book review — “Healing: Our Path from Mental Illness to Mental Health,” by Thomas Insel (Penguin, 336 pages).

As Insel acknowledges in his new book on the state of psychiatric care in our nation, “Treatment: Our Path from Mental Illness to Mental Health,” This failure to make a significant difference in the lives of people with serious mental illnesses, such as chronic major depression or schizophrenia, has plagued him. “Our science is looking for causes and mechanisms,” he wrote, “and the effects of these diseases are increasing death and disability, increasing incarceration and homelessness, and increasing frustration and hopelessness for patients and families.” He argues , while research should continue long-term, mental health policy urgently needs major reforms now.

Putting on the reporter’s hat, Insel tries to diagnose why so many mentally ill people are doing so badly and find out what exactly can be done to improve their lot. To his credit, he was thorough in reporting and interviewing a wide range of sources, including numerous patients, affected family members, mental health advocates, clinicians, and policymakers.

As pointed out by Insel, according to 2006 report Americans with serious mental illness typically die 15 to 30 years earlier than others, according to the Substance Abuse and Mental Health Services Administration. He largely blamed political and economic factors. He points to how former President Ronald Reagan slashed federal spending on community mental health centers and other psychiatric services for low-income patients who also suffered from social security concerns over the past few decades. The net is gradually weakened and squeezed.

Insel laments that in our profit-driven society, the mental health care system has not only been disrupted, but completely disappeared: “At best, we have a mental illness treatment system designed to deal with the crisis, but without vision. Focus on Mental health for prevention and recovery.” He emphasized that this sick care system was established by insurance companies and pharmaceutical companies. Sadly, even in times of crisis, Americans without private insurance often struggle to get the services they need — like hospital beds. In most developed countries, there are 71 public psychiatric beds per 100,000 people; in the United States, the corresponding figure in 2014 was only 12.6, according to National Association of Mental Health Program Directors.

Moreover, even insured patients who are hospitalized often face what he calls a “cliff of service” when they are discharged. Given that the main purpose of expensive short-term hospital stays is to stabilize patients on a mixture of psychotropic medications, there is little consideration for a viable long-term care plan. “Hospitalization in this case,” Insel writes, “is a railway station on the journey, with no apparent connection to previous or subsequent stations.” Thus, the so-called revolving door syndrome—where desperate patients end up more return to the hospital – not uncommon.

But despite these enormous socioeconomic barriers, Insel insists that effective mental health care is available. He maintains that today’s standard treatments — namely, drugs including antipsychotics and antidepressants, as well as psychotherapy — can work relatively well when properly managed. The problem is that patients are rarely matched with the right specialist. As he points out, nearly 80 percent of antidepressant and anti-anxiety medications are prescribed by primary care physicians, not psychiatrists.

Insel also believes that only a fraction of the nation’s 700,000 mental health providers offer state-of-the-art psychotherapy. Rather than relying on scientifically proven treatments such as cognitive behavioral therapy, clinicians often turn to popular approaches advocated by some charismatic practitioners. In his view, psychotherapy should be carefully monitored by regulators so that more patients receive evidence-based care, rather than “care based on excellence” (to use his neologism, which attempts to explain why patients are so often affected by their therapist).

In the most moving part of the book, Insel emphasizes that tackling the scourge of serious mental illness requires more than just providing the right medical solutions. During a visit to Skid Row in Los Angeles, he interviewed a clinician who told him that recovery revolves around “the three Ps, man.” As Insel admits, he initially thought the cryptic phrase was a veiled reference to three popular drugs: Prozac, Paxil and Prolixin. But it dawned on Insel when the clinician explained that he meant “people, places, and purposes.”

As he now realizes, people with severe mental illness have the same aspirations as everyone else. To live fulfilling lives, they also need to form deep relationships, find a safe place to live, and find meaning in a world that is far from perfect. Insel highlights how a series of innovative programs has helped countless patients do just that. For example, over the past seven decades, mental health advocates have created 330 clubs in 33 countries around the world. These “intentional communities” provide recovering patients with social support, places to meet and eat, and access to job placement services, he wrote.

Insel’s foray into journalism led him to believe that only science and technology — including new drugs or smartphone app – There will never be a cure for any form of mental illness. This is because, compared to cancer treatment, mental health treatment inevitably requires more than eradicating the disease in the body. But his newfound sensitivity to the day-to-day struggles of psychopaths raises a series of compelling questions about the future of NIMH, which he glosses over.

Founded in 1949, NIMH funds not only research but also efforts to treat and prevent mental illness.However, since the late 1980s, all leaders, including Insel, have reinterpreted their missions, choosing instead to focus on almost About basic science. So if, as Insel acknowledges in his book, decades of brain research have yielded little tangible results, should the federal government continue to spend billions on purely theoretical research? Or should many of these scarce funds be allocated to social programs that can help prevent or treat mental illness, as critics say?For example, Allen Frances, former chair of the Department of Psychiatry at Duke University, recently Aeon: “NIMH has the right to focus on the future, but not at the expense of immediate immediate needs. Brain research should remain an important part of a balanced NIMH agenda, not its sole preoccupation.”

Insel’s thoughtful and heartfelt book makes an important contribution to the ongoing debate about how to address the current crisis that is preventing so many Americans with serious mental illness from rebuilding their lives. “Rehabilitation,” he stressed, “is both a personal goal and a necessary condition for healing our nation’s soul. Our house is on fire, but we can put it out.”