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My Experience at the Massachusetts Mental Health Center and My Views on Mentorship, Mental Illness and Wellbeing
My research within the Clinical Research Training Program at Harvard during 2001-‐2003 was conducted at the Massachusetts Mental Health Center (MMHC). Well-‐known for its pioneering research in schizophrenia, the MMHC has produced a number of clinical leaders in psychiatry. It may come as a surprise to many that the MMHC (previously known as the "Boston Psychopathic Hospital") was the most influential sites for psychiatric training at Harvard for over 90 years until it was it closed in 2003.
A special tribute was made at the center’s closing ceremony in honor of the men and women who, at various points in their lives, have dedicated their efforts to provide long-‐term care for severely ill patients. Those who have crossed path here reminisced on an era of progress in which Psychoanalysis transitioned to Biological Psychiatry. The MMHC is rather a small institute, largely unknown to many new students in the field, but it was an important driving force behind this shift in psychiatry. The links below contain articles on a heart-‐warming tribute to this very special place on its closing day in 2003. http://www.1856.org/bloom/main.html or http://www.thisiscolossal.com/2012/03/bloom-‐28000-‐potted-‐flowers-‐installed-‐at-‐the-‐massachusetts-‐mental-‐health-‐center/ Potted flowers (28,000 of them) were installed throughout the MMHC. A picture of an old office at MMHC that resembles my old office (upper left) and pictures of other parts of the building for the closing ceremony
At the MMHC, I had a rare opportunity to interact with unique individuals who made significant impact on the way “mental illness” is viewed. These individuals also gave me a glimpse into the inner world of the human mind. I had the pleasure to meet Dr. Allan Hobson, a pioneer in quantifying conscious and unconscious mental events during sleep associated with brain states. Through conversing with him and studies of his work, I saw that he had a profound insight into the processes of the mind well ahead of his time. I also had the honor to be mentored by and worked with Dr. Joseph Schildkraut, who many consider "the father of psychopharmacology". He first proposed a neurochemical basis of psychopathology through his treatise on the norepinephrine theory of depression. I saw the genius in Dr. Schildkraut and gained valuable insight into the neurochemical basis of depression through working with him. My research mentor within the CRTP was Dr. Alan I. Green, who then was a Harvard Professor of Psychiatry. He was also a former mentoree and a long-‐time colleague of Dr. Schildraut at the MMHC. Currently, Dr. Green is Department Chair and Professor of Psychiatry, Professor of Pharmacology & Toxicology and Director of SYNERGY – The Dartmouth Center for clinical and Translational Science. My initial meeting with Dr. Green came about almost by coincidence. Before I arrived at the MMHC, I had daylong interview with PIs across different institutes affiliated with Harvard. Toward the end of the day, I received a last-‐minute notice that Dr. Green wanted to talk to me. A national leader in the treatment of schizophrenia and co-‐occurring substance use disorder, Dr. Green discussed with me about the prevalence of substance use disorder in patients with schizophrenia and his effort trying to understand whether certain abnormality in the brain reward circuitry of these patients that was responsible for this comorbidity, known among clinicians as a condition that was “notoriously difficult to treat”. Coincidentally, I had been curious for some time about a possible link between depression and schizophrenia, because my Ph.D. research found that depression involves elevated tonic release of the neurotransmitter acetylcholine in the nucleus accumbens (a central component of the brain reward circuitry), while the opposite seems to occur in schizophrenia – patients with schizophrenia are known to have a deficiency in the number of cholinergic neurons in the same region. As fate has its way, I subsequently joined Dr. Green’s group. As a recent Ph.D. graduate previously engaged in laboratory research, coming to the MMHC has broadened my view of the complexity of psychiatric practice in the real world. I found that many of the patients being treated had multiple psychiatric disorders that compounded their problems and greatly complicated treatment. But there was one thing I learned that stood out from the rest. Through my conversations with Dr. Green I gained a rare insight into the minds of patients with schizophrenia whose lives were transformed in an amazing way after receiving clozapine treatment. Many of these patients transformed from being withdrawn and incommunicable to being delightfully sociable, as well as having a great sense of humor. Interestingly, these patients also ceased to use alcohol and substances. On the other hand, I could feel the sense of hopelessness in those who did not get well despite receiving multiple different kinds of treatment. I could also imagine the confusion and despair in individuals afflicted by similar or other psychiatric disorders, many of whom do not have access to care or might not seek care for a variety of reasons, including lack of insight into their own conditions. During my journey trying to understand the body, brain and mind, I met individuals whose extraordinary visions and life philosophies have made lasting impression on me. Among them was Prof. Stuart T. Hauser, M.D., Ph.D. former President of Judge Baker Children Center. He was known for his work in adolescent development and his focus on resilience to adversity. An excerpt from Harvard Gazette commented on his work that highlighted the humanity aspect of clinical care and research noted: http://news.harvard.edu/gazette/story/2011/03/stuart-‐t-‐hauser/
