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Skills Building: Developing Resilience is the Best Antidote to Student Stress

Dr. Richard A. Friedman. Credit: John Abbott

These days, everyone seems to be talking about stress, burnout and wellness. Nowhere is this more a topic of conversation than in medical schools, and for good reason: medical students face unique stresses and suffer from higher rates of depression than their age-matched peers. For example, it’s estimated that up to 27% of medical students experience clinically significant depression, compared to nine percent among 18- to 25-year-olds in the general population.

What makes medical school so stressful? To start, you have a group of very smart, high-achieving, idealistic young people who are accustomed to being at the top of their class, who soon discover that won’t be possible for most of them in medical school. Then there is the sheer amount of information to learn, which can be overwhelming—to say nothing of the unique stress of learning to take care of patients and becoming a doctor. Next, most students have left their friends and family behind to come to medical school, so they experience a sudden loss of their supportive social network during a transition that is exciting yet stressful. And finally, these students are a medically healthy but psychiatrically at-risk group for the simple reason that three-quarters of all mental illnesses that we see in adults occur by the age of 25. And depression and anxiety disorders typically have their onset in life during late adolescence and early adulthood.

Put all these factors together and it’s easy to understand why medical school is stressful. But stress, especially the good type, can be healthy and promote psychological resilience—the ability to adapt to stress and adversity, and bounce back from it both psychologically and physically. It’s bad stress that we want to avoid. What’s the distinction?

Student doing yoga.

Credit: Stephanie Diani

Stress is the body’s and brain’s response to challenge. The key to good stress is that it is something you can manage and even master. We all have experienced the relationship between a challenge and the degree of stress we feel in response. It follows the famous “inverted U” function: as the pressure goes up, so does performance—but only to a certain point. Beyond that, anxiety rises and performance starts to drop. So there is a sweet spot for stress: too little and you are bored and under-stimulated, too much and you are anxious and overwhelmed.

When humans experience acute stress, we respond by secreting the hormones cortisol and adrenaline, which help us respond to the demands of the situation. A burst of cortisol mobilizes glucose for energy and enhances immune function, while adrenaline increases attention. But chronic stress—when adrenaline and cortisol levels are persistently elevated—is harmful and leads to serious medical problems like obesity, diabetes and hyper- tension, while also impairing various cognitive functions. A brief pulse of cortisol can enhance neurogenesis (the growth of new neurons) in the hippocampus, which is critical to learning and memory. But chronically high cortisol levels have the opposite effect, causing those neurons to shrink and impair cognition. Also, chronic stress typically causes insomnia and sleep deprivation, which can disrupt the formation of new neurons in the hippocampus, a brain region that is critical to memory formation. So if you like to pull all-nighters to study, think again: your sleep-deprived brain is a poor learner.

I’ve seen all of this first hand over the 18 years that I’ve been director of Weill Cornell Medicine’s Student Mental Health Services. We are passionate about our mission to promote student mental health and focus on treating common psychiatric problems—like depression and anxiety—that are a source of pain and dysfunction in our students.

What about stress and burnout? It isn’t possible—or even desirable—to protect students from normal everyday stress, like disappointing academic performance or social rejection. And every day, good stress helps foster resilience. It shows students that they can deal successfully with difficult challenges, which enhances their self-esteem and sense of general fitness. There is also preclinical evidence that the neurotransmitters norepinephrine (which is released during acute stress) and serotonin play an important role in resilience. Of course, there are some unacceptable stresses—like bullying and sexual harassment—that have no place in the school or work environment and which all institutions must do all they can to eliminate. We want to help our students learn to distinguish healthy from unhealthy stress and develop various coping strategies to keep stress manageable, such as exercise, meditation and healthy eating. That is one of the goals of wellness initiatives.

Another important role of wellness programs is to remind students of what most of them probably know, but forget when they feel overwhelmed by school: that you have to find a reasonable balance between work and life. You cannot study all the time, socially isolate yourself, neglect your hobbies and expect to feel happy and well-adjusted. Exercise and social contacts don’t just make people feel better; they contribute to resilience by raising the level of brain-derived neurotrophic factor (BDNF), which promotes neurogenesis. (We know BDNF has this effect in animals and may do the same in humans, too.)

