Spiegel's road to Stanford Medical School began with a California dream
Psychiatrist David Spiegel, who is internationally known for his work studying the effects of the mind on physical health, recently took the helm of the Faculty Senate.
After experiencing life in the Northeast – a childhood in Queens and the North Shore of Long Island, undergraduate studies in New Haven, Conn., medical school in Boston – psychiatrist David Spiegel was ready for a change of scenery.
"I had a California dream," Spiegel said during a recent interview in his office in the Psychiatry and Behavioral Sciences Building at the School of Medicine.
It was a dream that began during a trip to San Francisco.
"When I was a student at Yale, I just got on a plane by myself and went to San Francisco," said Spiegel, the Jack, Samuel and Lulu Willson Professor in Medicine and the chair of the 43rd Faculty Senate. "I fell in love with the place."
Spiegel, who graduated from Harvard Medical School in 1971 and completed his psychiatric residency at Massachusetts Mental Health Center and Cambridge Hospital in 1974, also was attracted to the intellectual climate on the West Coast.
"Back then, psychiatry was a lot more progressive in California than it was in Boston, which was still very tightly controlled by Freudian psychoanalytic thinking," he said.
Psychoanalytic psychiatry, Spiegel said, is a discipline focused on the belief that painful childhood memories contained in the unconscious are the cause of mental illness and that extensive analysis of these memories and dreams is absolutely necessary for effective treatment.
"There was a sense that this is the way you have to think," he said. "I felt like I was fighting it. I couldn't breathe. I was getting hostile questions about why I wanted to use hypnosis or antidepressant medication with patients. I felt constrained intellectually.
Spiegel was drawn to the client-centered therapy of Carl Rogers, a California psychologist and one of the founders of the humanistic approach to psychotherapy, which focused on issues such as positive regard and openness on the part of psychotherapists, and exploration of self-actualization, love, creativity, relationships and meaning in psychotherapy.
He shared the goal of a sojourn in California with his future wife, Helen Blau, who was greatly in favor of the adventure. Blau, who was then a Harvard doctoral candidate, is now the director of the Baxter Laboratory for Stem Cell Biology at the Medical School.
Still, the young couple wasn't planning to stay very long.
"I thought we'd be here for a couple years, then go back to New York and get serious," Spiegel said.
Instead, Spiegel and Blau, who have been married for 34 years, made their home here. They raised two children, both of whom attended Stanford as undergraduates. Their son, who later attended the Graduate School of Design at Harvard, is an architect and their daughter is now studying law at Yale.
Spiegel spent his first year in the Bay Area working for the San Mateo County Community Mental Health Program, prescribing medications and running support groups for people with chronic mental illnesses.
Refused to sign a loyalty oath
He didn't get the first job he applied for at Stanford. And he almost lost the second – as an assistant professor working at the Veterans Affairs Hospital in Palo Alto – on his first day of work. That was the day the VA personnel director asked him to sign the oath: I am not now, nor have I ever been, a member of the Communist Party.
Which led to the following exchange with the VA personnel director:
Spiegel: You've got to be kidding.
VA: No, I'm not kidding.
Spiegel: Well, I won't sign it.
VA: Well, then, you're not hired.
"Here I finally get the academic job of my dreams and I just couldn't bring myself to sign the damned thing," Spiegel said. "And I thought to myself, 'nice move, David.'"
As chair of the Faculty Senate, David Spiegel said he hopes improve student mental health care.
Still, he wasn't ready to just walk away. He sued the Department of Veterans Affairs. A federal judge ruled in his favor, saying Spiegel didn't have to sign the oath because he wasn't just a VA doctor, but was working at the VA as a condition of his employment at Stanford. It was a very limited decision that saved Spiegel his job. But it set a precedent. The government agency quietly dropped the loyalty oath nationwide a few months later.
Spiegel began working at the VA in 1975, the same year the Vietnam War ended. He stayed for five years, treating veterans for post-traumatic stress disorder and conducting research on the condition.
"The patients were fascinating," he said. "I treated guys who would have flashbacks and relive their experiences in Vietnam. I taught them hypnosis to help them and it worked remarkably well."