“His passion was to understand the construct of self-‐identity development—the growing capacity of the individual to integrate diverse sources of information (internal, social and environmental), balancing the needs of self and other, to move forward in the world. As much as Stuart was committed to understanding the development of the individual human organism, he also recognized at a deep level the profound ways in which family interactions shaped this development. Not content with the paper and pencil measures available at the time to assess these interactions, Stuart developed methods for observing family interactions in vivo, so that key qualities of family
relationships could be better understood by researchers. Not surprisingly, a favorite adjective of his applied to human development was ‘complex’, and he continually sought a deeper understanding rather than simple, facile explanations.”
Another pioneering clinician and researcher I met was Prof. Joseph J. Schildkraut. An article commented on his research philosophy (independent thought, rationality and objectivity) that reflects current approaches in contemporary research: http://news.harvard.edu/gazette/story/2008/10/joseph-‐j-‐schildkraut/
“[In 1959], having selected the Massachusetts Mental Health Center because of its reputation as a program offering a psychoanalytic approach, he found himself as a trainee intrigued by the dramatic response of depressed patients to the administration of electroconvulsive therapy, and imipramine and phenelzine, then being used clinically for the first time. Although Joe continued to be respectful of psychoanalytic treatments, that revelation altered his academic trajectory, and stoked a career that soon played a major role in launching research into the biological mechanisms of depression. The result of this work [measuring metabolites of norepinephrine] was a paper, “The Catecholamine Hypothesis of Affective Disorders: A Review of Supporting Evidence” (1965). This paper … launched 25 years of global research on the relationship between neurotransmitter function and affective disorders … he elaborated the concept presented in his seminal review article by defining subtypes of depression that could be identified by their biochemical “signature”. In retrospect, this work was a pioneering precursor of current research that seeks to replace diagnoses based on clinical signs and symptoms with a classification scheme grounded in biological markers that are much closer to actual disease processes. It also anticipated current efforts toward personalized medicine, to identify treatments that are tailored to attack disease subtypes defined by biological markers, including, now, allelic variants of DNA.”
A pioneer in behavioral neuroscience dear to my heart was my former Ph.D. advisor Prof. Bartley G. Hoebel from Princeton University. Bart was a visionary researcher who set out to discover the brain reward circuitry. His enthusiasm for this important line of research is reflected by the fact that he truly cared for the wellbeing of his students and the society. He was a mentor who taught cooperation and how to live a healthy balanced life. His friends and colleagues commented: http://www.princeton.edu/main/news/archive/S30/80/58G73/index.xml http://www.examiner.com/article/food-‐addiction-‐expert-‐bart-‐hoebel-‐leaves-‐widely-‐recognized-‐legacy-‐for-‐future
“His interest in the brain mechanisms that control appetite and body weight went back to his Harvard days, when he studied under renowned behaviorist B.F. Skinner. A member of the Princeton faculty since 1963, [Bart’s] interest in understanding how the brain rewards behavior encompassed a breadth of research and led to discoveries in the areas of eating disorders and obesity, addiction, alcohol consumption and depression. Some of his earlier research included examinations of how animals regulate their body weight and the neural pathways and neurochemicals involved with motivation. A 1999 study involved examining the brain chemistry of motivation and depression, looking at how dopamine [and acetylcholine] reinforces connections between cognitive inputs and behavioral output, so that successful behaviors are repeated. “Bart’s research on sugar addiction in rats generated worldwide attention for its possible public health applications. His work allowed scientists to examine more deeply the connections between food cravings and brain physiology, with the hope that the research could one day influence work related to humans with eating disorders.
