Friday, April 23, 2010
The Cave that DSM Built? What Addicts and The School of Athens May Have to Teach Us about the Future of Psychiatry
Recent advances in medicine have enabled earlier and more specifically targeted interventions to treat disease. Consequently, there has been a substantial decline in both morbidity and mortality for many conditions. Many illnesses, previously considered fatal, are now known as chronic disease states. However, despite advances made in the field of psychiatry, mental illness continues to be cited as the preeminent cause of global disease burden. This is due a number of factors, including: 1) the lack of universal consensus as to what constitutes a mental disorder; 2) the dearth of knowledge of biological causation of currently classified mental disorders; and, 3) the inability to target interventions aimed at specific pathophysiologic points at less advanced stages of disease evolution.
Since its introduction in 1952, the system of classification of mental disorders in the United States has been encoded in the Diagnostic and Statistical Manual. It is soon to enter its fifth edition in 2013. Due to the relative lack of knowledge regarding causation, the DSM, as it is known, has been a classification system of observable behavioral phenotypes and syndromes. It has targeted reliability and more recently has incorporated functional impairment but has not been able to provide a nosology with clear predictive validity. As the technological tools needed to elicit causation become more available, social, political, and moral imperatives for a classification system based on etiology will be brought to bear. This predicates a future with personalized mental health care emphasizing prevention, earlier intervention, and when possible, curative therapies. Clearly, a re-examination of the priorities of psychiatry is in order. The current period of public comment on the American Psychiatric Association's DSM-V draft seems a particularly apt time to examine the neuroethical issues and technical challenges which lie ahead for the field.
This lecture will examine these issues within an ethical perspective framed in both Socratic and Aristotelean tradition. Utilizing Plato's often cited Analogy of the Cave, and Raphael's famous The School of Athens housed in the Vatican's Apostolic Palace, we will explore the history of psychiatry nosology in the United States and seek to understand why mental illness has been "different" in its therapeutic developmental trajectory. The discussion will then shift to more recent changes in how mental illness is being conceptualized, as occasioned by astute clinical observation and reasoning, the impact of genomics and molecular diagnostics, and advances in neurotechnology affording heretofore unparalled multilevel visualization of the central nervous system. A neuroethically informed search for, and curation of, the new knowledge of causation with its potential promise and limitation will be explored. (Was this what Plato and Aristotle were discussing?) Reference will be made to the National Institute on Mental Health's Research Domain Criteria (RDoC) plan. .
Dr. Daniel Hall-Flavin (MN, USA)
A native of St. Louis, Missouri, Dr. Daniel Hall-Flavin is an Assistant Professor of Psychiatry aod Consultant in the Department of Psychiatry and Psychology at the Mayo Clinic in Rochester, Minnesota. USA where he is also Director of the Addiction Psychiatry Fellowship Training Program and former Section Head and Medical Director of the Mayo Addiction Psychiatry Service. Prior to joining the consulting staff at Mayo he served for 12 years as Medical Director for the National Council on Alcoholism and Drug Dependence in New York and Washington, DC. while also being actively involved in academic practice. Dr. Hall-Flavin's clinical work and teaching activities have focused primarily in the area of Addiction Psychiatry for the past 25 years, and his interests have come to center on the impact of translational medicine in the practice of adult and addiction psychiatry. Recent research work has focused on the practical applications of pharmacogenomics testing in the practice of general adult psychiatry (improving clinical care in the treatment of major depressive disorders through appropriate utilization of pharmacokinetic and pharmacodynamic genomic infonnation); improving predictability of response to antidipsotropic medications through pharmacogenomics testing; and, improving treatment outcome in individuals who suffer from comorbid bipolar illness and addiction disorders. He has a keen avocational interest in the application of philosophy and humanities in the practice of medicine.
Dr. Hall-Flavin has authored a number of peer-reviewed and invited publications, book chapters, editorials and abstracts in the field of Addiction Psychiatry, and has presented on numerous occasions both nationally and internationally. He is a clinical member of the Samuel C. Johnson Genomics of Addiction Study Section at Mayo, and has been a previous participant in the Oxford Round Table series. He has been a Visiting Scholar at Blackfriar's Hall at the University of Oxford.
For additional information, tentative schedule, media access, or to register, please contact Guillermo Palchik at email@example.com