The Mosaic of Contemporary Psychiatry in Perspective Anthony Kales Chester M Pierce Milton Greenblatt Editors

The Mosaic of Contemporary Psychiatry in Perspective

With 14 Illustrations

Springer-Verlag Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest Anthony Kales, MD Chester M Pierce, MD Department of Psychiatry and Central Pennsylvania Harvard Medical School and Harvard Graduate Psychiatric Institute School of Education Milton S Hershey Medical Center Cambridge, MA 02138 Pennsylvania State University College of Medicine USA Hershey, P A 17033 USA

Milton Greenblatt, MD Department of Psychiatry and Biobehavioral Sciences University of at School of Medicine Los Angeles, CA 90024 USA

Library of Congress Cataloging-in-Publication Data The Mosaic of contemporary psychiatry in perspective / edited by Anthony Kales, Chester M. Pierce, Milton Greenblatt. p. cm. Includes bibliographical references and index. ISBN-13: 978-1-4613-9196-8 e-ISBN-13: 978-1-4613-9194-4 001: 10.1007/978-1-4613-9194-4 1. Psychiatry. I. Kales, Anthony. II. Pierce, Chester M. III. Greenblatt, Milton. RC458.M64 1992 616.89-dc20 91-42161

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Production managed by Francine Sikorski; manufacturing supervised by Robert Paella. Typeset by Asco Trade Typesetting Ltd., Hong Kong. 987654321 Preface

For more than a 40-year span beginning in 1950, ence it was agreed that the papers presented Louis Jolyon West has been a driving force in could form the nucleus of a book, which could our profession. For 15 of those years, he chaired be expanded by invited contributions from the Department of Psychiatry, Neurology and other clinicians and researchers, contempo• Behavioral Sciences at the University of Okla• raries of Dr West, whose careers had also been homa School of Medicine; then for the next 20 significantly influenced by him. years he chaired the Department of Psychiatry The purposes of this volume are: (1) to trace and Biobehavioral Sciences at the UCLA the evolution of major developments, changes, School of Medicine. During this 4-decade and advances in the field of psychiatry; and (2) period, there has been a dynamic evolution in to discuss and review Dr West's many, multi• the field of psychiatry. Psychiatry, neurology, faceted contributions to the field. These two and the biobehavioral sciences have undergone approaches are quite complementary. While a tremendous information explosion, with contemporary psychiatry is truly a mosaic of subsequent rapid changes in concepts of etiol• numerous intertwining and interacting perspec• ogy, diagnostic approaches, and treatment tives, the same can be said of Dr West's career, methods. As a result, the clinical mental health interests, and contributions. West has exem• professions have experienced pronounced shifts plified in his work the need to utilize fully as well in preeminence from psychoanalytical to be• as to extend the limits of our psychiatric knowl• havioral to biological models of thought, while edge, although it involves risks, requires cour• recently moving toward a more integrated and age, and may even have negative political or eclectic framework. This synthesis and integra• social consequences when one is too bold for the tion of conceptual frameworks are congruent community's grasp of a current issue. Few in with Dr West's lifelong, broad perspective contemporary psychiatry have accomplished about our profession. what he has, or have done it so well in so many To honor Dr West on the occasion of his different areas, as is evidenced throughout retirement from the University of California this volume on The Mosaic of Contemporary at Los Angeles Neuropsychiatric Institute, a Psychiatry in Perspective. The following topic gathering of psychiatrists, neuroscientists, and areas are included among West's seminal mental health researchers was held in Los studies: alcoholism; cocaine abuse; marijuana Angeles on May 12 and 13, 1989. Topic areas and the amotivational syndrome; LSD; drug de• covered a broad spectrum of psychiatry and pendency; sleep deprivation; hallucinations, biobehavioral subjects. Each speaker was en• dreaming, and neurophysiology; racism; civil couraged to reminisce and elaborate on West's rights; violence; Tarahumara Indians; and contributions to the field as well as on his or her quacks; homosexuality in the military; remedi• own career development. Following the confer- calization of psychiatry; and the medical school

