With over 5000 journals indexed in PubMed, the announcement of a new journal generally elicits a raised brow along with some variation on these questions: Do we need another journal? Who can

read even 10% of the journals covering neuropsychiatric science, either basic or clinical? Will more journals just permit more publishing of mediocre science? The answers depend on the

journal or, more specifically, on the topic. _Translational Psychiatry_ addresses a topic that is timely and important. The parallel revolutions in basic neuroscience and genetics have not

translated to a revolution in clinical psychiatry. Indeed, few clinical researchers and even fewer clinicians understand the transformative power of the changes that have taken place in the

However in 2011, none of these findings are changing how clinicians diagnose or treat serious mental illness. Although neuroimaging has given us a window into brain development, connectivity

and function, is there any scan that reliably influences clinical care? Even the early diagnosis of Alzheimer's disease, one broadly recognized application of positron emission

tomography imaging, has yet to be shown to change the course of dementia. Would it be irrational exuberance to claim that this ‘valley of death’ between basic science and clinical care is

about to be bridged? I think the bridge is already well underway, and the span is not only from the traditional ‘bench to bedside’ but also increasingly from the clinic to the lab and back

again. Indeed, if there is a culture shift that underscores the timeliness of _Translational Psychiatry_, it is the blurring of what used to be the divide between basic and clinical

research. Consider a few examples, all of which are taken from current National Institute of Mental Health-funded projects: * Discovery of a new risk gene in people with schizophrenia or

autism leads to studies of this variant in neural development in a mouse or synaptic plasticity in slices, searching for cellular pathways that might explain abnormal brain function. *

Induced pluripotent stem cells from people with 16p11.2 or 22q11.2 mutations are differentiated into parvalbumin-positive interneurons along with pyramidal cells to create a ‘disease in a

dish’ that can be used for high-throughput screening of small-molecule modifiers. * Splice variants of candidate genes are mapped in the developing human cortex to identify where and when

sequence variation alters transcription. Are these basic or clinical studies? For most of the twenty-first century, science may not be divided into these categories. What we call

‘translational’ today will likely become the center of our efforts: humans will be the animal model of choice, and information from human studies will guide bench science as often as bench

discoveries influence human research. Of course, the real test of translation will be its impact on public health more than its impact on science. That bridge is still very much under

construction, but it is perhaps the best argument for _Translational Psychiatry_. Public health impact, measured as a decrease in morbidity and mortality, will depend on three breakthroughs

in our understanding of mental illness. First, we need biomarkers for early detection. Currently, all mental illnesses are diagnosed by abnormal behavior and cognition. We know from other

brain disorders (for example, Parkinson's, Huntington's and Alzheimer's disease) that changes in behavior and cognition are a late stage of a chronic process, and we know from

other areas of medicine (for example, cardiovascular disease and cancer) that early detection and early interventions are associated with better outcomes. Neuroimaging, genomics and perhaps

other ‘omics’ will give us these biomarkers for mental disorders. Second, we need pre-emptive interventions for those detected to be at risk or those in pre-symptomatic stages of a mental

illness. These interventions could include medication, but more likely will be psychosocial supports for families or devices such as video games to improve executive function. Finally, we

need better treatments for people with symptoms. Current medications are not good enough. Translational science can yield new molecular targets, new small molecules and a generation of new

early-phase clinical trials that focus on specific domains of function rather than diagnostic categories. Again, we have experience with this drug discovery process for other medical

disorders. With the advent of novel molecular targets for mental disorders, we can expect a generation of new small molecules, some of which will become entirely new classes of treatments,

perhaps as adjuncts to psychosocial treatments as part of a personalized approach to care. These three breakthroughs will be necessary, but not sufficient, for bending the curve of morbidity

and mortality from mental illness. A lesson learned from the rest of medicine is relevant to _Translational Psychiatry_. There are three spans to the translational bridge: the traditional

span (T1), described in the previous paragraph, bridges bench and bedside, or perhaps more often in psychiatry, from imaging lab to imaging suite. Equally important will be the bridge from

clinical lab to practice (T2). The gap between clinical science and clinical practice is legendary in medicine, where a decade or more can separate a new discovery from its broad

implementation in practice. The gap in psychiatry is even greater, as most clinicians come from disciplines outside medicine, and hence much of mental health care is provided in schools,

homes and institutions outside traditional health care. Translational research that focuses on implementation and dissemination needs breakthroughs as much as T1 research. However, there is

yet another span, especially important for psychiatry. The T3 span is the bridge from practice to policy. Even if a $20 000 positron emission tomography scan could reliably diagnose bipolar

disorder (T1), and even if this could be shown to work in a ‘real world’ clinic (T2), would this scan be reimbursed by payors or required by guidelines (T3)? If translational science only

makes mental health care more expensive and less accessible, we cannot expect to be successful in terms of public health impact. All of these issues are within the domain of this new,

exciting journal _Translational Psychiatry_. Yes, there are too many journals for anyone to read, and yes, this proliferation will lead to too many papers being published. However,

_Translational Psychiatry_ has an opportunity to make a difference by publishing the best science at a time when we can see this historic bridge being built that will link science, practice

and policy. I, for one, will watch (and read) with enthusiasm. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * National Institute of Mental Health, National Institutes of Health, Bethesda, MD,

USA T R Insel Authors * T R Insel View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to T R Insel. ETHICS DECLARATIONS

COMPETING INTERESTS The author declares no conflict of interest. RIGHTS AND PERMISSIONS This work is licensed under the Creative Commons Attribution-NonCommercial-No Derivative Works 3.0

Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/ Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Insel, T. A bridge to

somewhere. _Transl Psychiatry_ 1, e2 (2011). https://doi.org/10.1038/tp.2011.4 Download citation * Published: 04 April 2011 * Issue Date: April 2011 * DOI: https://doi.org/10.1038/tp.2011.4

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