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Dr. Bernard J. Carroll, ‘Conscience of Psychiatry,’ Dies at 77

Dr. Bernard J. Carroll, whose studies of severe depression gave psychiatry the closest thing it has to a “blood test” for a mental disorder, and who later became one of the field’s most relentless critics, helping to expose pervasive corruption in academic research, died on Sept. 10 at his home in Carmel, California. He was 77.

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Benedict Carey
, New York Times

Dr. Bernard J. Carroll, whose studies of severe depression gave psychiatry the closest thing it has to a “blood test” for a mental disorder, and who later became one of the field’s most relentless critics, helping to expose pervasive corruption in academic research, died on Sept. 10 at his home in Carmel, California. He was 77.

His wife, Sylvia Carroll, said the cause was lung cancer.

Bernard Carroll was all of 28 when he published a paper that seemed to herald a new age of psychiatry, one rooted in biology rather than Freudian theory. Trained both in endocrinology and psychiatry, he applied a test from that first specialty — the dexamethasone suppression test, or DST — to people with mood problems.

The test measures the body’s ability to suppress its own surges of cortisol, a stress hormone. In a 1968 article in The British Medical Journal, Carroll announced that when the test was administered to people with the severest species of depression — a paralyzing gloom then called melancholia, or endogenous depression — their bodies were shown to have trouble suppressing the hormone. People with other kinds of mood disorders had normal scores.

The test did not mean that failure to suppress cortisol caused depression, just that it was associated with it.

“I thought of it as a confirmatory test, to support a diagnosis, not to make one,” Carroll, known as Barney, said, in a recent interview in his home, “and possibly as a way to monitor progress in treatment.”

It didn’t happen. In 1980, experts revising psychiatry’s influential diagnostic manual eliminated distinctions in kinds of depression. Melancholia was lumped with many other mild and moderate conditions under the classification “major depressive disorder.”

Soon after, modern antidepressants hit the market, and pharmaceutical companies paid top academics around the world to help interpret studies, massage data and promote their products. The field chased the drugs, and the money, and learned nothing about the biology of mental disorders.

“Barney’s application of the DST to serious depressive illness was a huge step forward in establishing a biological base for serious depression,” Edward Shorter, a historian of psychiatry and author of “How Everyone Became Depressed” (2013), said in an email. “It identified a biologically homogeneous group of serious depressives that could then be studied with the tools of molecular biology.

“Unfortunately,” he added, “the DST was pushed aside before anyone had a chance to do this, and one of the few biological tests in psychiatry has since then laid fallow.”

Billions of federal research dollars have since poured into other kinds of biological psychiatry — brain scans, animal models, genetics — but the field has yet to deliver anything of practical value to psychiatrists or patients.

In 1998, after winding down his professional life, Carroll and his wife moved to California, where be began another kind of career. He and a lifelong friend, Dr. Robert Rubin, a professor of psychiatry at the University of California, Los Angeles, dissected psychiatric studies as they appeared, flagging sloppy work and sniffing out conflicts of interest. They then broadcast their findings to former colleagues and allies through various email lists, often taking their findings to the news media.

“He never stopped; he was up at all hours,” said Dr. Allen Frances, a former Duke colleague. “I mean, I’m an early riser. I’d get up and there’d be a bunch of emails from Barney.”

In the 2000s, Carroll and Rubin worked with Paul Thacker, then a staffer for Sen. Charles Grassley, R-Iowa, to help expose huge undeclared payments to top academic researchers at Harvard, Emory University and other institutions. He knew very well how this world operates; he had consulted widely with drugmakers himself.

Carroll concluded that the psychiatric drug literature had become so polluted as to be virtually meaningless; he called most drug trials “infomercials.”

“We weren’t after anyone, nor did we care how much money people were making — we were concerned about how corrupt the science had become,” Rubin said in a phone interview. “The tragedy in all this was that the corrupt science was affecting countless people’s lives.”

Carroll’s work ethic and vast connections helped convert many younger researchers to his cause; they now view the published psychiatric science with his skeptical eye.

“He was the conscience of psychiatry,” Frances said, “and he spawned a generation of future consciences along the way.”

Bernard James Carroll was born on Nov. 21, 1940, in Sydney, one of seven children to William Carroll, an accountant, and Alice Maude (Webber) Carroll, who worked in the household. The family moved to Melbourne when he was a teenager, and he attended the University of Melbourne, graduating in 1971 with degrees in psychiatry and medicine.

Carroll studied for a time under Dr. John Cade, who in 1948 had discovered that the salt lithium could settle the mood swings of bipolar disorder, a discovery that is still, far and away, the crowning achievement of biological psychiatry.

Carroll married Sylvia June Sharpe in 1966. He continued his career in the United States, first at the University of Pennsylvania and later at the University of Michigan.

In addition to his wife, he is survived by two children, Senga and Jeremy. In 1983, Duke University hired him to take over its medical school’s psychiatry department, and he helped put it on the map, greatly diversifying its expertise. He reigned there with a steady stream of Aussie malarkey, colleagues say, as well as an exacting scientific and ethical purism that rankled some.

After clashing with a colleague a Duke, he left in 1991 to become clinical director of a geriatric hospital outside Durham, North Carolina.

“That was considered a real step down, in our world,” said Barbara J. Burns, a Duke psychiatry professor whom Carroll had hired. “But he loved it there, the clinical work. He had this flat-bottomed boat, and when I’d visit him we’d go out fishing in a little lake there, on his lunch hour. It was — well, he had fun, you know?”

He worked until the end, Sylvia Carroll said, finishing a last paper and, as ever, expanding his electronic presence. His email lists were active; he had started tweeting (he was terrible at it, Frances said); and he contributed to various blogs, including Margaret Soltan’s “University Diaries,” for which he sometimes wrote limericks under the name “Adam,” like this one:

And then we have just across campus
The medical guys playing scampers.
They’ve learned to beguile,
To increase their cash pile
Once grant funds are safe in their clampers.
— Adam.

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