Knowing More About Less Posted on November 30, 2007 The career path of Charles L. Bowden (bio) began with the question, "What is beneath the surface?"

I did always have an interest in research. It was not just how to do something, but how beneath the surface of doing that, prescribing medication, diagnosing, how it worked. So this "what's the goal of it, what's behind it" was always an interest of mine, and I think if one has that kind of curiosity, you tend to gravitate to places where there'll be individuals with similar curiosity and skill sets that work in that direction.

I did this in medical school. I did this in my residency at Columbia. There was then called a Division of Biometrics that contributed to the move of diagnosis into the research diagnostic criteria and now the DSM system. And that's recently been renamed the Division of Phenomenology, interestingly, but one focus on research is phenomenology. What does it look like? What are the symptoms? What are the primary symptoms? How do we measure them? Are they the same in women and men, schizophrenics and bipolar patients? What improves when the patient is recovered? Does it stay improved?

So a simple way to do this is to develop some kind of scales where you assess. Rather than simply take your individualistic impression, you, I, our colleagues in other places would use the same scales, so at least we would be reliable in the way we define something such as distractibility or impulsivity or affective moment-to-moment lability. So one defines those and then lives by those and has some ways that you capture that, and that's one consistent theme that's stayed with me from over the past forty years.

One of our current efforts is developing a comprehensive scale for all of the symptoms that make up what we think of as the umbrella of bipolar disorders. Those become tools, just building blocks that could be ends in themselves in a research sense, but they also can be tools that allow us to put that piece together with some other piece so that we can build on it. There's a certain method to this madness, but there's a certain chance quality to it as well. The method is to have the right skill sets and colleagues. The madness or the chance part is: things happen in the conduct of research or just the conduct of clinical practice that we may not expect.

I participated in this National Institute of Mental Health collaborative study of the psychobiology of depression.

I and another colleague still working in this area, Alan Swann, then at Yale, now at the University of Texas Health Science Center at Houston, looked at the data, and where we saw the most exciting, and unexpectedly so, data were in the bipolar depressed patients and in the bipolar manic patients. And it's a bit like traveling down a road and saying, "Well, I'd planned to take this route, but this alternative route has more appeal." And I've not regretted that, so for 20 years, based on that serendipitous experience, I've come to know more and more about less and less, in terms of the extent of my interest.

My original thinking was always to look at what was behind the clinically interesting and always moving and just in terms of the importance and the opportunity to work with severely ill individuals - what was behind that? Take, for example, I had my residency training at a time when there was a military draft, and for physicians it had the name the "Berry Plan." So it wasn't a question of whether one served in the military; pretty much every physician that wasn't physically disabled had to have two years of military service or the equivalent.

Mine was in the Public Health Service, and the National Institute of Health are parts of the Public Health Service, and a research facility and treatment facility jointly operated by the Federal Bureau of Prisons and the National Institute of Health. And it had to do with the treatment of and the conduct of research on persons with heroin addiction, principally.

And so because I had this interest in assessments, I took advantage of that two-year military obligation as a lieutenant commander in the Public Health Service to conduct research on the outcome of patients in a federal treatment program for narcotic addiction treated with methadone. And even that, then working in addiction treatment and research early in my career, I recognized that addiction career was not just a single-core phenomenon, that it was often wrapped around a mood disorder and anxiety disorders.

And that's how I actually moved into mood disorder research, seeing that to only work with the addiction was to miss what was a kind of fundamental drive, not the only factor, but one of the fundamental reasons that these people, one, got into abusable substances in the first place, and, two, were in the group who had difficulty giving up the abusable substance. Because some people do give up addictive substances. What are the differences in those who do so and those who do not?

« Back to Article