“Why is it that a 17-year-old would take you up on a dare to drink 38 shots of tequila, but a 35-year-old would not, given that their brains are essentially the same in the regions that exercise good judgment?” asked Steven Schlozman, HMS assistant professor of psychiatry at Massachusetts General Hospital. Such questions are the stuff of Human Development, the study of changes throughout a person’s life—biological, cognitive, emotional, and moral—that govern healthy maturation.
In past years, this material was distributed among various courses. Now, HMS will join the majority of medical schools that offer Human Development as a stand-alone course. It will take up one afternoon session a week during a five-week block starting in August of the second year, preceding Psychopathology and paralleling courses in both Pharmacology and then neurobiology (called Human Nervous System and Behavior), taught during the same time frame.
It is apt that Harvard is giving the topic this attention, since pioneering work in the field was done at the University by, for example, Erik Erikson. Yet concrete educational concerns rather than homage to the past drove the decision to craft the course. Research suggests that practicing physicians may overlook developmental differences between patients or factors that affect normal development unless the doctors are explicitly trained to do otherwise, according to Schlozman, who co-directs the new course with Jonathan Alpert, HMS associate professor of psychiatry, also at MGH.
A 17-year-old, for example, grasps nutritional counseling in very different ways than a 13-year-old, though otherwise the two patients seem similar. Alternatively, a 35-year-old patient’s age may mask a regression in his reasoning ability caused by the stress of illness.
Case studies will be the crux of the class. Schlozman will contribute one from his own experience: the instance of his then six-year-old daughter fracturing her wrist in a minor accident on a set of monkey bars. That simple incident was the result of a complex web of developmental milestones, Schlozman said. She needed to have acquired emotional confidence that she could master the bars, cognitive skills to judge that she could climb safely, cerebellar development to grant her the necessary fine motor control, and the necessary bone development for the fracture to occur in the first place.
“The point is to study all of these things from a normal perspective,” he said, “because that allows you to recognize when things have gone astray.” And this, in turn, is the focus of Psychopathology, which will follow and build upon themes introduced in Human Development in another example of the new curriculum’s integrated approach.
Schlozman will be joined by instructors from throughout the Medical School, reflecting both the multidisciplinary nature of the field and the technological advances of the last two decades that have enabled the field of human development itself to develop.
“We have the tools now to study what’s going on neurobiologically as people undergo these changes. Most folks would have said a 15-year-old is different from a 22-year-old; now we can construct a postulate, from looking at their brains, as to why these changes take place.” The new capabilities explain why that teenager would drink amounts of tequila his elders would refuse: adolescents, in the heat of emotion, use more primitive areas of the brain to make choices, even though their prefrontal cortex, the font of good judgment, is as fully developed as an adult’s.
