Alumni Profile: Psychiatry Blooms
During the 60-Year Career of Robert Michels
by BRIDGET M. KUEHN
When psychiatrist Robert Michels, ’58 MD, began his career, it was stigmatizing for a person living in the community to talk with a psychiatrist or take medication for an emotional disorder.
Like most psychiatrists of his generation, Michels got his start working in hospital settings with profoundly disabled patients. But throughout his career, he has witnessed a rapid evolution of the field and its place in medicine. In addition to a shift to treating community-dwelling patients with less profound mental health concerns, the science behind psychiatry has matured and produced a host of better and more tolerable medications.
“When I was a resident, we had very few drugs that any patient would want to take unless they were desperately ill, because the effects of the drugs were so devastating on people,” notes Michels, currently the Walsh McDermott University Professor of Medicine at Cornell University in New York. “Now, a great many people take drugs that reduce their anxiety and reduce their depression without devastating their ability to function in the world.”
Tending the Garden
An interest in the brain and how it relates to people’s thoughts, feelings and behaviors drew Michels to take elective courses in the joint neurology and psychiatry department at Northwestern. He notes that at the time just a handful of medical schools still had such joint departments that covered illnesses related to the brain.
“Northwestern had a lively department, which was more focused on neurology than psychiatry,” he explains.
But the fields were already diverging, with neurologists focusing on movement disorders and other brain pathologies, while psychiatrists focused on mental illness.
“My interests shifted over to psychiatry and stayed there,” he says.
During his time at Northwestern, Michels says he learned from skilled clinician mentors to love talking with patients, getting to know them and helping them. And he took that passion with him to his internship at Mount Sinai Hospital in New York, and later to his residency with the New York State Psychiatric Institute at Columbia University. Throughout his early career, he taught and helped train psychiatrists at Columbia. During that time, he saw psychiatry become more attractive to students, particularly as other medical specialties became more time crunched.
“Psychiatry is one of the few fields where you actually get to know your patients,” he says. “A lot of medicine has been forced into almost assembly line-like patterns of care, which are less rewarding for the practitioner.”
It’s a wonderfully exciting field. It’s going to blossom in coming years. The science is already brilliantly advanced, and the translational steps will follow.
He eventually became chairman of the Department of Psychiatry at Cornell University — one of the largest in the country with more than 400 inpatient beds, in addition to outpatient care. He served in that role for almost two decades, before becoming dean of Cornell University Medical College for five years.
One of the lessons he learned at Northwestern that he likes to impart on students is the importance of team-based multidisciplinary care. “Physicians have to work as a team and creatively work with other disciplines,” he says. “That’s essential to modern medicine.”
Though Michels says his teaching and administrative experiences have been “richly rewarding,” he continues to find patient care the most fulfilling part of his career.
“I love seeing patients,” he says. “It’s sort of like Voltaire in his garden. You always know you’ve done something at the end of the day when you’ve met with a patient.”
A Blossoming Field
The growing scientific evidence base supporting modern psychiatric care, as well as the development of better and more tolerable treatments, have eased the stigma that has long shadowed mental healthcare, Michels says.
Despite growing acceptance of psychiatric care, the National Institutes of Mental Health has found that only half of patients with mental illnesses receive appropriate care. Michels notes that a shortage of psychiatrists and difficulties accessing care hamper treatment for many. He believes that in the current U.S. health system, patients often receive expensive care that may not be valuable, while inexpensive care that is beneficial for the individual and the public good may be hard to come by.
“We have to educate the public and our decision-makers on this and reorient the way our resources are devoted,” Michels says.
Another challenge that lies ahead is translating scientific discoveries about the basis of mental illnesses into better care, particularly for more severe conditions like schizophrenia and bipolar disorder. Michels is optimistic that the science will continue to advance. In fact, he notes that at U.S. medical schools, psychiatry departments often boast one of the largest research portfolios.
“It’s a wonderfully exciting field,” Michels says. “It’s going to blossom in coming years. The science is already brilliantly advanced, and the translational steps will follow.”
With exciting prospects on the horizon and the opportunity to work closely with patients, Michels highly recommends the field.
“If you’re interested in people and how they think, how they act and how they live their lives, I can’t imagine a more rewarding career,” he says.