Issue link: https://tmcpulse.uberflip.com/i/425954
t m c » p u l s e | d e c e m b e r 2 0 1 4 15 fashions—both in health and disease. On one occasion when I was eight years old, Dr. Foshee was driving us across a very high bridge spanning the Ohio River that separates Kentucky and Indiana. I asked him why we would feel so anxious when we looked down into the water from the bridge—even though we knew we were safe on the sturdy bridge. Dr. Foshee answered by detail- ing Freud's theory of a 'death wish' that he had learned while a medical student in Boston. It was my first introduction to the world of the unconscious mind and how repressed conflicts manifested as fears, wishes and symptoms. I was enthralled and wanted to learn so much more about how the mind works, and to grow up to be just like Dr. Foshee. Although it remained undiagnosed for decades, one other primary influ- ence of my childhood is that I have a dyslexia. Letters and numbers that I see somehow lose their sequence in my brain, with the result that I could and still cannot 'sound out syllables' when I read. I reverse the letters of words and numbers in columns when I write them down. The net result was that I was a very poor student throughout elementary and middle schools, and for most of high school. Around the 10th grade, things started to change for me. By complete accident, I stumbled upon a new way to read and calculate. I would recognize how a whole word looked— without having to sound out the letters and syllables, as I had been taught to do. If I knew the meaning of that word, I could fly forward. So I made a big effort to learn what a lot of words mean. I also learned to solve mathematics problems in my head, where, for some reason, the numbers and columns didn't 'jump around' until I tried to write them down. By college, I was no longer held back by my dyslexia. Paradoxically, along with the abun- dant upset and frustrations associated with dyslexia, my self-perception of being 'pretty stupid' held some unexpected advantages. For exam- ple, by being a slow, labored reader, I learned to appreciate much more than the content of writing—particularly the quality of how words are expression by excellent writers. And when I began to read rapidly through my new method, I felt like a blind person who could suddenly see. My perceived 'stupid- ity' taught me how to recognize and appreciate the exceptional abilities and qualities of others: people with abili- ties and knowledge that I do not have. Valuing what other people have to say about a vast array of subjects, I began to read nearly everything I could get my hands on—and still do. Thinking of myself as 'stupid' also taught me how to be very persistent and how to overcome my being slow by working longer and harder than many others. It taught me not to give up easily. I learned to pursue creative approaches to escape the con- fining box of my dyslexia. Finally, I also know how it feels to struggle and be 'down and out,' which affords me empa- thy and a credential with my patients when they say, 'You have always had it so easy, Dr. Y. How could you possibly understand what I am going through?' No one who is suffering wants to accept help from someone who they think is pretty close to being perfect. Q | What did you do after you completed your residency? A | When I completed my residency, I was asked by my Psychiatry Chairman at Columbia, Dr. Lawrence Kolb, to work on an inpatient psychiatry teaching service that was located in the Neurological Institute (NI). The NI is a specialized hospital for patients with neurological disorders that is operated by the Columbia Department of Neurology. The patients at the Neurological Institute suffer from such disorders as brain tumors, trau- matic brain injury, Parkinson's disease, multiple sclerosis, intractable seizures; and, for many years, I cared for patients with the psychiatric concomitants of these conditions. As a result, I became very interested in a field called neuro- psychiatry, which focuses on the psy- chiatric aspects of neurological disease and the neurological aspects of psychi- atric disease. For example, we treat the depression of patients with Parkinson's disease, the psychosis associated with stroke, the aggression and irritability associated with traumatic brain injury, and the psychological, interpersonal, family and occupational life disruptions that these devastating illnesses invari- ably lead to. I did research associated with the impulsive aggression, violence and irritability that often is associated with brain lesions. My team and I focused on developing standardized scales to measure aggression, violence and agitation, and we have used these scales to do outcome research on the effectiveness of a broad range of medi- cations in treating these disorders. Q | What would you say are the proudest moments of your career? A | My proudest moment is when a patient says, 'I've been suffering for such a long time, and now I feel better. I just never thought I would feel any better.' Patient care is at the very center of my professional identity and gratifi- cation. I had another moment of pride yesterday when I received, out of the blue, a simple, single-paged note from someone whom I taught when he was a medical student on my neuropsychiatry service at Columbia/ Presbyterian, 40 years ago. He said that what he learned during that experience has helped him take better care of patients throughout his career. For many years a dear friend and colleague, Robert E. Hales, M.D.—a West Point graduate, psychiatrist, and current chairman of the Department of Psychiatry at University of California, Davis Campus—and I have collaborated on two textbooks— 'The American Psychiatric Press Textbook of Psychiatry'; and also the 'American Psychiatric Press Textbook of Neuropsychiatry and Behavioral Neurosciences.' Published by the American Psychiatric Association, both will soon be in their 6th editions and are published in many languages. They are considered standard textbooks in psychiatry and neuropsychiatry for medical students, residents and practic- ing psychiatrists. I also take some pride in two hybrid books that I have written for both mental health professionals and the general public. Both are—to my surprise—well received and quite successful. 'Fatal Flaws' is a book about personality disorders—like borderline personality disorder, narcissistic per- sonality disorder, antisocial personality disorder, obsessive compulsive person- ality disorder, histrionic personality disorder, etc.,—from the perspectives of people in close relationships with people with those conditions. My proudest moment is when a patient says, 'I've been suffering for such a long time, and now I feel better. I just never thought I would feel any better.' Patient care is at the very center of my professional identity and gratification.