When I orient the incoming medical students each summer, I always tell them this: you are embarking on four of the most exciting—and stressful—years of your life. We care about you, and we have every confidence that you can handle adversity because you wouldn’t have made it this far if you couldn’t. Will you feel stressed and overwhelmed at times? Of course; that’s entirely normal. You have to find a way—and it takes some time to figure it out—to balance your work with the rest of your life. Don’t forget your friends, families and hobbies. They are important to keep in your life for many reasons, including the fact that they will help you adapt to stress and become more resilient. If, along the way, you are having difficulty that you can’t handle, please come and talk with me and we’ll help you.

So can medical school ever be stress-free? Of course not. But there is a lot we can do to promote mental health and resilience in all our students.

Dr. Richard Friedman, a professor of clinical psychiatry, is Director of Student Mental Health Services and Weill Cornell Medicine and a contributing opinion writer for the New York Times.

This story first appeared in Weill Cornell Medicine, Summer 2019

Hearts & Minds

Jonathan Avery, MD

By Heather Salerno
Photos by John Abbott

Robin Kellner’s daughter, Zoe, was the kind of child that would make any mother proud. She was bright and beautiful, creative and curious. But by the time Zoe was a sophomore at a college in Florida, she was struggling with drug misuse—once accidentally overdosing while Kellner was visiting in fall 2003. Kellner rushed to the ER to find Zoe on a gurney, incoherent and her mouth black from the charcoal doctors had used to try to absorb the Xanax in her stomach. But during the 36 hours that her daughter spent in the hospital, Kellner says the two were treated with disdain; Kellner was even told to sit down and be quiet when she tried to ask questions. No one offered much guidance on how to support Zoe once she was discharged, Kellner says, or informed them that Zoe was at a significantly higher risk of overdosing again in the future. As Kellner recalls: “I was left trying to figure out, ‘How did this happen? What do we do now?’”

 Ever since her daughter, Zoe (seen in a black-and-white photo in the family home), died of an accidental overdose, Robin Kellner has advocated for awareness that drug addiction is a disease that deserves compassionate treatment.

A MOTHER’S MISSION: Ever since her daughter, Zoe (seen in a black-and-white photo in the family home), died of an accidental overdose, Robin Kellner has advocated for awareness that drug addiction is a disease that deserves compassionate treatment.

After Zoe returned home to New York City, Kellner reached out to doctor after doctor, desperate for advice. She says their responses were often unsympathetic and unhelpful—with one prominent physician recommending that she have her daughter arrested to scare her into sobriety. “There were so many moments when Zoe interacted with doctors that I think were missed opportunities, that could have really turned things around,” Kellner recalled in January during a seminar for first-year internal medicine residents at NewYork-Presbyterian/Weill Cornell Medical Center who were learning about substance use disorder. “But instead of looking at Zoe as someone who had mental health issues that were pushing her in this direction, she was looked at as a spoiled kid who was indulging in bad behavior. No one was saying, ‘This is a sick child, and this is what her treatment should be.’” Zoe eventually started going to therapy, resumed her studies in the city, and seemed to get better; then one day, Kellner came home from work and Zoe was high again. Finally, someone told Kellner about an addiction specialist who might be able to help. Zoe agreed to meet with him, but in April 2007— just days before her appointment—she died in her bedroom of another accidental overdose. She was only 22. “Stigma is a killer,” Kellner told the six residents. “It keeps people from getting the help they need.”

Capturing the raw and sometimes harsh experience that patients like Zoe can endure is integral to the mission of Dr. Jonathan Avery, director of addiction psychiatry and an associate professor of clinical psychiatry at Weill Cornell Medicine and an attending psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center. His goal is to reform a pervasive problem that is slowly gaining attention: many clinicians—even psychiatrists and addiction specialists—hold negative attitudes toward patients with substance use disorders, which can increase these patients’ feelings of shame, discourage them from seeking treatment and limit the quality of care they do receive. He is studying the stigma these patients face and—in part with philanthropic funding from Kellner and her husband, John Sicher—is developing interventions at the educational and practice levels that are aimed at shifting doctors’ mindsets, with the goal of improving the likelihood that people with substance use disorder will overcome their dependence on alcohol or drugs. “It turns out that doctors aren’t different from anyone else,” Dr. Avery says. “Even after they learn the neurobiology of addiction and how it’s a brain disease, doctors can still view it—much like the general population— as a moral failing, or people making bad choices that deserve more punishment than treatment.”