v vi Preface

curriculum, particularly the incorporation of their involvement in the development of fresh the behavioral sciences. insights into their solutions. Each author has the The traditional focus of psychiatry has been knowledge and clinical and research experience rooted in philosophical, theological, and scien• to write authoritatively, clearly, and concisely tific origins. In the last century, however, a in his/her particular area. One objective of complex array of subdisciplines (biological the book is to produce an up-to-date, well• psychiatry, psychoanalytic/dynamic psychiatry, integrated, and technically sound text that will social and community psychiatry, and cul• enhance the knowledge and technical skills of tural psychiatry) has evolved, each with its all clinicians in every field of mental health, but respective model of mental illness. Along with especially in the practice of psychiatry. Another the emergence of these models has come an important objective is to facilitate clinicians in unfortunate tendency toward fragmentation their endeavors to integrate coherently the past, and a polarization of intensely valued views. present, and future in a variety of areas in Like the proverbial blind men describing the psychiatry . elephant, all are correct-but only partially. Louis Jolyon West unfailingly combined and Furthermore, priorities in funding and shifts integrated within his own unique style and cap• in social and political policy have created dis• abilities: an abiding interest and curiosity for tortions in the emphasis of one area of spe• complex issues; consistent and reliable sup• cialization over another. As a result, a growing port and encouragement for junior and senior need exists for meaningful integration of these colleagues; caring and compassion for his fel• subdisciplines into a single, broad mosaic of low human beings; extensive experience and psychiatry. Psychiatrists, by the nature of the knowledge of the community and culture; en• complex problems that afflict patients, must thusiasm and zeal of -the dedicated investiga• be increasingly multidisciplinary and inter• tor; wide general erudition; and vast clinical disciplinary in their perspectives. knowledge and skills. He has made major con• The Mosaic of Contemporary Psychiatry in tributions in the field of psychiatry from Perspective is organized into six main topic clinical, societal, educative, research, and ad• areas: Social and Community Psychiatry; ministrative standpoints. His fresh viewpoints Anthropological/Sociocultural Considerations; led the way to looking at vexing problems in Brain and Behavior and Mental Phenomena; new and creative ways, thus leading to innova• Psychiatric Disorders and Dysfunctions: Phe• tive approaches to their solutions. In addition nomenology and Treatment; Drug and Alcohol to his own many noteworthy achievements, Abuse; and Education and Administration . . West's encouragement and support for the The overall goal of this volume is to address efforts of others have been extraordinary. As these major lines of thought that have shaped many of the contributors to this volume ac• and influenced the scope and breadth of knowledge, West is the optimal leader-an modern-day psychiatry. In general, individual excellent recruiter of the best people, and a chapters begin with a historical perspective on provider of maximal support and encourage• the topic discussed, followed by a description ment without interference or overdirection. and overview of the subject, and conclude with Finally, he has accomplished this while exem• a look at the future of psychiatry in that area. plifying the finest personal characteristics. Authors frequently cite West's published works To quote one of our contributors, Robert as well as include, in their chapters or in their Coombs, "I regard him as a model of human respective section introductions, vignettes and kindness and decency, one who consistently personal recollections as to how he strongly overlooks and forgives the abrasive, some• affected the subject under consideration and/or times mean-spirited actions of others. He is encouraged their own career activity. truly a giant among men in every sense of the The volume is designed not only to inform word." our readers but also to stimulate their vision of We hope that this volume reflects some of new facets of some old problems and to elicit West's ambition and enthusiasm for psychiatry Preface vii

and that it will help to increase the momentum able contributions. We also gratefully acknowl• of efforts by other professionals in the field to edge the immeasurable help and skilled assis• learn from our past as we work in the present to tance of Toby Cronin and Cheryl Medich. establish an even better future for psychiatry. Finally, we are indebted to Louis Jolyon West, The editors express their deep appreciation to to whom this book is dedicated, for his inspiring all of the authors for their important and valu- leadership to our field.

Hershey, Pennsylvania Anthony Kales, MD Cambridge, Massachusetts Chester M Pierce, MD Los Angeles, California Milton Greenblatt, MD Contents

Preface...... v Contributors ...... xiii

Part 1 Social and Community Psychiatry

1. LJ West's Place in Social and Community Psychiatry 3 Milton Greenblatt

2. Linking the Public Mental Health System With Academia (UCLA) ...... 14 Milton H Miller

3. Psychiatry and Legal Regulation: Thirty Years of Beneficence or Three Decades of Bedevilment? ...... 24 Mark] Mills and Mark S Lipian

4. Human Sexuality and Law: Three Decades of Transition...... 36 Richard Green

5. Reflections on Psychiatry and the Death Penalty 44 Hugo Adam Bedau

6. Violence, Personality, and Post-Traumatic Stress Disorder: Developmental and Political Perspectives ...... 53 Robert S Pynoos

