One of the areas that is widely acknowledged to be filled with excitement and promise in its potential to provide important breakthroughs is that of the field of psychiatry. Usually when a field acquires this degree of popularity and promise, there is a stampede, or at least a rush, to become involved. While there is no dearth of interest, psychiatry's growth in popularity has not been matched by the kind of financial support necessary to sustain and nourish these thrusts in Canada.
The reasons for the excitement and promise associated with psychiatry are not hard to identify. This century has been marked by creative and ever-increasing interest in matters psychological, including how they relate to the field of mental health and mental illness. With psychoanalysis providing the springboard, the field has travelled in countless different directions; many new concepts have been introduced that have radically changed the practice and efficacy of psychiatric treatment. Cognitive behavioural therapy, for example, has shifted the thrust considerably.
The psychopharmacological revolution has streamlined and humanized the treatment of all psychiatric patients. The general disapprobation in which society holds large institutions has also changed forever the hospital landscape.
The enormous technological advances in brain imaging with a host of different techniques, many of them not even thought of a generation ago, have perhaps done more to unite the brain/mind duality than anything else. Should one then be concerned at all about research being done in this field or, more particularly, about researchers in Canada being occupied and dedicated in this endeavour?
In addition to the increasing availability of improved methods of finding answers to complicated questions is the increasing realization of the importance of psychiatric illness in the social scheme of things. Next only to the burden of cardiovascular illness is the burden placed on society by psychiatric illness, including alcoholism and other addictions. Increasingly, all illnesses have a biopsychosocial element. There will be an important coming together of results to enhance knowledge and treatment in the mental health field. In today's society, however, facts and figures often do not stand out enough to attract the attention of decision makers, so active advocacy is required.
As times change, issues take on different complexions, and so it is valuable and timely that matters concerning the training and retention of researchers in Canada become a focus for discussion. The articles by Doctors Nady el-Guebaly and Mark Atkinson in this issue are important for many reasons, if for no other reason than that they point out the need for the general psychiatric community to become involved, concerned, and interested in this topic. Science tends to pride itself on themes of universality. Thus, it comes as no surprise that the Canadian research activity scene would, in most ways, reflect the general scientific climate. Nevertheless, it is important to understand the ways in which we resemble and/or differ from other systems of psychiatric research, especially those current in the United States, since both Canadian and American medical education, practice, and research have grown and developed not only in parallel, but as part of the same tree. This active comparison allows us to benefit from the experience of others in identifying and solving problems.
The authors discuss a very important area of education in general, and that is the role of mentoring, or to use other terms, role modelling or identification. Not so long ago, when recruitment into psychiatry was alarmingly diminished, 1 of the solutions identified was to expose medical students to exciting teachers. This was pointed out as necessary to stimulate and maintain the curiosity and interest of young students who enter medicine with a high degree of enthusiasm and energy, and with still relatively unformed directions and outlook. Enhancing opportunities for undergraduate students to become involved in psychiatric research projects or endeavours would ensure that those students interested in exploring research would do so in a psychiatric field. This is even more important during residency training and will require continued evaluation of those programs already in place. Good programs would allow residents interested in pursuing research careers to have exposure to a research project and to spend some of their training time in a research milieu.
Critical evaluation, knowledge of rules of evidence, and the establishment of evidence-based practice are important modalities requiring future practitioners to be highly sophisticated consumers of research data. These elements could profitably be intertwined in the educational endeavour, particularly if a certain standard of accomplishment is required as an exit criterion for fulfilling fellowship requirements. Such a requirement could ensure that each of the programs in Canadian departments of psychiatry has within it, or closely associated with it, a major research endeavour. The authors point out some collaborative endeavours that might become very useful in this regard.
Funding is another issue that the authors bring to our attention. It is a perpetual source of difficulty, and is increasingly so in times of rearrangement of priorities. The role of the universities is, as always, paramount in the development of a cadre of individuals who are capable of research endeavours, but the agenda for research will in large measure be dictated by society. Broadly speaking, the role of those who, as the authors put it, are entrusted with the leadership of psychiatry and the future of the departments of psychiatry will be to help direct the flow of funds into research that will not only advance the pool of knowledge in particular ways, but advance the health of patients in society.
There have been attempts to direct funding in ways that would promote the development of young investigators (for example, research training programs and fellowships). This has been a tried and true approach that has been used quite successfully not only in Canada, but elsewhere. Updating and revisiting all funding approaches would be an important sequel to these papers.
In their 2nd article, el-Guebaly and Atkinson point out that in Canada, as in the United States, women are under-represented in academia, particularly in the higher ranks and in research endeavours. They allude to the interruption of academic careers faced by many women as a result of their taking time out for childbearing and child rearing. What may be more important, however, would be to determine the factors that drive the interests and the wishes of women who want to enter the research field, to ascertain at which point in their lives or careers they wish to do so, and to define the difficulties that are encountered. These questions may be equally valid for the small number of faculty regardless of sex who come "late" to an interest in research. Provided that the proper training has been undertaken and that reasonable ideas and projects are in hand, it may be useful to treat certain groups as "young investigators," in this way making seed money more available. To the investigator who is coming relatively late onto the scene, the lack of a sufficient track record makes starting research a very difficult endeavour. Established research groups should work to find ways of welcoming "latecomers" as possible participants.
The development of new knowledge and the adaptation of findings for the care of patients are some of the main goals of research and will continue to be major activities of developed societies. While Canadian science participates actively in the global effort, its contribution may require some particular national organization. With research endeavour being so important, it behooves the various leadership groups that already meet and have contact with each other to make this matter a high priority for further advancement and solution.