 Dr. Avery (center) gives medical students an introductory lesson on issues surrounding drug misuse.

THE BASICS: Dr. Avery (center) gives medical students an introductory lesson on issues surrounding drug misuse.

Dr. Avery’s advocacy around the judgment that people with substance use disorder encounter coincides with a broader societal reckoning with inequities rooted in racism, sexism and other forms of discrimination. The soul searching extends to medicine, where practitioners are reflecting on their own entrenched biases and wondering how they can provide more equitable and appropriate care. Dr. Avery believes his work is tied to these important movements, since individuals with substance use disorders face prejudice on many fronts—and he isn’t the only one trying to reduce addiction-related stigma. Doctors from institutions such as Massachusetts General Hospital and Johns Hopkins University are addressing the problem, and the New York City-based nonprofit Center on Addiction has made eliminating stigma part of its mission. “Hopefully,” says Dr. Avery, “the current environment of advocacy and sharing difficult life experiences will help.”

His work is also critical given the country’s current opioid epidemic, which the U.S. government has officially declared a public health emergency. According to the Centers for Disease Control and Prevention, drug-related deaths have more than tripled since 1999, with more than 70,000 lives lost in 2017 alone. In New York City, more people die of drug overdoses than homicides, suicides and motor vehicle crashes combined, with opioids involved in more than 80 percent of all overdose deaths. Despite this crisis, Dr. Avery says, many clinicians avoid working with patients who have addictions. Just 10 percent of patients with addictions to substances other than nicotine receive treatment, according to a 2012 report from the Center on Addiction. Discrete courses on addiction are rare in medical schools, and required addiction-related content on board exams is “minimal,” according to the report. What’s more, it found that of the 985,375 actively practicing doctors in the United States, just 1,200 are addiction specialists, with 355 self-identified as addiction psychiatrists. With most medical training based in hospitals—where substance use disorder patients tend to be in crisis, and with little exposure there to positive outcomes—many physicians are disillusioned and feel disempowered by the time they complete their training, Dr. Avery says. But he says that possessing the skills and comfort to treat affected patients is essential—not only as a matter of social justice, but of practicality, since such patients present throughout the healthcare system. “There needs to be this culture shift where all doctors are addiction doctors,” Dr. Avery says, “where we’re happy to see these patients and can help them.”

Dr. Avery is working to bring fellow psychiatrists and physicians from other specialties—from emergency medicine to internal medicine to OB/GYN—into the fold by teaching them the best strategies to engage with and treat those who misuse drugs or alcohol. He directs seminars for medical students, interns and residents that are partly intended to inspire empathy for people with substance use disorders—a feeling he hopes will stay with these doctors throughout their careers and motivate them to take a more active interest in helping such patients get better. Dr. Avery gives similar talks nationwide, including at meetings of medical organizations like the American Psychiatric Association, and has created a series of videos highlighting patients in recovery, which have been viewed by more than 10,000 doctors nationwide. Dr. Avery also co-authored The Stigma of Addiction: An Essential Guide, one of the few books on the subject; published in January by Springer, it discusses ways in which professionals and laypeople can avoid stereotyping addiction and improve negative attitudes, with the aim of achieving better outcomes. “Jon isn’t just working in our local community, he’s working in a way that others can be educated on a broader scale,” says Dr. Francis Lee, chairman of psychiatry at Weill Cornell Medicine and psychiatrist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. “I think what he’s doing to target doctors in other fields is also brilliant, because most of the physician workforce is going to encounter these patients—not just psychiatrists, who mainly see them when their condition is very bad. They typically present in the general emergency department or in primary care settings. And ultimately, we all need to be aware that if clinical care providers have negative attitudes toward these patients, they will likely not get better.”