Spiegel said the VA was a great place for young clinical investigators – doctors involved in clinical trials – to begin their careers, because they had two sources of grant money, the National Institutes of Health and the VA.
"You have clinical work to do, but the academic VA hospitals are understanding about giving young faculty some protected time to do research," he said.
In 1980, Spiegel became the director of the adult psychiatric outpatient clinic of the Psychiatry and Behavioral Sciences Department at the Medical School. He has been an associate chair of the department since 2000.
An expert on mind-body interactions
Spiegel is internationally known for his work in gauging the effects of the mind on physical health. He was the first to demonstrate, in an article published in The Lancet, that participation in group therapy could extend survival time for cancer patients. These data have since been corroborated in studies worldwide.
As director of Stanford's Center on Stress and Health, he oversees a team studying how stress and support affect mind, brain and body. In one study for the National Institutes of Health, he is examining the effect of sleep disruption on the survival rates of women with metastatic breast cancer. In another, he is showing that stress and diurnal cortisol levels affect cancer patient longevity.
Spiegel also is the medical director of the Stanford Center for Integrative Medicine. The Center provides alternative and complementary services – such as acupuncture, meditation, hypnosis and massage – to help patients cope with cancer and other conditions, including chronic pain, gastrointestinal diseases, anxiety and stress.
Spiegel, who has authored more than 500 research papers and chapters in scientific journals and books, has won numerous awards for his research on mind-body medicine. In 1993, he was featured on Healing and the Mind, the Emmy Award-winning PBS series by Bill Moyers.
Spiegel also was featured on The Oprah Winfrey Show. In 2008, he appeared on the TV show Good Morning America with Diane Sawyer to demonstrate the benefits of hypnosis.
"Diane is a tough-minded reporter and was not hypnotizable, unlike many of her staff," Spiegel said, referring to the filmed hypnosis segment of the program. "But the show successfully highlighted the power of hypnosis, of mind over matter."
The son of two psychiatrists
Spiegel is the co-author of Trance and Treatment: Clinical Uses of Hypnosis, a 550-page textbook he wrote with his late father, Columbia University psychiatrist Herbert Spiegel, whom the New York Times described in a 2010 obituary as "far and away the country's most visible and persuasive advocate for therapeutic hypnosis, having established it as a mainstream medical technique."
The father-and-son team wrote the second edition of the book in 2004, more than a quarter century after they had collaborated on the first edition.
Last March, Spiegel dedicated his lecture on "Mind-Body Interactions" during a session of the Continuing Studies Program's Mini Med School series to his late father. Spiegel's late mother also was a psychiatrist, and the author of some 100 papers and a best-selling book, Sweet Suffering: Woman as Victim.
Asked what influence his parents had exerted on his career choice, Spiegel joked: "They told me I was free to become any kind of psychiatrist I wanted to be."
They may have laid the groundwork for medical school for Spiegel and his late sister, Ann Spiegel, who was a pediatrician in Phoenix – with fascinating dinner table conversations.
"They were trained by some of the greats in mid-20th century American psychiatry, so it was an exciting time," he said. "I remember my dad made a film of a patient, a woman who had non-epileptic seizures. I saw her flopping away, almost falling off the couch while they were filming. My dad was teaching her how to use self-hypnosis to control the seizures, and to make them less and less intense. She was able to reduce these seizures to a slight nod of her head. And she felt proud."
Spiegel didn't seem destined for medical school as an undergrad at Yale, where he majored in philosophy and read the great existential philosophers – Søren Kierkegaard, Martin Heidegger, Jean-Paul Sartre, as well as the dialectician Georg Hegel and epistemologist Immanuel Kant.
Still, by the time Spiegel was a senior, he had a yearning for facts.
"I loved thinking about how the mind works and theories of being," he said. "But I was beginning to get hungry to understand the interaction between the brain and the body."
Getting in hot water for using hypnosis
Spiegel first used hypnosis while he was a third-year medical student working at Children's Hospital in Boston. He had just started taking a class in hypnosis.
"I heard the sound of the wheezing down the hall," he said. "I walked into the room and saw a white-knuckled teenage girl sitting in a hospital bed, desperately trying to breathe. She'd been unresponsive to medication. Her mother was crying. The next step was general anesthesia. It was a bad situation."
