A Career That Has Mirrored Psychiatry's Twisting Path
The patient, Keith, was a deeply religious young man, disabled by paranoia, who had secluded himself for weeks in one of the hospital's isolation rooms. In daily therapy sessions he said little but was always civil, seemingly pleased to have company and grateful for a cigarette and a light.
Until one spring morning, when he wrestled the lighter from his therapist's hand and held it to his own head — igniting his hair.
"I grabbed him and was slapping at the flames, and he immediately became passive," said Dr. Thomas H. McGlashan, the man's therapist. "He went limp and pulled a blanket over his head."
He added, "That patient, that experience, changed everything for me."
In a career that has spanned four decades, Dr. McGlashan, now 64 and a professor of psychiatry at Yale, has with grim delight extinguished some of psychiatry's grandest notions, none more ruthlessly than his own. He strived for years to master psychoanalysis, only to reject it outright after demonstrating, in a landmark 1984 study, that the treatment did not help much at all in people, like Keith, with schizophrenia. Once placed on antipsychotic medication, Keith became less paranoid and more expressive. Without it, he quickly deteriorated.
Dr. McGlashan turned to medication and biology for answers and in the 1990's embarked on a highly controversial study of antipsychotic medication to prevent psychosis in high-risk adolescents. But doctors' hopes for that experiment, too, withered under the cold eye of its lead author.
Early this month, Dr. McGlashan reported that the drugs were more likely to induce weight gain than to produce a significant, measurable benefit.
Through it all, he has remained optimistic, restless, hopeful that he is close to understanding some of schizophrenia's secrets. In a way, his work mirrors the history of psychiatry itself, its conflicts and limits, its shift away from talk therapy to drugs and biological explanations for illness.
And for those who want a sense of what direction the field will take next — and how — Dr. McGlashan may serve as a kind of bellwether.
"Basically, you're talking about a person who can walk into an extremely hostile environment and deliver bad news; I don't know how to describe him better than that," said Dr. Wayne Fenton of the National Institute of Mental Health. He is a former colleague of Dr. McGlashan's at Chestnut Lodge, a psychiatric hospital in Rockville, Md., closed in 2001. .....