Herbert Pardes, M.D., President of the Scientific Council and Executive Vice Chairman of the Board of Trustees of New York-Presbyterian Hospital, shares his insight on mental illness.
Dr. Pardes reflects on the last 25 years of leading the selection process for NARSAD Grant-funded research, and muses on what lies ahead for mental illness in terms of breakthroughs, funding, and stigma.
Twenty-five years ago, the Brain & Behavior Research Foundation was founded with a vision of transforming brain and behavior research through dramatically accelerated investments to better understand the causes of mental illness, develop better treatments and improve lives. Since that time more than 4,000 NARSAD Grants have been funded—with almost $300 million of donor contributions—to scientists around the world. This investment has shaped the psychiatric field and enabled countless discoveries that are paving the road to curing the diseases of the brain.
Has the Foundation changed since its inception in 1987?
The aim has always been to improve our understanding of the causes of psychiatric illness and to develop better treatments—that is and will remain the aim of the Foundation forever. It’s astounding to me that a set of conversations which began 25 years ago with considering whether we would pay out the first $50,000 in NARSAD Grants has led to a program that has supported psychiatric research to the tune of close to $300 million in thousands of NARSAD Grants around the world. This investment has transformed the psychiatric field and helped advance our understanding of and treatments for brain and behavior disorders.
What types of researchers and institutions receive NARSAD Grants?
We are very proud that we support any and all disciplines—neurologists, psychologists, sociologists, pharmacologists, biochemists, psychiatrists—from all over the world. NARSAD Grants foster a large scale, open, collaborative effort with as many people as possible to get rid of the scourge of mental illness. We try to bring as many young people as we can into the field. We also attract some of the most distinguished investigators. As we’ve seen from the World Health Organization, the impact of mental illness on people’s daily functioning and life is one of the most significant determinants in terms of medical illness we know.
As a result of this worldwide commitment to research, how has the psychiatric field, as well as our understanding of psychiatric illness, evolved in the last quarter century?
We have made enormous progress, though illness in general is very complex. Take the number of years we have been studying diabetes, hypertension, various types of cancer, and we’re still trying to understand their causes. That’s true of psychiatric illness as well. At one point, nobody thought genetic factors were of any consequence. Today it is widely accepted that genes play a substantial contributory role. We’ve learned today that there are not only genes that cause illness, but also genes that have modifying effects.
Additionally, there are more quality psychiatric research programs around the country than ever before. In the late ’70s, early ’80s, there were very few institutions with reasonably sized programs in the U.S. Today, 25 years later, almost every academic medical center of any consequence has a psychiatric research effort, and it’s often one of the biggest efforts in that center. This means more young people and more bright minds are contributing to this field.
Also, this enables respected psychiatric researchers to work in the same setting as other medical, surgical, and epidemiological researchers. There’s often commonality between how some mental illnesses and physical illnesses develop and even some connection between the two. For example, there is a connection between depression and heart disease as well as other disorders. This has become increasingly recognized and we now know how consequential that is.
And despite all this progress, there is still stigma attached to mental illness. What role does the Foundation play in reducing stigma?
The Foundation is very concerned about stigma. It understands that reducing stigma comes with increased knowledge about the illnesses, the underlying biology and how to treat and ultimately prevent and cure them. We focus on supporting research in a vigorous enough way to have a better understanding of mental illness and to continue to make the work on it more widespread.
Over the last 25 years, research on mental illness in children has increased significantly. Is the Foundation focused on this area?
The Brain & Behavior Research Foundation is very much interested in early intervention with mental illness. Research has demonstrated that the course of most mental illnesses is much more positive when they are treated early on in their development. We are also interested in diseases in children and we support research in this area heavily. The issues of psychiatric illness in children are important—both to look at those illnesses in children and also to understand how a psychiatric illness develops. Are there manifestations of it early in a child’s life? How can we trace the development and progression? Can we get better diagnostic tools and can we intervene earlier on before both the personal and socioeconomic consequences are disastrous?
Is it possible in the future that new types of brain and behavior disorders will emerge that we’ve never seen before?
That’s not impossible to conceive. Certainly as people age, we see illnesses that were relatively infrequent before developing now. There are certain kinds of brain diseases that are better known now—Alzheimer’s disease, autism. But if you have people living to 80, 90, 100, when in 1900 the life expectancy was 47 years, that immediately suggests there are going to be differences in the types of things you see. Back in the early 70s, Alzheimer’s was not recognized as a distinct disease. It was thought that everyone became senile. In those years there were some outstanding neurologists and other scientists who showed that Alzheimer’s is a separate, specific illness.
What breakthroughs in research or treatments do you see on the horizon?
I’m very excited about the ability to map the human genome in individuals. There has been a significant reduction already in the cost to map an individual’s genome, so this will continue to open up options for identifying biomarkers for mental illnesses, developing preventive treatments and offering personalized medicine that works specifically for the individual’s needs. From all of this, outcomes should hopefully improve. I’m also excited about the different kinds of work using new technologies such as brain imaging to show what happens over time in regards to the development and progression of mental illness. Also the different kinds of novel treatment—deep brain stimulation, transcranial magnetic stimulation—there’s a lot of inventiveness applying technology for new treatment options.
Why do you continue to volunteer your time as President of the Foundation Scientific Council?
I became fascinated with psychiatry in my college and medical school days. I’ve done virtually every kind of psychiatry—individual and group psychotherapy, psychoanalysis, hospitals, pharmacotherapy, outpatient care and adolescent inpatient care over the years. I feel deeply troubled by families whose lives are made miserable by these illnesses and I want to make it better.
I’ve enjoyed very much working with this organization; I feel it’s a terribly important thing to do. Also, the fact that for years, psychiatric illness was a low priority in comparison to all the other medical illnesses, made me feel that more of us should pitch in and try to do something. All of us, myself included, have had people in our families who have had psychiatric illness and anything we can do to eliminate the likelihood or get patients better treatments is a wonderful mission.
Do you think it is possible to have a world without mental illness?
Can we imagine seeing a world without mental illness in the very near future? That seems like quite a stretch. But to say that’s what we want to do, that we want to get rid of illnesses that affect so many people, that’s right on target. We certainly have made significant progress in treating mental illness in the past 25 years. And in comparison to 100 years ago, when there was little if any treatment, things are getting demonstrably better step by step.