Shifting Outlooks

Dr. Avery’s own studies reinforce the need for such change. One of his latest investigations, published earlier this year in the Primary Care Companion for CNS Disorders, found that resident physicians’ attitudes toward people misusing substances was more negative than those toward people with schizophrenia or major depressive disorders—and that those attitudes tend to get worse over time. Plus, he found that emergency medicine residents held a poorer view of these patients than did residents in internal medicine and OB/GYN. Why? Dr. Avery believes it’s because doctors who work in acute care settings like emergency departments more frequently encounter the most severely ill substance-using patients, who can be challenging when they’re intoxicated or in withdrawal.

At the same time, he says, most doctors and healthcare workers are rarely exposed to individuals who have overcome their addictions—even though the latest figures show there are 23.5 million Americans in recovery, a bigger population than the estimated 21.5 million who currently suffer from a substance use disorder. “If your active experience is with those who are using or misusing substances,” says Dr. Avery, “you tend to forget about the people who get better or are likely to get better in the future.” Michael Sideris, a third-year medical student who is assisting Dr. Avery with research in this area, witnessed the problem firsthand when he worked as an EMT in Boston after graduating from college. He was shocked by comments his colleagues sometimes made when they got repeated calls to help the same overdosing patients—things like, “We should just let them die. Why are we even going?” “That experience had a profound effect on me,” Sideris says. “If patients can’t even get their foot in the door without feeling stigmatized or mistreated, then providers are doing them a disservice in the long run. They deserve better.”

Dr. Avery counts himself fortunate to have witnessed good outcomes early in his training, which informed his understanding of the issue. As a resident, he followed one patient who used alcohol excessively and was hospitalized for depression, but ultimately went on to stop drinking, get married, and have a child. “Starting with medical school, I started having these really positive experiences with people with substance use disorders,” says Dr. Avery. “They’re at rock bottom, and before you know it they have a family and a career and their life is back on track.” He notes that there are many paths to recovery. Addiction can be treated in numerous settings—from long- and short- term residential treatment to individualized and group counseling—using a variety of behavioral and pharmacological approaches. According to the National Institute on Drug Abuse, there are currently 14,500 specialized drug treatment facilities in the United States that provide services to patients with substance use disorders. Though relapse is common, with rates between 40 and 60 percent, experts point out that these rates are similar to those for other chronic diseases like hypertension or Type I diabetes. Research, too, backs up the idea that treatment can work. Data from the Partnership for Drug-Free Kids and the New York State Office of Alcoholism and Substance Abuse Services indicates that 10 percent of all American adults have overcome a problem with alcohol or drugs.

To encourage a more optimistic view among his colleagues, Dr. Avery includes real patients in recovery in his training seminars and videos. They include Liam (who asked that his real name be withheld to protect his privacy), who has been giving in-person presentations to Dr. Avery’s students and others at NewYork-Presbyterian/Weill Cornell Medical Center for the past three years. Liam has been sober since 2012, after more than a decade of misusing alcohol, marijuana and other drugs. “Alcoholics and addicts are not necessarily bad people turning good,” he said, speaking at the same session as Kellner. “We’re sick people getting well.” Liam noted that he was hospitalized 13 times before finding a psychiatrist who properly adjusted his medications for a mood disorder, a major factor in his drug use. He added that having physicians who listened to him without judgment was also critical in his recovery. “I know doctors don’t always have time for that,” he said, “but even 10 minutes can make a big difference.”

That ability to meet patients where they are is another strategy Dr. Avery addresses with medical students and residents, and he explains how to shift from scolding a patient about substance misuse— what he calls “finger wagging”—to discussing the problem in a respectful, open-minded way in a technique called motivational interviewing. Word choice can be a subtle but course-shifting tactic: He points out that terms like “addict,” “junkie” and “abuse” demean patients who have a real disease, and can turn patients off from continuing to work with a doctor. Instead, he suggests that physicians ask patients if they can share their concerns about the effects of addiction (for example, “Would it be all right if I share some thoughts on why I’m worried about your marijuana use?”), rather than simply providing information, since most patients already know that their behavior is unhealthy. He argues that motivational interviewing is not just better for patients—it also relieves pressure on doctors who may feel they need to “save” them on the spot. “The idea is that there’s a part of everyone that doesn’t want to change and a part of everyone that wants to change, and so through patience and questioning you align yourself with the part of the person that wants to change,” Dr. Avery says. “It’s really just about rolling with resistance and being patient in knowing that the likelihood is that people will get into recovery and that motivation will come.”