7. Medical Ethics ...... 66 Bernard Towers

Part 2 Anthropological and Sociocultural Considerations

8. Louis Jolyon West and the Ecological Model of Psychiatric Disorders: A Lecture in Medical History-October 6, 2024 .... 79 Michael T McGuire

IV x Contents

9. Psychohistorical View of Transcultural Psychiatry ...... 89 Joe Yamamoto

10. Contemporary Psychiatry: Racial Perspectives on the Past and Future ...... 99 Chester M Pierce

11. Mental Health Among Hispanic Americans: Four Decades of Research ...... 110 Marvin Karno

12. Jikuri, the Tarahumara Peyote : An Interpretation ...... 121 Alfonso Paredes and Fructuoso Irigoyen-Rascon

13. Cults, Coercion, and Contumely ...... 130 Margaret Thaler Singer and Marsha Emmer Addis

Part 3 Brain and Behavior and Mental Phenomena

14. Advances in Biological Psychiatry ...... 145 Anthony Kales andAlexandros NVgontzas

15. Positron Emission Tomography Studies of Brain Function in Depression and Obsessive-Compulsive Disorder ...... 163 Lewis R Baxter, Jr

16. On the Interaction of Genetic and Epigenetic Factors During Language Development: A Quantitative Histological Study 173 Arnold B Scheibel and Rod Simonds

17. LSD and Psychiatry: A Personal Trip ...... 182 Daniel X Freedman

18. Hallucinations and West's Perceptual Release Theory...... 191 Ronald K Siegel

19. Sensory Deprivation and Sensory Isolation Research, and Political Torture: A 35-Year Critical Retrospective...... 200 Jay Talmadge Shurley

20. The Dynamics of the Organism: Can Mind and Body Be Integrated? ...... 211 Herbert Weiner

Part 4 Psychiatric Disorders and Dysfunctions: Phenomenology and Treatment

21. The Anxiety Disorders: A Review...... 225 Robert 0 Pasnau and Alexander Bystritsky Contents xi

22. Dissociation in the 1990s ...... 238 Stephen S Marmer

23. Reflections on Multiple Personality Disorder: A View From the Looking Glass of Hypnosis Past ...... 247 Martin T Orne and Brad L Bates

24. From Westto Mesmer...... 261 Norman Cousins

25. Schizophrenia: From Institutionalization to Community Reintegration ...... 269 Jerome V Vaccaro, Robert P Liberman, and LisaJ Roberts

26. Suicide and Violence Reduction: Research and Publicity...... 281 Robert E Litman

27. The Psychiatric Subspecialty of Sleep Disorders Medicine ...... 291 Joyce D Kales, Rocco L Manfredi, and Edward 0 Bixler

28. Consultation-Liaison Psychiatry ...... 306 James L Mathis

Part 5 Drug and Alcohol Abuse

29. Children of Alcoholics: Are They Different? ...... 315 Ernest P Noble

30. Neuropsychological Deficits in Alcoholics: Cognitive and Motivational Factors ...... 328 Oscar A Parsons

31. Substance Abuse...... 338 James S Ketchum and J Thomas Ungerleider

32. Nicotine: Medication or Scourge? ...... 347 Murray EJarvik

Part 6 Education and Administration

33. Professional Socialization of the Physician: Implications for EmotionalImpairment or Well-Being ...... 363 Robert H Coombs

