The Future of Psychiatry Saturday, November 10th, 2018 at 2:30pm Past Event Watch the video » Psychoanalysis ushered a new era of understanding psychiatric conditions which lasted half a century. The advent of psychopharmacology moved the focus back to the importance of diagnosis and selection of the appropriate medication. As we learn more about the brain, with increasingly sophisticated technology, we are looking towards a revolution in diagnosis, etiology and treatment of mental illnesses. This roundtable will be exploring this future. Participants: Michael First Professor of Clinical Psychiatry, Columbia University Michael B. First M.D., is a Professor of Clinical Psychiatry at Columbia University, a Research Psychiatrist in the Division of Behavioral Health Scienes and Policy Research, Diagnosis and Assessment Unit at the New York State Psychiatric Institute, and maintains a schematherapy and psychopharmacology practice in Manhattan, Dr. First is a nationally and internationally recognized expert… read more » Laura Hirshbein Professor of Psychiatry, University of Michigan Laura Hirshbein is professor of psychiatry at the University of Michigan. She completed her MD and psychiatry residency at the University of Michigan, and also completed a PhD in the history of medicine at the Johns Hopkins University. Her first book, American Melancholy: Constructions of Depression in the Twentieth Century was published by Rutgers University… read more » Francis Lee Mortimer D. Sackler Professor & Vice Chair for Research, Department of Psychiatry, Weill-Cornell Medical College View Papers / Presentations » Francis Lee is the Mortimer D. Sackler Professor and Vice Chair for Research in the Department of Psychiatry at Weill-Cornell Medical College, and attending psychiatrist at New York-Presbyterian Hospital. He received his MD and PhD from the University of Michigan, and psychiatry training at Payne Whitney Clinic and completed postdoctoral training, at New York University… read more » Robert Michels Walsh McDermott University Professor of Medicine and Psychiatry, Weill-Cornell Medical College Robert Michels, M.D. is the Walsh McDermott University Professor of Medicine and Psychiatry at Weill-Cornell Medical College, where he previously served as Provost, Dean, and Chairman of the Department of Psychiatry. He is former Joint Editor-in-Chief of The International Journal of Psychoanalysis, and a former Training and Supervising Analyst at Columbia Psychoanalytic Center. Miklos Toth Professor of Pharmacology, Weill Cornell Medical College Miklos Toth is a neuroscientist, professor of Pharmacology at Weill Cornell Medical College in New York City. His laboratory has long been interested in the pathomechanism of neuropsychiatric diseases. The research group uses genetically modified mice to reproduce symptoms of these conditions, including anxiety, hyperactivity disorders, and cognitive and social behavioral abnormalities. They study the… read more »
Michael First Professor of Clinical Psychiatry, Columbia University Michael B. First M.D., is a Professor of Clinical Psychiatry at Columbia University, a Research Psychiatrist in the Division of Behavioral Health Scienes and Policy Research, Diagnosis and Assessment Unit at the New York State Psychiatric Institute, and maintains a schematherapy and psychopharmacology practice in Manhattan, Dr. First is a nationally and internationally recognized expert… read more »
Laura Hirshbein Professor of Psychiatry, University of Michigan Laura Hirshbein is professor of psychiatry at the University of Michigan. She completed her MD and psychiatry residency at the University of Michigan, and also completed a PhD in the history of medicine at the Johns Hopkins University. Her first book, American Melancholy: Constructions of Depression in the Twentieth Century was published by Rutgers University… read more »
Francis Lee Mortimer D. Sackler Professor & Vice Chair for Research, Department of Psychiatry, Weill-Cornell Medical College View Papers / Presentations » Francis Lee is the Mortimer D. Sackler Professor and Vice Chair for Research in the Department of Psychiatry at Weill-Cornell Medical College, and attending psychiatrist at New York-Presbyterian Hospital. He received his MD and PhD from the University of Michigan, and psychiatry training at Payne Whitney Clinic and completed postdoctoral training, at New York University… read more »
Robert Michels Walsh McDermott University Professor of Medicine and Psychiatry, Weill-Cornell Medical College Robert Michels, M.D. is the Walsh McDermott University Professor of Medicine and Psychiatry at Weill-Cornell Medical College, where he previously served as Provost, Dean, and Chairman of the Department of Psychiatry. He is former Joint Editor-in-Chief of The International Journal of Psychoanalysis, and a former Training and Supervising Analyst at Columbia Psychoanalytic Center.
