Judith Edersheim JD '85 MD '95

I’m Judith Edersheim, a physician and an attorney. I practice forensic psychiatry. I co-founded and co-direct the Center for Law, Brain, and Behavior at Mass General Hospital.

Why did you choose to be both a physician and a lawyer?

I practiced law first, and then I returned to do my post-baccalaureate for the premed courses and entered medical school. When I was practicing law, I realized it wasn’t as fulfilling as I had hoped it would be.

What drew you to law?

Law is a beautiful way of structuring your thoughts. Legal arguments are careful, well-researched, thoughtful, historically grounded, and serve important social functions. The appeal of that kind of thinking really drew me, and I also wanted to do good — and you can do a lot of good in law. I loved law school, too. The training of law school is something you can never undo. It’s a bit like imprinting a little duckling—you can never unthink like a lawyer. That’s a warning! Once a lawyer, always a lawyer.

What drew you to medicine?

The feeling that I wanted to offer immediate help. That said, that goal has shifted a bit over time as I chose psychiatry as my specialty. Psychiatry is often about helping someone help themselves. It’s about providing a scaffolding so they can discover their strengths and see what’s holding them back; what’s interfering. It isn’t a specialty, then, where you can just fix things, like in orthopedics. It’s a specialty where you support, accompany, and inspire insights, but you have to sit with your feelings and maintain your boundaries.

Still, it is the greatest privilege to be involved in someone’s life at that level and to be able to help with the skills you have.

What were some of those skills that have since stuck with you?

The law trains you to be able to think on your feet and not just give a spontaneous answer, but give the best answer—an answer that will satisfy now and later. When you’re thinking about law, you have to think about the answer and every ramification in the future of what you say now.

These skills have helped me a great deal in medical practice, too. For research, there is no one more relentless than a lawyer, as you have to prove everything you say. I did have to pare down some of my writing: a medical review article is six pages, and a law review article is eighty pages with many footnotes because one anticipates a challenge to every statement. For patient care, I have learned from law to leave no stone unturned. Lawyers are always a little suspicious, and that suspiciousness is very good in medical settings to prevent distraction. I once had a very senior preceptor in a pediatrics who, on the first day of my rotation, took me around the corner and said, “Judy, there are assassins everywhere.” When I finally understood this, I realized that he meant to convey that we should never take statements at face value. They have to be proved. Caring for patients means that perhaps the symptom they report is not the end of the inquiry. You have to go further, go longer. This relentlessness is not the end, just the start. You also need the empathy, the caring, the intimacy from medical training, too.

How did you develop those skills of building connection and empathy in medical school and training?

Being a physician demands a certain minimum degree of empathy. After all, you’re a doctor because you want to help and protect people, to make their lives better. Certain specialties, however, require a greater degree of intimacy. If you’re a pediatrician, for example, you’re following a family throughout your patient’s childhood and adolescence, and you have that honor and intimacy with the entire family. You know everything about your patients’ lives because you need to keep them healthy for their lifetime. If you’re more procedure-driven, you will know less about their lives, and perhaps more about their specific symptoms. So that degree of empathy is something that’s very personal and draws you to one specialty or another.

I’m a psychiatrist, and one of the things that drew me to psychiatry was the real honor of knowing someone’s struggles and triumphs and trying to assist them as they navigate life.

Did you know you wanted to practice psychiatry going into medicine?

I had an inkling that I wanted to do either neurology or psychiatry. Ultimately, it was the stories that drew me to psychiatry. Of course, now psychiatry encompasses a great deal of neurology, and now neuroscience is at the center of a lot of what we do. Ultimately, I think I got the best of all worlds.

How have you seen the field evolve and grow over time?

Psychiatrists and neurologists share the same organ, which is the brain. One hundred years ago, we thought of these as two distinct specialties, but now there is training in neuro-psychiatry and behavioral neurology as they intertwine. Still, many of the gold standards for different treatments and disorders—what the public thinks of as talk therapy, cognitive, and behavioral therapies—still recruit the person in the treatment, and that is very rewarding.

Now, the Center for Law, Brain, and Behavior was an invention with my closest colleague, Dr. Bruce Price, who is a behavioral neurologist and Chair of Neurology at McLean Hospital. We took a clinical observation and built it into the center, which I believe is a wonderful way to start an endeavor. We saw a misuse of neurology, psychiatry and neuroscience in the courtroom, so we wrote about it. Then, we realized that the best cure for this would be to bring excellent neuroscience into the courtroom in the service of justice. That was how we started fifteen years ago, bringing the best neuroscience has to offer in the service of justice.

What has the impact of the Center been?

