Spotlight Interview with Dr. David C. Henderson

“When I went to Somaliland, I saw so many people chained up. However, their families didn’t do that to be mean or to punish them; it was actually to protect their loved ones. If they are running around the community, they could get killed. It makes me have a newfound respect for what chains represent. It kept their loved ones safe. In order to get rid of the chains, you need to deliver mental health care.” – Dr. Henderson

Location: Boston, MA, USA

Bio: David C. Henderson, MD, currently serves as Psychiatrist-in-Chief for the Division of Psychiatry at Boston Medical Center (BMC) and Professor and Chair in the Department of Psychiatry at Boston University School of Medicine (BUSM). Dr. Henderson previously served as the Director of The Chester M. Pierce, MD Division of Global Psychiatry at Massachusetts General Hospital (MGH), Director of the MGH Schizophrenia Clinical and Research Program, and Medical Director of the Harvard Program in Refugee Trauma. Dr. Henderson currently serves as the Co-Director of the NIMH T32 MGH-BUSM Global Psychiatry Clinical Research Training Program. He has worked internationally for the past 27 years in resource-limited settings, and areas impacted by mass violence, disasters, and complex emergencies. Dr. Henderson has conducted research and training programs in Bosnia, Cambodia, East Timor, Ethiopia, Haiti, Liberia, New Orleans, New York City, Rwanda, Peru, South Africa, and Somaliland, among other places. His work has consisted of field studies, needs assessments, mental health policy development and strategic planning, quantitative and qualitative surveys, mental health capacity building programs for specialized and primary health professionals, and skill transfer program evaluation. In the United States, he has conducted more than 30 randomized clinical trials in severely mentally ill populations. Dr. Henderson has also directed a schizophrenia research training fellowship and mentored trainees and junior faculty who have progressed to K awards and secured other independent funding. He actively mentors ten psychiatry residents and four postdoctoral fellows on data-driven international research projects.

Let’s start at the beginning, when did you know you wanted to be a doctor?

My dad passed away when I was a little kid. He died of cancer. So at the age of thirteen, I knew I wanted to be a doctor so I could find a cure to cancer, as with many little kids who lose their loved ones dream to do.

My actual journey through pursuing medicine led me to a fascination with both internal medicine and psychiatry. I ended up applying to both types of residency programs and decided on attending an internal medicine internship. However, after one year I switched to pursuing a psychiatry residency at Massachusetts General Hospital (MGH). I still had a longing to go back and complete my internal medicine training and it really took me ten years to give up on that notion. I soon realized after I began my research in schizophrenia that there were many overlapping issues that really involved a lot of internal medicine, such as the correlations between obesity, diabetes, and cardiovascular diseases. At the end of the day, physicians are physicians. We are trained to really understand it all. However, most of my colleagues in psychiatry don’t draw blood or perform EKGs. I try to hold onto all my medical skills learned and apply them.

During that time, when did you meet Dr. Chester M. Pierce and begin your mentorship with him?

It was during my postgraduate year two (PGY2) of psychiatry residency at MGH when I remember walking down a hallway and seeing this distinguished African American man. I thought “Oh my goodness, who is that man?” At that time in my life, there weren’t many men who looked like me in medicine. Time passed and during a rotation I had a buddy wanting to connect me with a colleague named Chester M. Pierce. I had agreed but had absolutely no idea who this man was. Finally, everything just clicked and I realized he was the man I had seen in the hallway. “Chet” [Chester Pierce], my colleague, and I would meet once a month for lunch or dinner at Chet’s favorite Chinese restaurant in Harvard Square. After that, the rest is history. He very clearly changed my life.

When did you start getting involved in global health?

When I graduated from my residency at MGH, I stayed and worked in the community clinic focusing on serious mental illnesses (SMIs) and schizophrenia. I ended up taking a job at Massachusetts Institute of Technology (MIT) in the health services department, which had a big mental health team. Soon after working there, I realized that the clinical knowledge I learned during my residency wasn’t translating to the patient population at MIT. I really felt stumped and frustrated that certain treatments weren’t working for my patients. I was sharing all my frustrations to Chet at one of our monthly dinners and he laughed at me. He said something along the lines of, “Well I think it’s time you get an international experience. I think this will all help put things into perspective. Give me a little bit of time to set something up and find an opportunity for you.” So in my head, I’m thinking I need to touch up on my French! I’m going to Paris! Or maybe I should freshen up on my Spanish if I’m going to Barcelona! About three months later, I receive a call from Chet saying he has a friend who has a project for me. We developed a field study to conduct and, having never done that, three months later I am on a plane, and we are landing in complete darkness.

