Minds, Maps, Meanderings

In her book Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness, historian Anne Harrington challenges psychiatrists to embrace complexity. Her central message is that society has often projected a lot onto psychiatry, with our field far too eager to accept these and to fill an expertise void: at one point, with psychoanalytic grandiosity, later with overpromised, underperforming biological boasts and reified diagnostic labels. Echoing Foucault, Harrington invites us to avoid mistaking the name of the thing for the thing itself and to keep struggling for answers, embracing a slow science, marketing expertise humbly.² Although some may feel defensive in their reading of Mind Fixers, I found it an invitation to recognize that the successes and failures of psychiatry's past are our inheritance. It is up to us to learn from this past, to be humbled and encouraged by it, and to examine how we are promoting our field in the present. We need to advertise that although many aspects of neural functioning elude us and although we rely on many of the same therapeutic practices from the past, we are not without direction for the future. For example, an elegant roadmap was laid out a year ago by Karolina Kauppi and colleagues wherein they combined a data set for schizophrenia risk genes and another set of genes associated with antipsychotic drug targets.³ Using this “network biology” approach, they identified four schizophrenia risk genes that were also antipsychotic drug targets (GRM3, DRD2, CHRM4, and CYP2D6); they also found several molecular targets that are not currently connected to antipsychotic drug treatment, providing researchers with some potential targets for novel therapeutics.⁴