– Of Two Minds: An Anthropologist Looks at American Psychiatry (2001)
In the summer of 1994, I called Randy Gollub because a senior psychiatrist had described her to me as a star. (Unless otherwise indicated, the psychiatric scientists in this chapter are identified by their real names.) She was a laboratory scientist. […]
Randy turned out to be a lean, lanky woman, rather attractive, very determined. At first, she said, her scientific zeal had indeed been fueled in part by her feminism and by her determination to advance the status of women in science. “I didn’t want to earn as much as a man,” she recalled. “I wanted to earn more.” So she credentialed herself well. She took a medical degree not because she wanted to do clinical work but because she had been advised that as a neuroscientist she would do better in the grant world with an M.D. The lore says that doctors are better funded, because they have more resources to tap for funds and more prestige. The lore also points out that a medical degree is superfluous to their work, at least in comparison to their academic training, that it is graduate and postdoctoral work that teaches a doctor to think like a scientist. Many future scientists get their medical degrees nonetheless.
Then she fell in love with the science and, more remarkable to her, the clinical side of medicine. “Much to my surprise, I really enjoyed the clinical work, and I couldn’t give it up now.” Randy did an M.D./Ph.D. at Duke and a postdoc and residency at Yale. Eighteen years after she started her undergraduate degree (four for the B.A.; four for the M.D.; four for internship and residency; six for the Ph.D. and postdoc), she took her first non-student job. She was over thirty-five. In 1994, the American Psychiatric Association Press published a book coauthored by one of Randy’s mentors – the director of the lab in which she was given space – that set out the intellectual basis for this kind of serious psychiatric science. The Molecular Foundations of Psychiatry by Steven Hyman (then at Harvard, now the director of the NIMH) and Eric Nestler (at Yale) describes the neural structure of the brain. It is a brilliant book, written with a sophisticated understanding of the interaction between genetic abnormality and environmental influence. It is also strikingly technical, with paragraphs for the ”general” reader distinguished from paragraphs for the reader who wishes to pursue material in depth. It displays the brute fact that psychiatric laboratory science exceeds the everyday medical student as graduate-level work exceeds the freshman and is beyond the grasp of the average psychiatric resident. The determination and early dedication needed to choose this professional road winnow out all but the very few. This makes a person like Randy very rare. The existence of people like her can make a young psychiatrist who discovers this kind of psychiatric science in residency feel awed and humbled. […]
To a young psychiatrist looking in from the outside during residency, this is a glamorous, powerful world. From the inside, it often seems less romantic, and the noble pursuit of truth seems chained to pragmatic expediency. Randy had an enviable position: an academic title, start-up money for the lab, the support of a powerful university’s name. But her salary support was not guaranteed beyond a few years. In a time in which perhaps 10 percent of all scientific grants were funded, the medical school expected her to generate her own salary from grants. Any grant submission requires an intense period of work; many people suggest that a reasonable scientist should devote an entire month to the preparation and submission of one of these twenty-five-page, single-spaced packets, which have accompanying pages and pages of appendices, human subjects clearances, cost estimates, budgets, summaries of previous work, and so forth. After a year or two, Randy would be expected to pay for all her expenses: petri dishes, lab technicians, postdoctoral fellows, secretarial support. Her mentor then had fifteen people on his payroll, and their livelihood depended entirely upon his capacity to generate funds. “As a scientist,” he said, “you must live with a combination of great confidence and great fear.”
These days, science is about generating money. Very few psychiatric scientists are paid by their universities to teach and do research, the way historians and anthropologists and classicists are, even though they too have academic titles and teach in academic settings. Almost all of them must, like Randy, raise their own salary from grants as well as pay the costs of running their labs. (Actually, some portions of their salary may be generated by clinical work. The actual structure of an academic physician’s salary can be fearsomely complex, with “X,” “Y,” and “Z” components subdivided and assigned to different grants, different clinics, and so forth.) To be a working scientist – to pay your mortgage, buy your groceries, clothe your children – you must be funded. Not only must you be funded once, but you must work on projects that can be reliably funded year after year until you retire. Most scientists, then, cannot indulge themselves in good but speculative ideas. The peer review system that awards the grants tends to be conservative, and speculative projects often fail. Those projects do not, by their nature, have much preliminary data. The system is intensely competitive, and your chief rivals may be the ones to review your grant submission. The whole setup makes many researchers bitter and tense. “What I hate about science,” said one of Randy’s senior colleagues with a grimace, “is the financial structure. If you don’t get the grant, you can’t do the work. So you go from gig to gig. You go where the money’s good because you can’t afford not to. I’ve been one of the lucky ones. But you worry about when you’ll be forced to leave Broadway and take a cheap soap opera job to make ends meet.”
To handle such a job well, you need to be able to handle stress well, or at least develop a modus vivendi. While I was writing this chapter, I had lunch with a biologist at my own university. He told me – he is a very accomplished scientist – that he would become so tense about grants and laboratory results and whether the laboratory would produce enough data for him to give talks and get funded that he had developed long-standing problems with his jaws. (It is quite possible for a very bright postdoctoral or doctoral student to work on a project for an entire year and get nowhere, with no data to present. If a senior scientist has a small laboratory, with perhaps one to three people working there, it is quite possible for the lab to produce no data for a year or more and thus to fail to be funded again and be forced to close.) He then recounted the back problems of a score of other scientists. He explained that one of the most important issues for a scientist was whether and how he was able to relax. He himself, he said, read pulp fiction. It is not pleasant to live on grants or even to have to rely on grants to be able to do your research. Historians, anthropologists, and literary critics can continue to work and think regardless of whether they get funded. Scientists can’t.
The hours are also long. Experiments often don’t work, data are often jumbled and messy, techniques fail more often than they succeed, and getting data means interpreting an array of results that may be largely due to error. Young, ambitious scientists are expected to spend all their time in the lab. One postdoctoral fellow in a large lab, where corridors of tables were lined with beakers and little plastic cartons and young people in sneakers were perched on high swivel seats, told me a story about such-and-such famous lab, where the lab director – the gray-bearded senior who directed the lab’s research – would come around the lab on Saturday nights and Sunday mornings to make sure that the students and postdocs were there. It may be an apocryphal story, but the postdoctoral fellow swore that it was true.
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