Here we were in post-conflict Rwanda, only three months after the genocide. We met a Belgium diplomat and altogether traveled throughout the country interviewing Rwandan people. As a result, we wrote up a policy document for the government to implement trauma related interventions. It only took about fifteen years for some of the policies to be implemented.  

What were some lessons learned from this trip?

I admit now that I was not prepared to do that kind of work. The stories we heard were unbelievably traumatic and eye-opening. The first thing I encountered was an asylum overcrowded with people, especially women in their 30s and 40s, barely resourced with medications, and with no proper care. We had to use many interpreters. It was strange because when we talked to the clinicians at the asylum, they told us that all of their patients’ diagnoses were the same, yet the patients had none of the same symptoms. Most of how the patients ended up there came from a similar story: women were naked and running around their town yelling and screaming. They were picked up and left at the asylum. As I met with patients, I found nothing to properly diagnose them with. So continuing on with our travels, I included a different type of question in our interviews with the town’s people: “What would you do if you saw a woman naked, running and screaming?” Everyone said, “nothing.” They suggested that the naked woman’s husband likely didn’t come home last night. For them, it was a normal expression of distress. Meanwhile, we thought it was severe psychopathology. So it kind set off a reaction of, “Oh my gosh, how many more of these ‘diagnoses’ are similar situations?”

Throughout my career, I have had to determine: “Is psychosis, psychosis? Are they actually psychotic? Could what they’re saying actually be real?” Our American Diagnostic and Statistical Manual for Mental Disorders (DSM) just doesn’t apply to these culturally diverse populations. Every society determines what’s normal and abnormal. It simply is not captured in our American medical literature, so we can make huge mistakes.

Could you share another experience you’ve lived while working globally?

I’ve seen so many other blatant examples. After the Rwanda trip, I started with this group, the Harvard Program in Refugee Trauma. We started working in Cambodia, training 100 primary care doctors. There were no psychiatrists in country at the time. I would see patients in the evening in their villages. There seemed to be a lot of psychotic people that I would diagnose, even the doctors would say they experienced the same symptoms as their patients. I was really shocked at the time. On the last day of our trip, we had a big celebration. The Minister of Health got up and said we are going to spend the last minutes helping Dr. David. “It seems he is the only one here that is not in touch with his ancestors.” I was like, “What are you talking about?” Then it soon came to my realization that when I was asking the question, “Do you hear voices?” the way I was trained to ask, and the way we approach Cambodian patients in our ER, if they say no, that’s a bad thing because that means they are not in touch with their ancestors. When we were asking about hallucinating and hearing imaginary voices, they responded with yes because in their culture, they are connected to their ancestors. This was a huge disconnect!

Another thing I learned was that some Cambodian people metabolize medications slowly. I didn’t know anything about their character pathology. A colleague’s patient wasn’t talking due to antipsychotic medication and she really couldn’t figure out why. After digging deeper, we realized the dosage was way too high. After fixing the prescription, the patient became the most friendly and talkative person! Some populations metabolize drugs differently. Ethnopsychopharmacology is such an important and underrated field. Based on my experiences globally, you truly realize your patients are affected due to their genetic dispositions, some due to their environment and diet, and others due to their cultures and beliefs.  

It wasn’t until 2002 when Gregory Fricchione, MD, Chester Pierce, MD, and Jerry Rosenbaum, MD, started an international division of psychiatry at MGH. Their vision was to expose U.S. trainees to international settings. They believed if we create and train our students to be more culturally sensitive and aware, we will produce better doctors. I took it over in 2009, and we decided to rename the division to The Chester M. Pierce, MD Division of Global Psychiatry to honor Dr. Pierce’s contributions to global mental health. We really changed the focus of the division to capacity building, so we could always give back to those less resourced than us. This capacity could be around clinical care, training, policy and advocacy, research — whatever it was, we needed to build capacity.

Why global research and why not just focus on the U.S.?

