Country's Turmoil, Violence Shaped Psychiatrist's Career

Some lives are marked by one monumental event that impacts their attitudes, decisions, and goals.

For psychiatrist Marcela Horvitz-Lennon, M.D., this event took place on September 11, 1973, when she was a girl growing up in Santiago, Chile. The day brought a dramatic political shift that would change the future of her homeland and the course of her life.

This was the day that General Augusto Pinochet executed a military coup that resulted in his rising to power and heading a military dictatorship in Chile that lasted for the next 20 years. Tens of thousands of people who were judged to be opponents of Pinochet were murdered in the months after the coup as the country erupted in violence.

“Part of my family went into exile, and a close family member was killed [during the coup],” Horvitz-Lennon told Psychiatric News. “My life changed from that day forward.”

Horvitz-Lennon is an assistant professor of psychiatry at the University of Pittsburgh School of Medicine.

She became an adolescent in a country in which free expression, which had once been welcomed, was now stifled. “This was hard for a young person to navigate,” she recalled. She and her parents, who were avid followers of politics, noted a stark contrast between the former socialist government, which was interested in the well-being of the people, and the then-current dictatorship, in which only the wealthy would thrive. “Inequality rose, and there was a vast increase in the nation's poverty levels,” she noted. “This meant more wealth for the fewer.”

Psychiatry Proves Perfect Fit

Horvitz-Lennon entered medical school at the University of Chile in 1980, with her father's guidance and the desire to serve others. While in medical school, she discovered that during clinical rotations she most enjoyed talking to people and helping them sort through their problems. Furthermore, her political interest, passed down from her parents, may have influenced her decision to specialize in psychiatry—“I was interested in the social situations of my patients and how that related to their mental health status,” she said.

The practice of psychiatry also ran in the family. Her grandfather and granduncle were psychiatrists, and the main state hospital in Santiago, known as “The Horvitz” was named after her granduncle.

Horvitz-Lennon came to the United States in 1988 to begin a psychiatry residency at the University of Maryland Medical School along with her husband, Carlos Camacho, a Chilean physicist, who entered a Ph.D. program at the university.

As a resident, she had the opportunity to work on an assertive community treatment (ACT) team, providing clinical care and studying the factors that impacted medication adherence among patients who received services from the ACT team.

Focusing on the Bigger Picture

She was able to combine her clinical skills with her desire to “think about the bigger picture” in terms of organizing psychiatric services for underserved populations by completing a master's program in public health program at Johns Hopkins University as part of a two-year community psychiatry fellowship.

While training in the United States, Horvitz-Lennon became acquainted with professional colleagues who became her mentors and role models, including Howard Goldman, M.D., Ph.D., at the University of Maryland and the late Bruno Lima, M.D., at Johns Hopkins University, whom she described as “very generous—an amazing person,” who supervised her in her research at Johns Hopkins.

Upon completing the fellowship, Horvitz-Lennon returned to Chile to work for the Mental Health Unit of the Ministry of Health to help the Chilean government create policies that would enable citizens to receive mental health services through the country's national health care system. Many of the people who would benefit from these policies, she noted, were destitute and living with chronic mental illness. “For me, it was the ideal position,” she said.

Horvitz-Lennon eventually returned to the United States to work at Harvard Medical School in the departments of psychiatry and health care policy, and in 2004 she joined the Department of Psychiatry at the University of Pittsburgh.

Since that time she has been working on an ACT team and has conducted research on quality of care and outcomes for patients with severe mental illnesses, maintaining a focus on health care disparities.

Current projects that have been funded or are awaiting funding are related to evaluating disparities in care for racial and ethnic minorities, developing mental health services for recent immigrants, and implementing evidence-based treatment for patients with schizophrenia.

Of mental health disparities research, Horvitz-Lennon said that although it is true that some barriers to quality mental health care for racial and ethnic minority patients can be attributed to problems that arise in doctor-patient interactions, “there is consensus that larger socioeconomic forces unrelated to the health care system, as well as differences in access to quality care, play a critical role” in these mental health care disparities.

Horvitz-Lennon said that “as a human being, it pains me we live in a technologically advanced society which can explore Mars, yet we haven't achieved true equality in access to food, education, housing, or employment.”

“As a physician,” she continued, “it pains me that social status and the color of one's skin affects the quality of health care that people receive. I'm committed to doing what I can to change this.”▪