“A passport to the young”

An alumnus and Harvard professor uses film to teach lessons in law and psychiatry.

By Cathy Shufro

Early in the 1990s, psychiatrist and law professor Alan A. Stone, M.D. ’55, noticed a change in his law and literature class. When he asked which students had read a certain lay or novel—Thomas Mann’s Death in Venice, for instance—not a single hand went up. Then a student would venture: “I think I saw the movie.”

“Young people are incredibly well-informed about film and incredibly ill-informed about literature,” said Stone. “And I’m talking about students at Harvard College and at Harvard Law School.”

Stone, the Touroff-Glueck Professor of Law and Psychiatry at Harvard Law School, was trying to use literature to connect students with the large themes of psychology and justice. Reading fiction, said Stone, provides “an incredible opportunity to talk about moral issues that are usually approached in law school through such arcane discussions that the moral issues disappear before your eyes.” But the approach was no longer working: few students had read Sophocles or Dostoyevsky, Austen or Flaubert. Stone needed, as he puts it, a new “passport to the young.”

He found such a passport when fellow law professor Randall L. Kennedy, J.D. ’82, asked Stone to write about white racism for the magazine Reconstruction. Stone used the 1989 film Glory to address the issue. His analysis—that the movie resorted to racial stereotyping in its depiction of the first all-black regiment to fight for the Union in the Civil War—generated numerous letters to the magazine.

By then, Stone had realized that the shared stories of the new generation were not written in the pages of books but, rather, recorded on film. He created a popular course called “Law, Psychology and Morality: An Exploration Through Film.” “This allows students to grapple with issues that are the reason they came to law school in the first place: to identify and correct injustice,” said Stone. The primary texts for the class include the films Do the Right Thing, Lone Star, Crimes and Misdemeanors, The Battle of Algiers and Character.

Unexpectedly, the Glory essay proved to be a passport of sorts for Stone himself: the former president of the American Psychiatric Association and residency director at McLean Hospital entered new territory as a film critic. Since 1993, he’s written more than 100 reviews for the bimonthly Boston Review.

Stone is not drawn to movies for diversion but instead to witness the stories of people thrust into situations that test character, such as Oskar Schindler’s insight that he could save the lives of Polish Jews forced to work in his factories.

MIT Press recently published 15 of Stone’s reviews in a small volume titled Movies and the Moral Adventure of Life. Films reviewed in the book include American Beauty, The Passion of the Christ, Pulp Fiction, Antonia’s Line and Henry V.

A Los Angeles Times critic called Stone “a discovery to rejoice at.” Stone’s film analysis, wrote David Thomson in November, “is not the breathless rave on this Friday’s release, but a culmination of the process by which a picture can be seen a few times, mulled over, seen again and then at last written about—as if film writing might be as contemplative, gradual and enriched as any other scholarship.”

At 78, Stone looks forward to writing many more reviews. (He still sees a few psychotherapy patients, too.) The films he finds worth his attention, he said, are “films that challenge me and make me reflect on the moral adventure of life.”

To read reviews by Stone, visit http://bostonreview.net/onfilm.html.

Bookshelf focuses on books and authors at the School of Medicine. Send suggestions to Cathy Shufro at cathy.shufro@yale.edu.

Book notes

IICAPS: A Home-Based Psychiatric Treatment for Children and Adolescents
by Joseph L. Woolston, M.D. ’70, the Albert F. Solnit Professor of Child Psychiatry in the Child Study Center and professor of pediatrics; Jean A. Adnopoz, M.P.H. ’81, clinical professor in the Child Study Center, and Steven J. Berkowitz, M.D., assistant professor in the Child Study Center (Yale University Press) Intended for health providers and planners, this book presents a model of mental health treatment for children with serious psychiatric disorders. The IICAPS (Intensive In-Home Child and Adolescent Psychiatric Services) program offers an alternative treatment paradigm for families that has proven effective in reducing the need for inpatient and other institution-based services. The authors conclude with a discussion of some of the unresolved challenges inherent in home-based care for children with serious psychiatric disorders.

