Dr. Hamilton Interview Part One

Dr. Hamilton Interview Part One

This week I had the pleasure of interviewing Dr. David Hamilton. Dr. Hamilton is a psychiatrist and assistant professor at the University of Virginia’s School of Medicine. This is the first part of a two-part interview series, in which Dr. Hamilton speaks on his background, what bioethics means to his practice, and how he views the mind.
 
How did you get to where you are today in your career?

 
I was a philosophy and mathematics double major in undergrad, and then I worked on Wall Street for about a year. I couldn’t decide between medicine and philosophy, so I decided on philosophy. I went to grad school, and did mostly philosophy of mind, ethics, and theory. I also kept up with a lot of volunteer work in the hospital. I was starting to have a little bit of success in philosophy, through teaching and writing, and like a lot of academic disciplines, you become successful by focusing very narrowly on something. The fact that what I was thinking about and writing about helped no one but myself, and was only interesting to maybe a few dozen people in the world, I decided that wasn’t how I wanted to spend my career. So, I decided to transition to medicine. I did my pre-med requirements at Goucher, and worked at a think tank during my glide year. I went to medical school in Los Angeles, and what was interesting about that was that I went to become a psychiatrist. But, I got caught up and ended up doing mostly surgery in medical school until I realized that I didn’t like being in the OR. So I decided on psychiatry and came to UVa for training, where I did my internship, residency, and fellowship. I did forensics as a fellowship, because it seemed like a way to tie in ethics and philosophy with science and medicine. I worked in the private sector for five years, and then came back and joined faculty here.

What does a typical day look like for you?


What I do depends on what day of the week it is. Half the time, I see patients who aren’t in the psychiatric ward: in the ER, and in other areas of the hospital. I also do psychotherapy and research. My research is in neuromodulation and genetics, treating depression with things other than drugs. We use transcranial magnetic stimulation to modulate brain function. I also teach and supervise senior residents in their outpatient clinics, and do forensics. 
 
How would you define bioethics, and how does it relate to your practice?

 
I would define it as right action in the application of medical treatment. If morality is about one’s relationship to the good, and ethics is about one’s relationship to right action, I think bioethics has to do with how that shapes our interaction with patients as physicians. I see that play out every single moment; almost every patient interaction, every decision, has some ethical quality to it. For example, depression makes people feel powerless. From an ethical standpoint I can prescribe a medication, but one of the things we can do to help restore agency is to give them a choice, and let them feel that medical therapy isn’t happening to them, but that they’re the captain of the ship. I’m the navigator, I know the charts and where the deep water is, but it’s their boat. So I think if we can act as trusted advisors, that stance is an ethical one.
 
 Do you believe that mind is a purely physical entity that can be treated through physical means? If not, what factors do you think go into a person’s well being other than physical intervention?
 
Absolutely not. I can tell you exactly how to build a bicycle; I can tell you what the wheels should be made out of, I can tell you the tension on the derailleur and the brake calibers, but that has nothing to do with how it feels to ride a bike, or win the Tour de France. Those are two very separate things. The literature is clear that in almost every circumstance in terms of mental disorders, it’s always a combination of medication, psychotherapy, and the development of social support that works, never one therapy in isolation.


This interview has been lightly edited for length and clarity.
 

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