I've been wanting to write a "psychiatry is dead" piece for the longest time. The proximate cause for finally getting around to it is a conference I attended this week, Exponential Medicine put on by Singularity University.
Singularity University was founded by the type of people who make their own rules and in the process - in their own words - "address humanity's grand challenges." Fittingly, the keynote speaker was Craig Venter, the man who essentially said f_ you to the establishment and decided to sequence the human genome on his own.
The result was completion of the project years ahead of schedule. This was back in 2000.
The turn of the millennium is a good place to start. The science journals from that year featured no shortage of commentary that looked toward the future. This included a piece in Science by Nobel Laureate Eric Kandel who talked about the "new science of the mind."
In a 2013 article in the New York Times, Dr Kandel elaborated:
Dr Kandel trained as a Freudian psychiatrist, but he spent virtually all his professional life in the lab, investigating the neural basis of memory. His findings, which helped crack open the neuron, inspired new generations of brain researchers. Their research, in turn, raised the whole question of psychiatry's very relevance.
By this time, psychiatry had entered the modern age. The catch was the world had turned post-modern. The brain science people were talking about things like short alleles and Val-Met variations. The psychiatrists were handing out antidepressants and calling it evidence-based medicine.
At the same time, new generations of patients began laying siege to the validity of psychiatry's so-called "medical model."
To better understand what was going on, we need to rewind the clock back to 1962 and the publication of Thomas Kuhn's The Structure of Scientific Revolutions. Basically, radical shifts in how we think - say from a Ptolemaic universe to a Copernican one - come from outside the field.
The establishment is way too set in its old ways to tolerate meaningful change, and nowhere is this more evident than in psychiatry as we know it. Its leading thinker - Emil Kraepelin - died in 1926. That's how bad it is.
I could write at length about how a field that has been co-opted by Big Pharma is ill-equipped to meet the challenges of the new post-Big Pharma era. But what we really need to know is that psychiatry is a closed shop that does not welcome outsiders, even from within its ranks.
This came through loud and clear with last year's release of the latest edition of psychiatry's diagnostic Bible, the DSM. This new edition - the DSM-5 - was the work of psychiatry's old guard. Sample this withering criticism from Nassir Ghaemi of Tufts, one of the new guard who actually finds collaborating with patients worthwhile. Wrote Dr Ghaemi in a blog last year in Psychology Today:
Despite the fact that the specific leaders for each DSM revision are different people, those leaders are all of the same generation (in their 70s or more now). Their second-in-command has been the same person for each revision. And the majority of leaders of DSM task force subgroups have not changed since DSM-III in 1980 to IV to 5. The only thing that's changed is their ages: they were 30 or 40 somethings then; they are 60 or 70 somethings now.
As a thought experiment, you might want to imagine an open-source DSM - what that would look like and who would participate. In an open-source world, no diagnostic bible would be credible without massive input from patients. Neither would any treatment modality.
Patients - along with new ideas and trends and technologies - represent that unwelcome entity known as disruption. The music industry's celebrated failure to adapt to digital downloads is one example.
Disruption came through loud and clear at the Exponential Medicine Conference that I attended. Speaker after speaker pointed out the absurdity of not placing patients at the center of the new order. For change to happen - call it creative disruption - patients need to be calling the shots.
But have you ever heard of a patient - particularly a psychiatric patient - having a voice in approving of a major research project or advising a drug company on new drug development or refereeing a journal article submission or, for that matter, in being consulted by the people responsible for the DSM?
Okay, let's do a another thought experiment: Patients with wearable monitors or brain implants. The wearable monitors are already in use as mindfulness tools for ADHD and depression and were on display at the conference. Implants are around the corner.
Here's something to boggle the mind: Imagine implants that not only enhance individual brain function but can connect to a sort of collective cloud-based brain. Ray Kurzweil, author of The Singularity is Near, raised this very possibility.
In an age of printing out organs using stem cells as biological ink, this is not far-fetched. Experimental 3D-printed tracheas are already in use. Dare we imagine a replacement for an over-reactive amygdala?
Of course we can. The catch is we need to think non-linearly, having regard for exponential changes (another conference theme). Exponential growth is happening in the field of "big data," speaker after speaker informed us, which is making clinical trials and other forms of research sound quaint. Meanwhile, Dr Venter reminded his audience that DNA sequencing is changing faster than Moore's Law.
This prompted a question of whether it is possible to create a super-human. Dr Venter's response: "If you can define one, we can create one."
That sort of answer raises a dark side to a bright promise. Clearly, everyone needs to be in on this conversation, but is psychiatry even aware of one going on?
You might want to ask yourself: What is psychiatry's conversation at the moment and who is participating in it?
My answer to this: Who cares and does it really matter?
The real conversations are taking place outside the field. So why not make this official? Psychiatry as we know it is dead.
Your comments are welcome. Fire away ...