Text: Allen Frances

Allen Frances, Professor of psychiatry at Duke University

The current focus in neurosciences harms mental health patients.

For the neurosciences, this is the best of times. The expansion of knowledge and tools has exceeded all expectations and represents a triumph of technological innovation. For the psychiatric patients who are the presumed beneficiaries, this is the worst of times: a tragic regression into a new dark age in which mental illness is once again criminalized.

Why the disconnect? Accomplishing the difficult step between basic science and clinical practice has been frustratingly slow in all of medicine and so far completely impossible in psychiatry. We have learned a great deal about normal brain functioning; but despite mighty and expensive efforts, we know nothing useful about the pathophysiology of mental disorders and have no biological tests for their diagnosis.

The brain is the most complicated contraption we are ever likely to encounter and reveals its secrets only in the tiny pieces that make up an intricate jigsaw puzzle with a trillion permutations.

Each of our mental disorders is a final common pathway for hundreds of different pathological processes involving the brain interacting with its physical, psychological and social environment. Sorting this out will require tiny steps forward, achieved painstakingly over decades – with no breathtaking wholesale breakthroughs.

By focusing funding and advocacy on finding future breakthroughs, we, to a shameful degree, ignore the desperate needs of patients in the present. In the U.S., the enormous resources of the National Institute of Mental Health are single-mindedly devoted to a narrow neuroscience agenda. Its research portfolio is distressingly short on clinical and health-services studies and almost completely bereft of psychosocial studies.

During the past 50 years, mental health budgets in the U.S. that were never adequate have been gradually but mercilessly cut. Neglected patients receiving grossly inadequate care (and often enough becoming homeless) are frequently imprisoned for nuisance crimes that could easily have been avoided had their basic needs been met. In contrast, most European countries have done

a better job of combining deinstitutionalization with proper community care and decent housing. The hoped for, but uncertain, gains to be derived from a high-tech future have triumphed over the much less glamorous, but much more useful and necessary, task of providing good care and housing to people who need it now. Neuroscience research is a great good, but exaggerated claims of what it can accomplish and when have inadvertently contributed to the great evil of criminalizing mental illness.