Building Bridges in Iowa

It’s funny sometimes how thoughts can tumble over one another, how musing on one subject can easily morph or multiply into something puzzling, enlightening, or even startling. I was thinking about bridges the other day, mainly in a metaphorical sense. I thought about the Tacoma Narrows Bridge collapse in 1940, about which there are a few entertaining and thought-provoking on line articles and videos.

The design was chosen over another because of its slim and elegant profile.The Tacoma Narrows Bridge collapsed partly because bridge engineers forgot about the changing winds over Puget Sound. They slapped the bridge with not much more than gale force winds, which brought it crashing down. The bridge was rebuilt 10 years later, allowing for wind forces with a more practical flexibility in its design and it still stands strong today.

That drifted into a memory about a bridge engineer who was a potent motivating force in my life.

WHKSI’m sure Gene Guetzko never knew that. I knew him when he was the head of the structural engineering department at Wallace Holland Kastler and Schmitz & Co. in Mason City, Iowa–seems like centuries ago. I thought he was totally without fear because he was legendary for going out and bouncing up and down on bridges during many inspection tours across Iowa counties. I never witnessed him do that. But I heard others remark on his apparent lack of any fear of heights in brisk cross winds. I admired him and…I was just a little bit in awe of him. He was a natural teacher, in a militaristic way, which probably was related to his time in the Navy. His family established the Gene and Isabel Guetzko Scholarship in 2010 (opens a pdf file) to help the “average” student go to college–a bridge to a career. That surprised me a little. I always thought of Gene as being above average in every way. Gene was educated at The University of Iowa, graduating with distinction with a B. S. in Civil Engineering in 1949. My time as a draftsman and surveyor’s helper was a watershed in my life–when I was at above average risk.

A letter from Bev

A letter from Bev

That thought shifted to a message from Bev Klug, Director of Mindfulness Program here. She noticed my post on mindfulness for Antisocial Personality Disorder (ASPD) and suggested I have a look at “…a wonderful Mindfulness-based organization in northern CA that works with youth, most of whom have been incarcerated or are headed in that direction.  I really like their approach and they are also doing an interesting form of research to track outcomes.” They are building bridges between troubled youth and mainstream society. Bev’s mindfulness program is also building a bridge between our psychiatry residents and mindfulness practice (I’m coming up on two years with mine) as a way of dealing with the stresses of residency and also as an additional therapeutic tool to help their patients heal.

A practical book you can use

A practical book you can use

My thoughts meandered to the Grand Rounds presentation in our Psychiatry Department last week, at which I and another sort of bridge builder delivered a talk about poststroke syndromes, including poststroke depression (PSD). That bridge builder is Dr. Robert G. Robinson, MD, an internationally recognized expert in this area as a researcher, clinician, and teacher. It was his last Grand Rounds–but certainly not the end of his career. Although his retirement party was two days following that, he plans to staff the psychiatry outpatient clinic. He helped bridge my own interest in teaching to a scholarly project, which was the publishing of our book on consultation psychiatry.

His most recent review paper, co-authored by Dr. Ricardo Jorge, MD, is a tour de force. One of the most brilliant sections is the Etiological Mechanisms, in which Dr. Robinson urges the next generation to keep looking for the biological underpinnings of PSD. In it he outlines a bridge between the bio-psycho-social explanation for PSD and the biological mechanisms:

Thus, although there are numerous possible physiological mechanisms related to PSD, many investigators have concluded that this complex disorder, like most of the major psychiatric disorders not associated with stroke, may best be described as a bio-psycho-social disorder. However, this general theoretical framework does little to help us elucidate pathophysiological mechanisms leading to specific symptoms. These different etiological factors described above may have more salient roles in some forms or symptoms of PSD, and also their effects may vary at different times after the stroke. We believe future studies should attempt to identify the mechanism
of specific symptoms or clinical characteristics of PSD rather than the whole syndrome.

Robert G. Robinson MDNot many know that he earned his B.S. in Engineering Physics at Cornell in 1967. He’s a scientist and an engineer is a practical scientist, one who appreciates the elegant solution but who is also in search of the “good enough” solutions to practical problems in the real world. He began studying poststroke depression in the mid-1970s when most in the field dismissed it as a psychological reaction to impairment unworthy of serious investigation. And he built a bridge between etiological mechanisms in psychiatric illness by continuing his research in this area and teaching the Perspectives in Psychiatry to residents, in which Paul McHugh and Phillip Slavney outlined other models explaining mental illness in addition the disease model–life story, behavioral, and dimensional. Bob has stamina and his knowledge, skill, and flexibility has withstood the winds of change…and time.

The winds shift again and my thoughts turn to the next generation of doctors, one of them Terrence Wong, who is trying to build a bridge between medicine and business.

He and the other medical students notice bridges that might be built between depression and deliriumbetween EEG technology and delirium, prompting us to ask next how we might identify those at risk for developing delirium and ultimately how to prevent it.

Finally, another bridge is on the horizon in Iowa, this one between psychologists and psychiatrists and at issue is a bill that awaits a vote in the House that would allow psychologists to prescribe psychotropic medications. Some are wary of the bridge. According to an Iowa Press Citizen story published on- line April 24, 2016:

The legislation is meant to address a chronic shortage of psychiatrists and others who can prescribe medications for people seeking treatment for mental illnesses. A 2015 report estimated there are about 120,000 people in Iowa with serious mental illness, but only about 300 psychiatrists, nurse practitioners, and physician assistants who can prescribe medication.

Iowa is ranked 47th nationally in the number of practicing psychiatrists per capita.

I hope it allows for the winds of change.

References:

Robinson, R. G. and R. E. Jorge (2015). “Post-Stroke Depression: A Review.” Am J Psychiatry: appiajp201515030363.

Peters, M. E., et al. (2012). “Beyond the DSM: the perspectives of psychiatry approach to patients.” Prim Care Companion CNS Disord 14(1).

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