By Jane Ehrhardt
“I had the luck of the late birth,” says Birmingham psychiatrist Godehard Oepen, MD, PhD, about having been raised in West Germany shortly after WWII. “But we were living in the shadow of it.”
His father spent his years in Nazi Germany undermining the regime by joining the Neue Deutschland, a Catholic-based resistance. His grandfather had Huntington’s disease during the Nazi rule. A degenerative disease disorder that strikes as an adult, it manifests as irregular jerky movements from head to foot. They can only remain still while sleeping.
The Nazis initially castrated his grandfather. Later, they killed him during Tiergartenstraße 4, the five-year campaign of mass murder by involuntary euthanasia of 275,000 psychiatric patients. “The so-called ‘useless members of society,’” Oepen says. “That was the motivation for my father to get into medicine, and me as well, to see if there was something else we could do besides let them die.”
The treatment of his grandfather had a lifetime effect. “It was a major factor in my life to realize it’s not the main importance what you can do and enjoy and achieve and how much money you make and power and glory,” Oepen says. “It’s how much of what you do is actually useful to others, especially those who are considered useless.”
Oepen’s fascination with the human brain led him to medical degrees on two continents, three residencies, and a PhD, all related to neurology and psychiatry. “I wanted to better understand what makes humans tick and why we continue to make foolish decisions that you cannot rationally explain,” Oepen says.
Initially, after getting his first medical degree studying in both West Germany and Switzerland, he became a surgeon. But in less than two years, he found it was missing something. “I discovered that there is not much meaning in it,” Oepen says. “There’s action, it’s good money, and it’s very rewarding in terms of the work. But you don’t have personal connection to patients, and I didn’t realize that was important to me until then. So I changed venues.”
He has since spent a lifetime on research and clinical work focusing on behavioral neurology, producing 110 articles, book chapters, and three edited books covering anything from neuropsychiatric illness (Huntington’s disease, Parkinson’s disease, MS, schizophrenia, bipolar disorder) to borderline personality disorder, psychopharmacology, and philosophical issues in psychiatry.
“For me, the single brain of a patient is not the most important thing. It’s how is this person is relating in their context,” Oepen says, explaining that context includes their past, education, living situation, family, and especially their hopes, beliefs, and expectations for the future. “If you want to understand somebody, take some time to cover all these contextual factors.” Then, he says, you may be able to give more effective and beneficial advice to change something for those patients.
In 1989, NATO offered Oepen a grant to come to America and continue his research and clinical activities at Harvard University. Because the U.S. medical community does not accept foreign medical degrees, he spent nearly four years earning his second MD at Harvard.
“The hard part was to be an intern again at 37,” he says. “Harvard is spectacular. I’ve never seen anything like it in Germany. If you work with really, really brilliant people, they want to share their ideas and breakthroughs and methods, while the mediocre people hide what they do. There was more mediocrity in my experience in Germany.”
He admits he would feel better as a psychiatric patient in Germany. “In America, we have degenerated into a checklist approach to psychiatry, I’m sorry to say,” he says. “We have good people here, but you are under pressure as a psychiatrist to get patients in and get them out because you’re paid more for admission and for a discharge then for a follow-up.” Inpatients tend to stay four days or so, but not long enough for medications to reach full potency and the outcome to be assessed appropriately.
On the other hand, Oepen applauds the team approach in the U.S., which includes post-stay care by social workers, nurses, and case managers. “If you have a good team, it can make up in part for the shortcoming of the ‘get them through quickly’ approach,” he says.
Oepen’s widespread travel since he was a child has enhanced his outlook into humans and his personal philosophies. At 12—with a mutual post-war hatred still lingering between the two countries—he lived with a French family as an exchange student for a summer. At 15, he worked on a merchant marine boat taking him to Russia, Poland, Sweden, Norway and Holland. Since then, conferences and family travel have taken him to at least another eight countries on three continents, though he can’t remember them all.
The most memorable was with his brother, a physician who worked on public health projects in Africa for 25 years. They visited a village in the Republic of Upper Volta in West African and met a family living in one-room hut on $3 a year. “I had a hard time believing that. They had absolutely nothing,” Oepen says. “But they were smiling and laughing and hugging us. They also offered me a gift of their wooden spoons that I had admired, and refused my offers of help. These people were the most loving, magnanimous, happy people. I was touched by their humanity and their selflessness. And my bottom feeling was, this is really what life’s all about.”