Where are the new ideas?

I recently met a colleague who had been on the Harvard faculty for about twenty years. He finally left about two years ago to go to a state university psychiatry program in the mid-Atlantic region. "I came to Harvard thirty years ago to find an intellectual environment. I found it only after I left."

This experience made me think of a general problem in academic psychiatry, especially in prominent programs. I too trained in the Harvard system and taught within it, and still do to some extent. One of my Harvard teachers was Leston Havens, who used to say: "Be careful about institutions. Between your boss's needs and your eagerness to please, you can create a prison stronger than Alcatraz."
Young psychiatrists make this mistake commonly. It is the problem of institutions - and it is not at all unique to Harvard. The problem is that institutions have their own needs and goals; and these may conflict with the individual person's needs and goals. A young psychiatrist may have new ideas, or need special mentorship to progress to the point of being able to be an independent researcher, or need time to write. But institutions will have their own needs for clinical practice, and sometimes teaching, and what comes last is mentorship or help in advancing one's ideas. I once had a chairman who said that he paid the faculty to see patients, whether clinically or in research studies; they needed to write up their research on their own time - meaning nights and weekends. I have always thought this is one reason why academic writing is so terrible - both in style, and often in substance: It is devalued. No one pays for it. If it doesn't happen, the academic gets the blame for not putting in the extra effort. The institution never gets the blame for not providing the atmosphere where good writing, and good thinking, can happen.

I say all this because my interaction with my colleague reminded me how much even the best academic psychiatry programs these days suffer from intellectual mediocrity. New ideas do not abound; great books are not written; scientific articles are weak. This is partly a reflection of psychiatry as a whole; our profession is eclectic and practical, at least in the US. Intellectual critique is not common. Partly this state of affairs also reflects a larger institutional problem - the reality that all large institutions need to survive, and it is harder and harder to do so. Faculty become workers who keep the institutions alive, first and foremost. This may simply reflect the nature of modern institutions - the bureaucracy that Max Weber wrote about. And it is not limited to academic medicine. The social historian Russell Jacoby, in a disturbing book, described how American intellectual life has, paradoxically, been stunted by the rise of the universities. Where intellectuals used to be independent thinkers, in places like the Greenwich Village of the 1920s, now they follow the rules of academic life, rules which often encourage conformism and staying in the mainstream. "Public" intellectuals are increasingly uncommon.

Jacoby sees all this as an intellectual crisis; my friend's experience suggests it is less a short-term crisis than a long-term trend.