Spiegel asked her if she wanted to try hypnosis. The teenager, who had been hospitalized every month for three months, nodded. Once Spiegel had hypnotized her, though, he realized his hypnosis course hadn't gotten to asthma yet, which meant he hadn't learned what to say to calm a patient's breathing.
"'Each breath you take will be a little deeper and a little easier'," he told her. "Within five minutes, she was lying back in bed. Her knuckles weren't white anymore. She was breathing better. The wheezing had improved. Her mother had stopped crying. And the nurse ran out of the room and filed a complaint with the nursing supervisor that I had hypnotized a minor without parental consent. Now, while Massachusetts has a lot of weird laws, that is not one of them."
Soon, Spiegel also was in hot water with the intern, who told him he had to stop using hypnosis. Which led to the following exchange:
Spiegel: Why is that? You want to put her on steroids. That's a lot more dangerous than what I'm doing.
Intern: Well, what you're doing is dangerous and you may not be able to follow up with the patient. You need to tell her you will stop using hypnosis.
Spiegel: It's not dangerous. It's helping her. And I'll be able to do it as long as she wants. I'm just a medical student, so you can take me off the case if you want, but I'm not going to tell my patient something that isn't true.
There was more arguing among the medical staff. Then the intern settled on what Spiegel called a "radical idea" for the time: Ask the patient if she wanted to continue with hypnosis. She said, "Yes."
"She had only one hospitalization after that," Spiegel said. "So I figured that anything that could help a patient that much, frustrate the nursing and medical hierarchy and violate a non-existent Massachusetts law had to be worth looking into."
Spiegel said he has always been drawn to understanding the neurobiology – the interaction between the mind and the body – of people facing real life problems.
"Helping people with post-traumatic stress disorder, helping people living with cancer, helping people manage pain and anxiety – those are the things I've been drawn to," he said. "I like figuring out how to help people who are suffering with life stressors. That's pretty much what my career is."
In his presentation to the Mini Med School class, Spiegel, who has an easy-going lecture style, peppered his talk with charts – of brains, scientific diagrams, research findings – as well as anecdotes about patients, video footage from one of his cancer support groups, photographs and cartoons, including one showing a therapist, who is surrounded by empty chairs, asking a huge woman sitting opposite him: Do you remember what you were feeling before you ate the other members of the group?
Wielding the gavel as senate chair
Spiegel's repartee with another audience – the 55-member Faculty Senate – has been obvious during his first two meetings as chair.
His opening line that inaugurated the new academic year on Oct. 7: "I'd like to welcome you all to the first meeting of the 43rd Senate. President Hennessy informed me that my main task was to keep these meetings entertaining, so I'll entertain a motion to adjourn."
At the Oct. 21 senate meeting, which coincided with a National League Championship game between the San Francisco Giants and the Philadelphia Phillies, Spiegel was interrupted by laughter from some and drew puzzled expressions from others with an oblique reference to the game.
For the puzzled, Academic Secretary Rex Jamison filled in the blanks, in brackets, in the official minutes of the meeting, which were published the following week:
"'We are aware that there is an athletic contest at a less-well-known athletic center [the baseball stadium in San Francisco] between some refugees from the Polo Grounds [the San Francisco Giants, in yesteryear the New York Giants] and denizens of the city best known for a great combination of beef and cheese [the cheese steak] – [the Philadelphia Phillies, in a National League baseball playoff game]. We will try to move through this meeting as quickly as possible to enable those of you who are interested to witness that.'"
Spiegel was as good as his word. He wrapped up the meeting by 4:10 p.m., plenty of time for baseball fans to find a television and catch the 4:57 first pitch.
Spiegel said he decided to run for chair of the senate because it would give him the chance to "point the searchlight" at particular topics, including one he knows a lot about – helping people, students in this case, cope with stress.
"I am very interested in doing something to improve student mental health care," Spiegel said. "Stanford students are very stressed. Some of the students have serious psychological problems – that's my day job. But I am also very interested in helping students manage the daily stress and the life transitions they're going through here, and to get the most out of Stanford. I'm hoping the senate will spend some time addressing that issue."