multi-syllabic way of saying “we don’t know:” Insel

As usual, I cheer all the way through Thomas Insel's thoughtful and meaningful blog posts. His most recent, What Caused This To Happen, is a good example. It is okay to say "we don't know." In fact, when it comes to issues of such import to so many we damned well better start saying "we don't know" when we don't.

rorschach blot
Mental illness treatment is way too comfortable with offering answers to questions that haven't even been properly formed not to mention answered. Our clinical environment is resplendent with answers that have little or no basis.

Most mental health care out there is baseless. It's well-intentioned and deeply believed but absolutely without grounding and the public deserves to know it. If we were to stop paying for and spending time on anything but that which has been clearly established I wonder:

1.    Would the burden of mental illness be much affected?
2.    What would happen to all the resources saved?

The problem with "not knowing" is less the lack of knowledge -- that leads the way to finding solutions -- but the burden of all the treatment that is based on false knowing. There is far too much unaccountable certainty and hubris: being motivated by genuine caring, this is the most dangerous care of all.

yes, this is what you think it is.
I'm not saying that treatment has to be well-researched to be of value. I'm saying that not knowing the difference is a disservice to the point of cruelty because in the end it is the patient who suffers and is blamed for not getting better. We are failing sufferers of mental illness in so many ways.

We need to get comfortable with saying "we don't know." Only then can we see clearly what we do know and make a better map to look for answers.

P.S. in the interest of "keeping it real" must note that while Dr. Insel's blog is up to date the NIMH site is not. The eating disorders page is pre DSM5 and while not terrible is still riddled with thinking of the past about EDs. If it was written more to the tune of the Anxiety Disorders page (also a bit out of date) I would be happier. The NIMH should be cutting edge in all ways. Advocates and activists need our top experts to walk the walk for the public so that we can refer people to them with confidence.


  1. Yes! " . . .the burden of all the treatment that is based on false knowing."

  2. "We don't know"-- in Laura's world, means:
    "Parents have been 100% vindicated from any responsibility, ever!!!" Nobody will ever have to pretend to care how their daughter feels, ever again!"

    1. What you're missing, dear anonymous, is that the message that parents don't cause eating disorders is not a pass on doing or caring but permission and INSISTENCE that parents get to work on supporting and listening to and pursuing care. Guilt is easy and, well, narcissistic. Actually engaging and helping your kids through this disorder is some of the hardest, most personally challenging, deeply PARENTAL work we ever have to do.

  3. Laura - your book is inspirational. As a mother of a 13 year old recently diagnosed with anorexia (restrictive) I have spent the last 4 weeks in a dark pit of ignorance. not because I am unable to find information on the internet to help and support my family, not because I am unable to fathom out the situation with the help and support or my findings, and books like yours, but because, in France, the medical team, in particular the psychologist, has completely cut us off from our daughter by refusing to 1. allow her to receive ANY letters, packages (colouring books) drawings from her friends,2. refusing to let us either visit or speak with our daughter and 3, refusing to explain to us the type of treatment being undertaken. When requested to be put in touch with a support organisation for parents and families we were told there isn't one. We have not been allowed to be included in the care for our child, except for physical support in a different hospital in the first week when she was in intensive care and in danger of dying. Thank you for and F.E.A.S.T

    1. Thank YOU so much for coming back to let me know. It means so much. Keep on advocating for your dear daughter. Have courage. We are like people at the beginning of the understanding of germ theory, or that the world is not flat: we aren't believed YET, but have to do what we know is best.


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