Beginning the Decade With 2020 Vision

January 14, 2020

Here we are-beginning a new day and a new decade-and, once again, we are filled with excitement, hope, anxiety, and fear.

From the Editor

It seems like just yesterday that the world was filled with excitement, hope, anxiety, and fear as Y2K was rapidly approaching. A new century was about to begin, a novel experience to most of us alive at the time. Doomsayers were certain all the computers would crash as the clock moved forward into the first second of the 21st century. We did not yet have to carry the burden of 9/11 or of the wars in Afghanistan and Iraq to come. Eyes had not yet become entranced by smart phone technology, a true oxymoron. And climate change had not yet devolved to climate crisis.

But then, like the snap of a finger, two decades passed, and here we are-beginning a new day and a new decade-and, once again, we are filled with excitement, hope, anxiety, and fear. For us in the US, our country has become hyperpolarized beyond recognition, with the matter-of-fact acceptance of convenient relative truths rather than a civilized embrace of absolute truths. Science, although steadfastly moving towards a greater understanding of our objective physical world, has been deemed by many to be partisan and repackaged into a pseudoscience that serves the greed and desires of individuals with power but without wisdom. Sadly, the view through the lens of the past few years is distorted and blurry, unpleasing to the eye and the mind.

Over the past two decades we have experienced how technology and one of its byproducts, social media, have simultaneously guided us down two divergent paths: one filled with division, fake news, conspiracy theories, hostility towards opinions and beliefs that differ from our own, and a festering global pessimism; the other connecting our global community, improving the quality of health care, decoding more of the mysteries of our physical universe that create opportunity for actions to improve the quality of life for all of humanity and all of life on this tiny and fragile planet; and applauding the tireless and selfless effort by many to lessen human suffering.

Despite the discoveries and progress that has been made in our understanding of the structure and function of the human brain, mental illness continues to be stigmatized. The criminal justice system houses more individuals with serious mental illnesses than psychiatric hospitals. Access to treatment for the mentally ill continues to be quite limited and, in many parts of the country, substandard. Federal and state funding for the treatment of mental illness and ongoing research to understand its etiology and improve diagnosis and treatment continues to be cut. A significant delay exists for many with first onset mental illness from the time of symptom onset to the beginning of aggressive treatment. This delay in treatment is not acceptable, as the duration of untreated symptoms has a direct impact on decreasing ultimate function and degree of recovery.

But, alas, we are beginning a new decade, a perfect metaphorical time to reboot our relationship to our planet, our species, our culture, and ourselves. It is time put on our forgotten pair of corrective lenses and restore 20/20 vision. As in nature, human societies go through cycles, and we have a rich history of stepping up to the challenges of the times and making the healthy, compassionate, and wise changes that unify us all.

So, as we begin this new decade, I would like to submit my wish list for accomplishments in psychiatry that we potentially could revel in when this next decade comes to an end.

My Wish List

1) Increased funding for the necessary basic science, clinical, and social research to raise the standard of care for individuals with mental illnesses.

2) Redistribute the living conditions of the seriously mentally ill from prisons, jails, and living on the street to safe housing, group homes, and supported living settings with, ideally, a meaningful social network (family, friends, and supportive communities).

3) Rapid assessment and diagnosis for individuals with mental status changes with immediate implementation of the best evidence-based treatments.

4) Destigmatization of mental illness, so that a person presenting with acute psychosis is treated as rapidly and carefully as an individual who presents with an acute myocardial infarction.

5) Affordable health care access that is focused on prevention.

6) Continued education about healthy lifestyle adjustments-quality sleep, good nutrition, minimal substance use, safe living conditions, quality food and drinking water, individual-appropriate exercise, social supports, safe work conditions, responsible and realistic gun control reform, antibullying as a societal norm, adequate leisure and family time, teaching our children to learn how to critically think and learn, and self-reflection.

7) A successful decade addressing the substance use disorder crisis in which we currently find ourselves drowning.

8) A healthy partnering of universities, frontline clinicians and clinics, government agencies, the pharmaceutical industry, complementary medical practices, and all individuals collaborating toward the goal of upgrading our health care system so that all of these segments are respected and included in health care planning and implementation.

9) Replacing DSM-5 with a clinically meaningful and evidence-based diagnostic manual.

10) Naming medications by a nomenclature of some variant of the proposed neuroscience-based nomenclature (NbN). One example would be to replace the word antipsychotic with the more descriptive phrase dopamine-2-receptor antagonist and serotonin receptor modulator.

11) Aggressive innovation into new treatment modalities that have not yet been discovered.

12) Increasing your kindness and compassion to all, even to those with whom we do not agree, and working toward a common ground of policies that benefit us all.

From myself, and all of us at Psychiatric Times, we wish everyone a happy new year, and a new decade full of accomplishments that continue to move our young field of psychiatry forward toward ever improving mental health.

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