APS Fellow and Charter Member Richard Nakamura has been named acting director of the National Institute of Mental Health (NIMH), making him the highest-level psychologist at the National Institutes of Health (NIH). Nakamura has pledged to continue NIMH’s expansion of its support for basic and clinical behavioral research which began under former director Steven E. Hyman. Hyman left NIMH to become provost at Harvard University.
Nakamura, who has served as NIMH’s deputy director for several years, sat down with APS Executive Director Alan Kraut to talk about his journey from psychological researcher to NIH administrator as well as the goals he has set during his tenure and his views on behavioral research.
KRAUT: Thank you for taking the time to sit with me and give APS members an opportunity to get to know more about you, your thoughts about the Institute, and what you plan to do in your tenure as acting director. Let’s start with your background in psychology. Where did you get your degree? What were your areas of interest? And how did you come to NIH?
NAKAMURA: I guess my psychology career really started at the New School for Social Research in New York. After a disastrous sophomore year in college, I dropped out and spent a year in New York, where I took a course in social psychology at the New School, met Leon Festinger, and decided rather than chemistry or mathematics, psychology was much more interesting. I went on to graduate in psychology and physiological psychology at Earlham College, a small Midwestern school in Richmond, Indiana.
Later, I joined the pharmacology department at the Albert Einstein College of Medicine as a research assistant. After a year there, I decided to go to graduate school and went to the New York University psychology department, where I met Mike Gazzaniga, who became my mentor and my advisor. I followed him when he went to the State University of New York at Stony Brook, and that’s where I got my PhD in psychology.
From Stony Brook I went to Mort Mishkin’s laboratory at NIMH for a postdoctoral fellowship. Then I took a postdoc fellowship at the National Eye Institute (NEI), where I was looking at the pathway from visual input to motor output. I worked with Mort Mishkin and Alan Mirsky for eight years. Then I started shifting over into administration, where I ran NIMH’s bio-behavioral program.
KRAUT: So you left intramural completely?
NAKAMURA: No, it was a fairly long transition. It took about four years to go from the lab to administration. At the end of the four-year period, I had actually made the choice to go back into full-time research from a virtually full-time job in administration. But at the last second, after I had spent about $100,000 in equipment, I decided to stay in administration. Fortunately, I found another good scientist to use the equipment!
I became chief of the behavioral and integrative neuroscience research branch at NIMH. That was in the late 1980s through the early 1990s. During that time I began working on animal welfare issues. I was asked by Rex Cowdry, the acting director at the time, to help with the office of science policy and program planning. That takes me to 1996, when Steve Hyman came on board. Eventually Steve selected me to be his deputy. I became permanent deputy in 1999, but before that I served as acting deputy from 1997 to 1999. And for the first year, I also continued as head of science policy and program planning.
CONTINUITY IS KEY
KRAUT: You spent years as the deputy director under Steve Hyman, who had an enormous impact on the way the NIMH research portfolio was repackaged. He brought in new ideas, new people, new issues, many of which incorporate the best of what behavioral and psychological science has to say about mental health and mental illness. As acting director, what out of the existing portfolio would you like to make sure gets highlighted and continued?
NAKAMURA: The key will be continuity. Steve Hyman increased the value of very strong basic science across the board from the neurosciences to the behavioral sciences, and also encouraged the relevance of both basic and clinical science approaches to the ultimate outcome. Our mission is to reduce the burden of mental illness and behavioral disorders through research on mind, brain and behavior. Steve made sure that all of our research from the most basic studies to services research is relevant to that mission. We have to be able to see how each of those pieces will ultimately reduce the burden of illness on the American public. I see my role as continuing that effort.
KRAUT: Let’s talk about translational research, which I know has been a priority at NIMH: How can basic behavioral research make its way into clinical research and application?
NAKAMURA: There are many different ways in which the behavioral sciences, and psychology in particular, are relevant to progress toward our mission. From psychology as a basic science, in which we’re trying to understand the origins of behavior, we’ve shown that mind and brain are one in the same thing or different sides of the same coin, not a duo. Psychologists have been absolutely instrumental in showing how changes in the brain lead to changes in behavior, and vice versa, how changes in behavior affect the physical structure of the brain; how mental activity is generated from the physical structure of the brain and similarly, has an effect on the final structure of the brain. The “use it or lose it” concept of brain development is a key.
