1
JEROME LEVINE
Interviewed by William T. Carpenter, Jr.
Boca Raton, Florida, December 12, 2007
WC: This will be an interview with Jerome Levine for the Archives of the American College of Neuropsychopharnacology. We are at the annual meeting of the College, in Boca Raton, Florida. I am Will Carpenter. I would like to hear about your life and how you see the field progressing. Tell us about your early experiences, your education and how you moved into the field?
JL: I think that this is a terrific idea. We are at a point in time where we can still capture the whole history of modern psychopharmacology. I was born in New York City in 1934. I grew up in New York and on Long Island until I was about eleven years old. Right after the Second World War, in 1946, my parents decided to move to Buffalo, New York where we had relatives who they went into business with. I went to school in Buffalo, graduated from elementary school and onto high school at the time of the Korean War. Because of the war they were pushing people through school a bit faster, so I was able to leave high school before I graduated. No one in my family had ever gone to college so I didn’t know how to approach things, but I knew there was the University of Buffalo on Main Street up from my high school. I applied and started undergraduate school in 1951. I had always been interested in science and chemistry and my mother used to holler at me for doing experiments in the basement with my chemistry set. I started as chemistry major, but had to take some other courses in order to qualify for the BA degree. I started taking some psychology courses and liked it as much as chemistry. There were some excellent psychologists at Buffalo and I wound up a double major in psychology and in chemistry. As I was coming to the end of the four years, I wondered how in the world was I, going to continue with both of these passions? I thought maybe if I went to medical school and put together chemistry and psychology with research, because I was still very research oriented, that would be the way. So I applied and was accepted at the University of Buffalo, School of Medicine. My idea of going into research where I could combine chemistry and psychology really worked out. I went through medical school with the idea of going into psychiatry and in the year book it said I was the only student to keep the same specialty through four years of medical school. After graduation I did a rotating internship at E.J. Meyer Memorial Hospital, which was the county hospital. I have always been oriented toward public service with a strong research interest. While I was starting residency a huge change in psychiatry came about. Medications to treat mental illness came to the field, where before psychoanalysis had been the prevalent orientation.
WC: What year are we in, in the mid-1950s?
JL: It would be July 1958 that I started my internship. I went on to do two years of psychiatric residency in Buffalo at Meyer Memorial Hospital, which was like a small Bellevue. It was the place where the courts and police brought people if someone was acutely mentally ill, before going on to another facility.
WC: What were the drugs available to you when you were a resident?
JL: The antipsychotic drugs came on the scene in the fifties. So, I came into the field at that time.
WC: Did they call them antipsychotics then?
JL: No, major tranquilizers was the terminology then. One of the first things I did, coming from a chemical background, was to make a list of the psychotropic drugs and try to group them in some way. It turned out to be valuable to people and my teachers picked it up and used it as a teaching guide for the other residents and medical students. The classification I used, and that appealed to me, was psycholeptic, psychodysleptic and psychoanaleptic, meaning drugs that slow you down, make you go sideways or speed you up. As far as therapeutic classes were concerned, for the psycholeptics it was major tranquilizers, which we now call antipsychotics, and the minor tranquilizers, which we now call anti-anxiety drugs. The big ones at the time, we don’t even think about them much now, were meprobamate (Miltown), chlordiazepoxide (Librium), and diazepam (Valium) came on the scene. As psychoanaleptics, the antidepressants were the other big therapeutic class; the tricyclic antidepressants, prominently imipramine (Tofranil). Of course, there were no SSRI’s. The monoamine oxidase inhibitors came onto the scene a little bit later with iproniazid (Marsilid) being the first one. The residency program at the University of Buffalo, a private school then, had no research orientation whatsoever. In undergraduate school, I became interested in research through Saul Mouchly. I had a couple of summer Fellowships to do research, but there was no psychiatry research there, so, I worked in the surgical lab,.where Saul was interested in hepatic coma and ammonia because it was thought to be the offending agent. I helped develop a method for measuring blood ammonia and that was to becme my honors thesis; it .was the first piece of research that I ever formally wrote up. In the residency, my interest in research continued and I was perplexed because when we used the antipsychotics or major tranquilizers I would give them to people and some people responded beautifully and some didn’t respond at all. I couldn’t understand why we had responders and non-responders since clinicall they looked so similar bere tretamnet and we gave them the same dosages of the drug. Given my background in chemistry, I thought it must be a difference in metabolism. At that time, we didn’t have all the elegant methods that we have now and the way you measured phenothiozine metabolism was to collect urine and do something called the Forrest test, which was a color test. The developer, Irene Forrest, was a biochemist in Palo Alto. I put together a makeshift lab and found there was a problem with the Forrest test because some normal compounds like indican, interfered so you could get high or low readings, depending upon the interfering substances. That was the basis for the first publication I had in 1961 in The American Journal of Psychiatry.
WC: So, that was your first publication?
JL: That was my first publication.
WC: At that time the Korean War was on. Did you have any involvement?
JL: In my second year of residency I got a notice from the draft board and I knew about this program called the Commissioned Officer Residency Deferment program, CORD, of the Public Health Service, which said if you agreed to go in after residency you could be deferred. So, I joined the CORD program and didn’t go to Korea. When I finally did go into the Public Health Service I was assigned to the Hospital in Lexington, Kentucky, and that led into another era of my life. While I was still in Buffalo, I wanted to pursue a PhD in pharmacology so I talked with Doug Riggs, the chairman of pharmacology and he was interested that I was moving toward it but my chair, Saul Small, did not want me to do it and he prevented me from going into a joint PhD program. When I found that out, it soured me on him and Buffalo because he was somehow threatened by the fact that I wanted to get a PhD and an MD. Saul was a terrific teacher, but he taught me a lesson about not thwarting the aspiration of young eople but helping them to go in whatever direction they wanted. That is something that has stayed with me through my career. A lot of my colleagues from Buffalo stayed there, but I moved on.
