Dr. Schwartz, founder and editor in chief of Psychiatric Times, discusses his career as a clinician and entrepreneur.
In many areas of his life, John L. Schwartz, M.D., founder and editor in chief of Psychiatric Times, took the road less traveled and that has made an appreciable difference. He attended the Massachusetts Institute of Technology and graduated from Columbia College of Columbia University. After earning his M.D. degree at New York University on an Honors Scholarship, Schwartz did his psychiatric residency at Bellevue Hospital in New York and then completed a fellowship in child psychiatry at the University of California, Irvine.
Asked why he selected psychiatry as a career, Schwartz responded, "Most people who go into psychiatry want to help people and also want to master their own problems. That's true for me on both counts."
Schwartz, who was board certified in psychiatry in 1975, established a clinical practice in Orange County, Calif. "It was a general practice. I saw a fair number of patients with anxiety and depression in the office. Then in my hospital practice, I saw many patients with major disorders--bipolar disorder, schizophrenia and some organic conditions," he said. "Every once in a while I would diagnose a brain tumor. I have always felt badly that I missed a brain tumor in a patient, and that patient died. He probably wouldn't have survived even if I had diagnosed it, but he might have had a slightly better course of life if I hadn't missed it. I know that no one gets everything right or saves every patient, but I still feel badly about my mistakes."
Trained in both adult and child psychiatry, Schwartz worked extensively with children early in his practice. "Child psychiatry is often challenging, not just because of the difficult work itself, but because it is often hard to get anyone excited about paying for children to get care, including their own parents. So after a number of years of trying to get kids who needed care very badly into treatment ... I switched my practice to working primarily with adolescents and adults."
Founding CME and PT
Early in his career as a clinician, Schwartz became disillusioned with the continuing education meetings he attended. "I found them poorly arranged and not very useful for a clinician trying to take care of patients. Oftentimes, the faculty and organizers of the meetings seemed somewhat contemptuous of practitioners who were taking care of patients all day," he said.
Returning from one meeting, Schwartz said, "I thought, 'You ought to be able to do this better, to treat people better and to give them a better experience for the time and money they have invested.' So I set out to see if it could be done."
Schwartz started CME, Inc., in 1978. "For the first seven or eight years, almost all of my income except for the bare amount I needed to feed my family and myself went into subsidizing CME," he said. "It took a while to get it right, but we finally learned what we were doing and happily turned it around."
In 1984, Schwartz began to consider starting a newspaper for his fellow psychiatrists. "I thought there was a need for an independent newspaper that would report on things that I found newsworthy that I didn't see being reported in any of the other psychiatric publications," he said. "Also, I didn't have any political agendas to uphold. I simply wanted to cover developments that I thought were important to psychiatrists."
On a more psychodynamic note, Schwartz admitted that the newspaper business had "seeped into my pores." His father, the late Harry Schwartz, had been an economist, book author and member of the New York Times editorial board, writing on Soviet and East European affairs from 1951 to 1979. Then, in the 1970s, Harry Schwartz's interest turned toward health policy. After John started PT, Harry often contributed articles and story ideas.
When Issue 1 of Psychiatric Times came off the presses in January 1985, it represented three months of effort by Schwartz. "I worked all night on many a night pulling the first issue together. I even helped with the mechanical paste-up in those pre-personal computer days," he recalled.
A few years passed before the publication was in the black. Meanwhile, he maintained his clinical practice seeing patients in his office. "I continued to do that for a few years because I liked it. But as the psychiatric meeting business got better, which I think had something to do with PT's appearance, and as PT began to get more advertising, I got busier. I could no longer count on being in the office with the kind of regularity my patients deserved," he said.
In 1987, he told his patients that he would work with them one more year. If at the end of that time they had not finished their work together, he would refer them to other psychiatrists.
The next year, Schwartz closed his private practice to continue publishing a newspaper with a clinical focus. He also started the U.S. Psychiatric & Mental Health Congress in 1988.
