08 JULY 2019 | STORY AMBRE NICOLSON. PHOTO MICHAEL HAMMOND.

Professor Dan Stein received a lifetime achievement award at the 14th World Congress of Biological Psychiatry.

Professor Dan Stein, head of the Department of Psychiatry and Mental Health at the University of Cape Town (UCT), was recently honoured with a lifetime achievement award at the 14th World Congress of Biological Psychiatry. He looks back at the roles that cross-disciplinarity, curiosity and collaboration have played in his career to date.

Integrating disciplines

If there is a theme that runs through Stein’s work, it is integration.

“Medicine was attractive because it provided a bridge between the humanities and the sciences. In my clinical years, I became more and more interested in psychiatry, as this seemed to me to integrate different disciplines in order to understand people.”

Looking back, Stein says one of the reasons that he enjoyed his career is because psychiatry demands an integrative cross-disciplinary approach. This he experienced while studying psychiatry at Columbia University in New York.

“Columbia was a major teaching centre for psychoanalysis, but the lecturers were also pioneers in a wide range of other areas including cognitive-behavioural psychotherapy, psychopharmacology and biological psychiatry.

“The training was great in addressing my curiosity about a variety of fields.”

After completing a post-doctoral fellowship in psychopharmacology, Stein returned to South Africa where he expanded his work on anxiety and related disorders, including post-traumatic stress disorder. Some of his first research focused on psychiatric aspects of the Truth & Reconciliation Commission.

“Medicine was attractive because it provided a bridge between the humanities and the sciences.”

“Being back in South Africa, I was lucky to be mentored by Prof Robin Emsley, who supported my interest in asking questions in a number of different fields,” he recalls.

In 1997, Stein was awarded an SAMRC unit on Anxiety & Stress Disorders – a unit that continued until 2018, when he was awarded a new SAMRC unit on Risk & Resilience in Mental Disorders. In 2005, he became head of the Department of Psychiatry and Mental Health at UCT. During the same year, he initiated the Brain-Behaviour Initiative (BBI).

“The SAMRC units and the BBI were designed to integrate different methods and disciplines.” Stein’s work has therefore ranged from basic neuroscience through to clinical research and on to public mental health.

Stein argues that moving from “bench to bedside to bundu” (‘bundu’ referring to communities) is an important aspiration for medical and psychiatric research. He has become increasingly interested in integrating neuroscience and public mental health. The first focuses primarily on the psychobiological mechanisms behind mental illness, while the second focuses on social determinants.

Stein is positive about UCT’s new Neuroscience Institute led by Professors Graham Fieggen and Kirsty Donald. “The idea behind this initiative is also cross-disciplinary and integrative,” he says. “It is designed to bring together different perspectives.”

“Some have taken the stance that universities must choose between seeking truth or enhancing social justice, whereas UCT’s Vice-Chancellor believes that we must do both.”

Stein serves as the institute’s inaugural scientific director and notes that its key themes are highly relevant to South Africa: neurotrauma, neurodevelopment, and neuroinfection. “These are themes that require a transdisciplinary approach. Through the institute, experts in a range of fields are now able to work together under one roof.”

Combining curiosity and collaboration

Over the course of his career, Stein has published prolifically, including more than 40 edited volumes and multiple papers and chapters. This has been possible, he says, because of his wide interests and multiple collaborations, which extend across South Africa, Africa and globally.

“Collaborations have also helped me to be a better mentor.” Mentorship is clearly something crucial to Stein. He has supervised more than 100 research dissertations and postdoctoral fellows; many past students are now leaders, spearheading work in a diversity of fields.

“I’m privileged to have worked with postdocs who are focused on basic neuroscience, on the one hand, and philosophy, on the other. Fortunately, a number of these colleagues have continued to collaborate with me over the years.

“Professor Christine Lochner at Stellenbosch University, for example, has long led the work of our unit on obsessive-compulsive and related disorders. I would be lost without her and my colleagues.”

Stein lists three international collaborations that have, for him, exemplified the enormous value of collaboration. “The World Mental Health Survey consortium, which includes data from Africa’s first nationally representative study. It’s led by Professor Ron Kessler, an outstanding scientist.”

“The Enhancing Neuroimaging Genetics through Meta-Analysis Consortium – the world’s largest collaboration on brain imaging. And the Psychiatric Genetics Consortium, which is the world’s largest collaboration in psychiatric genetics and has really driven this field forwards. We’re helping by contributing African data.”

Understanding and action

Looking to the future, Stein believes that integrative transdisciplinary approaches are the best way to understand people and figure out how best to provide health care.

“So, if you really want to improve mental health and change the world, you have to have a clear and comprehensive understanding of people.”

“If you want to really understand people, you have to study them in context and use a range of methodologies,” he says. “While there are a number of such studies internationally, there are few cohort studies in low- and middle-income countries that look at both the genetics and environment of people, for example.”

Stein says one excellent example is the UCT-led Drakenstein Child Health Study led by UCT Professor Heather Zar. It is a multi-year study following 1 000 mother–child pairs that aims to investigate the role and interaction of risk and resilience factors. Stein works on the psychosocial aspects of the study.

“Some have taken the stance that universities must choose between seeking truth or enhancing social justice, whereas UCT’s Vice-Chancellor believes that we must do both.

“This makes particular sense in health care, where – to address treatment gaps and promote social justice – you have to understand the mechanisms underlying illness and you have to do research on how best to target them.

“So, if you really want to improve mental health and change the world, you have to have a clear and comprehensive understanding of people.”

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