By: Josh Hunsberger

Professor James W. Pier leads a double life that consists of both teaching and clinical work. During the day, he works at various clinics in the area and on Tuesday nights he teaches a psychology course at Wesleyan University. Combining both teaching and clinical work has fed Dr. Pier’s interest in psychology and has given him a varied lifestyle which he says fits well with his personality. Dr. Pier’s academic interests continue to supplement his practice in the clinic and keep him up on new advances in treatment.

Education

His interest in psychology began in high school. He attended a catholic Jesuit high school. It was here that he first learned about innovators of psychology like Freud and Jung and Ericson, and where he became fascinated by the subject and decided to pursue psychology as a major in college. He did his undergraduate work at Boston College from 1981 to 1985. He started off as a double major in psychology and biology. However, he soon grew to dislike some of the biology requirements, like organic chemistry lab. As a result, he dropped the biology major and finished his BA in psychology.

In high school and college, Dr. Pier has found courses in both psychology and related fields such as philosophy and theology quite intriguing. Through his course of studies, he developed a keen direction towards psychology as a possible career path. By the end of his undergraduate education, he was almost certain that he was going to pursue a career in clinical psychology. However, his advisor stepped in at this point and urged him to take some time off and consider all his options before continuing with graduate school. As Dr. Pier reflects on taking time off, he said that his advisor’s advice was excellent. Having time off allowed him to enjoy himself and renewed his desire to go ahead and get his doctorate in clinical psychology at Loyola University of Chicago.

Combining Clinical and Academic Jobs

Dr. Pier has a fascinating life that combines working as a clinical neuropsychologist at clinics such as Easter Seals Greater Hartford Rehabilitation Center and the Rehabilitation Hospital of CT along with teaching courses at Wesleyan University. Last semester, he taught a course in psychopathology, and this semester he is currently teaching a course on the introduction to clinical neuropsychology. The clinical neuropsychology course considers topics ranging from clinical interviews, normal aging, dementia and delirium, to drug and alcohol abuse, traumatic brain injury, Parkinson’s disease, and encephalopathies. This wide range of topics is supplemented with background reading. During class, Dr. Pier talks about his own experience with patients. This personal experience adds life to the abstract descriptions of disorders and makes the topics much more tangible.

Combining both teaching and clinical work has allowed Dr. Pier variability and flexibility in his continued study and work on clinical psychology. Joining both teaching and clinical work first began in graduate school. It was here that Dr. Pier took advantage of internships. In one instance, he happened to be in the right place at the right time. A faculty member at Loyola University of Chicago was taking a sabbatical, and the department knew that Dr. Pier’s master’s and doctoral research was in the area of substance abuse and addictions, exactly the area of clinical psychology that the teacher on sabbatical would be unable to teach. He took this teaching position and has always been on the look out for opportunities to teach.

In 1994, another opportunity to teach arose when Dr. Pier was completing his post doctoral fellowship. The psychology department at Wesleyan contacted Dr. Pier’s mentor asking her if she would be interested in teaching a course in clinical neuropsychology. She had other obligations so the teaching position was given to Dr. Pier after he sent in his resume and got the okay from Wesleyan.

Challenges of a typical day

Even with enjoying both clinical work and teaching, there are many challenges that Dr. Pier must surmount each day. Dr. Pier benefits from teaching because it continually forces him to stay current with the literature. He constantly finds himself reviewing recent books and journal articles on a variety of topics for his classes. This provides a nice benefit for his clinical work by keeping up on current advances in treatments.

Teaching has also provided Dr. Pier with the opportunity to delve into a variety of different subjects. This again aids him in his clinical work. The challenges with teaching come from the give and take. On one hand, teaching gives Dr. Pier a means of continued learning where he must further his understanding and learn what new research has been presented. On the other hand, Dr. Pier finds this learning intellectually stimulating and in teaching this material he can spend a significant part of his time on topics that he finds particularly enjoyable. Teaching also gives him a break from the daily clinical activity which he claims, while rewarding, can be a difficult task.

