Dr. Paul R. McHugh was in no mood for fake modesty, not with three days of ceremony and a seminar about to begin in his honor. So when someone casually asked the chief of psychiatry at the Johns Hopkins University School of Medicine how long a speech he was about to deliver, he had to laugh.
"As long as I want it to be," said McHugh. "This is one of those cases of: 'Where is the elephant going to sit?' "
The big laugh echoed down two flights of stairs as McHugh hustled toward Hurd Hall, filling to the back aisles with more than 300 people. Some were around in 1975 when McHugh assumed leadership of the department of psychiatry and began reshaping the place to suit his strong professional convictions. Now the school was dedicating a research chair in his name and the elephant, gracious but seldom bashful, would sit where he pleased.
In fact he spoke for just 30 minutes at the ceremony Thursday during which the Paul R. McHugh chair in psychiatry wasdedicated. Yesterday morning, he welcomed an international assembly of psychiatrists to a two-day conference in his honor and was scheduled to give the closing remarks today.
Also yesterday, McHugh received the title of university distinguished service professor.
If this weren't enough to make McHugh's day, Tom Wolfe has also dedicated his new novel, "A Man in Full," to McHugh, whom he met at a neuroscience conference a few years ago at Washington and Lee University. Wolfe, who arrived in Baltimore for the symposium yesterday, was treated successfully by McHugh last year for the depression he suffered after quintuple heart-bypass surgery.
"It's not just his brilliance as a psychiatrist," Wolfe said yesterday, "it's his extraordinary kindness."
McHugh was kept in the dark about the distinguished service title until it was announced but had heard some time ago about the research chair.
"I thought, 'Well, that's wonderful,' " McHugh said. "I was touched, I was moved that my colleagues, my university would think of honoring me in this fashion."
The endowment -- which the school hopes will grow from the $1.75 million in hand to $2.5 million -- will support a position devoted to research in what are known as the "driven" or "motivated behaviors." These include eating, sex and addictions.
These behaviors, especially eating, have been McHugh's preoccupations as a researcher for decades. As teacher and clinician, his focus has gravitated to the psychiatric patient, his pull always against what he considers psychiatry's tendency to drift from the verifiable to the fanciful. McHugh has regularly chastised his students and profession for not asking two questions: What do I know? How do I know it?
The deceptively simple mantra has been applied by a man whose abiding argument is against oversimplification. In his teaching and his writing, McHugh makes a prevailing point: A subject so complex and nuanced as psychiatry demands clinical practice to match. No one theory, no one approach, no one school of thought will do.
Along with his colleague Dr. Phillip R. Slavney, McHugh has translated this many-layered approach into a book, "The Perspectives of Psychiatry," the second and much expanded edition of which was just published. When it first appeared in 1983, the New England Journal of Medicine's reviewer wrote that the text "illuminates psychiatry more clearly than any other work I know."
McHugh's convictions have propelled him into the national spotlight as critic of such fashionable notions as multiple-personality disorder, recovered memory and physician-assisted suicide.
In essays for American Scholar, he has called Dr. Jack Kevorkian " 'certifiably' insane" and compared sexual-abuse accusations arising from multiple personality and repressed-memory cases to the Salem, Mass., witch hysteria.
His admirers would consider him vigilant in pursuit of intellectual rigor; his detractors might call him a narrow-minded public scold.
Nothing but public acclamation for the man has occupied these past three days at Hopkins. At Hurd Hall on Thursday, McHugh received a sustained standing ovation. He accepted by smiling and blushing. Then, in his best sendup of a giddy Oscar recipient, McHugh said, "Hearing the drumbeat of one's name, you can't help but love it."
In meeting McHugh for the first time, you can't help but find your expectations shattered. That is, if you expected a formidably earnest scholar. McHugh presents as a strange hybrid of intellectual and Boston politician, complete with native Massachusetts accent, bright blue eyes and gregarious charm. His vigor suggests a much younger man, a sense of excitement about his work that's at least as inspiring as John Glenn's latest spaceflight.
Joseph Epstein, essayist and former editor of American Scholar, said of McHugh: "I once called him a 'manic impressive' because the flow of energy is fantastic."
Wolfe said he found McHugh an effective psychiatrist because "he just makes you want to do better. It's that voice and that laugh and that personality. He becomes wholly wrapped up in the other person."
As his colleagues tell it, McHugh has over the years energized those around him, pushing residents to think harder, encouraging an active and continuing conversation about clinical practice between members of the psychiatry department and the rest of the medical school.
"The encounter with him heightens your awareness both of how much there is to learn and your capacity to learn it," said Slavney, a Hopkins faculty member who studied with McHugh at New York Hospital's Westchester County division in the early 1970s.
A September 1975 clipping from the Baltimore News American said McHugh took charge of a psychiatry department that had been "dispirited and disunified."
Dr. J. Raymond DePaulo Jr., a member of the Hopkins faculty who was a psychiatric resident at the time, said that's a fair description. Too many faculty members and residents were locked into only one of the several approaches that McHugh and Slavney identify in their text.
Department members "didn't have a good way of talking to each other," said DePaulo. "They were talking past each other."
McHugh said he felt one of his missions in taking charge of the department was "to make sure people talk sense. And know the rules that don't change, and that I didn't make up. If there's anything the matter with American psychiatry, for one thing it's too amorphous. It doesn't work hard enough to make its discourse coherent."
McHugh sought to change that by repeating his epistemological mantra. By encouraging argument based on evidence. By teaching residents and seeing patients on the wards, a rare practice among medical school department chiefs.
Every Friday morning, you'll find McHugh sitting down with the residents in a room on the ward. He conducts an interview with a patient, who is also questioned by the residents. Then the patient leaves and the discussion begins. McHugh's style is Socratic, never dictatorial, but he can be intimidating nonetheless.
Baltimore psychiatrist Dr. David W. Goodman, who was a resident from 1982 to 1986, recalled an occasion when McHugh took issue with a point Goodman made on manic-depressive illness. Perhaps he should go back and read up, McHugh suggested. Goodman read a text by German psychiatrist Eugen Bleuler and reported back, assuming he'd impress the director with his new understanding.
"What translation did you read?" was the director's question, as Goodman recalled. Hearing the answer, McHugh observed that this particular translation was notoriously flawed.
McHugh took a tough stance on sex-change surgery at Hopkins and ended the practice, which he described in a 1992 essay as another example of medicine serving cultural fad.
At the same time, largely because of McHugh's interest in motivated behaviors, Hopkins has become a national leader in research on drug and alcohol addiction. His own research, conducted chiefly during the 1970s and 1980s, focused on the biochemical mechanisms underlying appetite and body weight control.
In accepting the endowed chair, Hopkins President Dr. William R. Brody said McHugh "epitomizes the Hopkins ideal of the triple threat -- physician, researcher and teacher."
McHugh took it all in, loving every bit.
Pub Date: 11/14/98