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Top Biological Psychiatry Programs

Discussion in 'Psychiatry' started by splik, 02.05.12.

  1. splik

    splik

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    Using a ranking system more flawed and less transparent than USNews I have created a list of top programs for biological psychiatry with some deliberately controversial inclusions and omissions! There is some truth in it, but like most rankings don't take it too seriously but it would be nice if it started off a discussion and caused aggrieved residents to come and defend their program!
  2. splik

    splik

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    Whilst Mayo may be more style over substance, if you are looking for a strong training in medical psychiatry in the middle of nowhere, look no further. Lots of rotations in medical psychiatry, consultation liaison psychiatry, strong research in neuroscience and neurology, and little taste for psychotherapy provided by psychiatrists in Rochester make this a maple syrup-loving biological psychiatrist’s wet dream.
  3. splik

    splik

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    The sunshine state, with its OJ-guzzling octogenarians whose Medicare reimbursements won’t cover long term psychotherapy, Cuban exiles waiting for Castro’s demise and its coke-addled beach hotties is not the natural home of the psychiatrist. With sun soaked, large-breasted drug reps circling Grand Rounds like patriotic vultures feasting off the corpse of Osama Bin Laden, bucketloads of drug money, and 70’s porn star moustache-wielding Charlie Nemeroff at the helm, they safely join the ranks of biologically oriented psychiatry programs. And for the neurologically inclined, they continue to embody Cartesian ideals in their dual Neurology/Psychiatry residency program. An honorable inclusion for jumping into bed with pharma rather than Freud.
  4. splik

    splik

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    Associated more with interventional cardiology than interventional psychiatry, Cleveland Clinic does not usually rank in anyone’s ‘Top 20’ list of psychiatry residencies. Locally, it is usually dwarfed into insignificance by Cincinatti. Thanks to a relatively weak emphasis on psychotherapy, and a plethora of experience in medical psychiatry, neuropsychiatry, sleep medicine, chronic pain, ECT, and the presence of psychopharmacology and neuromodulation programs, CCF deserves a spot in the top 10 for biologically oriented psychiatry programs.
  5. splik

    splik

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    Man’s Greatest Hospital was once riddled with analysts, who during the politically-charged decades of the 60s and 70s did nothing to further the cause of women, homosexuals, and African Americans. Back then, (pre-Kristeva), they conceptualized female psychopathology in terms of penis envy, told African American residents they were unpsychoanalyzable because blacks had less develop super-egos than whites, and orchestrated witch-hunts against the rare resident who dared to be gay. From the 70s onwards analysts were rapidly expunged from the faculty in a mass culling of epic proportions. Today both MGH and McLean predominantly adhere to diagnostic psychiatry, psychopharmacology, ‘evidence-based mental health’, and even psychosurgery. The amount of pharma money flowing through here is the elephant in the room. But, let’s get serious – this is Boston and it was not long before psychoanalysis reasserted its existence in the circumscribed MGH Center for Psychoanalytic Studies and you would receive excellent training in all the main modalities of psychotherapy as a resident here which is why MGH/McLean falls to No. 7
  6. splik

    splik

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    So they probably have the best family therapy training in the country, and you will learn a good psychodynamic case formulation, but Duke is undoubtedly a biologically oriented program. The emphasis is on evidence based mental health, evidenced based psychotherapy, psychopharmacology and they have an impressive portfolio of research in genomics, proteomics, imaging, and neuromodulation. A heavy load of med management cases, an onerous call schedule, a PGY-3 neurology rotation, and the top med/psych residency in the country, contribute to Duke coming in at No. 6
  7. splik

