Thank you for your enquiry, which raises many important issues.
As to what is being done now to improve the lives of people with psychosis,
I can say that a great deal of research effort in Australia and
internationally is being undertaken to find better treatments, both
medications and psychosocial treatments. There are a couple of challenges
that stand in the way of progress, however.
First, there is insufficient financial investment in mental health research
relative to the magnitude of disease burden caused by mental illness. This
means that the extensive amount of work that needs to be done to develop new
treatments, and translate new – and even old – discoveries into clinical
practice, cannot be done at the pace required. The reasons for this are
complex, but boil down to community values, which in turn influence
political will. Currently our society assigns greater health research
priority to other conditions such as cancer and cardiovascular disease.
Second, I think there is a widespread underestimation of the complexities
involved in psychosis and other mental disorders, and hence the degree of
difficulty in understanding them thoroughly from a scientific point of view
is also underestimated. When you consider that, despite years of research,
the medications used to treat psychosis have not fundamentally altered since
the first discoveries of antipsychotic drugs made in the 1950s, such
disappointing progress suggests that our available technology has so far not
been equal to the task before us.
In answer to your question about how far we are from developing new and
better forms of medication, my response is based on the assumption that the
above conditions – insufficient financial investment and technology not
sufficient for the task – will continue to prevail. In that case, we will be
lucky to see a major treatment advance inside 20 years.
In the meantime, I do see that we have, within our current knowledge of what
we know that works, the potential to help people with severe mental
illnesses get back to a semblance of a normal life, as you put it.
Psychological therapies, rehabilitation strategies, support for social
engagement, accommodation assistance, supported employment programs and
other non-biomedical interventions can considerably improve quality of life,
help overcome social isolation and avoid hospitalization. The limiting
factors, however, are that these programs that are known to work are not
universally available, not sufficiently funded, and not adequately supported
by government’s current health and social services systems.
Your last remark that ‘we were told that a cure for schizophrenia was on the
horizon in 2003’ is very troubling to me because it possibly relates to how
medical research is reported to the public by various media outlets and
often by medical research institutions themselves. A cure for schizophrenia
was never on the horizon in 2003, nor is it on the horizon in 2017. How
could you have got such an impression?
I think it may have something to do with the research culture that prevails
in Australia and comparable countries. Scientists work in a highly
competitive environment. With a small pool of research money there is
intense competition for the limited resources provided by organisations that
disburse research funds in the form of grants. These organisations and the
scientific journals that report research findings, not to mention academic
promotions committees, have a strong preference for funding, publishing and
rewarding new discoveries, rather than repeating older studies to check that
they are correct. (This is called replication and it is critically important
for the advancement of science, but not done often enough and certainly not
very newsworthy.) Put this highly competitive research culture together with
very strong community and patient pressures to see research translated into
new and improved treatments, and the result is a medical research promotion
industry based on the production of ‘success stories.’ Consequently, the
stories get over-sold and hyped so as to capture the headlines for the day.
Under these conditions, it has been said, the need to be first trumps the
need to be true.
People will not be fooled, especially when promises are not fulfilled and
hopes are dashed. The most worrying thing about this, and I think it is
already beginning to occur, is that it can undermine the public’s trust in
science, and medical research in particular. At a time when maintaining the
integrity of science is so important in facing the many serious challenges
ahead, and when medical research is struggling to help relieve the suffering
associated with mental illness, we have to be very careful not to allow the
insatiable demand for ‘good news stories’ to influence how our work is
reported to the public.
If medical research does not remain true to its own principles in reporting
its findings to the public it will lose the trust of people like you.
Kind regards, and thank you again for your enquiry,
Yours sincerely,
Vaughan Carr
Professor of Psychiatry,
University of New South Wales and Neuroscience Research Australia