This past August, we packed up our family car and drove halfway across the country to take my son to school. Soon to be a college freshman, his excitement and anxiety were palpable as we drove off. Leaving behind a successful high school career, he was starting something completely new. He had some idea of what he was getting into. But most of all, he was eager to take on a new challenge and motivated to learn.
I knew exactly how he felt.
Not long afterward I arrived here at the NIMH with the same excitement, the same anxiety, the same eagerness, and the same motivation to learn. I had spent the last dozen years or so on the faculty in the Department of Psychiatry at Columbia University and the New York State Psychiatric Institute. There, I saw patients and taught residents, but I spent the majority of my time studying how psychiatric risk genes alter the function of neural circuits, and how neural circuit dysfunction leads to psychiatrically relevant behaviors, all in mouse models. Blessed with a rich array of enthusiastic collaborators and committed trainees, a supportive administration, and (yes) generous support from the NIMH and others, my lab flourished. But the opportunity to think more broadly about neuroscience, psychiatry, and everything in between, to serve my patients, community, and country, and to help build momentum towards transformative new treatments, beckoned. And so here I am.
Naturally, I am often asked about my plans for the Institute now that I’m here. But before I can make plans, I need to learn, so my initial plan is simple. I intend to spend most of my first year here listening. I need to understand what the major issues are; where there are gaps in knowledge and gaps in our research efforts; what NIMH is doing well and what needs to be improved. There are many voices that need to be heard, including members of the NIMH and NIH community, extramural scientists, caregivers, consumers and consumer advocates, practitioners, trainees, and policy makers. The constituency of NIMH is broad because the illnesses we study affect everyone, directly or indirectly.
That said, I do not arrive at NIMH as a blank slate. I have wrestled with diagnostic uncertainty, trying to fit a square patient into the round hole of a DSM diagnosis. I have sat with a suicidal bipolar patient in anguish, frustrated by limited treatment options. I have struggled to teach residents about the neural underpinnings of mental illnesses while simultaneously acknowledging the uncertainty engendered by our limited knowledge base. I have experienced directly how difficult it is to add to that knowledge base, plagued constantly with doubts about the relevance and rigor of work constrained by practical considerations.
These experiences have convinced me that in order to achieve its mission of transforming the understanding and treatment of mental illnesses, the number one priority of the NIMH has to be excellent science. When considering what to fund, the most important criteria should be whether the research proposed is well designed, whether those conducting the research adhere to the highest standards of rigor, and crucially, whether the results will be impactful. These should be our guiding principles, first and foremost.
Within the context of excellent science, we should be guided by the notion that diversity is the cornerstone of a strong research portfolio. Diversity in research takes many forms. For the NIMH, this means diversity in subject matter—basic, translational, clinical, and implementation science—as well as diversity of the workforce that investigates this subject matter, and the diversity of the individuals who participate in this research. Importantly, we must also have diversity of time frames. We must invest in research that has the potential to improve clinical care over the short, medium, and long-term. For while it is essential to deeply investigate the brain and its interactions with the environment to build our knowledge base and search for the truly transformative treatments of tomorrow, we must not neglect opportunities to fully investigate new treatment targets as they arise. Nor can we forget that research is often needed to help currently available, efficacious treatments reach all patients who need them.
These are my priorities: excellent science, and within the realm of excellent science, diversity. I have lots of other ideas that I hope to work on. Areas of particular interest include neural circuits, computational and theoretical approaches to psychiatry, and suicide prevention, each of which I will be writing about in the near future. Of course, I am aware of the several challenges facing the NIMH, including maximizing the utility of the RDoC and experimental therapeutics approaches, as well as weighing the relative contributions of consortia-driven “big science” vs. hypothesis-driven “small science.” For now, though, I will stick to my plan, and like my son, focus on learning—in my case, from those inside and outside of NIMH whose insight can help inform the future directions of our research programs.