    splik

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    The ultra-liberal, über-intellectual Seattle is home to several Psychoanalytic Institutes, a Jungian Institute and even affords the possibility of training in existential psychotherapy. None of this however has touched UW’s psychiatry department. Although no longer anti-psychoanalysis, UW values the psychiatrist as physician first and foremost with strong training in consultation-liaison psychiatry and geropsychiatry, and the interface of medicine, psychiatry and neurology. It is easy to get away with the minimum psychotherapy requirements (i.e. 1 brief analytic therapy case). Despite having Marsha Linehan on the faculty you are more likely to learn ECT than DBT. There is however plenty of elective time to pursue training in an array of evidence-based therapies, or to elect psychoanalytic training at one of the cities institutes.
  8. splik

    splik

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    UCLA’s Resnick Neuropsychiatric Institute is sometimes referred to as the ‘best in the west’. But it is also one of the best in the world. Using citation index as a marker of academic prowess, UCLA ranks in at No. 3. Rest assured this research portfolio does not stem from psychodynamics but neuroimaging, genetics, psychopharmacology, endocrinology, psychophysiology, neurophysiology, molecular psychiatry, and cognitive neuroscience. When I arrived looking for the beardy analysts, I was coolly told that I had landed on the wrong coast! In California, biological psychiatry rules ok, and David Geffen alumni enamored with analysis have often gone elsewhere. Some of the faculty quipped that personal analysis is the fastest way to end your marriage. Whilst die-hard Freudians should look elsewhere, UCLA manages to put together a fairly balanced residency program so graduates should be as familiar with Melanie Klein as with Nathan S. Klein.
  9. splik

    splik

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    Ahh… UPMC…. Famous for bullying smaller hospitals out of existence, flouting competition laws, and taking the lion’s share of NIH grant money, the Pittsburgh based monstrosity/hospital complex also boasts one of the largest clinical and academic psychiatric powerhouses in the world. And predominantly biologically based it is. There is psychotherapy research going on here, but not in dynamics. You will find innovative research into CBT, and Ellen Frank, inventor of Interpersonal and Social Rhythms Therapy. Patients even receive psychotherapy on the inpatient units. There are opportunities to do electives in a plethora of psychotherapies, and carry many cases even for psychodynamic therapy. But make no mistake: there are fewer therapy didactics here than in many other programs and you can easily get away with seeing 1 psychodynamic case in 4 years. The bar is set low and deliberately so. Although there is more balanced training than previously, WPIC attracts some serious researchers who would rather run PCRs than think about their preconscious and they make allowances for them.
  10. splik

    splik

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    Despite the first Chair of Psychiatry at Hopkins being the Grandfather of American dynamic psychiatry, a disciple of Siggie himself, and garbled proponent of the psychobiological approach to psychiatry, Hopkins is derisive of the grip that psychoanalysis had on American Psychiatry for so long. There is no ‘biopsychosocial’ approach here. Hopkins has great clinical training and supervision, no doubt, and this is also true for psychotherapy training, but, rest assured, much of the faculty have a barely concealed contempt of analysis, you will learn the bare minimum of the ACGME required psychodynamic curriculum, and you will learn that psychotherapy is not the role of the psychiatrist, who is the medical expert and diagnostician above all else.
  11. splik

    splik

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    Currently embroiled in a bitter lawsuit, and quietly tucked away from coastal civilization, it is easy to forget that WashU is the birthplace of American Diagnostic Psychiatry that slowly superceded the psychodynamic hegemony. Starting with the Feighner criteria, WashU researchers set out to create more reliable criteria for psychiatric diagnoses. Initially aimed for research settings, the Feighner criteria sowed the seeds of change and brought us the ‘a-theoretical' DSM-III, and banishing terms like ‘neurosis' and ‘reaction' from the psychiatric nomenclature overnight. WashU also pioneered much of the early research into the genetics of severe mental disorders, and continues to be a research powerhouse in biological psychiatry today. Psychodynamics is of ‘historical interest' here and history of psychiatry didactics are influenced from the staunchly anti-psychoanalytic viewpoint of Edward Shorter.They deservedly earn the top stop for biological psychiatry.
  12. Sneezing

    Sneezing Even Bears do it!

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    Not a perfect list, but one worth arguing over with a Guiness in hand.