34. Teaching Psychiatry to Medical Students: A Pocketful of Wry .. 372 Robert J Stoller xii Contents

35. Psychiatric Education: With Some Remarks on the "West"ernStyle ...... 381 Joel Yager and Fawzy Ibrahim Fawzy

36. Child and Adolescent Psychiatry: Building the Data Base ...... 392 Peter E Tanguay

37. Building Research Careers in Child Psychiatry ...... 403 Dennis P Cantwell and Richard E Mattison

38. Geriatric Psychiatry ...... 413 Lissy F Jarvik

39. Toward Integration of Clinical and Policy Perspectives in Mental Health Services Research ...... 423 Kenneth B Wells

Author Index ...... 435 Subject Index ...... 441 Contributors

Marsha Emmer Addis, Deputy Director for Dennis P Cantwell, MD, Joseph Campbell Pro• Administration, Jonsson Comprehensive Can• fessor of Child Psychiatry and Director, Child cer Center, University of California at Los Psychiatry Training Program, Department Angeles (UCLA) School of Medicine, Los of Psychiatry and Biobehavioral Sciences, Angeles, California. Neuropsychiatric Institute, UCLA School of Medicine, Los Angeles, California. Brad L Bates, PhD, Clinical Research Psy• chologist, Unit for Experimental Psychiatry, Robert H Coombs, PhD, Professor, Depart• Institute of Pennsylvania Hospital, Philadel• ment of Psychiatry and Biobehavioral phia, Pennsylvania. Sciences, Neuropsychiatric Institute, and Chairman, Student Affairs Committee, UCLA Lewis R Baxter, Jr, MD, Associate Professor School of Medicine, Los Angeles, California. and Director, Mood and Anxiety Disorders Clinical Treatment Program, Department of Norman Cousins, MD (hon), Adjunct Profes• Psychiatry and Biobehavioral Sciences, Neuro• sor, Department of Psychiatry and Biobe• psychiatric Institute, and Associate Investi• havioral Sciences, Neuropsychiatric Institute, gator, Laboratory of Nuclear Medicine, UCLA School of Medicine, Los Angeles, Cali• UCLA School of Medicine, Los Angeles, Cali• fornia (deceased). fornia. Fawzy Ibrahim Fawzy, MD, Professor, Depu• Hugo Adam Bedau, PhD, Fletcher Professor ty Chair and Deputy Director, and Chief, of Philosophy, Tufts University, Medford, Consultation-Liaison Psychiatry Service, De• Massachusetts; and Chairman, Board of Direc• partment of Psychiatry and Biobehavioral tors of the National Coalition Against the Sciences, Neuropsychiatric Institute, UCLA Death Penalty, Washington, DC. School of Medicine, Los Angeles, California. Edward 0 Bixler, PhD, Professor and Chief, Daniel X Freedman, MD, Judson Braun Pro• Division of Research, Department of Psychia• fessor of Psychiatry and Pharmacology and try and Central Pennsylvania Psychiatric Insti• Executive Vice Chairman, Department of tute, Pennsylvania State University College of Psychiatry and Biobehavioral Sciences, Neuro• Medicine, Hershey, Pennsylvania. psychiatric Institute, UCLA School of Medi• cine, Los Angeles, California. Alexander Bystritsky, MD, Assistant Clinical Professor and Director, Anxiety Disorders Richard Green, MD, JD, Professor, Depart• Program, Department of Psychiatry and Bio• ment of Psychiatry and Biobehavioral Sci• behavioral Sciences, Neuropsychiatric Insti• ences, Neuropsychiatric Institute, UCLA tute, UCLA School of Medicine, Los Angeles, School of Medicine, and Faculty, UCLA California. School of Law, Los Angeles, California.

