Your brain’s power supply may hold the key to mental illness

Dr. Cohen's laboratory has led the way in developing techniques that grow living brain cells from patient samples using induced pluripotent stem cell technology. He describes these advances as "giving us leads we did not have forty years ago." Through this approach, his team has identified key disruptions in how brain cells generate energy and connect with one another -- processes that appear central to many psychiatric illnesses affecting millions globally. With more than 400 scientific papers and five patents, his research points to new treatment strategies that could prove far more precise and effective than traditional therapies.

Mitochondrial Mysteries Transform Treatment Paradigms

The discussion highlights how Dr. Cohen's team uncovered widespread disturbances in cellular energy metabolism underlying major psychiatric conditions. These findings have far-reaching potential for designing targeted treatments that could benefit people in many regions and populations. His studies show that brain cells created from individuals with schizophrenia, bipolar disorder, or Alzheimer disease display intrinsic metabolic defects that may be corrected even before symptoms emerge.

This energy-based framework challenges decades of conventional thinking centered on neurotransmitter imbalance. Dr. Cohen explains that the brain relies more than any other organ on finely tuned energy production and communication between cells. His results suggest that restoring these fundamental cellular functions could help prevent or ease symptoms in vulnerable individuals worldwide, independent of background or environment.

By combining genomic analysis, advanced brain imaging, and cellular modeling, Dr. Cohen promotes a multidisciplinary approach to mental health research. This integration provides scientists with a powerful model for exploring complex brain disorders -- especially mood, psychotic, and cognitive conditions -- that appear across cultures and regions.

Challenging Century-Old Diagnostic Models

Instead of the status quo expert-consensus diagnostic systems, that place people in categories, Dr. Cohen advocates implementation of an evidence-based dimensional approach for describing patients. He argues that terms like "schizophrenia" should be retired in favor of scientifically accurate alternatives that reduce stigma while better capturing illness complexity. His proposed dimensional model focuses on symptom profiles rather than categorical labels, offering clinicians more nuanced tools for patient assessment and treatment planning.

This diagnostic revolution extends beyond mere terminology. Dr. Cohen's research demonstrates that traditional categorical systems fail to reflect underlying biological realities or clinical presentations adequately. His dimensional approach aligns with how clinicians actually evaluate patients, globally, providing richer individual descriptions while enabling formation of more homogeneous research cohorts. Such reforms could transform psychiatric practice internationally, improving diagnostic precision and treatment outcomes across diverse healthcare systems.

The interview explores how these new models could particularly benefit regions where Western diagnostic frameworks have proven problematic. By emphasizing observable symptoms and illness trajectories rather than culturally bound categories, dimensional approaches offer universal applicability while respecting local contexts and experiences.

From Laboratory Bench to Hospital Leadership

Dr. Cohen's impact extends beyond research laboratories. As McLean Hospital President and Psychiatrist-in -Chief from 1997 to 2005, he reversed financial decline while establishing over 30 new programs advancing both clinical care and scientific investigation. His leadership philosophy emphasized supporting frontline staff and reducing bureaucracy, principles applicable to healthcare institutions worldwide facing similar challenges.

Under his guidance, McLean achieved record levels of patient care, research funding, and educational training. These accomplishments demonstrate how scientific rigor combined with compassionate leadership can transform struggling institutions into thriving centers of excellence. His experience offers valuable lessons for hospital administrators globally confronting resource constraints while striving to maintain quality care and research productivity.

Particularly noteworthy was his establishment of Waverley Place, a peer-run center supporting individuals with mental illness living in communities. This innovative model, prioritizing mission over revenue generation, demonstrates how psychiatric institutions can serve broader societal needs while maintaining financial viability.

Personal Journey Shapes Scientific Vision

The interview offers a window into the personal experiences that guided Dr. Cohen's path as a scientist. His fascination with physics and mathematics in his youth, combined with meaningful interactions with psychiatric patients during medical training, helped shape his approach to research and care. He recalls his first psychiatric patient, a young woman whose remarkable recovery through medication left a lasting impression and underscored psychiatry's power to rebuild lives affected by mental illness.

Dr. Cohen also speaks candidly about the anxiety and shyness that sometimes limited his professional opportunities. His openness about these challenges offers a rare glimpse of vulnerability in a leading researcher. By sharing these reflections, he highlights that perseverance and commitment, rather than the absence of difficulty, are what truly define scientific achievement. His honesty serves as encouragement for young scientists who may encounter similar obstacles.

Family plays a central role in his story. His father, a respected internist, modeled a deep sense of medical dedication and the value of collaboration in research. Having been married for more than 55 years, Dr. Cohen credits his family's steady support as a cornerstone of his long and productive career. Together, these elements reveal how great science often grows from human connections and experiences that extend far beyond the laboratory.

Future Directions and Global Impact

Looking ahead, Dr. Cohen expresses optimism about the future of psychiatric research while recognizing the societal hurdles that remain. His current work aims to identify specific biological mechanisms that influence vulnerability to mental illness, with a strong focus on prevention. Because psychotic disorders usually do not appear before adolescence and dementia tends to develop later in life, he believes early interventions are becoming increasingly achievable.

The discussion emphasizes how new technologies, particularly in cellular reprogramming and genomic analysis, are transforming what researchers can uncover about the origins of psychiatric disease. These methods, now more widely available thanks to international initiatives (including those supported by Genomic Press), are accelerating discoveries and opening the door to more effective treatments.

Dr. Cohen also stresses the need to nurture creativity and risk-taking in science, cautioning against the tendency to fund only predictable or incremental research. He envisions a global scientific community where innovation can flourish in any country or institution, free from hierarchy or limitation. This philosophy aligns with the open-access approach advanced by Genomic Press, ensuring that important findings can be shared broadly without financial barriers, promoting a truly inclusive and collaborative model of discovery.