A Conversation with Joshua A. Gordon.

Dr. Gordon: I spoke generally about what I perceive as the challenges and opportunities in psychiatric neuroscience. In particular, we in psychiatry—in trying to understand our disorders and help our patients—have significant challenges that we face around the burden of our disease, around challenges in terms of diagnoses and whether they correspond to the real entities that are causing people’s suffering. In terms of what we call biomarkers, tests that we can do in people to help diagnose them or guide treatment decisions, we have none. And our treatments, although they generally do work for many people, don’t work well enough for many and don’t work for a significant chunk of the patients who need help. You put those together and we face considerable challenges in terms of trying to help people who are suffering from mental illnesses. The opportunities, though, are equally impressive. We now have, in the area of genetics, knowledge of 200+ places in the genome that predispose to various psychiatric illnesses, included schizophrenia, bipolar disorder, and depression. Each one of those places in the genome that’s associated with psychiatric disorder represents a clue as to the biology underlying the disorders, and those clues are then opportunities for us to understand and potentially develop treatments for these illnesses. We also face tremendous opportunity in a specific area of neuroscience that’s really blossomed in the last 10 years, circuit neuroscience, wherewe’ve gained—at least in mice —the ability to monitor and modulate neural activity in very precise parts of the brain. Not just anatomical parts, but neuron-specific cells in the nervous system, specific projections, specific wires within the nervous system that have allowed us to dissect the elements of the brain that control behavior. The hope is that, in understanding those elements, we can develop knowledge or treatments for psychiatric illness. The third area that presents a unique opportunity for psychiatry are computational and theoretical approaches. We have “big data” approaches, machine learning approaches, but also modeling approaches and theoretical approaches that allow us to ask questions about how the brain produces behavior and how that might go awry in psychiatric illness with greater sophistication and greater precision. So I think if we are able to exploit genetics, neural circuits, and computational approaches, we can make progress more rapidly than we’ve been able to do in the past.