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From the Editor

FROM BEDLAM TO BIOMARKERS The transformation of ’s terminology reflects its 4 conceptual earthquakes

I fell in love with psychiatry at age 14. I was enchanted by Henry A. Nasrallah, MD and its explanation of mental illness Since then, I have witnessed this med- Editor-in-Chief ical specialty reinvent itself 4 times. because, growing up, I had been told that madness is caused by demonic spir- This transformation is unique in medi- its and bad behavior and it is completely cine, and reflects ultra-rapid changes untreatable. By the time I was in high in understanding the divine - school, I had decided to become a psy- ities of the brain/ continuum chiatrist, and was practicing what I read Psychiatry is the by “counseling” my classmates about over the past half century. Pandora’s box of family conflicts, raging drives, and frus- trating relationships with girlfriends. medicine, full of Consider here my journey in psychiatry wonderful scientific since my adolescence. Growing up in the Rising tide of 1960s and 1970s, I did not watch much twists and surprises television; my father was convinced My love for psychiatry never wavered and a shifting jargon TV would be “too distracting” for us during my undergraduate years. I children. At first, I was angry about his focused not only on required pre-med rule, and would occasionally watch pro- courses but enthusiastically took many grams such as Bonanza at -overs. , sociology, and anthropology electives to expand my understanding The lure of psychoanalysis of human behavior. In medical school, I Gradually, I became grateful to my enjoyed all rotations, but psychiatry was father because—in contrast to my simply sublime. Often, I offered (to my classmates, who sat passively for classmates’ delight) to take their week- hours watching TV after school—I end call at the so I voraciously read the piles of fiction could see more patients. and nonfiction books that I checked After my internship, I married my out from the school library every wife (a behavioral ) and To comment on this editorial week, expanding my general knowl- embarked on psychiatry residency train- or other topics of interest, edge and perspectives. One of my ing with gusto. I was far better prepared, visit www.facebook.com/ favorite genres became psychology I realized, than my fellow residents; CurrentPsychiatry, or go to CurrentPsychiatry.com and click on and psychiatry, including many of my faculty supervisors noticed that I the “Send Letters” link. Sigmund ’s works. answered questions more often than

Current Psychiatry Vol. 14, No. 1 5 From the Editor

Editorial Staff Table EDITOR John Baranowski MANAGING EDITOR Erica Vonderheid The lexicon of psychiatry has evolved across ASSOCIATE EDITOR Patrice Kubik the 4 eras of the specialty WEB ASSISTANTS Connor Kennedy, Jacob Remaly Psychopharmacology Molecular Asylum era Psychodynamic era era neurobiology era Art & Production Staff CREATIVE DIRECTOR Mary Ellen Niatas Bedlam, catatonia, Id, ego, superego, Acetylcholine, adjunctive Akt, astroglia, biomarkers, ART DIRECTOR Pat Fopma chains, , conflict, conscious, drug, adverse effects, brain, brain repair, eugenics, unconscious, agonist, akathisia, connectome, cortex, DIRECTOR, JOURNAL MANUFACTURING Michael Wendt hydrotherapy, ice , defense antagonist, augmentation dendrites, dendritic spines, pick, insanities, mechanisms, , therapy, cytochromes, dentate gyrus, DISC1, PRODUCTION MANAGER Donna Pituras institutionalization, drives, family schism, deinstitutionalization, dysbindin, epigenetics, Publishing Staff insulin coma, family skew, , dopamine, dose schedule, excitotoxicity, executive PUBLISHER Sharon J. Spector lobotomy, , polymorphous dyskinesia, dystonia, GABA, functions, gene knock-in, ASSOCIATE DIRECTOR, eBUSINESS mental hygiene, perverse, primary glutamate, medication, gene knock-out, glia, DEVELOPMENT Joshua Norton possession, rotating process, psychoanalysis, neurotransmitter, gray matter, genome- MARKETPLACE ACCOUNT MANAGER chair, shell shock, , reaction parkinsonism, wide study, Linda Wilson sleep therapy formation, refrigerator pharmacokinetics, interneurons, microglia, CONFERENCE MARKETING MANAGER mother, , pharmacotherapy, plasma mirror , Kathy Wenzler , resistance, levels, postsynaptic , neuregulin, neurite schizophrenogenic presynaptic neuron, protein extension, neurocognition, Editor-in-Chief Emeritus mother, sexuality, binding, receptors, reuptake , James Randolph Hillard, MD , inhibition, revolving door neuroinflammation, suppression, toxic syndrome, serotonin, neurogenesis, Frontline Medical Communications parents, , synapse, therapeutic drug neurogenetics, neurons, CHAIRMAN Stephen Stoneburn monitoring neuroplasticity, nitrosative EVP DIGITAL BUSINESS DEVELOPMENT/CFO stress, oligodendrocyte, Douglas E. Grose optogenetics, oxidative PRESIDENT/CEO stress, pluripotent cells, Alan J. Imhoff progenitor cells, single DIRECTOR OF SALES Phil Soufleris nucleotide polymorphisms, PRESIDENT, CUSTOM SOLUTIONS subventricular zone, JoAnn Wahl tractography, white matter VICE PRESIDENT, FINANCE Dennis Quirk EXECUTIVE DIRECTOR, OPERATIONS Jim Chicca VICE PRESIDENT, AUDIENCE DEVELOPMENT many others during rounds and lec- stay to an absurd 5 days), and I saw sub- Donna Sickles tures. (Thanks, Dad, for banning televi- stantial improvement in many of my VICE PRESIDENT, MARKETING & CUSTOMER ADVOCACY Jim McDonough sion!) I relished every psychotherapy patients before discharge. VICE PRESIDENT, CUSTOM PROGRAMS session and spent hours listening to I was so enthralled by the rising tide Carol J. Nathan audiotapes of my patients’ sessions to of psychopharmacology that I decided in CORPORATE DIRECTOR, RESEARCH & COMMUNICATIONS Lori Raskin improve my skills and to discover the PGY-2 to conduct psychopharmacology Subscription Services: (800) 480-4851 psychodynamic nuances of their psy- research—which, I came to realize, was chopathology. Being supervised by easier than research on psychotherapy. I In affiliation with Global Academy for Medical Education, LLC. expert psychoanalysts was the highlight secured a mentor from the department VICE PRESIDENT, MEDICAL EDUCATION of my week as I honed my psychody- of pharmacology. In PGY-3, I presented & CONFERENCES Sylvia H. Reitman, MBA VICE PRESIDENT, EVENTS David J. Small, MBA namic psychotherapy skills. my data at the Annual Meeting of the But something interesting hap- American Psychiatric Association; in pened during my residency: PGY-4, the paper was published in the Psychopharmacology and electro- American Journal of Psychiatry. 7 Century Drive, Suite 302 Parsippany, NJ 07054 convulsive therapy were helping my By the end of residency, I had applied Tel: (973) 206-3434 severely ill psychotic, manic, and to the National Institute of Mental Fax: (973) 206-9378 www.frontlinemedcom.com depressed patients much faster than Health (NIMH) to pursue a research fel- psychotherapy could. Length of stay in lowship in the neuropharmacology of Published through an educational partnership the wards typically was 30 days (there schizophrenia to prepare me for an aca- with Saint Louis University was no managed care back then to limit demic career. I participated in numerous