‘[Bart] was a pioneer who was never afraid to put forth a new idea and run with it when others might not agree. He wanted to come out with something that paved the way for new areas of research. Bart was very creative and always tried to come up with original ideas. His most significant research unlocked mysteries about how neurotransmitters send messages between the brain and the body to turn on and
shut off behaviors. He showed that sugar addiction causes changes in the brain seen with drug abuse and the use of cocaine, morphine, and nicotine.’
Dr. Sarah Leibowitz from Rockefeller University, a colleague and longtime collaborator with Bart.
‘Bart always loved to contribute. His science on diet and food disorders seemed to be motivated mainly by an enthusiasm for helping people,’
Michael Graziano, associate professor of psychology at Princeton.
“Beyond his research, Hoebel was a gracious mentor to colleagues and students, his peers said. [Bart’s] accomplishments led many to call him a Rennaissance man, and he was much loved for his sense of adventure and fun, and for generously sharing his time and knowledge. He followed the same advice he gave everyone: 'Do what you love.' 'Lead by example.' You do a lot more by doing than talking.’
‘He loved teaching and was dedicated to teaching undergraduates – not just getting up there and lecturing in class, but training young people to be scientists and really caring about the outcomes of their lives.’
Barry Jacobs, professor of psychology and the Princeton Neuroscience Institute.
‘Bart was the very best example of a friend, professor and mentor. He was always the most generous with his time, ideas and support. He helped many of his students achieve great things but also to find a balance in their lives.’
Mark Gold, chair of the department of psychiatry at the University of Florida.
Sadly, Drs. Hauser, Schildkraut, and Hoebel all have recently passed away. They’ve reminded me that my current work and understanding have benefited from the collective efforts of early pioneers and the wisdom that they passed down to generations of students. At times, I’ve wondered whether my encounters with these three individuals came from my desire to understand the brain and mind from their points of view. At other times, I’ve also wondered whether I was placed in places where I could meet these individuals to learn from them. In either case, they taught me three fundamental principles that I needed to know in order to make a difference in someone’s life. Over the years, I became more aware that my quest to understand the human body, brain and mind was really about discovering what it is to be a human being. From the onset of my career, I have always been focused on applying my research to help better people’s wellbeing and to lessen their suffering and pain. Over time, I became more keenly aware that “individual wellbeing” is intimately tied to “collective wellbeing” within and across communities. When view this way, I clearly see that working toward bettering “collective wellbeing” is an important endeavor. Such effort requires cooperation, which often does not come easily. Nevertheless, history tells us that successful cooperation is not totally outside the realm of possibility, even during difficulty times. In the spirit of an ideal from one very special person, Dr. John Nash, cooperation can occur even when there are differences in goals and opinions. Many societal issues, such as joblessness, poverty and improper diet, can adversely affect brain-‐body-‐mind health. These root causes can be resolved if individuals and communities recognize that it is in the best of their interests to focus on finding solutions for improving collective wellbeing as well as the wellbeing of individuals. In my view, Dr. John Nash’s life is an embodiment of this ideal. While he himself faced enormous difficulties, through the support from his family, friends and colleagues, he in turn was able to make a difference in so many other lives. -‐ David. T. Chau June 19, 2015
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