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Topics: Clinical & Translational Research, Diversity & Inclusion, Education & Training, Mentoring

Summer Sessions: Embracing Diversity and Researching the Roots of Psychosis

Five Questions with Erik Velez Perez and Paulo Lizano.

Erik Velez Perez knows what it’s like to be different. He identifies as a gay Latinx and is an activist for LGBTQ+ justice. He grew up in Puerto Rico and pursued his dream of becoming a public health researcher in psychiatry against all odds, enrolling in the MD and MPH programs at Ponce Health Sciences University. This summer, he got a taste of what it’s like to conduct leading-edge research at a world-class translational neuroscience lab through our Visiting Research Internship Program (VRIP), an intensive eight-week mentored internship.

His mentor Paulo Lizano, MD, PhD, knows about beating odds as well. A first-generation college graduate who overcame childhood poverty and a failing school district to pursue a career in psychiatry and translational neuroscience, he now heads the Lizano Lab at Beth Israel Deaconess Medical Center. Finding supportive mentors helped him get there.

Lizano sees his mentorship of Velez Perez as paying it forward. In the process, he helped shatter Velez Perez’s culturally ingrained perceptions of what it’s like to conduct research at a Harvard-affiliated hospital.

The two paired up in VRIP’s summer internship to test a theory about the roots of psychosis and shine new light on a central question about the physiological chain of events underlying serious mental illnesses such as schizophrenia.

VRIP aims to promote inclusion and diversity in translational sciences. Why does diversity matter in science and healthcare?

VELEZ PEREZ: I always remind myself that embracing diversity is key to success, not only on a personal level but also for our society as a whole.

Yet we are trained in medical school to see patients as standardized cases. In practice, however, it’s very different. We encounter individuals from diverse backgrounds and cultures, differing in color, age, sexual orientation, gender identity, religion, and life stories. Embracing diversity might allow us to reduce stigma in the standardized healthcare system.

I recall a patient who experienced stigmatization in clinic for having a mental health condition and identifying as trans. I witnessed how profoundly it affected their medical care. This patient was sick, worried, and desperately seeking treatment. They went from one doctor’s office to another seeking help to no avail. Eventually, the patient was found to have cancer. The stigmatization by doctors increased the burden on the patient and society, leading to a higher utilization of healthcare resources than necessary.

Additionally, I believe diversity is about representing and advocating for equity and inclusion not just with words but also with actions.

As a Latinx gay man from Puerto Rico and part of the LGBTQ+ community, I am grateful for the opportunity to contribute to diversity within the healthcare system. We need representation from the LGBTQ+ community, particularly in psychiatry, the specialty I am most interested in. We know that LGBTQ+ communities are highly affected by mental health conditions. My goal is to contribute to decreasing the health disparities that currently exist, particularly among Latinx and LGBTQ+ communities.

“We are trained in medical school to see patients as standardized cases. In practice, however, it’s very different. Embracing diversity might allow us to reduce stigma in the standardized healthcare system.”

These disparities come at a great cost to society. I believe embracing diversity and fostering a diverse workforce can enable us to provide high-quality care to our patients.

PAULO LIZANO: It’s so complicated, right? But for me, diversity is just the inclusion of all. Respecting everyone and their backgrounds, their stories, where they come from, the color of their skin, the perspective that they bring, the hope, the joy, all of it.

Having diversity across the healthcare system and beyond is really important. From a patient’s perspective, having a doctor of a similar background who can speak their language and understand certain cultural aspects can enable treatment to progress in a shorter amount of time. Patients trust you more quickly. If you recommend a treatment, they’re more likely to do it. You as the physician can understand what they’re experiencing a little bit better. Patient outcomes improve and we eliminate, potentially, people getting lost in the system, as Erik was describing, or people receiving poor care because they’re not understood.

The last piece, I would say, is the hope that we give to the people that come after us. I grew up quite poor with parents who had limited education in a school system that was about to be taken over by the state. Having mentors who were kind and were willing to take the time to show me the way and get me excited about things made all the difference. They didn’t necessarily have to be from the same background or color; it was just important that they were there to inspire. Being able to pay that forward in ways like this that can help increase diversity in science and healthcare, and across society, is gratifying.

Dr. Lizano, what is the gap in knowledge that this research seeks to fill, and how does that fit into your lab’s broader work?

LIZANO: A big question in the field of psychotic disorders is: Where does the pathology start? In psychosis, people have hallucinations that can be auditory, visual, tactile, gustatory or olfactory. So they have misperceptions in their environments related to the five senses. Some work has explored whether these abnormalities or altered function appear early on in sensory processing, which would indicate a “bottom-up” hypothesis. But other research has demonstrated “top-down” effects involving more complex cognitive networks that integrate information from sensory stimuli to make sense of it.