xiii xiv Contributors

Milton Greenblatt, MD, Professor Emeritus Erikson Center for Adolescent Advancement, and Vice Chairman, Department of Psychiatry Tarzana, California. and Biobehavioral Sciences, Neuropsychiatric Robert P Liberman, MD, Professor and Direc• Institute, UCLA School of Medicine, and tor, Clinical Research Center for Schizophre• Chief of Psychiatry, Los Angeles County• nia & Psychiatric Rehabilitation, Department Olive View Medical Center, Los Angeles, of Psychiatry and Biobehavioral Sciences, California. Neuropsychiatric Institute, UCLA School of Fructuoso Irigoyen-Rascon, MD, Private Prac• Medicine, Los Angeles, California; Chief, Re• tice, McAllen, Texas; and Former Director, habilitation Medicine Service, West Los Center for Regional Studies, University of Chi• Angeles Veterans Affairs Medical Center huahua, Chihuahua, Mexico. (Brentwood Division), Los Angeles, Califor• nia; and Director, Camarillo-UCLA Clinical Lissy F Jarvik, MD, PhD, Professor and Chief, Research Unit, Camarillo, California. Section on Neuropsychogeriatrics, Depart• Mark S Lipian, MD, PhD, Assistant Clinical ment of Psychiatry and Biobehavioral Sci• Professor, Department of Psychiatry and ences, Neuropsychiatric Institute, UCLA Biobehavioral Sciences, Neuropsychiatric School of Medicine, and Distinguished Phy• Institute, UCLA School of Medicine, Los sician, West Los Angeles Veterans Affairs Angeles, California; and Director, Psychiatric Medical Center (Brentwood Division), Los Services for Orange County Mental Health Angeles, California. District Conditional Release Program, Orange Murray E. Jarvik, MD, PhD, Professor, De• County, California. partment of Psychiatry and Biobehavioral Robert E Litman, MD, PhD, Clinical Profes• Sciences, Neuropsychiatric Institute, UCLA sor, Department of Psychiatry and Biobe• School of Medicine, and Chief, Psychopharma• havioral Sciences, Neuropsychiatric Institute, cology Unit, West Los Angeles Veterans UCLA School of Medicine, Los Angeles, Cali• Affairs Medical Center (Brentwood Division), fornia. Los Angeles, California. Rocco L Manfredi, MD, Assistant Professor Anthony Kales, MD, Professor and Chairman, and Director, Sleep Disorders Clinic, Depart• Department of Psychiatry, and Director, Cen• ment of Psychiatry and Central Pennsylvania tral Pennsylvania Psychiatric Institute, Penn• Psychiatric Institute, Pennsylvania State Uni• sylvania State University College of Medicine, versity School of Medicine, Hershey, Pennsyl• Hershey, Pennsylvania. vania. Joyce D Kales, MD, Professor and Chief of Di• Stephen S Marmer, MD, PhD, Assistant Clin• vision of Social and Community Psychiatry, ical Professor, Department of Psychiatry and Department of Psychiatry and Central Penn• Biobehavioral Sciences, Neuropsychiatric In• sylvania Psychiatric Institute, Pennsylvania stitute, UCLA School of Medicine, and Senior State University College of Medicine, Her• Faculty, Southern California Psychoanalytic shey, Pennsylvania. Institute, Los Angeles, California. Marvin Karno, MD, Professor, Department James L Mathis, MD, Professor Emeritus, De• of Psychiatry and Biobehavioral Sciences, partment of Psychiatric Medicine, East Caroli• Neuropsychiatric Institute, UCLA School of na University School of Medicine, Greenville, Medicine, Los Angeles, California. North Carolina. James S Ketchum, MD, Assistant Clinical Pro• Richard E Mattison, MD, Blanche S Ittleson fessor, Department of Psychiatry and Biobe• Associate Professor of Child Psychiatry and havioral Sciences, Neuropsychiatric Institute, Director, Division of Child Psychiatry, Depart• UCLA School of Medicine, Los Angeles, Cali• ment of Psychiatry, Washington University fornia; and Medical Director, Erik and Joan School of Medicine, St Louis, Missouri. Contributors xv

Michael T McGuire, MD, Professor, Depart• havioral Sciences, Neuropsychiatric Institute, ment of Psychiatry and Biobehavioral Sci• and Assistant Dean of Student Affairs, UCLA ences, Neuropsychiatric Institute, UCLA School of Medicine, Los Angeles, California. School of Medicine, Los Angeles, California; and Director, Nonhuman Primate Laboratory, Chester M Pierce, MD, Professor of Education Sepulveda Veterans Affairs Medical Center, and Psychiatry in the Faculty of Medicine, Sepulveda, California. Graduate School of Education and Faculty of Public Health, Harvard University, Cam• Milton H Miller, MD, Chairman, Department bridge, Massachusetts. of Psychiatry, Harbor-UCLA Medical Center, Torrance, California; Professor and Vice Robert S Pynoos, MD, MPH, Associate Pro• Chairman, Department of Psychiatry and Bio• fessor and Director, Program in Trauma, Vio• behavioral Sciences, Neuropsychiatric Insti• lence and Sudden Bereavement, Department tute, UCLA School of Medicine, and Deputy of Psychiatry and Biobehavioral Sciences, Medical Director, County of Los Angeles Neuropsychiatric Institute, UCLA School of Department of Mental Health, Los Angeles, Medicine, Los Angeles, California. California. Lisa J Roberts, MA, Project Coordinator, Mark J Mills, JD, MD, President, Forensic Treatment of Schizophrenia and Stimulant Sciences Medical Group, Rancho Santa Fe, Abuse Research Project, Clinical Research California; and Clinical Professor, Depart• Center for Schizophrenia & Psychiatric Re• ment of Psychiatry and Biobehavioral Sci• habilitation, and Staff Research Assistant, ences, Neuropsychiatric Institute, UCLA Department of Psychiatry and Biobehavioral School of Medicine, Los Angeles, California. Sciences, Neuropsychiatric Institute, UCLA Ernest P Noble, PhD, MD, Thomas P and School of Medicine, Los Angeles, California. Katherine K Pike Professor of Alcohol Studies and Director, Alcohol Research Center, De• Arnold B Scheibel, MD, Professor of Anatomy partment of Psychiatry and Biobehavioral and Psychiatry, Departments of Anatomy and Sciences, Neuropsychiatric Institute, UCLA Cellular Biology and of Psychiatry and Bio• School of Medicine, Los Angeles, California. behavioral Sciences, and Director, The Brain Martin T Orne, MD, PhD, Professor of Research Institute, UCLA School of Medi• Psychiatry, University of Pennsylvania, and cine, Los Angeles, California. Director, Unit for Experimental Psychiatry, Jay Talmadge Shurley, MD, Emeritus Pro• Institute of Pennsylvania Hospital, Philadel• fessor of Psychiatry and Behavioral Sciences, phia, Pennsylvania. Oklahoma University College of Medicine, Alfonso Paredes, MD, Professor, Department Oklahoma City, Oklahoma. of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, UCLA School of Ronald K Siegel, PhD, Associate Research Medicine, and West Los Angeles Veterans Professor, Department of Psychiatry and Bio• Affairs Medical Center (Brentwood Division), behavioral Sciences, Neuropsychiatric Insti• Los Angeles, California. tute, UCLA School of Medicine, Los Angeles, California. Oscar A Parsons, PhD, George Lynn Cross Research Professor Emeritus, Department of Rod Simonds, MD, PhD, Department of Psychiatry and Behavioral Sciences, University Anatomy and Cellular Biology, The Brain of Oklahoma Health Sciences Center, Oklaho• Research Institute, UCLA School of Medi• ma City, Oklahoma. cine, Los Angeles, California. Robert 0 Pasnau, MD, Professor and Direc• Margaret Thaler Singer, PhD, Adjunct Profes• tor, Professional Relations and Alumni sor, Department of Psychology, University of Affairs, Department of Psychiatry and Biobe- California, Berkeley, California. xvi Contributors