"I had the sensibilities of a clinician. I knew the challenges they face. It's hard to keep up to date, it's hard to know what to do, and it's hard to know everything you need to know. I was interested in trying to present useful information that would really be helpful to people," he said.
The goal was to make the publication eclectic, focusing on everything from neuroscience and psychopharmacology to psychotherapy. Psychotherapy, Schwartz believes, continues to be an important yet undervalued therapeutic approach.
"We sort of abhor people who turn to alcohol and substances to feel better, and yet our society wants people to get better quickly with some magical drug or other. God forbid that we should spend any of our treasure in helping people work with experienced, skilled psychiatrists in psychotherapy to understand their histories and current problems and how they might do better," he said.
In his article in the first issue of PT, Schwartz adapted a phrase from Charles Dickens' A Tale of Two Cities: "These are the best of times and the worst of times." That description is even more true 20 years later, Schwartz contended.
We have much greater knowledge about the physiological basis of many of the illnesses that plague human beings and have made wonderful progress in neuroscience, he said, but at the same time, the world has become a much more complicated place. Delivering care has gotten much more expensive, in part, because much better care is being delivered. He added that there are innumerable calls on society's resources, and health care is only one of them.
In his first PT article, Schwartz also discussed stigma. Two decades later, he believes that a powerful stigma about psychiatry and mental illness still persists.
We have done very little, he said, to convince people that there would actually be a terrific benefit from investing in the treatment of these illnesses, though some good studies exist demonstrating those benefits. Another problem, he said, is that policy-makers and payers need to be willing to acknowledge the results of those studies.
In March 1999, Schwartz sold CME, Inc. He described the experience as both "wrenching" and "bittersweet."
"I made the decision to sell it over a couple of years," he said. "There were 65 companies that bid to buy CME in the auction we had. I was happy that we had built something that a lot of people thought was good."
What Schwartz learned from the sales process was "whether you have money or not, you still have to contend with the slings and arrows of fortune--you still have to figure out how to live a meaningful, good life; you are still open to losses, rejection, illness and other vagaries of life, including losing the people you love, and ultimately losing your own life as we all do."
Schwartz still attends the U.S. Psychiatric & Mental Health Congress each year, delighting in "seeing hundreds of old friends at the Congress" and he still serves as PT's editor in chief, attending editorial board meetings and providing feedback on the publication.
For some 12 years, PT has been among the best read psychiatric publications in the world, Schwartz said. Implicit in that fact, he added, is a responsibility to serve the interests of psychiatrists and their patients and to cover matters affecting their ability to provide care.
Life After CME
Always oriented toward an active life, Schwartz now serves on the board of governors for the University of California, Los Angeles; on the board of UCLA's Center on Aging; and on the advisory board for an adult stem cell company. Apart from that, he has been mentoring several biotech entrepreneurs. Since both Schwartz's aunt and father suffered from dementia, he is particularly interested in assisting one company that is developing teaching and learning software to help patients with dementia by slowing the disease's progress.
Believing that psychiatrists need to be active in politics, Schwartz last year met with Cameron Kerry, the younger brother of former presidential candidate Sen. John F. Kerry (D-Mass.), and more recently with Gov. Mitt Romney of Massachusetts. "I'm trying to meet these people, learn their views on things and, where appropriate, ask them questions about issues related to medical care, generally, and psychiatric care, specifically," he said.
"I guess I am an entrepreneur at heart," Schwartz admitted. "I am not a golfer, and I don't drink. I like traveling and taking it easy, although not for more than a week or two at a time."
Other priorities in Schwartz's life include his wife, his two sons and stepdaughter, and particularly his year-old grandson, Aden, and his Lhasa Apso, Wally. "I am overjoyed spending an hour on the floor with Aden as he plays with blocks and toys and tugs my glasses off my face. It is great fun," Schwartz said. "I'm the luckiest guy in the world."