Somebody could be pulling you up and you should pull somebody else up with you. You cannot get to equity with isolated work. Take for example the pandemic: when you leave out countries and populations, COVID will keep coming back. Africa is poorly vaccinated; when you leave out others you just let issues continue on. We have a tremendous amount of resources here in the U.S. To me, I don’t understand how you reconcile not wanting to help. That’s the beauty of the Global & Local Center for Mental Health Disparities (GLCMHD) at BMC/BUSM. We can have a greater impact by helping everyone and especially the most disadvantaged. One such program we initiated was the Liberia Psychiatry Residency Program. Liberia only had one psychiatrist, and then we hired another from Nigeria. We put together a residency program and by next year, we will have two psychiatrists graduating from the program. It is amazing because initially we, the U.S. side, started funding the program, and now the Liberia College of Physician and Surgeons (LCPS) is funding it themselves and the program is becoming sustainable.

How do you initiate a fair, global partnership?

It’s simply building and respecting the foundations of a partnership, not coming in to save anyone or rescue anyone. My first trip to a country I don’t say anything; I’m there to listen. I ask questions such as how can we start working together and where we want to go with it. We’ve also built partnerships through colleagues who are already established and well connected with the community. It’s really up to our partners to determine what they need and us figuring out how we can help them with that. It’s also important to note that sometimes you are not the right partner and respecting that some people are better suited to help certain populations.

This is why I believe in the Africa Global Mental Health Institute (AGMHI). There are so many different relationships and it’s built on a network.

Can you expand on the purpose and goals of the AGMHI?

Our first meeting was in 2002. It was a special meeting with an unbelievable group of people. A lot of recommendations came from that meeting, but we were not in the position to execute them. Now the world is in a different place and we are ready to pursue actions. The AGMHI really is centered on capacity building. It’s a network for people to connect. We initially wanted to share resources such as curriculums and grant proposals. There is no need for people to start from ground zero when someone else out there could have the information you need. You just have to adapt it to your country and gather information so you can deliver whatever you want to deliver. The knowledge is available and that is something we can share. Sharing physical things such as medicine can be hard to provide, but mental capacity we can give. I think it’s important to note that the AGMHI was not my vision; it was Dr. Chester Pierce’s vision. A beer in Cape Town with the right people and we started getting it going. Our next step is to really focus on getting funding, and we know funding has to come our way because the mental health crisis is the next wave.

When we go to the continent and we teach it’s such a different response. The students hang on to your every word. They truly have a thirst for knowledge, and they just think, “How I can help other people?” Here in the U.S., it can be really different. We take certain fundamental things for granted. Eventually, the AGMHI should hold as a model for every continent to connect.

Can you talk about your intentions for the T32 BUMC-MGH Global Psychiatry Clinical Research Training Program?

The purpose is to build global scientists to get a K award. Ideally, the K award would then fund their work in a country for eight years. Our fellows should develop and build long-lasting relationships. All of our fellows teach and share knowledge when they go. We want them to also become mentors and continue to take on students themselves.

What are your goals for 2022?

I look forward to potential travel come the New Year. I have a lot of catching up to do with our global partners and would like to meet them in person. We have used Zoom the best we can; however, there is no substitute for being on the ground.

One life lesson?

For me, it’s understanding that people are the same yet different. We have to catch ourselves from putting people in boxes. This also can be applied not just to people, but to countries.

If you could have one wish that would be granted, what would it be?

I would wish for accessible mental health care everywhere. I would want to bring proper mental health care to vulnerable populations who have the least access to the basic care they need. The thing is, we have effective treatments here in the U.S., but we can’t deliver them. It is not like we have to design a new rocket! We have it! We just can’t get it to people. People are suffering all over the world and we know what to do.

When I went to Somaliland, I saw so many people chained up. However, their families didn’t do that to be mean or to punish them; it was actually to protect their loved ones. If they are running around the community, they could get killed. It makes me have a newfound respect for what chains represent. It kept their loved ones safe. In order to get rid of the chains, you need to deliver mental health care.

What advice do you have to give those interested in pursuing a similar path?

To those interested in this field, you need to jump on opportunities and just have experiences. Make good connections and make sure you are being connected to people who are doing it the right way. Do your research and don’t join groups that seem like they are helping others but in reality, make a group of people dependent on them and then disappear. So if you enter this field, do it the right way.

Closing thoughts

There is so much for us to learn in the field of psychiatry. We don’t have physical tests that we can perform to diagnose mental illnesses; it really is subjective. We have to be open. Right now, the approaches we take need to be adaptable to all cultures and people. It is truly about being collaborative to create better outcomes for our patients. Simply, we have to do the work; we can’t just sit back. It is up to us to be the best learners.

 By Joanne Won, January 2022