Q&A With TMS Los Angeles

Darkness cannot drive out darkness: only light can do that.
-M.L.K.

“Leuchter” is a German-origin root word that translates in English to “candelabra”, “chandelier”, and others, depending on the prefix used. Leuchter could have a lengthier translation: 
“The base from which a thing shines light around itself”. This is a fitting name for a pair of physician-neuroscientists that specialize in clinical neuromodulation.

There is more than just the common name that define Andy and Michael Leuchter, father-and-son members of The Clinical TMS Society, Distinguished Professor and Director of the Neuromodulation Division at the University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, and PGY-4 Psychiatry Resident at UCLA, respectively. 

On behalf of CTMSS, I met virtually with both physician-scientists Leuchter because many are curious to understand how the working and personal relationships between these two interact. They were gracious enough to give a peek into their personal and working lives. We present their full unedited answers here as originally written. Questions appear in italics preceding each author’s response. Answering author’s names are shown in boldface type.

What is it about your family-work relationship that makes it work well, and why do you think some family-work relationships don’t work out?

Andy: We always have had a close father-son relationship built on nightly family dinners, Scout campouts, projects around the house, and years of bedtime reading. In addition to knowing each other very well, we have a strong foundation of trust and respect. Working together feels very natural to both of us. 

Michael: What he said! We've built a strong foundation of trust and respect over the years, and work to maintain that to this day. On top of working together, we stay connected through working out together, sending memes and jokes back and forth, and lots of other ways. We maintain a natural lighthearted father-son connectedness while doing serious work, and I wouldn't have it any other way. 

How long ago did you suspect that you both would end up on a similar career path?

Andy: I always wanted my sons to choose their own career paths. When both Michael and his older brother Rich decided in college to pursue careers in medicine, I was concerned that they not feel pressure to follow in my footsteps. And when Michael selected psychiatry as a specialty, I must have asked him 20 times “are you sure that you really want to do this?” I do not think that Michael chose to be a psychiatrist and to develop a specialty in TMS because he wanted to be like me. I think he saw how much I enjoyed my career in academic medicine and how much fun I had in a clinical and research career, and that he decided to try it out for himself. 

Michael: My father insists he wanted all of us to choose our own career paths and not feel pressured to pursue medicine, though if that's the case, then why did he make his career path look so appealing?!? I was drawn to neuroscience throughout high school, added in an engineering bent in college, and sought to apply that in medical school. Of course, listening to my dad's advice to try out other specialties in medical school, I was torn for a time. But when another one of my mentors asked me which journals I'd like to be reading in 20 years, the answer became fairly obvious. 

On a “normal” day when you’re in the lab or clinic together, what is the most likely thing you might disagree about during work? What is the most likely thing you can read the other’s mind about? 

Andy: Michael and I worked together on the TMS Service for the past year, and it is strikingly rare that we disagree. Michael knows how I think, and his judgments are usually very similar to mine. We have heard from more than one patient on the Service “I did have a question, but I don’t need to talk with you about it — I already spoke with the other Dr. Leuchter.” I actually like it when Michael comes to a different conclusion on a clinical or research question. His opinions are always well reasoned, and it is rewarding for both of us when he persuades me to change my opinion. 

Michael: I frequently feel that my dad and I share a brain, and I can tell what he's thinking in terms of clinical decision-making and study design. We sometimes enjoy a robust back and forth as we reconcile our differing opinions, and we both learn a lot from those discussions. There is no attending who pushes my skills and makes me think quite like my dad does. 

Do you like to talk about work with the other at family gatherings and special occasions? Why or why not? What is the rest of the family‘s view? 

Andy: I always have been very good about separating work from family life. Working with Michael has changed that a bit. There always is something to catch up on, so that we sometimes grab a few minutes at family gatherings to talk shop. My wife tends to shut this down pretty quickly! 

Michael: We generally keep work and family life separate, but when you get to work with your dad it's hard to avoid talking shop. There's always "Ooh did you see this paper yet" and "you've got to check out the latest from so-and-so's lab" or "what if we tried doing this study" when we have a couple minutes, but we'll generally keep that to work or one-on-one time. Besides, with the rest of the family there's always so much else for us to talk about, whether it’s my sister-in-law's campaign for state assembly or showing off our latest adorable dog photos (my dog Cindy is by far the cutest)! 

In 30 or 50 years, how will clinical TMS be utilized and considered? How do you see the practice changing over time? 

Andy: I think that in 30 years, the next generation is likely to be asking “Can you believe that they used to make patients come in every day for months to put an electromagnet on their heads to treat depression?” I think that we are likely to see a whole host of at-home neuromodulation devices that we cannot imagine right now. At the same time, ECT still is a robust and widely-used treatment — we have just found ways to make it safer and more effective. I am glad that we have a new generation of thoughtful clinician-scientists like Michael to lead the way in new technologies, and figure out where the old ones will fit in. 

Michael: As Harold Sackeim has said, "in psychiatry we're only two or three steps past bloodletting." I for one cannot wait to see what will make our current treatments look old-fashioned by comparison. I think before long we're going to see a whole host of modifications to current treatments and brand-new treatments emerge with varied novel methods of stimulation, focality, portability, etc. that will enable us to more effectively and broadly treat a whole host of conditions. Neuromodulation as a field is growing exponentially, and we're already able to do so much we never thought possible. I still remember dad nerding-out about his first TMS machine at dinner, and now I have at least a handful of new papers in my feed every day telling me how we can use it better. Hopefully 30-50 years from now we will be five or six steps from past leeches and bloodletting, or we at least figure out how to use them to augment TMS!

Perspective
I volunteered to pursue this project and draft this article for a selfish reason. In my own career path, I have experiences like Michael. My dad Edward Mischel retired last year after three decades working as an administrator and clinical social worker in the Department of Psychiatry at our alma mater, Wayne State University in Detroit. While WSU and UCLA may not seem to have many (or any!) similarities on their facade, they share a common mission based simply on their positions as major research and teaching institutions found in high needs urban centers, Detroit and Los Angeles, respectively. Like Michael, I funneled an interest in philosophy and neuroscience into the medical doctor path, choosing research and ultimately specializing in psychiatry and behavioral neurosciences. I didn’t do this because my dad told me to. I chose psychiatry because it was the rotation where I felt “at home”. I didn’t move back from residency to raise a family in metro Detroit because my dad told me to (even though he did!). I live here and work at Wayne State because my dad made it our home and our purpose. Thank you to Drs. Andy and Michael Leuchter for your generous work!

Written by Nicholas Mischel, MD, PhD