Psychology professor Mark Detzer works as a clinical psychologist at the White River Junction Veterans Affairs Medical Center. He is interested in health psychology, the study of the influence of psychological processes on physical health, and his work at the VA Medical Center is devoted to pain management of chronic diseases. Some of his research has included improving pain management techniques in the field of health psychology for people with cystic fibrosis and adolescents with diabetes. Detzer teaches an undergraduate course every winter called Psychology 54.02, “Health Psychology.”
What got you interested in the field of psychology?
MD: My dad actually got his doctorate in theology and he became a minister, which was the plan, but eventually he wanted to teach, so he ended up teaching at the college level, and he was really interested in psychology of religion. He taught classes in medical ethics and was always interested in mind-body interrelationships. These days, people seem to be much more accepting of the mind-body connection, but in the old days often people that worked on the medical side did not see as much value on the psychology side. With any kind of change there’s a leading edge to that, so my dad would go to these conferences and I’d tag along with him where there were these world-renowned, certainly nationally known experts. So when I went to college, I went to University of California, Davis, which was a state school. I have always been interested from those early days of being exposed to mind-body health of the interrelationships, so I ended up majoring in nutrition science and minored in psychology. I wasn’t at that point ready to go on to the next steps, so I actually taught high school science for five years. That was my first career. I had only planned to do it for a couple years, but I really enjoyed it, so I kept doing it. I taught chemistry and physiology and spent time trying to decide what I wanted to do. Around that time, I got exposed to this whole sort of field that was developing around health psychology, the idea that there was a scientific study of these kind of things that really mattered to me most: how people manage their health and kind of the mind-body connection and how people think about their health and how we use the mind to help us better manage our lives.
Why did you decide to work at Dartmouth?
MD: I went to grad school at the University of Vermont and I went back out to California. I interned in the VA in Palo Alto and I did my post-doc at Stanford [University], so at that point I really thought I would end up in an academic medical center setting, kind of like I am now. But a job opportunity working with patients with chronic pain that was in the private sector was really appealing, and actually took us to Arizona, and what I found is I really missed working with a variety of patients. I really missed the teaching and learning process of an academic medical center setting. We loved New England and Vermont, and this job at Dartmouth-Hitchcock opened up and I applied and was accepted, and I developed a program for adolescents with chronic medical issues. I worked at Dartmouth Hitchcock across pediatrics and psychiatry, and during that time explored the idea of teaching a class at the college in health psychology, and the faculty were really receptive and supportive of that. [Psychological and brain sciences] has a very strong neuroscience department — it’s very highly regarded, with amazing professors in neuroscience, and at the same time they really value the application and the clinical part, so there’s several clinical psychologists like myself who are teaching more the clinical and applied classes. It ends up being a real nice win-win for everybody, I think. So, I started teaching at Dartmouth in 2004 while I was still at Dartmouth-Hitchcock. There was one point at which I was teaching both a first-year seminar in positive psychology and also the health psychology. As I switched over to the VA for my clinical hospital work, I just got too busy with the hospital-based work, and I couldn’t manage two courses a year anymore and so health psych became the main course. With just a few exceptions I’ve taught that pretty much yearly since 2004.
What do you hope students take away from your class “Health Psychology”?
MD: So I spend a little bit of time at the beginning of [the class] trying to get people oriented to that way of thinking about things. I always say it’s not a textbook class — at times I haven’t used a textbook, we use a lot of peer-reviewed scientific journals. There’s a high expectation of reading peer-reviewed literature or scientific literature, and then I have popular press books that are written by M.D. and Ph.D. doctors who are experts in the field and who are addressing some of the more clinical side of this.