Similarly, modern understanding of genetics tells us that the genome does not provide a final blueprint of any individual’s brain, but simply starting points and some of the critical junctures. It is behaviors that all along the way feed back into the genetic blueprint, changing the structure. Again, psychologists have played a key role in that understanding. One example is the work of [APS Member] Jackie Crawley, here in the intramural program within NIMH. Her role has been to understand the behavioral changes that result from genetic changes in mice, and she has developed many of the standard protocols for understanding differences in behavior among mice. She is seen as perhaps the key member of the new neuroscience center.
KRAUT: And in terms of translational efforts, it’s important to get those basic scientists to start asking what happens in the thought processes of mental illness and how that sophisticated technology and research methodology be brought to bear in a clinical setting. I think that’s true even if a psychologist is not at the edge of neuroscience; for example, getting people who are looking at the development of emotion or the development of cognition, to consider potential clinical uses of their work.
NAKAMURA: Exactly. What we have wanted very much is to convince those basic scientists to think about how and why to use their science to change human behavior.
Changing behavior is the key to moving people out of behavioral disorders. Look at what happened with AIDS, and how the science of changing behavior – which continues to be the only real way of stopping transmission of the AIDS virus – has been led by behavioral scientists.
There is a science and a set of principles that can be applied to change behavior. Seeing the dramatic changes that have occurred in our society as a result of the application of those principles, and seeing the changes in the trajectory of the AIDS virus in this country, has led to a clearer understanding of the important role of behavior in health and mental health.
EMPHASIS ON CLINICAL SCIENCE
KRAUT: I know one of the initiatives that began under Steve Hyman is the development of clinical science and the recruiting of more clinical researchers. Can you talk a little bit about that?
NAKAMURA: Let me split this up into a couple of things that may be of interest. Steve started an initiative to encourage clinical researchers, because although we have had a relatively easy time attracting basic scientists to conduct research for NIMH, we have increasingly seen a shortage within those areas where there is direct involvement with patients. This applies to both MD and PhD researchers. We have placed some additional emphasis on MD clinical researchers because we have noticed a trend line, which is heading right toward zero among MD researchers, even within psychiatry departments where we still have a lot of funding. More and more we notice that PhD researchers are the recipients of those funds. We are concerned that the access to direct hands-on clinical care is being impeded by this change. So we have some programs, including loan repayment, and some ways of trying to attract clinicians of all kinds into our research to slow that trend. We don’t know yet if that will be effective.
KRAUT: We’re hoping to get the word out for clinical scientists because we find that in our clinical programs as well, there is a trend away from research for lots of reasons, not only the burden of repayment of loans, but also because there’s such an emphasis on practice during training and only so many hours in the day.
NAKAMURA: I agree. We are encouraging psychiatric training programs to take a hard look at how research generally, and the possibility of training opportunities for future clinician-researchers, can be enhanced. We’d like to encourage that with clinical psychologists too.
KRAUT: Related to that, I’m delighted to point out that representatives from clinical science programs, known collectively as the Academy of Clinical Psychological Science, are going to come to spend the day with NIMH to start to talk about those issues and see where it goes. And you’re responsible for inviting us.
AFTERMATH OF SEPTEMBER 11
KRAUT: I recently attended a briefing on the federal budget held by NIH director, Ruth Kirschstein. One of the major initiatives for NIH this year focuses on bioterrorism. The deputy director from the National Institute of Allergy and Infectious Diseases (NIAID) talked about all of the parts of the institute that are going to be involved in bioterrorism research, the development, and analysis of anthrax, smallpox and other biological threats. But Ruth and I got into a discussion, and she seemed to agree, about the benefit of looking at the kind of results you just talked about with AIDS, to see what could be applied to bioterrorism. In the same way NIMH has developed persuasive communications that send messages about AIDS that are appropriate without raising fear, we have to develop messages about terror that give out information without raising fear.
NAKAMURA: I agree completely. One of the clearest lessons post-September 11 is that the terror component of both of these events – the anthrax and of the Twin Towers – has had a much more significant impact on the American public than the actual number of deaths involved in those major calamities. This was even truer of the anthrax scare, in which relatively few individuals were actually harmed. Understanding how to deal with the threat of terror for individuals who are susceptible to, let’s say, post-traumatic stress disorder or anxiety disorders, is really critical. We understand not only a lot about how these disorders develop but how they are cured through the work of psychologists.
