Boris Birmaher

Boris Birmaher is a child and adolescent psychiatrist and holds the Endowed Chair in Early Onset Bipolar Disease and is Professor of Psychiatry, University of Pittsburgh School of Medicine. He trained at Valle University, Colombia, Hebrew University, Israel, and Columbia University, USA. His special interests include anxiety, and depressive and bipolar disorders in youth.

If you were not a psychiatrist, what would you do?

I would be working as a pediatrician, especially together with groups like Doctors without Borders.

What has been the greatest impact of your profession on you personally?

Humility and awe when trying to understand and study the mind.

Do you feel stigmatised by your profession?

Perhaps at the beginning of my training when physicians from other specialties, without understanding psychiatry, criticised and put it down.

What are your interests outside of work?

Reading historical novels, travelling, good-quality movies, yoga, meditation.

Do you really understand what is going on in the brain?

Not yet.

Who was your most influential trainer, and why?

I am fortunate to have had several influential trainers throughout different stages of my career. For example, when I was a medical student, a very knowledgeable psychiatrist, Dr Ramon Jaramillo, opened my eyes to the world of modern psychiatry (I still keep his writings). During my training as an adult psychiatrist, Drs Haim Belmaker and Benjamin Lerer were influential, and during my child psychiatry training, Drs Joaquim Puig-Antich and David Brent.

What job gave you the most useful training experience?

There were several: (1) working as an intern in a psychiatric hospital in Colombia, (2) working as a general physician in the mountains of Colombia and then in a general hospital in Patterson, New Jersey, (3) working with people from different cultural backgrounds in Israel and New York, and (4) an enormous case-load during my residency at Columbia University.

Which publication has influenced you most?

Many, but at the moment I recall the books by Sigmund Freud, Anna Freud, Carl Jung and Aaron Beck, books on child psychiatry by Michael Rutter, a text on psychopharmacology edited by Donald Klein, and the book Manic Depressive Illness by Goodwin & Jamison.

How has the political environment influenced your work?

The lack of good healthcare policies to cover mental health often precludes the best treatment for the patient and their family.

What part of your work gives you the most satisfaction?

Seeing patients and teaching.

What do you least enjoy?

Fighting with the insurance companies to cover certain treatments.

What is the most promising opportunity facing the profession?

New technologies that allow us to ‘see’ the brain and the demand for evidence-based treatments for the management of psychiatric disorders.

What is the greatest threat?

Lack of adequate funding to continue to do research into the biological and psychological mechanisms and evidence-based treatments of mental illness.

What conflict of interest do you encounter most often?

I do not encounter conflict of interest because my main goal is the patient's well-being, even when being funded by pharmaceutical companies.

What is the role of the psychiatrist in countries emerging from conflict?

To help children and adults cope with the stress of ongoing conflicts so that they can eventually help themselves.

What is the most important advice you could offer to a new trainee?

Become well versed in psychopathology and a wide range of treatments. Do not become a fanatic for any specific theory or treatment. Be very empathetic and compassionate with the patients and their families and offer them the treatment that is most beneficial for them, not your own personal preference.

What are the main ethical problems that psychiatrists will face in the future?

To be highly objective regarding the many available treatments.

Do you think psychiatry is brainless or mindless?

Neither one - this is only semantics.

What is the role of the psychiatrist in rebuilding healthcare systems?

In the process of rebuilding the healthcare system, psychiatrists must advocate for people with psychiatric disorders because no other physician or politician really understands mental illness and the amount of suffering and disability experienced by people with mental health problems.

What single change to mental health legislation would you like to see?

I would like to see legislation passed that would provide the same level of healthcare coverage for mental illness as is provided for medical illnesses.

What single area of psychiatric practice is most in need of development?

More studies are needed regarding the primary and secondary prevention of psychiatric disorders in children.

What single area of psychiatric research should be given priority?

Aetiology of the major psychiatric illnesses using state-of-the-art technologies to study the brain.

How would you like to be remembered?

As somebody who cared about people with psychiatric illness and made some contributions towards the understanding and treatment of psychiatric illnesses in youth.