SUNY Upstate professor to lead World Psychiatric Association
By Chris Motola
Q: You’re a professor at Upstate and you’re the president-elect of the World Psychiatric Association. I understand it will be a while before you’re president, though.
A: Yes, it’s a three-year term as president-elect and then a three-year term as president. I do have a part-time position with Upstate but I’m not a regular professor there because I live in two worlds. I live in Germany and here. As a matter of fact, tomorrow I’m going back to Europe. I’m also a professor and chair in Munich. So two worlds, two lives, two citizenships, two houses.
Q: Does having a foot on two continents help run a worldwide organization?
A: I would think so. I’m researcher. I’m a psychiatrist. And I’m a scientist as well. And I’ve been doing this since 1997. I started in Germany, then I went to America, but I’ve always been very international. I was once president of the International Society of Psychiatric Genetics and it’s a very international field. There are a lot of international collaborations bringing together samples from all over the world.
Q: What sort of duties do you have as president-elect?
A: The World Psychiatric Organization is the umbrella organization of all national psychiatric organizations. So right now we have 147 member associations. There are some big ones, like the American Psychiatric Association. And there’s a German one, Japanese, the Royal College of Psychiatrists in the UK. These have a lot of members, a lot of voting strength. And there’s also smaller ones like the Psychiatric Association of Senegal, of Nepal; we represent them all. We’re the global voice of psychiatry. We want to help advance psychiatry all over the world. And we sometimes take on projects at the request of member societies. For instance when the field is facing hard decisions by governments or funding is cut we’ll go talk to representatives and try to find solutions. Right now I’m very interested in human rights and I work very closely with the Uyghur population, with allegations and mounting evidence of abuse of psychiatry in China and also maybe in Russia. And we have to start investigating yet. So it’s trying to help our member societies develop the mental health field in their countries. Our member societies are our foundation.
Q: Now your personal research has largely been in the genetics of psychiatry.
A: Yes, since I started in 1997. I’ve been doing genetics, genetics of psychiatric disorders. I was part of a group at the University of Bonn in Germany, which was one of the leading centers for psychiatric genetics at the time. All groups were similar at the time in that they hoped to find 10 to 30 genes that would basically explain schizophrenia, bipolar disorder, depression or what have you. What we’ve learned over the years, however, is that all of these disorders are highly polygenic with hundreds to thousands of genes each only having a small effect on the overall clinical presentation. But they work together. They interact with each other and environmental factors. So it’s become more and more complex. But this is actually an amazing gain in knowledge because we can refute the notion that there are just a few genes at the basis of these disorders. So that started becoming general knowledge in the first decade of the millennium. We were able to use the results of the Human Genome Project. We had so many more genetic markers to work with, better technology. And sure enough it’s more than one gene, more than 100. It’s polygenic. So now the question is how do you use that? The hope is that these many genes that you have, you build profiles and scores. And maybe people will differ in their scores, whether it’s for diabetes or mental illness, for any trait. And maybe you use that score in treatment planning and therapeutic purposes. And that’s what I’m doing at Upstate and my site in Munich. I’ve got funding from the European Union to do pharmacogenetics, trying to find genetic factors that will improve treatment outcomes and that’s eventually what we want to do here too. But it’s a worldwide endeavor.
Q: You mentioned earlier the idea of psychiatric abuse. That’s not a term you see paired with a medical specialty that often. What do you consider psychiatric abuse and what are some of the ethical ramifications of psychiatry?
A: It’s basically the use of treatment and involuntary admission directed at people who are politically not in line. For example, in the old Soviet Union they had their own diagnostic criteria one of the most infamous of which was called “sluggish schizophrenia.” Schizophrenia has international criteria: hallucinations, delusions and so forth. Sluggish schizophrenia was a diagnosis given to people who thought the government wasn’t working properly. They were considered delusional in their criticism of the government and ended up in a psychiatric hospital. So that is an example of the abuse of psychiatry. There’s a non-governmental organization called Safeguard Defenders that found 99 cases of abuse in China two years ago. I went to work with them because we have to independently confirm these things. In China there’s a right to petition the government. Let’s say you’re in a province and some governor does something you think is bad for the community — you can blow the whistle and go to Beijing to petition the government. But then the local official may hear about this and take action against you and you may end up in a psychiatric hospital. And there are allegations that this kind of thing is coming back to Russia as well.
Q: What are some of the challenges in developing diagnostic criteria that is objective as opposed to socially or politically convenient?
A: Let’s face it — psychiatry has a problem that will never go away. We don’t have an X-ray. If you break your leg playing soccer, you get an X-ray and they see where the ankle is broken. And then they can categorize it based on what they see and prescribe a treatment plan. If you’re acting strangely or depressed or have suicidal thoughts, there’s no X-ray, no lab tests. There’s nothing. It is observation. Talking. Listening. Sometimes they don’t talk to you. Sometimes they run away because you’re part of their delusional system. So we come together and look at the latest data and try to group symptoms. And we give these groups of symptoms names. And that’s how disorders are created. They’re not created in the sense that they’re bogus, but it’s a grouping of and interpretation of these symptoms — it’s manmade. That’s why diagnostic criteria are never carved in stone, why they shift over time as more information, better studies become available. Maybe one day we’ll have our X-ray, or our polygenic risk score. The only problem here is that we may be trying to build the X-ray on a phenotype that isn’t correct. So it can be kind of circular. We use criteria to come up with diagnoses, but then we use diagnoses to try to refine our criteria. So compared with other areas of medicine, that’s one of the biggest challenges we have.
Lifelines
Name: Thomas Schulze, MD
Position: President-elect of the World Psychiatric Association; Professor of Psychiatry and Behavioral Sciences at SUNY Upstate Medical University
Hometown: Nuremberg, Germany
Education: University of Erlangen-Nuremberg; University of Barcelona; University of North Carolina at Chapel Hill
Affiliations: SUNY Upstate Medical University, University Hospital of Munich, John Hopkins University, National Institutes of Mental Health
Organizations: World Psychiatric Association; International Society of Psychiatric Genetics; American Psychiatric Association; American College of Neuropsychopharmacology
Family: Wife, two children
Hobbies: Travel, languages