Chair’s Column October 2011

The future of mental health care: evolution toward increasing integration

J. Lake

Within the first decades of the 21st century psychiatrists and psychologists will embrace assessment and treatment approaches now excluded by orthodox Western medicine. Novel diagnostic and treatment modalities will emerge in the context of research on non-conventional modalities. Future explanatory models of mental illness will take into account established Western scientific theories, emerging paradigms, and non-Western healing traditions. In this process conventional mental health care will become a truly integrative paradigm yielding more complete understandings of biological, informational and “energetic” processes associated with mental illness. A future more integrative and paradigm will emerge from a synthesis of disparate explanatory models of mental illness. More complete understandings of complex dynamic relationships between biological, somatic, energetic, informational, and possibly also spiritual processes associated with symptom formation will lead to more effective assessment and treatment approaches addressing causes or meanings of symptoms at multiple inter-related hierarchic levels. Future studies on meditation, healing intention, meditation and prayer will elucidate the role of consciousness in health and healing.

The theories and methods that comprise conventional biomedicine and biomedical psychiatry in the early 21st century will probably follow one of two possible future pathways resulting in either continued conservative growth or radical change. Although it is not necessary to go outside the established paradigm of contemporary biomedicine to develop a conceptual framework for integrative medicine, the empirical validation of novel assessment and treatment approaches will require the rigorous evaluation of novel concepts in physics, chemistry and biology. This conservative pathway does not require the violation of orthodox scientific models of reality based on implicit assumptions of linear causality to explain illness and health. However the conservative model does assume that important future directions in medical research will not be completely determined by currently entrenched economic, institutional or intellectual dogma influencing beliefs and research studies in academic centers. A more radical pathway is conceivable in which an increasingly eclectic framework of conventional biomedicine will progressively embrace novel ideas in physics and neuroscience as well as concepts from non-conventional systems of medicine that rest on assumptions currently outside of the orthodox paradigm (Rubik 1996; Liboff 2004; Jonas & Crawford 2004). If intellectual, institutional and economic trends favor the more radical pathway in the coming decades it is likely that conventional biomedicine—and along with it biomedical psychiatry—will gradually transform into a fundamentally new paradigm that will have little resemblance to mental health care of the early 21st century.

The first decades of the 21st century will bring a gradual transition away from psychopharmacology as the dominant mode of treatment toward increasing reliance on advanced technologies for alleviating serious mental illness. Growing global access to broadband internet services will permit patients to benefit from psychotherapy through “tele-presence,” advanced biofeedback techniques and virtual reality exposure therapy, and therapist “avatars” in the comfort of their homes. By the year 2050 psychiatrists and other mental health practitioners will routinely use a scientifically validated integrative “tool kit” incorporating the most advanced biomedical technologies together with empirically validated traditional healing practices. The more integrative mental health care of the future will permit more accurate assessment of biological, energetic and informational factors associated with symptoms and lead to individualized multi-level treatment strategies addressing the unique pattern of biological, energetic and informational factors associated with each patient’s unique symptoms. The transformation of biomedical psychiatry to integrative mental health care will result in deeper understandings of mental illness, improved and more rapid treatment response, and reduced costs.

By mid-century a new paradigm will be solidly established and will inform the theories and clinical therapeutics of mental health care. Biomedical theory will be informed by complexity theory, novel theories in physics and information science and accumulating findings from the basic sciences and consciousness research. There will no longer be a rigid dichotomy between biomedical and alternative modalities. By mid-century advances in the genetics and neurobiology of mental illness will have yielded more specific, more effective and more individualized pharmacological, genetic and energetic therapies for major psychiatric disorders. Rigorously designed Western-style research studies will have verified the mechanisms of action of some non-conventional biological, mind-body and so-called “energy” modalities and validated their therapeutic claims. By the same token many contemporary conventional and alternative modalities will have been discredited as lacking efficacy by well designed studies and will no longer be used. Treatments that will be abandoned in the coming decades will include many conventional pharmacological therapies and psychotherapeutic treatments in current widespread use as well as natural products from diverse healing traditions. In parallel with these changes on-going advances in functional brain imaging will permit studies on postulated roles of magnetic fields, biophotons, and macroscopic highly coherent quantum field effects on normal brain functioning and mental illness.