Courtenay Harding took a backwards path to earning her PhD.
"Most people go from undergrad to grad school," says Harding, director of Boston University's Institute for the Study of Human Resilience and senior director of its Center for Psychiatric Rehabilitation. "I found my dissertation topic before I entered graduate school."
A single mother of three in her 30s, Harding needed to make up 42 credits she lost by switching majors from pediatric nursing to psychology after transferring from Vermont College to the University of Vermont. To earn research credits, she volunteered to work on a Vermont State Hospital study examining the 20-year anniversary of a schizophrenic rehabilitation program conducted by psychiatrist George Brooks, MD.
As the follow-up study's superintendent, Brooks found 87 percent of the original cohort after sending a single letter. One of Harding's mentors, George Albee, PhD, figured the high response rate presented a unique opportunity to comprehensively study the long-term outcomes for patients with schizophrenia, and he encouraged Harding to seek funding from the National Institute of Mental Health (NIMH) to conduct the study. Despite Harding being a non-PhD researcher, NIMH provided seed money for the study.
As the project expanded and Harding's research grew increasingly complex, she cobbled together a support team of psychologists and other academic mentors. Brendan Maher, PhD, then the chair of psychology at Harvard University, met with Harding every Friday afternoon for 18 months to develop the study's design and methodology.
Maher also connected Harding with many of his colleagues, including Joseph Fleiss, PhD, then dean of Columbia University's School of Public Health, who supported her NIMH application. Takamaru Ashikaga, PhD, of the University of Vermont's Medical Biostatistics Unit and Biometry Facility, analyzed Harding's data and coached her analysis throughout the study. By the time the study was published in the American Journal of Psychiatry (Vol. 144, No. 6), it had 10 pages of acknowledgments.
"I'm probably the most mentored professor around," she says. "I was given a university without walls for 18 months where I learned many ways to approach problems, what questions to ask, which instruments to pick and how to perform the analyses."
As the 2004-2005 recipient of the Alexander Gralnick Research Investigator award, Harding hopes to use the $20,000 award to mentor future psychologists in much the same way that she was mentored.
Changing public perception
Harding's undergraduate project turned dissertation followed up on Brooks's 10-year study of 269 people with severe and persistent mental illnesses.
In the 1950s, Brooks worked with patients from the Vermont State Hospital to create a model demonstration rehabilitation program, developing their social and work skills and building their confidence to cope with daily living. During the program's first five years, these patients were well enough to go back to their communities.
For the follow-up study, Harding ultimately located and assessed 97 percent of the Vermont study's cohort an average of 32 years after their first admission to Brooks's study, making it the longest follow-up study of deinstitutionalized patients in U.S. psychological literature. Research assistants who were blind to the diagnoses conducted interviews with the patients. Other research assistants blind to the field data reviewed their health records. Harding found 62 to 68 percent of the patients significantly improved or fully recovered across multiple domains of functioning, including the loss of many schizophrenic symptoms, getting a job, engaging in social relationships and providing self-care.
The results countered the contention of the then-current third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) that schizophrenia always portends poor long-term outcomes.
"The findings were very dramatic," says APA President Ronald F. Levant, EdD, who studies serious mental illnesses. "They provided a database by which to contradict stereotypes."
After Harding completed her doctorate work at the University of Vermont, she and psychologist Michael Desisto, PhD, the former chief of the Maine Bureau of Mental Health, conducted a replication follow-up study using data from patients at the Augusta State Hospital in Maine from 1956 to 1961 to validate the Vermont results. The Maine research team located and assessed 94 percent of the Maine patients using the same research protocol.
The Maine and Vermont comparison studies were published as a double article in the British Journal of Psychiatry (Vol. 167, No. 3). In the comparison, Harding and her colleagues matched each patient at the hospital with those in the Maine study by age, sex, DSM-III diagnosis and length of hospitalization. Harding surmised that, although Maine patients did not fare as well as the Vermont patients because they didn't receive rehabilitation, 49 percent did show marked improvement. The Vermont and Maine studies helped alter people's perceptions of persons with mental illness, according to Levant.
"I'm glad I've lived long enough to see the concept of 'recovery' come into popular usage," Harding says. "Patients used to be called a 'pool of chronic mental illness' and now we've adopted person-first language, such as 'person with schizophrenia.'"
Mentoring a new generation
In 1989, while co-teaching a seminar for senior psychiatry residents at the University of Colorado School of Medicine, Harding had a revelation.
"I thought to myself, 'I am a psychologist, as a professor of psychiatry why am I not teaching young psychologists?" Harding remembers.
Within two years, she and her colleague, Carl Zimet, PhD, established a postdoctoral program for public psychology--the first such program in the country.
The program works with the National Association of State Mental Health Program Directors, the Western Interstate Commission on Higher Education, the Colorado Department of Corrections and the Mental Health Corporation of Denver to develop research methods as well as public policy based on psychological principles. The program has trained more than 75 students, about 80 percent of whom have remained in public sector work since completing the program.
Since moving to Boston University, Harding's institute has mentored students from public health, education, rehabilitation, psychology and other disciplines. The Gralnick award will enable her to focus on that collaborative scholarly work, such as by formulating a new integrated resiliency and recovery model with Tom Dukes, a doctoral student in the School of Education. The model will integrate child psychologists' work on how adults recover after facing serious life challenges, such as serious mental illness and trauma.
Harding's passion for her research is in line with that of the namesake of the award, Alexander Gralnick, MD, notes Lisa Straus, APF program director.
"Gralnick had a strong belief in psychosocial treatments of serious mental illnesses that he thought the APF could address," says Straus. "He and his wife, June Gantz Gralnick, made gifts to APF that would perpetuate their belief in psychosocial treatment for patients with schizophrenia. Dr. Harding's work embodies the Gralnicks' vision."
The $20,000 award honors Gralnick's contributions to the field of serious mental illnesses.