Robert J Stoller, MD, Professor, Department Alexandros N Vgontzas, MD, Assistant Profes• of Psychiatry and Biobehavioral Sciences, sor and Director, Computerized Neurophys• Neuropsychiatric Institute, UCLA School of iologic Laboratory, Department of Psychiatry Medicine, Los Angeles, California (deceased). and Central Pennsylvania Psychiatric Institute, Pennsylvania State University College of Peter E Tanguay, MD, Professor of Child and Medicine, Hershey, Pennsylvania. Adolescent Psychiatry and Acting Chief, Divi• sion of Child and Adolescent Psychiatry, Herbert Weiner, MD, Dr Med (hon), Profes• Department of Psychiatry and Biobehavioral sor, Department of Psychiatry and Biobe• Sciences, Neuropsychiatric Institute, UCLA havioral Sciences, Neuropsychiatric Institute, School of Medicine, Los Angeles, California. and Member, Brain Research Institute, UCLA School of Medicine, Los Angeles, California. Bernard Towers, MD, Professor Emeritus of Anatomy and Psychiatry, Departments of Kenneth B Wells, MD, MPH, Professor, De• Anatomy and Cellular Biology and of Psychia• partment of Psychiatry and Biobehavioral try and Biobehavioral Sciences, Neuropsychi• Sciences, Neuropsychiatric Institute, UCLA atric Institute, UCLA School of Medicine, School of Medicine, Los Angeles, California; Los Angeles, California. and Senior Research Scientist, The RAND Corporation, Santa Monica, California. J Thomas Ungerleider, MD, Professor, Depart• ment of Psychiatry and Biobehavioral Sci• Joel Yager, MD, Professor of Psychiatry and ences, Neuropsychiatric Institute, UCLA Associate Chair for Education, Department School of Medicine, Los Angeles, California; of Psychiatry and Biobehavioral Sciences, and Presidential Appointee, National Commis• Neuropsychiatric Institute, UCLA School of sion on Marijuana and Drug Abuse, Washing• Medicine, and Assistant Chief of Staff for ton, DC. Residency Education, West Los Angeles Veterans Affairs Medical Center (Brentwood Jerome V Vaccaro, MD, Assistant Professor, Division), Los Angeles, California. Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, UCLA Joe Yamamoto, MD, Professor, Department School of Medicine, and Assistant Chief, Re• of Psychiatry and Biobehavioral Sciences, and habilitation Medicine Service, West Los Chief, Laboratory for Cross-Cultural Studies, Angeles Veterans Affairs Medical Center Neuropsychiatric Institute, UCLA School of (Brentwood Division), Los Angeles, Cali• Medicine, Los Angeles, California. fornia.