Miklos Toth Professor of Pharmacology, Weill Cornell Medical College Miklos Toth is a neuroscientist, professor of Pharmacology at Weill Cornell Medical College in New York City. His laboratory has long been interested in the pathomechanism of neuropsychiatric diseases. The research group uses genetically modified mice to reproduce symptoms of these conditions, including anxiety, hyperactivity disorders, and cognitive and social behavioral abnormalities. They study the… read more »
Shared by one of our audience members: “The future of psychiatry will begin not by some test or new technology, but by a paradigm shift as is the case in all matters of intellectual advancement. Science progresses by inspired realization, which leads to new questioning. One cannot see what you are not already looking for. If feeling good was all that being a human was all about, we’d find no issue with using heroin, cocaine, cannabis, etc… Adam & Eve would have not bitten into the apple. The brain is a computer specializing in adaptation. Human beings feel their best when they are effective in engaging the world. Any human narrative is a sampling of the individuals internalized model of how the world works with themselves as a central actor. Substances of abuse are evidence that our feelings about things can be manipulated chemically, however those systems of neuromodulators are geared to set the appropriate reactive dynamics towards objects within a context. Globally tuning them up or down is not necessarily conducive to optimizing an individual’s effectiveness in the world. That code is what is missing when modern society adopts a assembly line model to child rearing and discount the central importance of the attachment system in helping the child mimic and encode the principles by which humans effectively engage the world. So children who are neglected and/or abused suffer not simply by the absence of warm-fuzzy feelings, but by the lack of an effective model to engage the world. Anyone who puts a piece of chocolate in their mouth might appreciate it as delicious, however it would be highly unlikely for anyone who grew up outside of culture and had never seen a chocolate bar, only living off the wild things in the world, to imagine all the steps to make a chocolate bar from beans which are bitter. Instant gratification involves simply classical conditioning. Making a chocolate bar, a multistep process, requires trial-and-error learning (ie operant conditioning) which would otherwise be discounted in value due to the delay in gratification (ie delay discounting) in comparison to less costly rewards unless their value was bolstered by the attachment system; which makes it rewarding to be like those caregivers we love. Stress reduction can represent some instant gratification strategy only concerned with the local spatiotemporal consequences or it can be adoption of a delayed gratification strategy which appreciates more spatiotemporally global consequences. Such extended consequences are only appreciated through the integration of extensive experience and humans are capable of transmitting that wisdom more rapidly within and over generations through the neural code. I’m surprised none of the participants of the program yesterday were computational or complex systems theorists. How could anyone imagine a person who was not effective could ever be happy unless you gave them a drug which engaged the NAc to drive neuromodulatory traffic towards adjusting valuation? Yet, in a normal brain, wouldn’t you assume that the circuits would reassert a value to an object based on experience and the internalized model which has already been encoded? How could you be happy if your coding during development does not prepare you to interpret your experience in a manner which results in dealing effectively with disappointment; an unavoidable consequence of not having perfect knowledge. Meaning matters as effective strategies reduce stress. Meaning is biological as experience is translated using our neural code. However, as the CNS is a hierarchical complex system, disorders of meaning reflect the highest level of CNS organization. Depression, mania, psychosis… these are phenomena which superficially share similarities, but they are not diseases. They are states which arise from many etiologies within a complex system. While the most profound forms of dysfunction are most likely initiated at the deepest levels of the hierarchical CNS because these triggers are so fundamental that much function depend on their integrity, and may directly reflect genetics, the CNS is an open dynamical complex systems involve multiple modular subprocesses capable of degrees of compensation in support of the emergent functions of mind. Over time, however, even psychopathological processes triggered by meaning, if unresolved chronic stress produces consequential effects (ie immunological, disuse, desynchronization) that undermine the more fundamental levels of CNS processing.” Ken Garcia, MD Reply