We just don’t know where it’s starting. Is it starting in the eye and that’s where the changes are happening? Is it starting in the brain, and then being reflected in the eye? Or are changes happening in both places at the same time?

With advanced neuroimaging, we are at a point where we’re starting to understand what’s happening. I entered the field from vascular biology, and when I started looking at these tools, they were still kind of rough. You weren’t getting enough delineation in the brain structure to really understand what’s going on. And a patient had to sit in the scanner for an hour or longer, which can be anxiety-provoking.

So I asked: Is there an easier, quicker, better way of doing this? This is where the retina came up. I read a paper in the American Journal of Psychiatry that showed the back of the eye. I was like: “This is it. I’m going to study the retina in psychotic disorders.” This tack has allowed us to begin to close the knowledge gap as to whether the changes are happening in the eye first, or in the brain first, or at the same time. Can we then use this as an early diagnostic or prognostic marker, or maybe even a treatment biomarker?

All of this work extends a Sight & Science Vision Research pilot grant I was awarded by Harvard Catalyst in 2020. The pilot study is complete and a journal article based on it is under peer review. We are now in the second of four years of funding through my NIH K23 career development award and are applying for an NIH R01 Grant to expand this work.

Erik, what drew you to VRIP?

VELEZ PEREZ: A friend who attends Harvard Medical School provided me information about VRIP. I am a medical student, pursuing an MD/MPH, who also likes research, so I was very interested. During the past year, my research in Puerto Rico has focused on social determinants of health, specifically on understanding the role of social factors in anxiety and depression among the Latinx transgender population.

However, it’s been a long-time dream of mine to have the resources to conduct research on psychiatry, specifically on understanding the physiology of mental illness. Back home, we don’t have that. We have weekly electric outrages, yearly hurricanes, and few resources to conduct research in medicine. We don’t have a great socio-political situation or healthcare system right now. In Puerto Rico it’s very difficult to pursue a research career in medicine. For this reason, I decided to apply to the VRIP.

VRIP was the only program I applied to and I gave my soul to the application. I gave it my all, because I really wanted to be here. My love for research and my goals for the future were my only motivations. Fortunately, I was selected from many wonderful applicants and became the first person coming from Puerto Rico to get into the program.

Having Paulo Lizano as a mentor and having access to this network of people has helped me to broaden my view of the possibilities to do research as a medical student, and most importantly, to impact others’ lives through research.

Dr. Lizano, as a first-year VRIP mentor and a young investigator yourself, why take this on now?

I’ve known about the program for several years now and was just waiting for the day that someone like Erik would come along and be interested in psychiatry, especially the translational neuroscience aspect of psychiatry, and who would really value the work that we’re doing.

I’m excited about it, and working with Erik has been wonderful. I’m looking forward to welcoming more interns in forthcoming years as well. Our lab offers experience in clinical research, basic neuroscience, and translational neuroscience. I am also a clinician, so the interns are able to see patients with me in the clinic and get a sense of what it feels like to meet a patient for the first time, then to work with patients as they get involved in research and see what we do with that information afterward. So they get the full-breadth experience from beginning to end.

“I myself have been through mentorships and programs that have allowed me to get to where I am today. So this is my way of giving back, and I love doing it.”

My goal is to get them excited about psychiatry and translational neuroscience and provide the mentorship, guidance, and motivation to help them get there. I myself have been through mentorships and programs that have allowed me to get to where I am today. So this is my way of giving back, and I love doing it.

The VRIP program does an outstanding job with mentoring and guiding as well. They have regular meetings with Erik. They’re checking to see progress. They’re connecting him with other people within the Harvard system. It’s a well-organized program that I think helps keep students’ experience in mind but also asks: What is this going to mean for them going forward? It gets them into the best position possible to be able to match for example, at a Harvard-affiliated residency program, hopefully psychiatry in Erik’s case. It’s one way we can diversify our workforce.

Erik, has anything surprised you about your summer at Harvard Medical School?

VELEZ PEREZ: Growing up in Puerto Rico, I held the perception that people at Harvard were the most brilliant people in the world and so, superior to others. However, my experience has been quite different. Yes, people here are undoubtedly brilliant, but they are also approachable and genuinely helpful. I have never felt inferior to them. In fact, I was fortunate to be paired with a mentor who is incredibly humble, and this humility extends not only to my mentor but also to the people around me, including those from VRIP, as well as the doctors and researchers I have interacted with. This has been very astonishing to me and is one of the aspects that I really value here at Harvard Medical School.

It serves as a reminder for me to remain humble and grateful for this opportunity. I have learned that being brilliant doesn’t necessitate being superior to others. I aspire to maintain this perspective within myself as I continue my journey. I once was taught that physicians may have knowledge of medicine but patients hold profound knowledge about their own lives. It’s about establishing a genuine and compassionate relationship with the patient, not about asserting superiority. I now have that clear.

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