Authority on Schizophrenia Dies (New York Times. ) I seem to be noting more obituaries of my teachers and mentors here these days. Before he joined the Harvard faculty, I had the privilege of taking a course on psychopathology he offered to Harvard undergraduates as a visiting lecturer. This was the first touchstone of my lifelong fascination with schizophrenic thought processes. His best-known findings and most persistent research obsession, the eye-tracking disorder in schizophrenics, have not turned out to be particularly useful to those of us who treat patients with schizophrenia, nor have they gone very far in elucidating the central pathology of the disorder. But finding an easily testing abnormality that also occurred in the genetic relatives of schizophrenics did more to establish the important notion that there was a ‘schizophrenic spectrum’ from the full-blown disease to those in the family who had a watered-down dose of the genetic substrate of the disorder. Holzman’s other findings about schizophrenic language and memory have been more telling for me, in shaping my understanding of the schizophrenic ‘thought disorder’ in a way which informs a therapeutic approach. He also bravely charted the path I believe most Freudian psychoanalysts had to take, if they were interested in treating more disturbed patients with schizophrenia and other psychotic processes, to bridge the gap between psychology and pathophysiology.
In other schizophrenia-related obituaries, I was saddened to learn that the Schizophrenia Bulletin is phasing itself out. This quarterly journal published by the NIMH since 1969 (ironically, Dr. Holzman was on its advisory board) is unique in combining state-of-the-art review articles on aspects of schizophrenia research and treatment with, in every issue, cover art by a patient with the illness and a first-person account by a person with schizophrenia of the challenges of living with or overcoming aspects of the illness.
The statement from the director of the NIMH explaining the decision to phase out the Bulletin explains that “in this rapidly changing scientific environment it is time to develop communication mechanisms that are equally rapid.” I find this puzzling insofar as the Bulletin is not a vehicle for the latest peer-reviewed and time-sensitive research findings but rather more comprehensive theme-based reviews. Furthermore, it is a conceit to believe one needs to get even the latest research findings as quickly as possible, as opposed to labsorbing them as thoroughly as possible. I do not think it is merely reactionary nostalgia for the way I learned to approach the practice of medicine to lament the obsolescence of the medical journal as a vehicle for medical communication, which is what the authors of this move seems to suggest. When a journal arrives at my doorstep monthly or quarterly, it is a concrete invitation to sit down and get up to date in a way that might not happen with disembodied articles floating out there in the ether. Furthermore, when I read the articles of interest in a journal, I cannot avoid stumbling upon others I would not have suspected would be of interest. This too does not happen as readdily when I read an electronic article. Sad state of affairs…
But then again, readers of FmH will recognize that I have long ranted about the scientific illiteracy of many of my colleagues, so perhaps the medical journal has been obsolete for some time already. Granted, even as a resident I already had a reputation, for which I was both admired and assailed, for keeping up with the literature. I have always distributed articles of significance to my colleagues and students, covertly expecting them to read as well. But most doctors consider themselves “too busy” to keep up with the journals unless they are academics. Unfortunately, that leaves them practicing (in a field where the half-life of knowledge is around — what? — ten years or less) as they did the last time they were up-to-date, which was when they were in their residencies; or updating their knowledge base only by word-of-mouth or with the information provided by the pharmaceutical representatives who visit them. At least in my state, the requirement that a doctor have gotten a certain number of continuing medical education credits in order to renew her/his license is enforced only by the honor system; if you answer “yes” on the renewal application, they believe you. (And if you believe that most doctors who attend medical conferences are there to listen to the lectures, I’ve got a bridge to sell you.)
And let’s not confine this lament merely to the challenge of “keeping up.” How about “getting started”? In my own specialty of psychatry, what proportion of graduating psychiatric residents these days have ever even read any Freud, do you suppose? My guess — less than 10%. (You might argue the irrelevancy of Freudian thinking to modern psychiatric approaches, and I would essentially agree with you; but might not one wish to know one’s lineage, explore the seminal roots of the mysterious field one is in, and reach such a conclusion oneself, perhaps?)