I’m so amazed at the progress we’ve been able to make in a relatively short amount of time. We are at a special moment in time right now, too, where there is such a polarized political context that science is the best answer for common ground. When we seek solutions, we need to use science because it puts politics aside. The biggest strides we’ve made are in developmental neuroscience to inform juvenile justice policy, asking, how are adolescents different from adults? How can we improve the justice system by treating them differently? We’ve made similar progress in the realm of substance use disorders. Fifty years ago, these were treated as character disorders. People thought you could somehow “will” yourself by some magic to stop using substances. The neuroscience, the psychiatry, the neurology, the psychology of the field have demonstrated that nothing could be further from the truth. It is a medical disorder, a neurological disorder. These substances remodel the brain to require and cause cravings and symptoms. Our advances in the detection and the treatment of substance use disorders have been tremendously valuable in the justice system in diverting people from jail to more rehabilitative settings that provide treatment.

You touch on an important point there, which is that science is this foundation where different parties can meet and hash out their differences. What are your thoughts on approaching science communication? How do you speak to lawyers, for example, about science?

Science and law are so different. Science is a bit like golf—it’s one of the few sports where you call foul on yourself. Science is the same way. When you read a science paper, it sounds like this: we made a  wonderful finding, but there are so many limitations to the study. It should not be applied in this or that setting, the field could be improved, the sample size could be larger or more diverse, and so on.

That’s not law, however. Law is about making final decisions about two opposing parties before the court or making legislation that will apply across the board as soon as it is enacted. It’s definite and it calls no reserve upon itself. It’s not provisional at all. It’s about finality and certainty. It also upholds a social structure and has a moral imperative and political purpose. When you bridge these two, you have to understand where you are. You’re not in the American Journal of Medicine. You are in a courtroom. As such, you have to speak about science with modesty and metaphor. You are always the advisor, and you have to give metaphors. You cannot give your error rates or sample sizes. Instead, you have to make some kind of translation and make it faithful without making it useless. Somewhere in that sweet spot you can communicate science to the court.

That’s fascinating. I’ve never thought about law and science from that perspective. How do you bring all these disciplines together, then, in the Center?

We have a beautiful faculty of true luminaries at the Center. The scientists are working at the Center because they want to change the world right now, and take what they’re working on and put it directly into action. We have one of the world’s greatest scientists in the neuroscience of memory, Daniel Schacter, on our faculty. He has been an essential partner because memory plays such a tremendous role in the courtroom. In the past, memory was unimpeachable. It was believed to be like a video camera—you turn it on, and the person will retell their memories in pristine form for the court. As scientists, however, we know that’s not true at all. Memories are constructed, malleable and vulnerable to change. The courts need to learn this so they can make well-informed rules and decisions. The upshot of this research and intervention was to reverse convictions based on faulty memory and improve the standards for evaluating recall in the courtroom. Ultimately, the work of the Center is a great way for people to see their work go from the lab bench to the courtroom.

Our trauma and asylum project is concerned with the intersection of traumatic experience and neuroscience and its relevance for legal standards.  We also work in juvenile justice, looking at adolescent brain development with respect to sentencing projects. At the other end of life, with neurodegenerative disorders and aging brains, we ask, what does a person have the capacity to do? How does that affect liberty and autonomy and victimization in those cases? Unless the justice system gets the brain right, it won’t be able to protect people. We bring together legal scholars, judges, policymakers, and scientists to help chart the best path ahead.

Do you have a specialized branch of work you’re leading at the Center?

For me, it has been very important to keep up clinical work in addition to my research. For 20-30% of my time, I’m on the ground. I work on bail revocation or sentencing problems, looking at substance use disorders and treatment and how it can be improved in detention centers. I am personally involved in all of the Center’s project areas as well.

Looking ahead to the future, what do you see as the major challenges ahead for the Center?

One of the greatest challenges is that the current composition of the the Supreme Court level is less scientifically inclined. So far, the current Supreme Court seems less receptive to scientific concepts than it has been for the last 25 years. As a result, we will need to give more attention to State court and legislative initiatives, as they are now at the center of innovation in the justice system. For the next 25 or so years, we will really be engaging state lawmakers and policymakers. For example, we work with the Department of Corrections to help define the appropriate substance use care or psychiatric or neurologic care in facilities, or with state agencies to determine what a rehabilitative model of justice should look like for adolescents. We have lots of work to do there.

What words of advice do you have for our readers?

When you’re young, you’re being asked to make a decision that impacts the rest of your life when you’re not so sure who you are yet (this is the psychiatrist talking!). That’s the biggest challenge—trying to find what direction you want to go in. So, know yourself. Know what is sustaining for you, and that will help you pick your career and take that leap.

One last thing, too. I would encourage you to slow down and experience the joy of the journey, not just the end. I know it can be easy for me to say, but it is true. If you enjoy every part of the path you’re on, then you won’t look back and say it was the wrong path.

Judith Edersheim JD MD

JD 1985

MD 1995

Compiled and interviewed by Felicia Ho