Patients and Impatience: A Call to the Best and the Brightest

The recent proposal by the National Institute of Mental Health, or NIMH, to redirect a portion of its extramural research investment away from basic behavioral and social science research into research that more directly addresses issues of direct relevance to mental health and illness has created shockwaves for psychological science. Were that not enough seismic activity, patient advocacy groups and congressional critics, expressing increasing concerns about research priorities, have sounded similar themes.

For decades, grant applications to NIMH from psychological scientists have proposed studies of fundamental human processes in “normal” populations. These applications have all come with a promissory note asserting that knowledge garnered in normal populations about such processes as attachment, attention, decision-making, individuation, emotion, self, perception, and social interaction would yield important insights that would increase our understanding of the nature, course, etiology, treatment, and prevention of mental illness. And thus, encouraged by a peer-review system that has clearly valued basic research, our very best and brightest psychological scientists have been well-funded by NIMH to develop increasingly sensitive measures and increasingly sophisticated understandings of these fundamental human processes. But underneath the surface of this smooth-running research funding machine, two potentially troubling questions have remained:

• How much of this remarkable cutting-edge basic behavioral and social science research actually gets applied to reducing the burden of mental illness?
• How much do the needs of the mentally ill, their families, and health service providers influence and shape the questions that basic scientists pursue?

Although there are certainly some wonderful examples of basic research being directly “translated” to address mental health issues in the past (e.g., the application of basic research on learning and cognition into the development of highly effective cognitive-behavioral therapies for a number of disorders), leaders of NIMH, families of the mentally ill, members of Congress, and those who provide services to the mentally ill have become increasingly vocal in expressing concerns about the relevance that much of the basic behavioral and social science research funded by NIMH has to mental health issues. Moreover, even when the relevance of this basic research is recognized, there are criticisms about the perceived slowness of the pace of progress in developing effective treatments and cures for the most serious of mental illnesses.

Faced with these criticisms and threats to our research livelihoods, the first response of psychological scientists to this state of affairs is understandably to go on the offensive. We argue eloquently that the investment in basic research ultimately will pay huge applied dividends, and that attempts to micromanage the research of our top scientists will lead to a dilution of the quality of the science they produce. There is, of course, a great deal of truth to this response. But it is also true that significant advances in basic science have often come in response to clearly stated applied goals (e.g., the explosion in understanding of the functioning of the immune system in service of the goal of finding a cure for AIDS).

To me, this raises the very intriguing question of what might happen if even a portion of the talents and efforts of most or all of our best and brightest psychological scientists (including those from all subfields such as social, developmental, personality, biological, and clinical psychology) were applied to the goal of improving our understanding and treatment of mental illness. Advocates for the mentally ill have stated clearly and repeatedly that the most pressing burden shouldered by patients and their families are the problems the mentally ill face with such basic human functions as making decisions, sustaining attachments and social relationships, regulating emotions, maintaining attentional focus, developing a sense of self, dealing with stigma, and the like. The irony is that these are precisely the processes that basic psychological scientists are so expert in measuring, understanding, and even changing. And yet, as things stand now, most psychological scientists will spend their entire research careers without ever studying a schizophrenic, bipolar, depressed, or otherwise seriously mentally ill individual.

Why is this so? From conversations with many psychological scientists over the years, I do not think it is for lack of interest or concern. Rather it appears to reflect a perceived lack of relevant training and a perceived lack of opportunity. What are we to make of a state of affairs in which the very best and brightest of our psychological scientists are so isolated from a most pressing social problem for which their expertise is of such great potential relevance?

Next month, I plan to consider how we got into this unfortunate situation and what we might do to change it. As always, your thoughts on these issues of science, funding, and the apparent schism between large areas of psychological science and the study of mental illness are most welcome at [email protected].