The role of the psychiatrist in psychiatric research has changed during the last decades. From being a natural leader, we are gradually being sidelined in our own field. Are we as clinicians under the threat of becoming irrelevant to our field of research, or the other way around? How should we deal with these challenges in the future?
The UEMS Section of Psychiatry Standing Committee on Training (SCT) has defined seven competencies of a psychiatrist, of which one is that of the Scholar. According to UEMS, the psychiatrist as a Scholar “commits to lifelong learning, continuously improves her/his own skills and uses knowledge to achieve excellence in practice as well as in teaching others”.
These are indeed bold ambitions! In particular as they are supposed to complement the remaining six competencies. No wonder that a young Norwegian psychiatrist recently claimed that the Psychiatrist is the last Renaissance man (ref). However, one of the risks related to the attempt of being a Renaissance man, is to become a Jack of all trades, mastering none. This is a risk I have confronted regularly during my 15 years in the realm of psychiatric research. And to an ever-increasing degree.
From my experience, the field of psychiatric research has changed during the last 15 years. Not radically, perhaps, or abruptly, but significantly and probably irreversibly. When I started out in psychiatric research in the late 2000s in Norway, the field was by and large led by psychiatrists, and our scientific endeavors were undertaken in small, clinical samples recruited in a hospital setting. Since then, “big science has come to psychiatry” as stated in a famous paper in Neuron from 2010(1). In the field of psychiatric epidemiology, nation-wide registry linkages have provided ample opportunity for investigating prevalence, risk factors and consequences of mental disorders by comparisons with millions of individuals from the general population(2, 3). Researchers in the fields of psychiatric genetics and brain imaging have collaborated globally to carry out massive meta- and mega-analyses of a magnitude unimaginable just twenty years ago(4, 5).
To my experience, psychiatric research has also approached a more transdiagnostic focus than in previous years, when each professor often had his or her “favorite disorder” and personally handpicked clinical sample. Observations of widespread comorbidity patterns in naturalistic studies have led to the acknowledgement of a psychiatric nosology characterized by continuums and dimensions where we previously saw categories and distinct clinical entities(6). These lines of development are highly welcome, in my opinion, as we get more representative samples, less sources of bias and more precise and reliable results.
Bioinformaticians of various subtypes seem to be the new workhorse of medical science, with psychiatry as no exception.
Moreover, as sample sizes increase and biological data get more complicated to handle, our field has an ever-increasing need for methodological assistance from non-psychiatrists. As a result, the proportion of psychiatrists working with psychiatric research has decreased dramatically during the last decades, in favor of researchers with a background in fields such as statistics, genetics, neuroscience, and programming. Bioinformaticians of various subtypes seem to be the new workhorse of medical science, with psychiatry as no exception. Additionally, by their sheer number, psychologists dominate the field of psychiatric research in a similar manner as we know from clinical practice. And don’t get me wrong – cross-disciplinary efforts are indeed positive; however, taken too far this development could also represent some challenges to our field. One of my biggest concerns is that if psychiatrists get marginalized in our own research field, studies will be conducted by scientists with a purely technical background and lack of insight in our real knowledge needs.
Moreover, if we are not involved in research in our own field, it will prove difficult to implement findings into clinical practice in a meaningful way. This concern is probably even more relevant to psychiatry than other medical fields, as psychiatry by nature is exceptionally cross-disciplinary and multifaceted. As we lack a deeper etiological understanding and a grand unified theory of mental disorders, we run the risk of launching a thousand ships of science in all wind directions, without a common guiding map. Chaos and relativism lurk behind the noble ideals of multiperspectivism and cross-disciplinary collaboration. In line with such a notion, our field is already flooded with original research articles, often without being replicated and with results pointing in all directions. A quick PubMed search for “mental disorders” yields more than 1.5 million results, of which more than 70.000 were published only last year.
An abundance of research results from more and more specialized subfields combined with a replication crisis related to the one in psychological research makes it increasingly difficult not only for clinicians but also for researchers to acquire an updated overview of our field. Thus, one of the most important roles for the psychiatrist as a scholar should be to act as a gatekeeper, filtering relevant findings and sum these up in a clear and clinically meaningful way for non-researchers while not losing the complexity and uncertainty of the matter. The psychiatric scholar as a gatekeeper could also play an important role for sorting out which research results are ready for implementation in clinical practice versus those of a more preliminary nature. However, to act as a gatekeeper, one must not only obtain sufficient experience at an overarching level to get an overview of the research field and subfield, but preferably also possess some hands-on experience with advanced methods. Otherwise, it is easy to get confused and blinded by fancy figures, seemingly advanced statistics and technological innovations. The gatekeeper ought to be updated from the research front while at the same time resist to jump on the latest train of fashion.
Again – something close to a Renaissance man is obviously warranted. As such an ambition is probably not possible to achieve for all of us poor psychiatrists, at least we should have an open dialogue on the nature of the role as a psychiatric scholar. How should our role appear in the future? As a superhuman mastering all sorts of technical methods as well as excelling in administrative and clinical skills? As a jack of all trades, mastering none? As a mere clinical advisor? As a natural leader of the research team? Or a bit of everything? Should we aim for the role as Coachman of our own wagon, or risk becoming its fifth wheel? With this introduction I hope to have planted the seed for further discussion among my colleagues on this important issue. □
References by request
Sullivan PF. The psychiatric GWAS consortium: big science comes to psychiatry. Neuron. 2010;68(2):182-6.
Pasman JA, Meijsen JJ, Haram M, Kowalec K, Harder A, Xiong Y, et al. Epidemiological overview of major depressive disorder in Scandinavia using nationwide registers. Lancet Reg Health Eur. 2023;29:100621.
Plana-Ripoll O, Pedersen CB, Agerbo E, Holtz Y, Erlangsen A, Canudas-Romo V, et al. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet. 2019;394(10211):1827-35.
Thompson PM, Jahanshad N, Ching CRK, Salminen LE, Thomopoulos SI, Bright J, et al. ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries. Transl Psychiatry. 2020;10(1):100.
Sullivan PF, Kendler KS. The state of the science in psychiatric genomics. Psychol Med. 2021;51(13):2145-7.
Craddock N, Owen MJ. The Kraepelinian dichotomy - going, going... but still not gone. Br J Psychiatry. 2010;196(2):92-5.