Phillip Campbell, the editor of the journal "Nature," predicts the next ten years (2010-2019) will be the "decade for psychiatric disorders" because discoveries in genetics and neuroscience are transforming our understanding of psychiatric illnesses. What was once a mysterious mixture of philosophy and psychology has become a real field of medical science with chemistry making the most significant strides.

Dr. James Shield of the Tucker Psychiatric Clinic also believes that this is an exciting time for the science of the mind. A second-generation practitioner of psychiatry, he is known throughout Virginia as an expert in his field. He is past president of the Medical Society of Virginia and the Psychiatric Society of Virginia.

Shield considers the brain to be the new frontier in science. "There are so many new therapies and medications now that can really help people with serious problems," he says. "We can do so much more for patients today. We have a constellation of medications designed to fit specific brain chemistry."

In the past, he says, "these discoveries came about through lucky accidents. But now medications are being created in the lab and combined in new ways that really fine-tune their effectiveness."

In addition, genetic research is revealing amazing things. He points out that most people do not realize that Virginia Commonwealth University/Medical College of Virginia Department of Psychiatry has one of the top genetic research programs for alcoholism and schizophrenia in the entire country.

Shield believes we can use these exciting discoveries and combine them with psychotherapies to help people get better.

When patients come to see him, Shield gives them an understanding of what he sees—a diagnosis, a treatment plan (with medications if necessary) and counseling. "We build a therapy plan to help them manage their illnesses," he explains.

Shield asks his patients about their chief complaints, their history and family interaction. He asks questions such as: "Did your family talk about problems? Did you get into trouble if you talked about problems? There are three ways to handle problems: talk it out, act it out or internalize it."

"Resolving problems is a big part of staying mentally healthy," he explains.

While new medications and neurological discoveries are exciting, the downside of treating mental illness today is considerable.

"If you are disabled by an illness—physical or mental—you are in a bind—you can’t work and have no insurance," Shield says.

And while new drugs are wonderful, they can be extremely expensive and insurance companies may want patients to use older, generic brands, he explains. Also, there is less funding and health insurance coverage for psychological problems and very few hospital beds available.

"Even for a serious psychotic episode there are many hurdles to getting a patient the care he needs," says Shield. Most people do not realize that hospitalization for more severe mental illnesses such as schizophrenia, bi-polar and depressive disorders, is almost impossible to obtain beyond the short-term crisis. Most health insurance policies will pay for no more than a few days of hospitalization.

Even if a patient is hospitalized, there are few residential programs available for them upon release. As a result, many wind up on the streets or in jail. In fact, a recent report by the National Sheriff’s Association states that about 16 percent of the people in jails have a diagnosed severe mental illness. There is simply no other place for them to go.

Another problem is that the person having a psychotic episode may have no awareness of their need for hospitalization or treatment. And due to changes in the laws regarding an individual’s rights, it is extremely difficult to commit a person without their consent. Today, a person must acknowledge being suicidal or homicidal to be hospitalized involuntarily.

Shield’s advice to anyone who feels they may have a mental problem: Recognize and acknowledge there is a problem and listen to those who love you. Also, ask questions, do research and take action to get help. FP