Psychiatrist Ensures Field Has International Focus

The bird's-eye view of things is a luxury few people enjoy.

But some, like psychiatrist Javier Escobar, M.D., are able—because of birth and acculturation and experience and training—to see the global contours of things.

From his birth in Medellin, Colombia, and his medical training there at the University of Antioquia, to his early training in psychiatry in Spain, where he was first influenced by psychoanalysis and a wide reading of classic European psychiatric texts, and later to his rise in the American academic community as an expert on psychopharmacology, psychiatric epidemiology, cross-cultural psychiatry, and global health—Escobar has compiled an eclectic record of experience and achievement. This experience has made him a leader in understanding how psychiatric illness transcends boundaries and borders, racial and ethnic categories.

Today, he is associate dean for global health at the University of Medicine and Dentistry of New Jersey (UMDNJ) Robert Wood Johnson Medical School.

Escobar is also a founder of a consortium of researchers interested in mentoring young scientists dedicated to studying mental health issues in Latino communities. That group convenes an annual meeting on critical issues in Latino mental health, the sixth of which took place in March in Santa Fe, N.M., on the theme “Treatment of Latinos With Mental Disorders: Conceptual and Empirical Approaches.”

Annelle Primm, M.D., M.P.H., director of APA's Office of Minority and National Affairs, called Escobar a leader in the field of psychiatric research in diverse populations and cited his mentorship of young researchers as a contribution that will endure beyond his time.

“The annual conference he organizes attracts some of the best and brightest of young people interested in careers in mental health and substance abuse research,” Primm told Psychiatric News. “The nurturing, coaching, and enrichment that Dr. Escobar and his colleagues from various mental health professional disciplines provide to the mentees at the conferences and in between are priceless. This ensures a steady supply in the development pipeline of Latino mental health and substance abuse researchers, who receive sustained guidance over time.

“Ultimately, these investments will yield a greater supply of Latino researchers, which will contribute to better quality mental health and substance abuse care for Latino populations.”

Born to an Interest in Culture

He was christened Javier Ignacio Escobar, after Francis Xavier and Ignatius of Loyola—the first an early Jesuit missionary, the second the founder of the Jesuits, renowned for their scholarly dedication.

His origins in Medellin, the capital of Antioquia, a district of Colombia, may have presaged his interest in the mingling and influence of diverse cultures. Genetic studies appear to have confirmed local legend that the region has inherited not only Spanish but Sephardic influences left by Jews who left Spain following their expulsion in 1492.

Escobar attended medical school at the University of Antioquia, where he spent six years and an internship year at a hospital doing compulsory service in a rural town outside of Medellin. “I delivered countless babies and performed an estimated 40 Caesarian sections,” he said.

Following graduation, he moved with his wife to Spain, where he studied psychiatry under Juan Lopez-Ibor, M.D., well known for his pioneering work in understanding anxiety as a biological disorder and in psychosomatic medicine.

With European institutions still operating according to a German model of teaching and learning, Escobar recalled the experience largely as one of deference to the legendary Lopez-Ibor. “We participated in lectures and saw a few patients, but we were mainly there to be in the shadow of the big professor,” Escobar said.

But it was also there that Escobar was exposed to the classics of European psychiatry, including writings by Sigmund Freud, Karl Jaspers, and Kurt Snyder. “That experience really gave me the basis of classical psychopathology that Europeans had been developing for centuries,” Escobar said. “Today all our North American students are reading is the DSM and DSM-related publications.”

A member of the task force developing the DSM-V, Escobar says reincorporation of some of that more traditional understanding of psychopathology would be good for the field. “If we want to redefine some of the diagnoses, we need to invoke a little bit of that old history,” he told Psychiatric News.

Studying Latino Health in California

Later, Escobar moved to the United States, where he earned a master's degree in psychiatry/medical genetics in 1973 from the University of Minnesota.

Within six years he was named an associate professor at UCLA. It was there among California's enormous Latino community that his career as a researcher blossomed; he was principal investigator for a number of studies in psychiatric epidemiology of mental illness in Latino and non-Latino populations, and from 1981 to 1987, he was co-principal investigator for the Los Angeles Epidemiological Catchment Area Project (ECA), one of five sites included in the landmark ECA study by the National Institute of Mental Health (NIMH).

In 1994 he joined the faculty at the Robert Wood Johnson School of Medicine at UMDNJ as professor and chair of the Department of Psychiatry.

The range of his research interests is enormous, with a special focus on somatization in primary care, but he has maintained a leading interest in Latino mental health.

His work has added to a literature supporting the theory that certain aspects of traditional cultures can be protective against mental illness. Escobar and colleagues published a study of 1,500 users of primary care services in California, which found that compared with patients born in the United States, immigrants had a significantly lower prevalence of depression and posttraumatic stress disorder and better physical functioning scores despite their lower socioeconomic status.

That study was published in the September 1998 British Journal of Psychiatry.

“Traditionally, Hispanic families have been described as close-knit, extended-family networks that offer a great deal of support,” Escobar wrote in an editorial in the Archives of General Psychiatry that year. “Also, compared with whites, Mexican Americans have a higher proportion of two-parent families and lower rates of divorce and separation.”

From 1999 to 2003, he was a member of NIMH's National Advisory Mental Health Council and led the council group that prepared the report“ Racial and Ethnic Diversity in Mental Health Careers: An Investment in America's Future.”

“We found the underrepresentation of Latinos and African Americans among those who were doing research to be embarrassing,” Escobar told Psychiatric News. “It was less than 5 percent when these populations were 25 percent of the general population.”

Going Global

It was, in part, out of those findings that Escobar and other interested researchers applied for a grant to mentor young researchers in Latino mental health issues. The project was initially funded through 2007 and renewed for another five years through 2012 with NIMH money that has helped to support, among other projects, the March conference in Santa Fe.

Last year Escobar stepped down as department chair to assume his current position as associate dean for global health for the medical school. Though his new position has caused him to look beyond mental health to such global problems as HIV, malaria, and trachoma (an eye disease caused by chlamydia that can result in blindness and has ravaged parts of Africa and Latin America), he remains involved in international mental health.

During a sabbatical year from the medical school in 2003, Escobar served as a senior advisor to Thomas Insel, M.D., director of NIMH, to assist in forming an Office of Global Mental Health.

“I became aware of all of the global issues in mental health that tend to be neglected,” he said.

Escobar said that though philanthropists like Bill Gates have given millions of dollars to fight AIDS, malaria, and other infectious disease, disorders such as depression often go unrecognized or undertreated because people tend to present in primary care with physical symptoms.

Still, he pointed to a number of hopeful developments in international mental health. Among these is a new mental health educational module developed by the Global Health Education Council, a network of educators devoted to educating other researchers and medical professionals about global health issues.

Escobar is also a consultant to a project in Colombia looking at large families with a high prevalence of bipolar illness to identify genes related to the illness. He continues to be involved in the NIMH mentoring project, advising young researchers such as Gabriel de Eurasquin, M.D., an Argentine psychiatrist at Washington University in St. Louis, who is studying a native Indian population in northern Argentina with a high prevalence of schizophrenia.

“We have been down there in Argentina training people to use diagnostic instruments and showing them videotapes about mental illness,” he said. “These things will keep me involved in mental health.”

“Racial and Ethnic Diversity in Mental Health Careers: An Investment in America's Future” is posted at<www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/nimh-diversity.pdf>. Information on the Global Health Education Council is posted at<www.globalhealth.org>.▪