Innovation Nation: How America Is Losing Its Innovation Edge, Why It Matters, and What We Can Do to Get It Back
by John Kao, M.D. ’77 (Free Press) The author, a former Harvard Business School professor, offers a troubling portrait of the erosion of U.S. competitiveness in innovation in recent years. Kao then takes the reader on a tour of leading innovation centers in Singapore, Denmark and Finland. He proposes a national strategy that would empower the United States to marshal its vast resources of talent and infrastructure in ways that have been shown to produce results.

Means, Ends and Medical Care
by H.G. Wright, Ph.D., M.D. ’70 (Springer) The author uses the conceptual tools of cognitive science to analyze and critique some of the most basic concepts of contemporary medical care. By uncovering the complex internal structure of human concepts of health and disease, Wright shows the error of assuming that professionals always understand in advance the medical and moral ends involved in any medical situation. The result of this alternative view of mind and medical judgment is a model for reasoning that, although not specifiable by a set of fixed rules, can give realistic guidance for medical decision making.

The Healer’s Heart: A Modern Novel of the Life of St. Luke
by Diane M. Komp, M.D., professor emeritus of pediatrics (WaterBrook Press) The author creates a world around a fictional infectious disease specialist named Dr. Luke Tayspill. Luke’s story covers the world: his childhood home in Ohio; war-torn Sarajevo; London, where his estranged wife deals with post-traumatic stress disorder; a quiet Gullah island off the coast of South Carolina with unexpected family connections; and ravaged Sierra Leone, where Luke travels after finding an unpublished manuscript written by his beloved grandfather in order to complete a story his grandfather began.

Unnatural History: Breast Cancer and American Society
by Robert A. Aronowitz, M.D. ’85 (Cambridge University Press) The book traces the changing definitions and understandings of breast cancer as the author explores the experience of breast cancer sufferers; clinical and public health practices; and individual and societal fears.

The Papillomaviruses
edited by Daniel C. DiMaio, M.D., Ph.D., Waldemar Von Zedtwitz Professor of Genetics and professor of therapeutic radiology, and Robert L. Garcea (Springer) This volume offers a complete description of the current state of knowledge about the biology of the papillomaviruses. It evaluates the risk to humans posed by infection with human papillomaviruses (HPV), including cervical cancer, the second most common cancer in women worldwide. This book also considers the possible involvement of HPV infection in cancers in other body sites.

Alzheimer Disease and Other Dementia Types: A Practical Guide, 2nd ed.
by Marc E. Agronin, M.D. ’91 (Lippincott, Williams and Wilkins) This guide focuses on assessment, diagnosis and management of the complex array of dementia disorders seen in older patients. The author addresses all the subtypes of dementia and such associated psychiatric conditions as agitation, psychosis and depression. This edition features a new chapter on mild cognitive impairment as well as expanded coverage of Alzheimer disease and risk factors. Other chapters offer advice on caregiver support and legal and ethical concerns.

Help Your Child or Teen Get Back on Track: What Parents and Professionals Can Do for Childhood Emotional and Behavioral Problems
by Kenneth H. Talan, M.D., FW ’71 (Jessica Kingsley Publishers) This book shows the reader how to deal with a child who may have an emotional or behavioral problem. It describes the red flags and disruptions in development that cause concern; offers solutions that parents can implement at home; and advises when they should seek professional counsel. For parents who decide to seek professional intervention, the author explains treatment options that include psychological treatment, psychiatric medications and complementary and alternative therapies.

Epidemiology, Biostatistics and Preventive Medicine: With STUDENT CONSULT Online Access, 3rd ed.
by James F. Jekel, M.D., M.P.H. ’65, professor emeritus and lecturer in public health, David L. Katz, M.D., M.P.H. ’93, associate professor (adjunct) of public health, Joann G. Elmore, M.D., M.P.H. ’92, and Dorothea M.G. Wild, M.D., M.P.H. ’03, lecturer in public health (Saunders) This text contains the latest information on health care policy and financing, infectious diseases, chronic disease and disease prevention technology. It also includes 350 USMLE-style questions and answers, complete with detailed explanations of the correctness or incorrectness of various choices.

