Psychiatry: long past, bright future

We need to own our profession’s history, but current knowledge of the brain and the conditions that disturb it means that psychiatry has never been better placed to improve the lives of people with mental health problems, Jeffrey Lieberman (Columbia University, New York, USA) told a plenary session at EPA 2020.

With trillions of synaptic connections,1 the brain is uniquely complex among our organs – in structure, and in its role as the basis of thought and feeling, creativity and personality. It is also unique in that there are existential as well as directly biological causes of disease: the brain can become ill from loneliness or betrayal or loss, all of which have molecular consequences, Professor Lieberman said.

Psychiatry needed to overcome stigma, just as our patients do

Psychiatry has slowly become a scientific discipline fully integrated into mainstream medicine. But mental health continues to be under-represented in research expenditure: in the USA, according to data presented by Dr Lieberman, at a time when the National Institutes of Health as a whole received $36b in federal government funding, the National Institute of Mental Health received $1.3b.

Such disparity in relation to the burden of disease means that many patients do not get the evidence-based treatments they need.2,3

Stigma affected both patients and profession

Compassion will always be part of psychiatry

The reasons for such inequity include the age-old belief that mental illness was the result of possession by spirits, spurious associations with immorality and guilt, and early anatomists’ inability to find brain lesions relating to mental illness in the way that lesions in other organs related to physical disease.

Stigma came to affect not just our patients but the profession itself, Professor Lieberman argued. And that stigma was (to an extent) understandable given that our problematic past includes the inhumane incarceration of people with mental health problems and the infliction of treatments that were injurious and ineffective.4 

Brain science had to wait for technology

But, just as Galileo needed the telescope and Pasteur the microscope to make their discoveries, so people studying the brain needed technological advance before they could understand how it worked.

Progress began with Golgi and the staining of neurons, moved through Ramon Y Cabral’s exquisite mapping of neuronal architecture, and now encompasses receptor biology, neuroimaging and genetics – which, Professor Liebermann believes, is the latest game-changer in psychiatry.

We also, he argued, could not have made progress without the systematic, consistent, detailed approach to diagnosis encouraged by Robert Spitzer with DSM-III. 

Meeting future challenges

The need for mental healthcare and for public awareness of mental health issues has never been greater. Rates of mental disturbance are rising among young people, as is the social pathology – in Professor Lieberman’s description – that includes homelessness, suicide, and violence accruing from untreated mental illness.

Modern psychiatry can make lives better. But it faces continuing challenges from inadequate financial and human resources. We need to be pluralistic in relation to treatments, and compassionate towards our patients: psychiatrists still have time to get to know them as people.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.