Reaching Out

Dr. Avery also urges clinicians to talk about addiction with patients, even if they’re coming in about a separate medical problem. That made an impact on Dr. Chou Chou, a first-year resident in internal medicine who attended the January seminar. “As internists we’re on the front lines, and sometimes it’s easy to just roll with things when you’re in the hospital with a lot of sick patients,” says Dr. Chou. “Someone may come in with the flu or a heart issue, and we take a look at old providers’ notes and see ‘alcohol abuse,’ but it’s something that hasn’t really been addressed during the hospital visit because other things are going on. This was a nice reminder not to miss an opportunity.” Dr. Chou also appreciated that while Dr. Avery talked about the benefits of behavioral therapy and counseling, he emphasized that there are effective, FDA-approved medicines like naltrexone—which blocks the effects of narcotics—that physicians can prescribe to help manage alcohol and drug use disorders. “I never offered those medications before because I felt so uneducated about them,” says Dr. Chou. “It makes you feel like there’s something active you can do for those patients.”

Dr. Avery is finding that even short interventions with physicians can influence their attitudes. For a study published in February in the Hospital for Special Surgery Journal, he sent a questionnaire about individuals with alcohol and opioid use disorders to internal medicine and psychiatry residents, then had them view an eight-minute online training video about addiction stigma; when he followed up with the same questionnaire six months later, he found that the residents’ views of people with substance use disorders had improved significantly. While Dr. Avery acknowledges that the study had its limitations—for example, the clinicians’ attitudes might have been improved by factors other than the training video—he sees it as an encouraging sign, since those views tend to become more negative during residency training. “It’s about giving them tools that allow them to be open and non-judgmental,” he says, “and letting them feel that they have the ability to offer patients options—and hope.”

Dr. Zhanna Livshits

Another initiative that could make a marked difference is the medical center’s program for distributing naloxone, a drug that can reverse an overdose. If a doctor or nurse suspects that a patient in the emergency department is misusing opioids, he or she can ask if that patient or a family member would like to take home a kit containing two nasal spray doses; the patient is also given a list of local pharmacies that will dispense naloxone without a prescription. That program was supported by a gift from Kellner and Sicher, who also funded a separate effort through NewYork-Presbyterian/Weill Cornell Medical Center that distributes naloxone kits in the city. Programs like these are associated with a reduction in deaths from opioid overdose; they also give healthcare professionals an opening for a larger conversation about possible treatment. “We plant the seed that we’re here for patients if they ever want any resources,” says Dr. Zhanna Livshits, an assistant professor of clinical emergency medicine and clinical director of Weill Cornell Medicine’s Opioid Overdose Prevention Program. Dr. Livshits is also helping Dr. Avery examine whether the naloxone distribution program is affecting how equipped emergency medicine physicians feel to help patients with substance use disorder. “Every life is important,” she says. “People are allowed to have second, third, fourth, fifth and sixth chances.”

Dr. Arnab Ghosh, an assistant professor of medicine at Weill Cornell Medicine and an assistant attending internist at NewYork-Presbyterian/Weill Cornell Medical Center, is also collaborating with Dr. Avery to encourage more clinicians to treat addiction. Since federal law requires that doctors take an eight-hour training course before they can prescribe buprenorphine, a drug that reduces opioid cravings and withdrawal symptoms, much of his work involves making it easier for physicians to meet those requirements and encouraging them to pursue the training. Dr. Ghosh is part of a task force that is working on building an opioid education segment into training for nurses, social workers and patient care managers at the medical center, so they can better identify high-risk patients and direct them to appropriate outpatient facilities that provide specialized care. Dr. Ghosh also helps distribute information about those facilities to doctors who prescribe buprenorphine, so they know where to send patients who have an opioid use disorder. “We know that someone in New York City dies of an overdose every six hours,” he says. “There is an urgency to this.”

