Blazing trails in brain science

The police arrived at the house just after breakfast, dressed in full riot gear, and set up a perimeter at the front and back.

Not long after, animal rights marchers began filling the street: scores of people, young and old, yelling accusations of murder and abuse, invoking Hitler, as neighbors stepped out onto their porches and stared.

It was 1997, in Decatur, Ga. The demonstrators had clashed with the police that week, at the Yerkes National Primate Research Center at nearby Emory University, but this time, they were paying a personal call - on the house of the center’s director, inside with his wife and two teenage children.

“I think it affected the three of them more than it did me, honestly,” said Dr Thomas R Insel, shaking his head at the memory. "But the university insisted on moving all of us to a safe place for a few days, to an 'undisclosed location.'

“I’ll say this. I learned that if you’re going to take a stand, you’re going to make some people really angry - so you’d better believe in what you’re doing, and believe it completely.”

For the past 11 years, Insel, a 62-year-old brain scientist, has run an equally contentious but far more influential outfit: the National Institute of Mental Health, the world’s leading backer of behavioral health research.

Insel has not merely survived; he is the longest-serving director since Dr Robert H Felix, the agency’s founder, retired almost a half-century ago.  The extent of this remodeling is not widely understood outside scientific circles nor universally appreciated within them. But in recent months, its author has begun to reveal his instincts publicly

Last summer, he questioned whether people with schizophrenia should remain indefinitely on antipsychotic medications - a shot at accepted medical wisdom. For anyone with a psychiatric diagnosis, or a family member with one, Insel’s long, twisting career and the convictions it has fostered provide a guided tour through behavior science: where it has been, where it’s going and why. The first time he walked away was from premedical studies.

Dr H Herman Insel, an eye surgeon in Dayton, Ohio, and his wife, Ruth, a social worker, were determined that all four of their boys get a medical education, and the first three went fairly smoothly. The last one out of the house, the Eagle Scout who collected insects and snakes and filled the basement with aquariums, was ahead of the program, if anything.

Drug therapies

At the age of 15, Tom Insel had entered the prestigious six-year BA-MD program at Boston University. But two years in, the boy wanted out. He decided it was time to step off the treadmill and see the world. “My father didn’t want me going anywhere, and I was too young to be drafted for Vietnam,” Insel said. The two reached a compromise, and the son spent six months backpacking around the world. The experiences brought him full circle, back to medicine and to Boston, where he completed the M.D. program in 1974.

“I was sure I was going to be a doctor of global health or tropical medicine in some underdeveloped country,” he said. Instead, he found an untamed world closer to home: psychiatry, which in the 1970s was ruled by a cabal of Freudian theorists and lacked a scientific infrastructure. After a graduate course at Stanford, followed by an internship and residency in psychiatry, he landed a position in the mental health institute’s in-house research branch, known as the intramural program.

There he embarked on another kind of walkabout, this time studying the effect of an early antidepressant drug in people with obsessive-compulsive disorder. In a series of studies, he and a senior colleague, Dr. Dennis Murphy, showed that the drug soothed people’s symptoms within weeks, much faster than standard psychotherapy.

The pendulum has swung so far toward drug therapy in recent years that it is hard to recapture how disruptive those 1980s studies were. Insel’s work and that of many others, testing the effect of new medications, would turn the field away from long-term talking cures and increasingly toward medication and short-term behavior therapies rooted in the same kind of randomised, controlled trials conducted in other fields of medicine.

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