The new book by Dr. Thomas P. Insel begins with a confession.
He helped allocate $20 billion in federal funds and shifted the focus of the National Institute of Mental Health away from behavioral research.
I should have been able to help bend the curves for death and disability.
In the very first page of his new book, Dr. Insel calls the advances in neuroscience of the last 20 years "spectacular."
His book,Healing: Our Path From Mental Illness to Mental Health, is not an indictment of the science to which he devoted much of his adult life. The failures in our mental health system include the ineffective delivery of care, the gutting of community health services, and the reliance on police and jails for crisis services.
The United States, a country that leads the world in spending on medical research, also has dismal outcomes for people with mental illnesses. Over the last three decades, even as the government invested billions of dollars in better understanding the brain, those outcomes have deteriorated.
The country has been without breakthrough treatments for a long time.
At a time when there was optimism that advances in neurobiology would lead to new treatments, Dr. Insel rose through the ranks and became the head of N.I.M.H.
He said that they are probably significant, but you have to put a hundred of them together.
He said in an interview that he didn't regret making genetic research a priority, but he acknowledged that the returns were diminishing.
I don't think focusing on finding small effect signals for common diseases is how I want to spend my time. If we can get this stuff implemented, we can continue doing research until I'm in my 90's.
During his last year at N.I.M.H., he described an Epiphany that he had presented to a group of advocates.
The man in the flannel shirt told the story of his son, who has been hospitalized, suicide attempts and homeless. What are you doing to put this fire out?
In that moment, I knew he was correct.
Dr. Insel's statements have attracted attention because they are from one of the most influential neuroscientists of our time.
Dr. Insel was a champion of basic research and believed that understanding genes and neurobiology would help uncover some of the most complex mental disorders.
He steered the agency's research budget towards the biology of disease. Some in the field argued that the funding should be split more evenly between neuroscience and clinical research into treatments that could be used in the future.
The institute was warned that it wasbetting the house on the long shot that neuroscience will come up with answers to help people with serious mental illness.
In an interview last week, he said his warnings had been realized.
The end result of these last 30 years is an exciting intellectual adventure, one of the more fascinating pieces of science in our lifetimes, but it hasn't helped a single patient.
He said it was difficult to survey the homeless camps in so many American cities to feel proud of his 55 years of work. He said that people with severe mental illnesses were better off than now.
I have a happy life and I don't feel guilty, but if I look back on my career, I will regret it.
Dr. Insel sees something differently. He doesn't regret his work or criticize his successor at the N.I.M.H., like him an advocate of basic research. The country should double down on brain research.
He said that the country's mental health crisis is an implementation problem. It is not the job of scientists at N.I.M.H. to provide good treatments for serious diseases.
He said it has nothing to do with what they do.
His comments ruffled some feathers at the agency he led.
The current director of N.I.M.H., Dr. Gordon, said that Dr. Insel had failed to acknowledge some really wonderful things done at N.I.M.H.
There are two new treatments developed on the basis of research: brexanolone for postpartum depression and ketamine for treatment-resistant depression. He said that the N.I.M.H. funded a large-scale study that established the effectiveness of comprehensive services for people experiencing a first episode of psychosis.
He said that it takes decades to realize the big breakthrough. The work that led to new, effective treatments for Huntington's disease was done in graduate school by Dr. Gordon. He said that he wanted to see breakthrough treatments in the short term.
He said that treatments for the three disorders based on genetics are not likely to work in the next five or 10 years. Researchers have identified hundreds of relevant genes and are starting to understand the function of those genes in the context of the brain, which could provide a pathway to better therapies.
He asked if it was the same bravado.
Al Gore reinvented himself as a truth-teller on climate change after serving as a senator and vice president.
He hopes that the film about Mr. Gore's efforts will sound an alarm to the country.
I want to ring the bell to let people know that we can do better today, and that there is no excuse for allowing people with brain disorders to linger on our streets like this and die at 55.
He supports the work of the army of researchers he once led, but he can't wait 30 years.
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