At the clinic, Dr. Pier works in many different systems. Each has its own strengths and weaknesses, but the common challenge is to deliver proper care to his patients. His biggest frustration and headache comes from dealing with insurance companies, managed care, and HMO’s. Dr. Pier says with agitation, "They place restrictions in terms of my being accessible to patients." For instance, there are many times when a patient may need physical therapy and occupational therapy. In these treatments, there are many restrictions on the frequency and duration of treatment. So, it is easy to see that Dr. Pier has difficulties implementing the treatment and care that he believes will be best for a particular patient. Dr. Pier says, "I might make a judgment that somebody needs a neuropsychological evaluation that I think should take so long... and they only give me four sessions... so there they impose a rate limiting step on a lot of treatment...."

Busywork, paperwork, and forms are other frustrations that Dr. Pier encounters every day at the clinic. He has to constantly fill out forms that explain why he is requesting a certain treatment or evaluation even if the patient has been already referred to him by a neurologist or physiatrist. These forms often take around 45 minutes to fill out and are unnecessary. Many challenges are also presented just from the stress of dealing with patient care. Progress is quite variable, and there are many factors that go into determining somebody’s course and rehabilitation, such as their age or background. In treatment of patients, Dr. Pier tries to structure a patient’s environment around them to accommodate their deficits. This often helps in a patient’s recovery, which may only be a slight improvement, or possibly the patient will make a large enough improvement to become independent and self-sufficient.

Dr. Pier treats many different patients. Considering all the forms of treatments for all the kinds of patients that Dr. Pier encounters would be too cumbersome. Instead, we will specifically consider bipolar patients. Another term for bipolar disorder is manic -depressive illness. This mental illness, as its name suggests, cycles between manic and depressive episodes. The treatments that are available to bipolar patients range from drug therapy to counseling sessions to alternative treatments such as shock therapy.

Drug Therapy

Lithium and prozac are used most often to treat depression with lithium being prescribed most often for bipolar disorders. To know if a drug is actually working, it takes several weeks to see a pronounced effect. In Dr. Pier’s case, he is not in the position to prescribe medication for his patients. Instead, he must refer his patients to a doctor who has the legal right to prescribe medication. Dr. Pier’s role involves more of the counseling aspects that go into coping with depression. He believes that medication alone is not sufficient. He supports this by indicating the role of the environment in causing manic episodes, "Because we know an increase in stress can quite often launch someone into a manic phase."

Counseling

While counseling his patients, Dr. Pier looks to involve the family and manipulate the environment to stack the cards in the patient’s favor. Involving the family means educating them about depression. Often the family does not want to accept that their brother or spouse has depression. Dr. Pier begins by telling the family that depression is due to brain dysfunction. He uses an excellent analogy to facilitate this point. He compares depression to diabetes. He says, "In a patient who has diabetes there is a inability of the body to manufacture and use insulin. I attempt to get the family to see that it is likely the same for people who have these psychiatric disorders. This is not a situation where they can try harder or a character flaw." Depression is a fact of life that they must deal with each and every day. Their body is incapable of maintaining a healthy balance of neurotransmitters that maintains a positive, normal, healthy life perspective.

Dr. Pier goes on to say that even educating the patient is important. So often depressed patients have a whole set of cognitive distortions or biases in the way they look at life. People who are depressed, for example, tend to have a negative outlook on themselves , the world, and the future. There is a constant feeling of hopelessness, worthlessness, and incompetence. To make matters worse, Dr. Pier says that they are unlikely to make changes which would allow them to feel the opposite. So, a constant downward spiral is perpetuated which maintains that they are no good. This leads to inactivity, isolation, and withdrawal which further inspires their downward spiral.

