Richard Hill
Big Question
“What is the next big breakthrough you are waiting for in mental health?”
A number of developments over the past decade seem to be pointing to a possible shift in the way we assess the relationship of academic study and research to the benefit received by an individual. The goal of research is often to find a generalizable result so that the most benefit can be directed toward the most people. In doing so, research can become limited to protocols that have sanitized for so many possible confounding factors that something vital is lost. It is similar to the research into medicinal organic material: sometimes, the active ingredient may well be distilled, but when tested it is discovered that the active ingredient is only effective when included in the ‘whole food’ – there is an interplay that is necessary.
Neurobiological research is revealing so many fascinating activities of the brain. Bruce Ecker’s work with memory reconsolidation is just one example. The next step – effective application for an individual – is able to be better understood because of our generalizable knowledge, but how the individual incorporates the ‘active ingredient’ is very particular and can require very specific adaptations. Generalization, which we are now including in the concept of ‘evidence based’ practice, can be the very reason that an ‘active ingredient’ fails to positively benefit a specific individual.
We are now seeing the capability of designing medication specifically to the individual by examining the phenotypic genome: a generalised benefit is individually adjusted. This concept is just beginning to have an impact and I am curious as to what might emerge over the next decade. We may be seeing the beginning of a bifurcation in the complex system of psycho-neuro-biological healthcare in the recent arguments about the DSM V and a resistance to the limitations it is presenting. The announcement that the NIMH will not be using the DSM V as a limiting criteria for research grants may be part of an old feud, but it also an expression that getting it ‘right for all’ might be diluting the specific effectiveness of beneficial treatment of an individual.
I suggest that science itself will be making shifts in how it investigates the phenomena of human health, illness, therapeutic remedies and well being. Practical process and philosophical concept may well be in the same ball park again. I truly wonder if they can play together and give rise to an unexpected emergence in the way we think and the way we apply that new thinking.
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Richard, this is a very intriguing and thought-provoking possible future that you’ve raised here. I like the way you’ve drawn on what’s seems to be emerging in medicine and paired with what might be possible in psychotherapy. Therapists, as mostly independent practitioners have a long history of individualizing theory-derived treatment. And, I think there’s long been a gap between what therapist’s say they do (following their theoretical commitment) and what they actually do in practice. Hopefully, that difference is the result of the sort of customization you’re talking about.
Hi David! Let’s take this as our unofficial introduction and first g’day 🙂 Love your work on Shrinkrap Radio.
My wife is working on her PhD looking at the practice of massage therapy in aged care. We have talked about this in her work as well. The therapy utilized in the research is often so simplified and objectified, that the personal interaction component – the creativity, if you will – is disabled. That is the element that turns a manualized therapy into a therapeutic practice. It is impossible to remove the experimenter from the experiment, but we have to engage our subjective observation in a very careful and thoughtful manner. I think this thinking is rising again. I will certainly do what I can to add to it.