Magazine article Behavioral Healthcare Executive

Insel's Big Bet

Magazine article Behavioral Healthcare Executive

Insel's Big Bet

Article excerpt

History shows that human beings have been slow to recognize and respond effectively to the challenges of behavioral health. While medical science began to make everaccelerating leaps forward starting in the Age of Enlightenment, behavioral health has progressed much more slowly, with progress often triggered by individual theoretical breakthroughs. And, while names like Freud and Rogers are widely known and associated with mental health today, we may owe even more to people who aren't household names.

Consider Emil Kraepelin. Building on the work of fellow Germans, Kraepelin proposed in the 1890s that psychiatry was a branch of medicine and that mental disorders could be observed, identified, and classified scientifically based on syndromes - recognized and repeatable patterns of symptoms. He was the first to recognize the fundamental difference between mood and thought disorders. This distinction, which came to be known as the 'Kraepelinian dichotomy,' is in the bedrock of modern psychiatry and its "bible" - the Diagnostic and Statistical Manual of Mental Disorders (DSM).

While he placed great stock in the value of classifying mental illnesses, Kraepelin was also fascinated by the genetics and biology of the brain and sought, with his colleagues, to identify hereditary or physiological patterns associated with mental illness. Thus, for more than one hundred years, our understanding and treatment of mental illnesses - and addictions - has proceeded along two tracks. The DSM emerged and is now being released in its fifth major edition, while the study of brain physiology has proceeded alongside. The former provides the best practical treatment currently available, while the latter continues to seek the same genetic, biological, and neurophysioiogical clues that Kraepelin, his colleagues, and scores before and after have sought - "silver bullets" that treat mental illness as though it were diabetes or cure it the way "precision medicine" zaps a cancerous tumor. …

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