Schizophrenia Bulletin Advance Access originally published online on July 13, 2007
Schizophrenia Bulletin 2007 33(5):1151-1152; doi:10.1093/schbul/sbm084
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Commentary: Public Health Contributions
2 Provost's Office, Massachussetts Hall, Harvard University, Cambridge, MA 02138
3 National Institute of Mental Health
Keywords: schizophrenia / mental illness / cognition
Wayne Fenton dedicated his career to addressing the unmet needs of people with mental illness. His commitment to a public health approach was made clear by his actions: he left behind a leadership role in Chestnut Lodge, an institution dedicated to treating individual patients, to accept a position at the National Institute of Mental Health (NIMH) that would permit him to influence, albeit more indirectly, the health of broad populations with mental illness. As we all know, Wayne continued to treat patients—an activity that led to his tragic death—in order to stay grounded in clinical reality and to serve individuals in need. Nonetheless, the focus of his work at NIMH had a far broader purview. He sought to influence the ways in which the government, industry, and academic approached treatment development and the ways in which current treatments were evaluated. Of the many tragedies resulting from Wayne's death, one is certainly the tragedy that he could not live to see the public health impact of his work play out to the benefit of people with mental disorders.
A centerpiece of Wayne's work at NIMH was his attempt to make the cognitive disability produced by schizophrenia into a significant focus for treatment development. Wayne was not only simply interested in the amelioration of symptoms but also on the ability of people to lead meaningful lives. The negative public health and social effects of cognitive disability in schizophrenia are enormous. Even with effective treatment of positive symptoms of schizophrenia such as hallucinations and delusions, a very large fraction of people with schizophrenia are unable to continue in school or to hold down the jobs that their premorbid trajectories would have predicted for them. At a social level, this results in enormous loses in productivity, given the early age of onset and chronicity of schizophrenia, and contributes to such social problems as homelessness and poverty. Wayne's collaboration on the Finnish1 birth cohort study was demonstrating the cost in early mortality, as well. As has been well documented in other articles within this special issue of Schizophrenia Bulletin, Wayne took action to galvanize the research, clinical, industrial, and regulatory communities to remove obstacles that had impeded progress in this important area. As we look forward to success in targeting cognitive and other functional impairments in schizophrenia and other mental illnesses, we hope to see substantial improvements in population health and productivity.
Wayne's work in this area is exemplary for leaders in the field. He was not satisfied with the efficacy of current treatments. He saw little use in making small, incremental improvements. Rather, he challenged us all to target our research away from the safe and familiar toward goals that would make a substantial difference to consumers and to society. Similarly, he focused our attention on what we were missing in the clinical reality of people with serious mental illness. While many worried that speaking about violence and mental illness would increase stigma, Wayne argued for the need to confront the reality of violence in those with untreated mental illness as a path to decreasing stigma, increasing treatment, and ensuring the safety of those at risk. It is a second tragedy, both ironic and painful, that he became one of the rare victims of violence in an untreated patient with schizophrenia.
While pushing hard for new treatments, Wayne helped NIMH to ensure that we understood as much as possible the best use of treatment tools available to us today. He was a great advocate for the large, practical trials that NIMH launched in the early years of this decade, but at the same time, a thoughtful and engaged critic of their design and of their relevance to "real patients" in the "real world." From his platform at NIMH, Wayne exerted an important influence on the choice and scope of the trials and the philosophy behind them. Of course, a very large number of people came together to shape these large, practical trials and to improve their relevance to population health. As the senior clinician within the extramural program at NIMH, however, Wayne played an extremely important role in reassuring the research community that it was time to move from highly rigorous, small trials that ultimately had very little influence on clinical practice to trials that would answer questions that clinicians, consumers, and their families had about treatment in real-world clinical settings. The third tragedy, of course, is that he will not be involved in the healthy debates about how these practical results are implemented in the world of payers and providers, a world that Wayne was just beginning to master and enjoy in his position at NIMH.
Thus, Wayne Fenton could be said to have helped keep the Institute and the field focused on what was really important, at both ends of the research spectrum. He worked tirelessly to develop truly novel treatments that would address significant, unmet needs, and thus ameliorate high levels of disability. At the same time, he demanded that the clinical trials NIMH engaged in make good on the promise of large-scale public investment by providing information of true utility—information that could make a difference in treatment decisions day-to-day everywhere. As 2 NIMH directors who worked with him closely, we respected and depended upon his clinical wisdom, appreciated his irreverence for all things bureaucratic, and loved his passion for social justice. In a world of scientists, Wayne was a clinician with a natural scientific eye, always looking for what others were missing, always curious about the unknown, and always asking the hard questions. For both of us he was a friend as well as an advisor. His untimely death has been a profound personal loss for us as well as a tragic loss for the field and for those with serious mental illness.
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Footnotes |
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1 To whom correspondence should be addressed; tel: 617-496-5100, fax: 617-495-8550, e-mail: seh{at}harvard.edu.
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 Top References |
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- Lauronen E, Koskinen J, Veijola J, et al. Recovery from schizophrenic psychoses within the northern Finland 1966 birth cohort. J Clin Psychiatry (2005) 66::375–383.[Web of Science][Medline]
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