W. Edwin Fann: A History of the Tennessee Neuropsychiatric Institute.
Aitor Castillo’s comment
My TNI experience
I arrived at Nashville in early February 1979 on a snowy night. “This quite rare. Never snows in Nashville,” the taxi driver told me. It had been a long trip flying from Lima City to “Music City USA” with stops at Miami and Alabama. It was first time for me in the USA, just 27 years old, with an acceptable fluency in English. Nobody at the airport was waiting for me which, although I knew that in advance, was a kind of shocking experience because in Latin America most people used to go to the airport to welcome visitors.
Next morning, in pretty cold weather I took the bus from my apartment on Murfreesboro Road to the Tennessee Neuropsychiatric Institute (TNI). My first impression was of a huge psychiatric hospital with many buildings. Then, somebody pointed to an old brick three-story building and said to me “this is TNI.” Inside the quiet building a small and old elevator put me on the third floor. There I met Thomas Ban (Director of the Clinical Division) and William Petrie (Educational Director, Clinical Division) -- nice people, no doubt about it. I’ll never forget, one of the first actions by Tom was to ask his secretary to accompany me to First American Bank ir order to open a bank account. Certainly, it was the first and only time in my life that I used checks. I just hate banks but I realize they are still necessary.
My stay at TNI was just great. I can remember so many terrific experiences there. During my first days I had the opportunity to attend some conferences at Vanderbilt University (VU) not so far away from TNI. For example, Leo Hollister was lecturing about geriatric psychopharmacology (I can honestly say that at that time I had no idea who Hollister was). Then, a few days later I was chating with Edward Domino who was coming for a meeting at TNI. I also remember when I was introduced to Fridolin Sulser and learned something about his work on mode of actions of antidepressants.
I enjoyed Tom supervising medical students and discussing clinical issues. I also enjoyed our meetings with the whole staff on how to run clinical trials with new drugs; I had the opportunity to participate in some of them and learned about the right ways to implement research protocols.
One of my favorite anecdotes from TNI is this: Joe McEvoy, who was running an antipsychotic trial, appointed me to replace him one morning for the screening rounds on the hospital wards in order to recruite appropriate schizophrenic patients. Going with the medical students, I interviewed many candidates without much problem, but one of them was really hard to know his right diagnosis. Finally, I decided that he had a schizophrenic disorder and sent him to the research unit of TNI on the third floor. Next day, Joe arrived and openly and angrily disagreed with my diagnosis. After some discussion, we decided to present the patient to the chairman of the Department of Psychiatry at VU who used to run a clinical presentation on Thursdays every week. On that afternoon, there was Marc Hollander surrounded by the whole TNI staff excluding Tom Ban. Somebody presented the clinical case. Then Marc Hollander asked us for the discussion. Nobody wanted to risk an opinion. So I said to myself, “you originated this problem so you have to face it. You have to talk.” Trying to speak my best English ever, I concluded my short presentation saying that the patient had a pseudoneurotic schizophrenia disorder. Hollander widely open his blue eyes and, looking directly at me, said: “exactly.” Then he brightly continued elaborating about the case. At the end of the meeting the medical students could not believe that and said to me: “It is the first time Dr. Hollander raised no objections. How can you do this coming from a Spanish-speaking country in South America? You beat Dr McEvoy.” Finally, they invited me for a nice dinner at their home.
Approaching the end of my training period I needed to comply with the requisite of a lecture on some topic for the Department of Psychiatry at VU. During the last couple of months I had been preparing a lecture about a new and severe psychiatric disorder in Perú: Cocaine Basic Paste addiction. On my free time I went to the VU library to review all the available literature but I could not find anything about it. Instead of that, I found a lot of information about Cocaine Chlorhidrate addiction. Interesting enough, it appeared clear to me that smoked basic paste is a clinical phenomema pretty close to intravenous cocaine addiction. Then, I could present a very hot and interesting topic to my American colleagues, joining the literature evidence available and my personal clinical experience in Lima City. At the end of my presentation, Marc invited me for lunch at the VU cafeteria and I had the opportunity to see again the warm, empathic and modest personality that most high-quality American proffesors display. Finally, I wrote a paper on that issue (Castillo 1980).
As I said before, during my training at TNI I learned to run clinical trials and to write research protocols. At the same time, I became familiar with a lot of psychiatric rating scales used in order to evaluate the patients involved in those clinical trials. Interesting enough, William (Bill) Guy was working at TNI and his expertise in this area was very supportive (Guy 1976).
Last but not least, I made a lot of friends and certainly learned to enjoy the American way of life. Also, I appreciated the driving impetus of Tom´s team and the warm and friendly atmosphere at TNI. I can say that my experience at the institute was a vital breakthrough that accompanied me through all these years in my personal and professional life
Castillo A. Cocaína y Pasta Básica de Cocaína. Archivos Venezolanos de Psiquiatría y Neurología 1980; 26(54-55):41-48,
Guy W. Early clinical drug evaluation (ECDEU) assessment manual for psychopharmacology. Publication No. 76-338. Rockville: National Institute of Mental Health, 1976.
May 21, 2020