 A medical student examines a sample of Narcan (a brand of naloxone), which can reverse the effects of an overdose.

LIFE SAVER: A medical student examines a sample of Narcan (a brand of naloxone), which can reverse the effects of an overdose.

As for Dr. Avery, his next steps include creating an online interactive module that physicians and other healthcare providers could use to get immediate feedback on how their own attitudes about people who misuse substances compare with those of other clinicians. He also aims to develop a virtual reality program that would allow providers to better understand what addiction feels like from a patient perspective. In these, as in all of his training and intervention efforts, Dr. Avery wants to convey his belief that treating such patients can be incredibly rewarding. “All of medicine is about battling chronic diseases,” he says. “But I personally feel like you get more change with these folks than with any other patients. These are people who—if they can get their substance use under control—can live very different lives.”

This story first appeared in Weill Cornell Medicine, Spring 2019

Dr. Francis Lee Appointed Chair of the Department of Psychiatry at Weill Cornell Medicine and Psychiatrist-in-Chief at NewYork-Presbyterian/Weill Cornell Medical Center

Photo of Dr. Francis Lee

NEW YORK (July 12, 2018) – Dr. Francis Lee, a leading physician-scientist whose research focuses on anxiety disorders, has been named chairman of the Department of Psychiatry at Weill Cornell Medicine and psychiatrist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center, effective July 1.

Dr. Lee will oversee one of the largest academic psychiatric programs in the country, with more than 300 inpatient beds and numerous outpatient programs across two campuses – NewYork-Presbyterian/Weill Cornell Medical Center in Manhattan and NewYork-Presbyterian Westchester Division in White Plains. Dr. Lee will succeed Dr. Jack Barchas, who has served as chair of the department for 25 years and will remain on faculty.

Under Dr. Lee’s leadership, the department will continue to enhance its mission to provide exceptional psychiatric care and education, and conduct cutting-edge research on diseases of the brain and mind. The department has approximately 600 faculty across a range of psychological health areas including mood disorders, psychotic disorders, eating disorders, personality disorders, addiction, ADHD, autism spectrum disorders and neuropsychology. Dr. Lee has served on the faculty of Weill Cornell Medicine since 2002.

“Dr. Lee is an exceptional leader in the Department of Psychiatry whose research and clinical innovations have advanced the field and inspired new psychiatric approaches to benefit patients,” said Dr. Augustine M.K. Choi, the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine. “He is an outstanding physician, pioneering scientist and accomplished educator. I am thrilled Dr. Lee will continue to advance our efforts to provide the best, most compassionate care as the department’s chairman.”

“We congratulate Dr. Lee on his new roles at NewYork-Presbyterian and Weill Cornell Medicine,” said Dr. Steven J. Corwin, president and CEO of NewYork-Presbyterian. “An accomplished researcher, talented educator and skilled clinician, Dr. Lee is committed to the mental health and well-being of our patients. His pioneering research is paving the way for new, innovative treatments for anxiety disorders, and we look forward to the continued impact his work will have on patients and the field of psychiatry.”

Dr. Lee plans to further develop the department’s expertise in psychotherapy, molecular neurobiology and circuit-based neuroscience, among other research areas. “My vision is to capitalize on our strengths in order to maintain the department’s national presence, not only as a leader in education but also in our exceptional clinical care delivery and groundbreaking research,” said Dr. Lee, who is the Mortimer D. Sackler, M.D. Professor of Molecular Biology in Psychiatry and a professor of psychiatry, pharmacology and neuroscience at Weill Cornell Medicine.

Working with investigators in the Feil Family Brain and Mind Research Institute, Dr. Lee hopes to advance the department’s expertise in systems neuroscience, combining techniques such as functional neuroimaging with noninvasive neurostimulation techniques. These include transcranial magnetic stimulation—a noninvasive procedure that uses targeted magnetic fields to stimulate brain circuits—as well as streamlined behavioral interventions to treat psychiatric disorders such as depression. “We have a tremendous resource in our large number of outpatient visits and inpatient beds. One of my priorities is to translate the department’s incredible scientific advances into the actual delivery of innovative care to our patients,” said Dr. Lee, who is also research co-director of the NewYork-Presbyterian Youth Anxiety Center. 