Because of my interest in the metabolism of phenothiazines, I found a biochemist, Herb Posner, at Saint Elizabeths’ Hospital in Washington, DC, where there was the Clinical Neuropharmacology Research Center, the CNRC, part of the NIMH, headed by Joel Elkes. I couldn’t get into that because it was a government program so I applied for residency at Saint Elizabeths Hospital. I went there as a third year resident, but was assigned to the William A.White building where the CNRC was located.
WC: Who were the people doing the research at CNRC at the time?
JL: Joel Elkes headed it up and Fritz Freyhan was the clinician psychopharmacologist who was there with a whole array of other people. Mimo Costa and Steve Szara were there with a large interdisciplinary group. My job was to run a ward of female patients, who were chronically mentally ill and who had been at Saint Elizabeths for a considerable period. In the basement of the same building were the laboratories, so I did the phenothiazine metabolism research with Herb Posner, while running the ward.
WC: When did the CNRC start and how long did it last?
JL: It had been in existence about four or five years. Over the years it morphed into becoming a much more central part of the NIMH intramural research program.
WC: That did have a long strong history, didn’t it?
JL: It did and it was very interesting. Joel Elkes was a pioneer in our field and honored by this group and many others. His goal was to bring basic scientists and clinicians together so that they could learn from each other. Now we give it another name, translational research, but that is what he was after. He created a common room where we could have coffee or tea everyday around four o’clock and the idea was to bring the basic scientists and clinicians together. But what I observed was that the basic scientists and clinicians each went into their own corners and, unfortunately, cross communication didn’t occur. In order to get basic and clinical research and translational research going it is more efficient for it to be in one individual’s head. The idea of people developing a common approach to a problem will only happen if they jointly have the idea and the desire, so it has to come from the bottom up, not from the top down. That is something I think is still true. The MD, PhD and programs like that have been vital to moving the translational area ahead.
WC: What happened next in your career?
JL: I was at Saint Elizabeths for only one year to complete my third year of residency. While I was there, a man by the name of George Cosmides, who was a PhD pharmacologist, came to visit Herb Posner and was working at something called the Psychopharmacology Service Center at the NIMH. This was set up in 1956. A few people went to Congress and said these new drugs are going to revolutionize psychiatry and nobody is studying them so the NIMH ought to have programs that would. The NIMH, at that point, was not interested in psychopharmacology but congress appropriated two million dollars and created something called the Psychopharmacology Service Center (PSC); its first chief was Jonathan Cole. Jonathan is still around and is here at this meeting.
I owed my two years to the federal government for being deferred from the draft and when George Cosmides came around in the CNRC and saw my interest, he said I would love working at the Psychopharmacology Service Center, so he would see if he could get me there. I had been assigned to the Division of Hospitals of the Public Health Service, so Jon Cole tried to get me released to go to NIH. That wasn’t possible so I was assigned to the U.S. Public Health Service Narcotics Hospital in Lexington, Kentucky and moved there in 1962. In some ways that was a lucky break. I met another fellow who had been assigned there that year, Arnold M. Ludwig MD, who had a research orientation. After the first few months we realized that we were green around the gills and the addicts knew much more than we did abou addiction.We also realized that we didn’t have the foggiest idea of how to treat them. So, we did our administrative duties, retreated from patients and advanced into research. Arnold was interested in hypnosis and was trying to use it to control the withdrawal process. I was interested in discharge rates, why some people got out and why some other people didn’t. Another two-year-person, who wasn’t a psychiatrist, was working in some area at the Addiction Research Center, I did not know about came one day and said, “Jerry, you ought to come over and see some of these addicts. We do pharmacologic tests with LSD and some of them have an experience that changes them completely and I don’t understand it. It doesn’t happen all the time, but you ought to see some of these people”. I went over, talked with them and was intrigued by what they said. Then I went to the literature and saw that hallucinogens of various sorts were able to bring about a sort of conversion experience in some people. It sounded like it was a religious conversion experience and I got intrigued by that. Arnold and I got to talking and wondered if there was a way we could make this potentially therapeutic experience to happen on a regular basis. We hit upon the idea of controlling the LSD experience through hypnosis, and named it hypnodelic therapy. We asked the patient to take LSD and during the half hour or so before it took effect we hypnotized the person to have more control over the LSD experience, rather than letting the drug experience go in whatever direction it took. Combining hypnosis and LSD sounds pretty far out but we were about as non-far out as one could get. Getting into this area we had a lot of contact with Abe Winkler, Harris Isbell, and others and came to appreciate the wonderful facility the Addiction Research Center was. We did several studies down there and when our two years were coming to an end, Jonathan Cole got back in touch with me again because LSD was being touted as a very important treatment for alcoholism, psychoneurosis and other things. He wanted someone to set up a program to test whether there was any validity to the claim that LSD could be used as a therapeutic agent. He recruited me to do that in 1964 and I wound up going to the NIMH; two years earlier I had hoped to go there, but now I came with expertise and a mission.
WC: When you moved there, where was it located?