Nancy C. Andreasen, M.D., Ph.D.: Editor Emeritus Perfectus

“It’s perfect for her, it’s perfect for the Journal, and it’s perfect for Psychiatry,” remarked the person sitting next to me 13 years ago. We were just hearing the news that Nancy C. Andreasen had been selected as the Editor-in-Chief of The American Journal of Psychiatry. The speaker was Robert Cloninger, Professor of Psychiatry at Washington University and a renowned expert on character traits, and indeed, his judgment of character has never been better than it was on that day. The past 13 years have been perfect for Nancy and perfect for the Journal; the result has been perfect for Psychiatry.

Nancy began her professional life as a faculty member in the prestigious Department of English at the University of Iowa. Her specialty was the Metaphysical poet John Donne, one of the most difficult writers to interpret in British literature. Her characterization of him as a “poet and psychologist,” whose views of human nature were deeply rooted in Petrarch and Ovid, is quoted today as a staple of the literary criticism of Donne. A personal event, the experience of delivering her daughter, led her to change careers and become a physician and eventually a psychiatrist. Her medical training at Iowa embedded her in a movement to transform psychiatry into medical neuroscience, and while she embraced this ideal, she was never defined by it. Her thoughts about creativity and psychopathology include gleanings that range from Coleridge’s dreams to Freud’s view of the unconscious. Her literary background, her scientific integrity, and her desire to become a physician for very personal reasons formed the quintessential Renaissance woman who was indeed perfect for the Journal.

In Nancy’s mental world, whatever she is doing must be the very best. For those who do not know her well, this attitude may seem like hubris. I have learned that it is not. Her view is not a personal one of herself but rather one that encourages everyone to be part of the excellence that she seeks. Thus, the Journal became part of this world of excellence. Her comrade Sandra Patterson, the Journal’s Managing Editor for 13 years; her Deputy Editor colleagues David Lewis, Robert Michels, Carol Tamminga, and Jack Gorman; and the members of the Editorial Board, whom Nancy especially prized, all participated in what she wanted it to become. The result is a journal that spans from basic neuroscience to clinical trials, encompasses psychotherapy and brain imaging, and offers advice to clinicians along with philosophical perspectives about mental illness and its classification. Along the way, she added a very intimate Book Forum section, which every December allows us to share in Nancy’s cultural world beyond psychiatry. As a final touch, she brightened the somber green journal cover with remarkable artwork.

The Journal’s impact on the practice of psychiatry today and in the future is palpable. For instance, seminal review articles in the Journal highlighted the heretofore overlooked role of neurocognitive deficits in the poor psychosocial outcome of schizophrenia. As a result, the National Institute of Mental Health, in conjunction with major pharmaceutical companies, began a new initiative to find treatments for these problematic deficits. She also published reports from major clinical trials that resulted in improved treatment of bipolar disorder. She championed the use of neuroimaging to begin outlining the neurobiological substrate of basic psychopathological problems in patients with schizophrenia, anxiety disorders, addictions, and affective disorders. It is important to note that she welcomed a strong international presence in the Journal; today the number of libraries around the world subscribing to the Journal exceeds that of the United States. Authors from these countries have brought their problems, including the impact of war and terrorism, to share with American psychiatrists.

Nancy is a firm believer in the Journal’s educational role for psychiatric researchers starting their careers. She has used the review process to inform and shape their work, even if their papers were eventually published elsewhere. She is proud that she made more friends than enemies in this sometimes painful learning process. In the days before web-based reviews, a handwritten note from Nancy (which I received on more than one occasion) sometimes gave you much more information about your work than you wanted to hear, but it also let you know how to succeed in the future.

There have been many accolades for her research leadership. President Clinton awarded her the National Medal of Science. This year she received the Warren Award from the International Congress of Schizophrenia Research, recognizing her scientific leadership in this field. Her recognition of negative symptoms as equal in severity to more obvious positive symptoms and her evidence for structural brain pathology in schizophrenia are cornerstones of our conception of schizophrenia. Her curiosity about schizophrenia has never waned. For years, she has puzzled over the fundamental nature of thought disorder in schizophrenia. Her concept of cognitive dysmetria encompasses her appreciation for the nuances of formal thought disorder and her ability to use neuroimaging to view mental processes as a widely distributed network of neuronal activity.

The honor that she seems to value the most has been her election to the Institute of Medicine of the National Academy of Sciences. There she has found many colleagues like herself—determined, uncompromising, and leaders of their field. They invite her to speak at their graduations, they contribute papers to her Journal and she to theirs, and they are supportive of her mission to bring medical science to psychiatry.

The accolade I remember vividly was the simplest but the most sincere. At a meeting of an NIMH genetic consortium, our expert diagnosticians were deadlocked on how to parse schizophrenia with affective features from schizoaffective disorder—always a contentious issue. Suddenly, one of the most senior members, Raymond Crowe, her fellow Professor at the University of Iowa, said, “We need to call Nancy.” Everyone immediately nodded agreement, and a telephone call to Nancy established the seemingly undrawable line that allowed the research go forward.

Nancy holds Professorships in Psychiatry at both the University of Iowa and the University of New Mexico MIND Institute, a new imaging center dedicated to understanding mental illness. She is especially proud of the homes she has created in both places, one overlooking the rolling fields of Iowa and the other in an arroyo in the desert outside Santa Fe. The homes are her haven, which she shares with her husband Terry. There, as the sun sets, she may linger over a rare single malt scotch—because every aspect of Nancy’s life reflects the seeking of excellence.

She finishes her current role with the Journal reluctantly. So much of her has been poured into it that leaving it is difficult. The 13 years were but a blink of an eye, for her and for us. Throughout the transition, her first thoughts have been with the Journal, and she has worked both diligently and graciously with me to ensure that it will continue to reflect her vision of excellence. For Nancy, for the Journal, and for Psychiatry, her 13 years as Editor indeed have been as perfect as everyone thought they would be.