnered good press for NIMH (e.g., a NYTimes editorial).
NIMH's focus on genetics & neuroimaging actually began during Steve Hyman's tenure as director, before Tom. Steve killed most of the (then) existing biological psychiatry research but maintained focus on effectiveness & services research (he started CATIE) made possible by a doubling of NIH's budget by Clinton/Gore.
I remain at NIA & very much admire the NIA Director, Richard Hodes, since he pays attention to advice from Program scientists (e.g., me). Now is a very difficult time at NIH w/ all the changes made by the new administration. Nevertheless, we are making good progress on Alzheimer's
Very useful work and perspective here, as always. Appreciate your insights.
Szasz was right: the whole conceptualization of ‘mental illness’ is utterly absurd. Treating human behaviour as a disease and medicalizing it is an insult to our intelligence and a crime against our society. Insel was right to point out how there were zero biomarkers for any mental disorder, but the work needed to be done to exhaust the imaging and genetic angles. The effectiveness of CBT (basically Stoicism) in restoring emotional regulation may lead us in a new and fruitful direction.
“It’s the software, stupid. “
Messing with the hardware has completely failed.
Your example of neglected research is Kristina Olson - someone who studies implicit bias (a discredited concept) to bolster the idea of “gender-affirming care” (another discredited concept)! Maybe better at least to focus on real science, even if it doesn’t lead to immediate treatments.
I had similar concerns to you, so I looked her up, and you’re mischaracterizing her researcg and the current state of her field.
Kristina Olson doesn’t study implicit bias. She has used implicit association tests (IAT) to study how strongly respondents feel about their own gender identity. I share your skepticism about this methodology, but unlike implicit bias, it does appear to pass basic replication tests, and is not truly “discredited.”
Similarly, while gender-affirming care has its criticisms, calling it “discredited” is allowing politics to do your science for you—which is obviously bad epistemology. Ironically, that’s exactly what you’re accusing Olson of.
It’s reasonable to ask whether the NIMH should be funding studies using methodology heavily involving IAT, but the issues of IAT would not be addressed by adding an MRI scanner. Whatever you think of Olson’s research, the way the NIMH wanted her to change her research to make it eligible for their grants was farcical.
You are giving the benefit of the doubt where none has been earned.