Psychiatrist-Anthropologist Studies Drug Addiction and Recovery

Often you will find psychiatrist Helena Hansen, M.D., Ph.D., in a tiny office located off Washington Square in Manhattan. This is her office as an assistant professor of anthropology at New York University. But she is also an assistant professor of psychiatry, and in that role she has another office 24 blocks north.

Hansen has several passions that bridge both psychiatry and anthropology—social influences on mental health and, more particularly, social influences on drug addiction and recovery.

It all started in 1969 when Hansen was born to two psychology students at the University of California at Berkeley. Her mother was African American, her father Norwegian. “So it is not an accident that I ended up interested in cross-cultural psychiatry and social influences on mental health,” she said in a recent interview in her Waverly Place office.

She did her undergraduate studies at Harvard University, with a major in biology. While there, she found herself moonlighting at the Kennedy School of Government. “I used to sneak over and listen in on their policy debates. I was fascinated by government and how social groups were affected, particularly in terms of the health impact of policymaking.”

After graduating from Harvard in 1992, she spent three years working for the National AIDS Fund. “This was an exciting time, when a lot of community organizing around AIDS was taking hold,” she recalled. “I had the pleasure of running a mini-grants program for neighborhood leaders who wanted to prevent AIDS. In the process I got a sense of how important social forces are to health outcomes.”

At this point, she wanted one foot in clinical medicine, but the other in a domain in which social forces to improve health could be addressed. In 1995 she applied to an M.D.-Ph.D. program at Yale University. “I convinced the M.D.-Ph.D. committee to take me as its first social-science student. They had taken bench scientists up to that point. The reason why they took me, I think, is because I made a strong argument that social determinants have a large impact on health outcomes, and that just as we need basic science to be translated to the bedside, we need social science to be translated to the clinic.”

After she was accepted into the program, she decided to pursue a doctorate in anthropology. During her first year, she spent six weeks in Cuba and studied the Cuban response to the AIDS epidemic. She spent time in its AIDS sanatoria. “They are the only country in the world that has established quarantine for HIV-positive people,” she noted. Subsequently she studied whether needle-exchange programs helped prevent drug-induced HIV in inner-city Hartford, Conn., followed by a year of field work studying a network of evangelical addiction ministries in Puerto Rico. She found that the ministries were not a panacea, but did help some deal with their lack of employment and struggles with addiction and even gave them “respectable” identities as evangelists.

Meanwhile, Hansen got to know members of the psychiatry faculty at Yale and saw a place for herself in that field. “I think that psychiatry is a field that in the past has taken social influences on health seriously.” Thus, after she graduated from the M.D.-Ph.D. program at Yale in 2005, she entered a psychiatry residency program at New York University.

When she entered the program, it didn’t have much of a curriculum regarding social and cultural influences on mental health, she noted. In 2008, when she was a third-year resident, the faculty put her in charge of developing one. “I was able to bring experts from New York University’s Department of Anthropology and Department of Sociology up to New York University’s medical school to teach the psychiatry residents there. Those were exciting moments.”

In 2009, she completed her psychiatry residency and then did two fellowships: a clinical fellowship in addiction psychiatry and a population health research fellowship in the Robert Wood Johnson Health and Society Scholars Program. In 2011, she started her positions as assistant professor of both psychiatry and anthropology.

Today she teaches anthropology to graduate and undergraduate students and teaches psychiatry residents as well. She is in charge of the social, cultural, and mental health curriculum in the psychiatry residency program.

Recently, Hansen received a grant from the National Institute on Drug Abuse to look into barriers to buprenorphine treatment for opiate dependence in public clinics. “It draws on my training as an anthropologist. I am spending a lot of time in clinics—listening to what people say on the record and off the record to get a sense of what is happening. This contrasts with traditional psychiatric research, where you survey subjects with closed-ended questions.”

This project has made her realize how difficult it is for public addiction treatment clinics to integrate with public primary care clinics, even when staffs in both domains make a concerted effort to do so, because of the financial structures of the clinics. “We are seeing barriers to referring primary care patients for mental health services even within the same hospital,” she remarked.

Hansen also leads two group-therapy programs for patients recovering from drug addiction at Bellevue Hospital—therapies that she likes to think of as “socioculturally based psychiatric treatments.”

One is the community performance group. “We basically put on events for the hospital—one-act plays, karaoke parties. We are creating a sense of community and social connection among patients in the hospital. When people feel connected to one another and work collaboratively on projects, that is mental health giving.”

The other is called the video self-documentary group. With the help of staff and volunteers, addicted patients, many of them homeless and with less than a high school education, get together once a week to make videos about their lives. They are learning camera work, editing, and scripting. “There is therapeutic value in telling one’s life story,” Hansen observed. “And making the films helps give patients a different sense of identity, of oneself as a filmmaker, as opposed to simply being a patient in addiction recovery.”

Where does Hansen want to go from here? “I see myself continuing to build a research base pertaining to the cultural and social aspects of mental health and how we clinicians can intervene at that level. In essence, I hope to be able to stay the course in both psychiatry and anthropology and try to bring the best of both worlds to the other.” ■

An interview of Hansen by Psychiatric News, can be accessed here.