Molecular Neurology
edited by Stephen G. Waxman, Ph.D., M.D., the Bridget Marie Flaherty Professor of Neurology, Neurobiology and Pharmacology and chair of neurology (Elsevier Academic Press) Molecular neuroscience is revealing important clues to the pathogenesis and pathophysiology of neurological diseases and to the therapeutic targets that they present. Waxman explains the ways in which researchers use their understanding of the molecular basis of neurology to develop new therapies. The book highlights the principles underlying molecular medicine as related to neurology and presents up-to-date principles and disease examples. The author also reviews the concepts, strategies and latest progress in the field.

Ayurveda: A Comprehensive Guide to Traditional Indian Medicine for the West
by Frank John Ninivaggi, M.D., FW ’77, assistant clinical professor in the Child Study Center (Praeger Publishers) Ayurveda is the traditional medical system of India, used for thousands of years as a source of proactive health measures as well as integrated healing strategies for body, mind and spirit. The author explains the ways in which Ayurveda can promote physical and mental health by targeting such threats to health as acute and chronic stress, pre-diabetes, metabolic syndrome, obesity, coronary artery disease and diabetes.

The Bipolar Disorder Answer Book: Answers to More Than 275 of Your Most Pressing Questions
by Charles Atkins, M.D., lecturer in psychiatry (Sourcebooks) This book describes bipolar disorder, a condition that causes abnormal shifts in a person’s mood, energy level and ability to function. The book provides answers to common questions and serves as a reference for people with the disorder as well as for their loved ones.

Cardiovascular Molecular Imaging
edited by Albert J. Sinusas, M.D., professor of medicine (cardiology) and diagnostic radiology, Robert J. Gropler, M.D., David K. Glover, M.E., and Heinrich Taegtmeyer, M.D., Ph.D. (Informa Healthcare) This book is a guide to targeted molecular imaging of the cardiovascular system. It covers new methods for the analysis and management of cardiovascular pathophysiology and explains new technologies for analyzing cardiovascular receptors; reporter probes and gene expression; and vascular structure and biological processes that affect the heart and associated vessels.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, 300 George Street, Suite 773, New Haven, CT 06511, or via e-mail to cheryl.violante@yale.edu.

In circulation

With online videos library patrons learn the latest in how to do research

The growing popularity of videos has changed the public face of an institution not generally known for being trendy: the medical library. The website of the Harvey Cushing/John Hay Whitney Medical Library now offers 51 videos—and counting—but not of celebrity gaffes or political satire. Instead, they show library patrons how to do research online.

“The next generation of learners is more visual than textual,” said Lei Wang, M.L.S., an instructional design librarian at the library, referring to what’s sometimes called the YouTube generation. “They expect video from you.” Video sharing sites, such as YouTube, said Wang, have changed online norms even among people who use the library. Rapid changes in technology, he said, have made possible fast access to videos online. “The Web infrastructure is allowing large amounts of data to be transferred to personal computers.”

Over the course of a month early this year, Wang made 10 instructional videos that provide in-depth instruction in using the new OVID search interface. Topics range from such basic skills as accessing OVID and choosing a database to such specialized topics as using OVID to conduct comprehensive literature reviews. Wang limits each segment’s running time to about five minutes. “People’s attention spans are pretty short,” he said. Sometimes things change so fast that he has to revise an instructional video even before he has completed it. Wang keeps up with the latest by attending conferences.

Wang believes that if videos allow patrons to use the library’s resources more easily, they’re worth the effort. The library spends a lot of money on databases, such as those on the OVID platform, and on such knowledge management tools as RefWorks. “We pay for these products, and we want them to be used.”

—Cathy Shufro

To access instructional videos, visit http://www.med.yale.edu/library/education/guides/ or visit the home page of the Harvey Cushing/John Hay Whitney Medical library and choose “Guides & Tutorials.”

In Circulation focuses on activities at the Cushing/Whitney Medical Library. Send suggestions to Cathy Shufro at cathy.shufro@yale.edu.



Aghajanian		Collins



Taras		Eyler

On campus

LSD, mescaline and brain receptors

That the brain has specific receptors for various drugs is now an established fact, but it took a long, strange trip by George K. Aghajanian, M.D. ’58, HS ’61, FW ’63, a pioneer in neuropharmacology, to turn that theory into a certainty.

