Here at the annual meeting of the American Psychiatric Association, I’m learning all about what terrible shape psychiatry is in. It used to be that this kind of bad news was delivered by fringe groups–gay psychiatrists, for instance, who informed the APA at annual meetings in the early 70s that neither they nor their patients were mentally ill just because they liked to have sex with people of the same sex, or the psychoanalysts who argued that the world would end if the industry turned to a non-Freudian conceptualization of mental illness, or just your usual doomsayers carping about reduced insurance payouts and so on.
But this year, it’s coming from the top, from America’s #1 psychiatrist, Tom Insel, the head of the National Institutes of Mental Health. In a speech kicking off the conference yesterday morning, Insel didn’t mince words. “We don’;t talk much about this,” he said, but when it comes to mental illnesses, psychiatrists lag far behind their colleagues in other specialties. “Diagnosis is by observation, detection is late, prediction is poor. Etiology is unknown, prevention is undeveloped. Therapy is by trial-and-error. We have no cures, no vaccines. We’re not even working on vaccines. Prevalence has not decreased. Mortality has not decreased.”
And it’s not like we’re talking about treating wrinkles or baldness here. Accordinb to the World Health Organization, mental illnesses are the most disabling afflictions worldwide, measured in something called Disability Adjusted Life Years. There were 34 thousand suicides in 2007, 90 percent of them related to mental illness. That;s more people than die in traffic accidents, and double the rate of homicide–and both of these have decreased in the past decade. People with serious mental illness have a 25 percent reduced life expectancy. And so on.
In short, mental illness is out of hand and psychiatrists don’t really understand what it is, how to diagnose it, or what to do about it.
At least that’s what they say to each other.