Current Psychiatry 6 January 2015 studies on the NIMH research ward, has shifted its clinical and scientific brimming with patients who had refrac- paradigms through several conceptual tory schizophrenia (before the advent models—from demonic possession to of clozapine in 1989), and I published psychoanalysis to psychopharmacol- many articles with mentors and fellow ogy and, last, to molecular neurobiol- researchers. ogy. Four times in my life, the lexicon of psychiatry has undergone a complete make- Investigating brain biology over. This is a light-speed pace of scien- Then another funny thing happened: tific progress over a few decades—truly During my fellowship, one of my men- breathtaking! It’s like rewriting a dic- tors shared with me some early studies tionary over and over, with no 2 suc- about postmortem structural changes cessive editions resembling each other in the brain of schizophrenia patients. whatsoever. Four times in my life, That prompted me to spend hours in The Table shows 4 sets of examples the basement of the pathology depart- of psychiatric terminology, each repre- the lexicon of psychiatry ment examining the brains of dozens of senting 1 of the 4 paradigmatic models has undergone patients with schizophrenia, noting atro- that my generation of has phic changes and performing measure- had to adopt and use in clinical care and a complete makeover ments and histopathologic studies. research. I cannot think of any other Consequently, I embarked on neuro- medical specialty that has come close to imaging research to study the mor- evolving and transforming its language phological abnormalities of cortical and and conceptual models of etiology and subcortical regions in living patients. treatment at such a rapid pace. I found myself going beyond neuro- When I embraced psychiatry in ado- psychopharmacology and diving into lescence as my future career, I never neuroanatomy books and imagined, in my wildest dreams, that journals. I realized that I was continu- I would experience such successive ously learning and using a new scientific scientific earthquakes in my beloved language in my daily work. medical specialty. Perhaps that’s what After I left NIMH to begin a career of kept me stimulated and eager to come teaching, research, and patient care in a to work every day; I use all the models medical school setting, I was engulfed and treatment tools I have learned in by meteoric advances in neuroscience understanding and helping my patients producing unprecedented insights with evolving psychotherapeutic and about the molecular biology of schizo- biopharmaceutical tools; I also teach my phrenia and other severe neuropsychi- students and residents about the multi- atric disorders, leading me to pursue faceted wonders of the human mind new opportunities in neurobiology and the magnificent complexities of the while continuing my psychopharma- brain in health and disease. cology research. Psychiatry has been, and continue to be, a Pandora’s box of medicine, full of The rate of transformation is stunning scientific twists and surprises mind-boggling and a transformative lexicon to match. Looking back at the span of time from childhood through the exciting journey of my psychiatry career, I realize how massive a transformation I have wit- Henry A. Nasrallah, MD nessed and experienced. The specialty Editor-in-Chief

Current Psychiatry Vol. 14, No. 1 7