Sometime around 2010, about two-thirds of the way through his 13 years at the helm of the National Institute of Mental Health (NIMH)—the world’s largest mental-health research institution—Tom Insel started speaking with unusual frankness about how both psychiatry and his own institute were failing to help the mentally ill. Insel, runner-trim, quietly alert, and constitutionally diplomatic, did not rant about this. It’s not in him. You won’t hear him trash-talk colleagues or critics.
Yet within the bounds of his unbroken civility, Insel began voicing something between a regret and an indictment. In writings and public talks, he lamented the pharmaceutical industry’s failure to develop effective new drugs for depression, bipolar disorder, or schizophrenia; academic psychiatry’s overly cozy relationship with Big Pharma; and the paucity of treatments produced by the billions of dollars the NIMH had spent during his tenure. He blogged about the failure of psychiatry’s Diagnostic and Statistical Manual of Mental Disorders to provide a productive theoretical basis for research, then had the NIMH ditch the DSMaltogether—a decision that roiled the psychiatric establishment. Perhaps most startling, he began opening public talks by showing charts that revealed psychiatry as an underachieving laggard: While medical advances in the previous half century had reduced mortality rates from childhood leukemia, heart disease, and aids by 50 percent or more, they had failed to reduce suicide or disability from depression or schizophrenia.