In 1958, for his thesis research, Aghajanian said at a Leadership in Biomedicine lecture in January, he compared the effects of mescaline and LSD in animals and speculated that the receptors mediating their effects were closely linked. But he faced a largely dubious senior faculty in psychiatry. “There was the belief at the time that the brain was not relevant to psychiatry,” he said.

In the ensuing decades, Aghajanian, the Foundations Fund Professor of Psychiatry and Pharmacology at Yale, showed that LSD and related hallucinogens promote “spillover” of the excitatory transmitter glutamate from synapses in the prefrontal cortex, causing miscommunication between adjacent groups of neurons. His research helped pave the way for a new generation of antipsychotic drugs, which target brain receptors that modify the release of glutamate. “It just took 50 years,” he said. “I hope that the students who go on to become physician-scientists have better luck than I did—or better timing.”

—John Dillon

Genomics and personalized medicine

As the sequencing of the human genome approaches its fifth anniversary, Francis S. Collins, M.D., Ph.D. ’74, FW ’84, asked how it will affect the practice of medicine. Will it be used to save lives? Or will the information be used to deny people jobs or health insurance? In a talk on March 27 at The Anlyan Center, Collins set out two hypothetical scenarios to illustrate how genomics might be used or ignored.

Collins, director of the National Human Genome Research Institute at the National Institutes of Health, outlined his first scenario: in 2015, a patient he calls Betty chooses not to have her genome sequenced because she fears genetic discrimination. She never learns about her family history of heart disease and her doctor thinks genetics is irrelevant to clinical practice. Betty gains weight and develops high blood pressure, but side effects keep her from taking her medication. Ten years later, Betty dies from a heart attack.

In Collins’s second scenario, Betty receives all the benefits of genomics, including individualized treatment, and lives into the 22nd century. Collins implored his audience to make a commitment to personalized medicine and “SAVE BETTY!”

—Alix Boyle

Breakfast matters, even if it’s just a doughnut

Conventional wisdom took a recess when Howard Taras, M.D., told an audience at pediatric grand rounds in February about his research into the effects of nutrition on a child’s school performance.

Breakfast is important, said the professor of pediatrics at the University of California, San Diego, but whether kids eat fruit or a doughnut doesn’t affect academic achievement. “For performance it doesn’t really make a difference,” he said, adding that “a student with poor nutritional intake at each breakfast is more likely to have fewer productive years in life with which to utilize his or her education.”

His and other studies have also found that sufficient physical education “doesn’t really change the outcome of their grades,” Taras said. The research found, however, that children perform better on exams taken right after recess.

Poor sleep is “the most ignored” threat to school performance, said Taras, especially for children who have sleep apnea. He supports later starting times for the school day, adding that kids “aren’t going to bed later” to take advantage of them.

Administrators and students’ doctors need to communicate better with one another in order to manage children with chronic conditions, he said.

—J.D.

Vaccines and the flu virus of 1918–1919

In 1918, with the world in the grippe’s grasp, researchers were desperate for a way to stem the pandemic. They turned to new vaccines, all of which mistakenly targeted bacteria instead of viruses, said John Eyler, Ph.D., a medical historian at the University of Minnesota who gave the George Rosen Memorial Lecture at the Beaumont Medical Club in February. Medical journals and the lay press touted the vaccines’ efficacy even though experts—including the American Public Health Association (APHA)—harbored doubts.

By 1919, “the tide of professional opinion began to change” about the accuracy of the results, said Eyler. In retrospect it became clear that the early trials were rife with problems: poor selection criteria leading to biased samples and “no concern about who was a proper subject,” Eyler said.

“American physicians certainly were inexperienced at conducting trials,” Eyler said. They conducted them when the nation was “desperate” for relief from the pandemic, but the profession had no standards for what constituted an adequate vaccine trial.

The APHA established stricter standards for vaccine trials in 1919, though randomized trials wouldn’t become common practice until decades later.

—J.D.


			Originally published in Yale Medicine, Spring 2008. Copyright © 2008 Yale University School of Medicine. All rights reserved.