When there’s things like sleep, I have students track their sleep for a week and reflect on what they learned, kind of what patterns they see, get them to talk about it with each other, and have larger group discussions. I remember a professor told me: “I don’t care if they come to class, if they can pass the test and get an A, then they’ve mastered the material,” and my approach to education is the opposite of that. I want them there engaged every class because that’s how they’re going to get the most out of this material and this method of education. I have a pretty strong bias on active learning and hands-on learning. We do a lot with mindfulness and health and mindfulness meditation over the course of about a three- to four-week period, and so I try to sort of spice it up with some guest speakers, and the students tend to really take to that. So my goal is to create a really dynamic atmosphere where the students take away a lot, and I think I tend to get people that are game for that.
What research projects are you currently working on?
MD: At Hitchcock we did a lot with cystic fibrosis. I worked a lot with the cystic fibrosis team, and some of that was looking at quality of life, and worked with a project with diabetes. Since I’ve been at the VA, I’ve been part of some papers that looked at immediate access to care. The model is really mental health of the future that we’ve been doing at the VA for a while now of embedding mental health into medical settings. We have several articles that looked at how to do that, how to embed, how to create sort of immediate access. This is an outpatient clinic that’s staffed to take walk-ins, and it’s sort of the entry point to mental health care at the VA. So, it’s how mental health should be, in my opinion. You shouldn’t have to wait two months to go see a mental health provider. If you have a mental health issue you should be able to go in today and have that assessed and then come up with a treatment plan and talk about different treatment options, whether it’s medicine or individual or group therapy or some combination of that, and so we do that in that clinic.
One of the things that I spend a lot of time on in the course of the chronic pain work in the VA is we’ve developed a high dose opioid clinic for folks that have significant chronic pain and who have been maintained on very high doses of opioids, and there needed to be closer monitoring of patients in that category. So we’ve put a lot of time and energy and work into that clinic over the last three years. We’ve presented the outcomes of that clinic, we’ve had a pretty significant tapering of opioid medications for people on very high doses, so that’s been really rewarding and hard work.
How do you think the behaviors of college students today, and Dartmouth students especially, are affecting their health?
MD: One of the reasons why I like doing the positive psych stuff at the beginning [is that] it’s really trying to get them to look at their own values and strengths. I think at a place like Dartmouth, you guys obviously were all very high-achieving folks in high school. That hasn’t changed — what’s changed is now all those people are all gathered together in one group of 1,000 or 1,200 as a class, and so I think students really struggle at having to not lose sight of their strengths and not feel like they have to do everything, and to try to just be comfortable with who they are.
When it comes to the substance use, I think, like students at all universities, people under stress are at more risk for drinking more and using drugs. And so in the course of Dartmouth students’ health, part of why I try to hit the sleep stuff right away is — and believe me I relate to this — there’s a bit of burning the candle at both ends, and that can catch up with you. So I think sleep is really, really important for all kinds of reasons, health-wise. All that can kind of get thrown out the window once people start to get stressed, like two weeks in or three weeks in, when the first set of midterms really hits. I remember a student told me one time, “I start behind and I never catch up.” And I think that’s the challenge and the stress of these trimester systems because it goes so fast. I think this should be more than just getting your pre-med requirements done or getting all your business classes and networks set up so you’re going to be successful on Wall Street. So I think that Dartmouth students are at risk for overcommitting, not getting enough sleep, and then overdoing it with partying.
I think there’s a culture, a history with Dartmouth because of the all-male school, we’re still dealing with some of that even though we’re what, 50 years in since women have been part of the Dartmouth scene, and so I think there’s still this sort of struggle about how do you create the healthiest community possible. One of my final exam questions was writing a letter to President Phil Hanlon about how the students, based on the current state of the science of alcohol education and support for college students, based on the best peer-reviewed evidence as of 2017, would direct Hanlon to set up the best possible system for this 18-to 22-year-old population in terms of their relationship with alcohol and staying healthy. And I’m always so impressed with what the students put together for that, and how thoughtful they are, and based on their own experiences and just seeing what the literature shows makes a difference for college students. So, anyway, I really love them thinking about how they can be as healthy as possible and also at the systems level, could we be doing something better.
This interview has been edited and condensed for clarity and length.
