Wednesday, 01.12.2021

In Memory of Hagop Soreen Akiskal (1944 - 2021)

 

Kenneth Jaffe’s comments

 

 

        I read with great interest Tom Ban’s eulogy for Professor Hagop Akiskal (Ban 2021).  As I attempt to explain in the vignette below, Dr. Akiskal and his mentor at the time, Dr. Bill McKinney, played a truly career changing role in my life in 1973 when I was in the process of applying for psychiatric residency programs.

        In Ban’s tribute to Dr. Akiskal he kindly included his entire interview with Dr. Paula Clayton of Dec. 9, 2008, for the oral history project of the American College of Neuropsychopharmacology.  In that interview Dr. Akiskal spoke about his very positive experience working in Madison, Wisconsin with Dr. McKinney and other faculty at the department of psychiatry.  He also spoke at some length about the importance of his seminal article in the October 5, 1973, edition of Science, "Depressive Disorders: Toward a Unified Hypothesis," co-authored with Dr. Bill McKinney.

 

A Career Changing Article 

        I was doing a six week elective in adolescent psychiatry at the Menninger Foundation in Topeka, Kansas.  It was my senior year in medical school, November 1973. I had already applied and been interviewed at several psychiatry residency programs including the University of Rochester Strong Memorial, Georgetown University Medical Center, Mt. Zion Hospital in San Francisco and Upstate Medical Center in Syracuse, New York.  At Menninger’s I was working as an adolescent psychiatric counselor, assigned to one of the “cottages” that housed about 10 boys ages 14 to 16. It was a residential treatment program.  The average length of stay was about a year. These boys had serious problems getting along with both their families and peers. Most had been diagnosed with ADHD, anxiety, depression and behavioral problems.  

        Many of the counselors were graduate students in psychology or social work from The University of Kansas who worked there part time.  They had been chosen in part to be good role models for these troubled boys.  I received two hours a week of supervision from adolescent psychiatrists and also participated in two weekly seminars for first year psychiatric residents.  Most interesting to me was a weekly journal club that met after supper in one of the faculty member’s home to discuss important new journal articles with the psychiatric residents.

        One evening there was quite a buzz about Akiskal and McKinney’s 1973 article. I was wowed by this article.  It was a far more sophisticated theory of depression than anything I had ever seen.  It viewed depression as a final common pathway that had multiple contributing factors. These included genetics, infant attachment theory, Harlow’s primate model of depression, behavioral reinforcement theory and psychoanalytic concepts. All of these factors ultimately acted on neural reward centers.  I was so impressed that I wanted to find out where the authors worked so that I could apply for a psychiatric residency position there, assuming that one was still available for July 1974.

        I soon learned that Dr. McKinney was the Chairman of Psychiatry at the University of Wisconsin in Madison.  Dr. Akiskal had recently been there doing a post doctoral fellowship. Madison was also home to the famous primatology researcher Harry Harlow PhD.  I quickly called the department to request an application.  As soon as it arrived, I completed it and returned it promptly.  I made a point of mentioning that the recent article in Science had been an important factor in my decision to apply to the program.  Fortunately, I received a call shortly before Thanksgiving offering me an interview in early January.  I was both excited and relieved that all the residency positions had not yet been filled.

        When I arrived in Madison for my interview it was freezing cold, windy and there was quite a bit of snow on the ground.  By way of contrast, everyone I met with, from the faculty to the residents, to the secretaries was warm and friendly and welcoming. The faculty seemed to enjoy their research and also liked to teach. The residents I met appeared bright and open and happy with the program.  I even had a chance to meet briefly with Dr. McKinney, the chairman, who had co-authored the article I was so taken with.  He was the last person I met with that day. We discussed his article and he seemed to enjoy the fact that it had a big impact on me.  

        “So, would you like to do your residency here?” he asked. 

        “I sure would,” I replied. 

        He smiled broadly and said, “we’ll see what we can do.” 

        About a month later I received a letter of acceptance.  I was thrilled. The three years I spent in Madison were some of the best of my life. I received great psychiatric training. The program was strong in almost all areas, particularly biological psychiatry and psychopharmacology (McKinney, Jefferson, Marshall) but also cognitive and behavioral theory and treatment, psychodynamic theory and treatment, family therapy and child and adolescent psychiatry. Many of the faculty were both excellent teachers and mentors and unusually available to us as residents for all types of assistance.

        Had I not heard about and read that important article in Science during my elective in Topeka, Kansas, the middle of nowhere for this Philadelphia kid, I never would have applied to the University of Wisconsin at Madison.  I never would have had the good fortune to get the excellent training that I received there.

        Following my residency in Madison, I had a brief two-year stint in academia at the University of Texas Medical School in Houston where I ran a lithium clinic.  Since then, I have done primarily private practice in western Massassusetts, but I have maintained my interest in psychopharmacology research, particularly as it applies to depression and bipolar illness. It has been particularly gratifying to me to see that the two psychiatrists who co-authored the paper that brought me to Madison for my residency both became important leaders in our field.

 

References: 

Akiskal HS, McKinney WT Jr. Depressive disorders: toward a unified hypothesis. Science 1973;182(4107):20-9. 

Ban TA. In Memory of Hagop Souren Akiskal (1944 – 2021) By Thomas A. Ban. inhn.org.biographies. March 11, 2021.

 

August 5, 2021