Abstract
Leo Sher, Riverdale, New York, US:
Creativity and innovations are important for every field of medicine, including psychiatry [1, 2]. Charlton suggests that the ‘deceleration in major innovation has recently been documented for the field of psychiatry and psychopharmacology’ [1]. In his recent article [2], Horrobin states that ‘a person who develops nearly any type of cancer, common skin disease, asthma, or psychiatric or neurological illness is unlikely to be much better off than if they were receiving the best available treatment 30–40 years ago.’ No doubts, the psychiatric research road is long and difficult one with many problems to be overcome. However, effective clinical innovation is an ethical imperative.
Boxenbaum [3] suggests that once a researcher has taken a position within an organization, there are both positive and negative conditions that promote and discourage creativity, respectively. The following actions tend to promote creativity:
– Provide an atmosphere of psychological safety. The atmosphere should emphasize encouragement, empathetic understanding, etc; – Make creativity part of the culture in an organization or department; – Stop converting talented and creative researchers into medocre managers; – Provide resources for productive and creative work.
Individual creativity may be suppressed by the following:
– A military or command-mode management structure; – An environment in which the organization does not recognize creative or innovative ideas; – Discouragement of deviant views and radical innovations. Truly creative scientists, by their very nature, are persons dissatisfied with the status quo. Creative individuals need to find their niche within an organization; – An overemphasis on extrinsic (organizational) motivation. Intrinsic motivation is very important for the self-actualizing process of individual scientific creativity.
The story of James Lind, a creative and astute clinician, is an interesting example. In 1747, Lind, a young physician from Scotland, conducted a study on the prevention and treatment of scurvy [4]. He chose 12 sailors with scurvy and divided them into six groups of two patients each. All 12 sailors received an identical diet but the six groups differed from one another in what they received as a supplement to the standard diet: cider; elixir of vitriol; vinegar; sea water; oranges and lemons; and a folk remedy that consisted of garlic, mustard seeds, horseradish, balsam of peru, and gum myrrh. After one week of treatment patients who were given oranges and lemon improved dramatically. None of the other groups improved. Lind concluded that citrus fruit could treat or prevent scurvy. This discovery saved many lives. However, it would be extremely difficult for Lind to publish his report nowadays. The number of cases involved in his experiment is very small. He made a discovery on the basis of statistically non-significant data.
Modern research instruments and statistical analysis are important for the development of medical sciences. The progressive development of increasingly sophisticated and precise neuroscience research techniques provides new opportunities to unravel the mysteries of brain function. However, neither powerful research instruments nor contemporary statistical analysis can replace the sharpness of mind of a clinical researcher. As Schopenhauer noted, the task of the creative mind is ‘not so much to see what no one has seen yet; but to think what nobody has thought yet, about what everyone sees’ [5].