I’ve covered a lot of areas in bipolar disorder in my career, and it’s been a constant evolution. It’s a fascinating disease to work with, because you can enter it at so many levels. My current area of research over the last decade, decade and a half, has really been looking at not translation from bench to bedside, but really translation from clinic to public health significance.

So many of the interventions that we have are carefully crafted, well designed, and tested in highly selected samples in really leading medical centers around the country and the question that I’ve always had is well, what are we gonna do to get those out into the general public? How are we going to really make sure that we have the public health impact that we should be having for the dollars we spend?

That has led me to look at what are traditionally called fairly dirty samples or we’re now dignifying with the name effectiveness samples in large, practical clinical trials that are designed to ask questions of everyday relevance.

So for instance, that research has led me into the VA system, and I should say actually the VA system led me into this area of research, where we look at people in clinical trials with fairly loose selection criteria and design interventions for diverse and heterogeneous samples, and ask the question can we make differences in outcome in these real world samples?

I had grown up pretty much, if you will, professionally in the tertiary care academic medical center and had a great, great experience, and moved up to Brown and looked around. We have a network of hospitals up there and the chairman asked me, “Where would you like to work?” And for a variety of reasons I said, “I think the VA is probably the place.” It had to do with the teaching capabilities, the clinical load, the system that was there. But when I got there, I found that the patients that I was treating were totally different than the ones that had been over the multiple hurdles that you need to go over to get into a tertiary care medical center.

They often had co-morbid substance dependence, they often had co-morbid anxiety disorders, their diagnoses weren’t so clear, they got psychotic when they weren’t supposed to get psychotic, they were often impoverished, variably motivated for their treatment. There was just a completely different kind of patient, and as I subsequently learned, much more typical of the average patient in everyday care.