KRAUT: It’s almost trite these days to say that life has changed since September 11, but in fact, large-scale behavior change is something that NIMH knows something about. NIMH research can inform that process.
NAKAMURA: Right. We would like to do research as a follow-up to these events, to try to understand, for instance, what kinds of communication through the media is most or least likely to trigger post-traumatic stress or anxiety disorders. We would like to examine what kind of communication from the government – federal, state, or local – can best serve the American public and the type of communication that the American public needs from the director of the NIMH or from NIAID. We don’t know quite enough about that. But I think we can reduce the effects of some of these terrorist activities if we apply the knowledge that already exists as well as gain more knowledge as we learn from these experiences.
KRAUT: Psychologists constitute the largest percentage of PIs at NIMH as well as at the National Institute on Drug Abuse (NIDA) and the National Institute of Alcohol Abuse and Alcoholism (NIAAA). In fact, those three institutes all have substantial behavioral science portfolios and all of them are currently being led by acting directors. Have you thought about banding together and overthrowing NIH?
NAKAMURA: [laughing] We haven’t thought about overthrowing NIH, but on a more serious note, we have already banded together. I suggested that it might be good for all of us to get together to discuss how we can collaborate and how we can work together to pool resources. We have started meeting every other week. And we’re meeting in the offices of Raynard Kington, who is both acting director of NIAAA and director of the NIH Office of Behavioral and Social Sciences Research [see February 2002 Observer].
THE POST DOUBLING OUTLOOK
KRAUT: NIMH, along with the rest of the NIH, has seen huge budget increases recently as Congress has tried to stick to a five-year plan to double the NIH budget. This is the final year of the five, and all of us in the community that advocates for NIH have every hope that when this year’s budget is final, we’ll be seeing several billion dollars more for NIH to reach the doubling goal. But the question is: What happens post-doubling? What are some of the opportunities that still need to be taken advantage of and what are some of the risks if after a series of yearly 15 percent increases, Congress believes its job is done and goes to a two or three percent inflation-only increase?
NAKAMURA: Deciding how much emphasis to place on any portion of the federal government’s efforts is obviously the role of the President, Congress and the American people. Certainly we believe that we could continue to sustain a terrific research program at the current rate of increase. So there is no concern on our part that we would not know how to use this.
We have started some great clinical trial programs, we are about to get a flood of new information on major epidemiological studies aimed at understanding where we are in both the prevalence and the ability to treat and serve those with mental illness. We have superb programs going on right now to identify the key genes that influence our disorders and in particular, how they interact. It’s becoming clearer and clearer that there are relatively few so-called “bad genes;” instead, there are good genes that interact badly. This has proven to be an enormous technical task to pick up a gene with small degrees of influence over a mental disorder. But I think we are at last getting the power that we need and we just need to continue to have the adequate funding to identify those genes that contribute to mental illness. We will at last really understand how it is that mental illness comes about.
We need behavioral scientists throughout the process of understanding how a small molecular change in the protein can lead to a change in behavior and I think this will be one of the most interesting and exciting research agendas for the next decade.
KRAUT: Some of the things you mentioned are big science: clinical trials, and epidemiology. There’s also lots of imaging work that’s going on. Can you talk about that?
NAKAMURA: Imaging is really interesting because behavior is a dynamic activity of the brain. It’s only since we’ve been able to have machines that could follow the dynamic activity of the brain that we’ve started to make progress. Now that we know that psychotherapy changes the brain, and some of the ways in which it changes the brain, imaging is offering a huge opportunity for individuals to try new approaches to psychotherapy and then have relatively quick feedback on whether or not it’s having an effect.
We would love to see more research proposals from individuals in psychology departments doing basic science today who come up with ideas for psychotherapy and how it can change behavior using modern neuroimaging techniques as well as the best behavioral science techniques.
One area this applies to is simple recovery of function. Once we pull an individual back from the brink of psychosis or deep depression or obsessive-compulsive behavior, there is still often a long way back to productive behavior in society and as members of families. It’s behavior, psychology, and social sciences that, through treatments like multi-systemic therapies, are allowing people to complete the last steps of that journey back. We need more research on that phase.
KRAUT: With all this big science, is there still a role for the individual investigator with the good idea who is by himself or herself?
NAKAMURA: The vast majority of our research funding still is for those individual scientists. Thirty-eight percent of our principal investigators (PI) are psychologists. These are individual scientists with their laboratory groups, they do not have big science labs. They are producing some of the key ideas for the future.