Manipulating the environment can undo this downward spiral by increasing the patient’s faith in themselves through positive, successful experiences. Medication can also be used to help patients sleep better and have more energy. All these factors can contribute to a positive cycle that can also feed on itself. Dr. Pier says that getting this cycle going is of course difficult and frustrating where progress goes two steps forward and then one step back.

Shock Therapy

Shock therapy is an alternative treatment method for severe depression. Dr. Pier says that ECT is a viable treatment method that can be used for severe depression when other forms of treatment do not appear to work. He states cautiously, however, that precautions should be taken with the significant side effects that can occur. The bottom line is ECT has been shown to work with people who are depressed, and until there is evidence that shows ECT causes permanent damages, it should be considered as a possible treatment method for severe depression.

Self Treatment

There are many reasons why patients who suffer from depression have difficulty coping with their illness. One reason is the frequent use of illegal substances and alcohol to self-medicate themselves. Dr. Pier believes many times people aren’t aware of what is going on. He says, "They just know that they are miserable. They don’t know that there is a name for that called depression, and that it is treatable. So, they look around for things that they think will make them feel better." This is why, so often, bipolar patients turn to alcohol, marijuana, cocaine and other drugs which they believe will solve their problems by making them feel better. Dr. Pier says, "In the short run those solutions actually do make them feel better. But the problem is only in the short run." In the long run, use of these chemicals makes matters much worse.

In the short run, there is a brief period where patients feel good. This period of "feeling good" lasts until the effect of the drug wears off and then they feel terrible again. This causes them to go back to the drug and soon a viscous addictive cycle is perpetuated by a need to "feel good." Dr. Pier further says, "So they might not understand what is going on. They just know that they are miserable." He also says that depressed patients are often unaware that medication or counseling could be helpful. This drug effect gives them a short term anesthetizing effect or euphoria which rouses them from a depressed state and can be quite reinforcing. And if this was not enough, Dr. Pier says that society also poses a stigma attached to mental illness where the mentally ill are thought of as weak people that are unable to "suck it up."

Cognitive Functioning of Manic Depressives

Individuals who are bipolar show a wide range of academic and social abilities that range from superior to quite limited. For instance, if the bipolar patient has poorly controlled symptoms, then their social function, interpersonal skills, and ability to function in an occupational setting or educational setting would be severely hindered. There is no doubt, Dr. Pier contends, that if depression goes untreated these individuals will be more likely to have low average intelligence and be poor students. Depression actually has an indirect effect on cognitive abilities. Depression decreases cognitive abilities by lowering motivation, activity, and self-worth.

Depression can be unleashed at any age. Dr. Pier says it can be brought about by a life trauma or negative event. Each case has its own set of variables. Some bipolar patients have tremendous support from their family while others are struggling with divorce and financial pressures where they can not go to work and either do not have a family or are estranged from their family. These variables make treating bipolar patients quite a challenge.

There is a genetic tie to siblings of manic depressive parents showing risk for unipolar depression as opposed to bipolar depression. Unipolar depression, Dr. Pier says, "is a depressed state with out the manic phases." He also contends that it is possible that research did not follow those subjects long enough for them to have their first manic phase of the illness.

In conclusion, Dr. Pier’s double life of teaching and clinical work has allowed him to overlap his jobs in a single discipline, psychology. In this overlap, he is able to complement each job with experiences from the other. Teaching makes Dr. Pier keep up on the current literature to keep him informed on current advances while working in the clinic allows him to bring to class lectures personal accounts with patients that illustrate a particular injury or dysfunction. This illustration by example allows for a more interesting class lecture, as well as better understanding of the tests administered and the disease symptoms. Dr. Pier has always had a natural curiosity and interest in human behavior and with his catholic Jesuit high school education he said, "I found motivation to find some course of study and career where I might hope to improve my little corner of the world and psychology gave me a [means to fulfill this goal]." Dr. Pier has improved his patients’ lives and given families a better understanding and a means of coping with such illnesses as depression. And his little corner at Wesleyan University has blossomed with knowledge and understanding in the topics of clinical neuropsychology.