As chair and psychiatrist-in-chief, Dr. Lee plans to strengthen collaborations between basic science investigators and physicians who provide psychiatric clinical care at Weill Cornell Medicine and NewYork-Presbyterian. He also will work to foster new opportunities for scientific discovery and clinical care with collaborators at Columbia University Vagelos College of Physicians and Surgeons, Memorial Sloan Kettering Cancer Center and The Rockefeller University.

The Department of Psychiatry encompasses multiple renowned research institutes including the Sackler Institute for Developmental Psychobiology, the Weill Cornell Institute of Geriatric Psychiatry, the DeWitt Wallace Institute for the History of Psychiatry, and the Center for Autism and the Developing Brain — a collaborative program between NewYork-Presbyterian, Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons — all of which provide myriad opportunities for collaboration across specialties.

Dr. Lee’s research is currently focused on why many psychiatric disorders emerge during the transition from childhood to adolescence, hypothesizing that this is a critical stage for emotional development, particularly as it relates to fear and anxiety. He is studying the brain circuits and molecular mechanisms that underlie this transition with the goal of understanding why emerging adolescents may be vulnerable to psychiatric disorders. Using these insights, he is developing treatments targeted for this critical period.

In addition to his research, Dr. Lee remains active as a clinician. “It means so much to me to see patients, because I learn from them,” said Dr. Lee. “I can read articles, but when I hear from patients directly about the devastating impact of their psychiatric illnesses, it truly puts my work into perspective – that there’s a certain level of urgency to what we’re doing.”

As chair of the department, Dr. Lee follows in the footsteps of his mentor, Dr. Barchas, a renowned physician-scientist. “It is a great honor and will be a great challenge to succeed someone as accomplished as Dr. Barchas, who has had such a powerful impact on the department,” Dr. Lee said. “To be able to build upon what he has established is one of my greatest joys.”

About Dr. Francis Lee

Dr. Lee is a neurobiologist and psychiatrist studying the molecular basis of anxiety disorders. He earned his bachelor’s degree with highest honors from Princeton University and his medical degree and a doctorate from the University of Michigan, followed by psychiatry residency training at the Payne Whitney Clinic at NewYork-Presbyterian/Weill Cornell Medical Center. He completed postdoctoral training in molecular neuroscience at the Skirball Institute, New York University and the University of California, San Francisco. Dr. Lee joined the Weill Cornell Medicine faculty in 2002 as an assistant professor of psychiatry and of pharmacology. In 2011, he was named vice chair for research in the Department of Psychiatry, and has served as interim director of the Sackler Institute for Developmental Psychobiology since 2016.

Dr. Lee has served on several panels and boards at the National Institutes of Health and national mental health foundations, and has received numerous honors and awards including the Presidential Early Career Award for Scientists and Engineers, the Burroughs Wellcome Clinical Scientist Award and the Siegel Family Award for Outstanding Medical Research. He has been elected a member of the American Society for Clinical Investigation, the Association of American Physicians and the National Academy of Medicine.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine — faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization—are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian Lower Manhattan Hospital, NewYork-Presbyterian Queens and NewYork-Presbyterian Brooklyn Methodist Hospital. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.


NewYork-Presbyterian is one of the nation’s most comprehensive, integrated academic healthcare delivery systems, whose organizations are dedicated to providing the highest quality, most compassionate care and service to patients in the New York metropolitan area, nationally, and throughout the globe. In collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and innovative, patient-centered clinical care.

NewYork-Presbyterian has four major divisions:

  • NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the Honor Roll of “America’s Best Hospitals.”
  • NewYork-Presbyterian Regional Hospital Network comprises hospitals and other facilities in the New York metropolitan region.
  • NewYork-Presbyterian Physician Services, which connects medical experts with patients in their communities.
  • NewYork-Presbyterian Community and Population Health, encompassing ambulatory care network sites and community healthcare initiatives, including NewYork Quality Care, the Accountable Care Organization jointly established by NewYork-Presbyterian Hospital, Weill Cornell Medicine and Columbia.

For more information, visit www.nyp.org and find us on Facebook, Twitter and YouTube.

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