On the Shoulders of Giants 2015: Tom Insel on Building the Future of Mental Health Care

The Child Mind Institute welcomed an inquisitive crowd yesterday to the auditorium at the New York Academy of Medicine for its fifth annual On the Shoulders of Giants scientific symposium, celebrating achievement in neuroscience and the strong community that nurtures that success. This year the neuroscience lecture series honored the 2015 Child Mind Institute Distinguished Scientist, Dr. Tom Insel, director of the National Institute of Mental Health, and also featured presentations by Dr. Conor Liston, of Weill Cornell Medical College, and Dr. Nim Tottenham, of Columbia University.

Dr. Insel laid out a bold and optimistc vision for the future of mental health services delivery, aided by scientific advances. His theme was that while “we have problems with access and problems with quality” in mental health care, the central challenge is to better understand the treatments we have now, and when and with whom they’ll be effective. He drew the parallel to the revolution in childhood cancer mortality, which wasn’t due to a “magic bullet” treatment. “What really happened is that the way we provided care got better,” he said. “We moved practice into research so that every family became a partner in research, and that’s what needs to happen here.” Dr. Insel hopes that both advances in academic research technology like genomics and imaging, as well as the ubiquity of smart phone tech for data gathering in the everyday world, will contribute to a sea change in service delivery where all the appropriate treatments can be integrated into high quality “network solutions.”

For example, Dr. Insel noted, “many of the projects coming out of the Child Mind Institute, particularly a project like the Healthy Brain Network, are going to give us the fundamentals, the kind of science we need to be able to provide far better services in the future.”

Of course, “we do have real treatments that work for these developmental brain disorders,” Dr. Insel reiterated in answer to an audience question. But often which one will work for which individual is still something of a mystery, “so what care your child receives depends on what door you knock on.” A version of this problem motivates Dr. Conor Liston, whose research runs the gamut from stressed-out rodents to depressed human patients. In a freewheeling presentation, Dr. Liston described how his lab’s observations about dysfunction at the synaptic level led to measures of subtypes of depression based on abnormal brain connectivity identifiable in MRI brain scans—in short, biomarkers not only for depression, but for novel subtypes of the disorder.

That is not what excites Dr. Liston, however. “Bottom line is we don’t need a brain scan to diagnose depression,” he said. But if it could inform treatment, that would have an impact. “Our treatments do work well for some people, but they typically take a long time and they often don’t work on the first try. So it would be great if we could design better treatments based on these observations.” One area where he is already seeing promise—both in treatment response and in the predictive power of his research—is called transcranial magnetic stimulation.

Finishing off the morning, Dr. Nim Tottenham began her presentation by sternly (and jokingly) reminding the audience that “childhood is important.” Her research concerning the connection between brain regions responsible for emotion and emotional regulation (the amygdala and the prefrontal cortex, respectively) and how it changes over time allowed her to paint a detailed picture of childhood behavior and offer a convincing explanation of how normal development can go off track.

Dr. Tottenham showed through her lab’s research and experiments that “the caregiver exerts a powerful regulatory influence” on the developing neurobiology of emotion, limiting the power of the amygdala maintaining immature brain processes and relationships for the extended period of human development. In other words, as she put it, “immaturity is a luxury humans were given.” And while all of the secrets of childhood may rightly elude us, the complex social, biological, and developmental factors at play conspire together so that there is “something special about events that get under the skin” during our earliest years—bad or good.

Prior to the presentations, five New York City-area high school seniors were awarded Rising Scientist Scholarships for their already demonstrated commitment to scientific inquiry. “These are five remarkable young ladies who give us hope,” said Child Mind Institute president Harold S. Koplewicz, MD, before presenting the awards. In the spirit of On the Shoulders of Giants, Dr. Koplewicz thanked parents and teachers for getting the winners this far, and then read a selection of what their nominators had written about them: “Meticulous. Patient. Responsible. Organized. Extraordinary. Simply outstanding. A natural scientist.”

“I think we can all have hope that these five women will carry the ball,” he concluded.

Dr. Insel took a moment to echo the message of community and lineage at the beginning of his remarks to the general audience. Scientific progress “builds incrementally over generations,” he said, “and it’s part of the fun of being part of scientific life—you both get to benefit from mentors who care and you get to generate the next group who will in turn also be mentors.” Science is “a very social endeavor.”