    Here are my corrections having interviewed at several and residing at one of them.

    1. Wash U
    2. Johns Hopkins
    3. UPMC
    4. UCLA
    5. Duke
    6. MGH
    7. Clevland Clinic
    8. Mayo
    9. U Washington
    10. U of Miami
    Last edited: 02.05.12
  13. Chimed

    Chimed

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    I'm about to pour one myself. My favorite..:love::love::love:
  14. OldPsychDoc

    OldPsychDoc Senior Curmudgeon Moderator Emeritus SDN Advisor

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    At least there's one thing we can all agree on in this thread. :D
  15. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus

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    I guess one of WashU's former residents might have started some legal action against them (who knows), but are they "embroiled in a bitter lawsuit." That sounds a little more dramatic than is likely is. Who knows if any lawyers actually agreed to take that guy's case.

    I'm not sure I see the value of these lists, but I guess I would agree with WashU being #1 since they're the one program I interviewed at that specifically identified themselves as a biologically oriented program. It seems like a defining thing for them. The only other programs on your list that I'm familiar with are UCLA and UW, but I got the impression one could get good psychotherapy training at both.
  16. watto

    watto Sleek White Pantsuit

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    Well, having graduated from UCLA NPI, I will say that the absolute most rewarding experience I had in residency was excellent supervision in psychodynamic psychotherapy from faculty trained in analysis, as well as training in brief attachment-based psychodynamic psychotherapy from a Davanloo disciple. My mentor in med school was also a UCLA alum and had a similar experience.
  17. nitemagi

    nitemagi Senior Member

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    ISTDP is big in SoCaL.
  18. watto

    watto Sleek White Pantsuit

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    I know, I had no idea it even existed until residency, and then BAM. 4 hour sessions of "Tell me how you are going to destroy those who have hurt you, tell me what the body looks like!" Interesting stuff. The videos are pretty gonzo.
  19. Salpingo

    Salpingo

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    Thought I'd add a couple of places. When assessing the strength of biological training, I looked at research opportunities and accessibility. Not sure if having good psychodynamics/psychotherapy disqualifies a program from being "biological", at least for the sake of this thread.

    Harvard Longwood- David Silbersweig, pretty much the godfather of neuropsychiatry, seems like he plays a very active role in the program and residency training. There's also an entire center dedicated to non-invasive interventional therapy. The program really prides itself in resident research, and a good number of the senior residents I talked to had some really interesting biological projects going on.

    Emory- Some of the biggest names in DBS (Mayberg) and biological pathways of PTSD (Ressler, Rothbaum) live here. They've been doing some exciting work on the next big pharmacotherapy, cycloserine, and have tons of basic science facilities. The residents that were interested in biological research were killing it here, with tons of publications and posters, and worked personally alongside some of the big names. The department definitely paid the costs of dipping too deep into Big Pharma's pockets, but it looks like they're rebounding strong.
  20. splik

    splik

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    Yes it does.
  21. nitemagi

    nitemagi Senior Member

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    Disagree. Having a body of faculty that teaches psychodynamics well doesn't preclude the department from focusing moreso on research and the biology of illness. Especially since all residencies are required to have psychodynamic teaching.
  22. splik

    splik

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    this is my completely arbitrary list using my completely arbitrary definitions! make your own! :)

    There isn't the polarity that once existed between psychodynamic (Meyerian) vs diagnostic (Kraepelinian) psychiatry in training in most top programs these days because of ACGME requirements and recognition that the top applicants want to get a balanced training. However there are still programs that privilege a biomedical discourse and that is what this list is about. Longwood and Emory have strong research portfolios in imaging and endocrinology respectively but the training is heavily, heavily psychoanalytically influenced and thus cannot be regarded as 'biological' by any stretch of the imagination. Also there are programs which accept more money than is good for them from pharma and they make it on this list too.
  23. nitemagi

    nitemagi Senior Member

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    Fair enough -- regarding this thread, that is :D
  24. PETRAN

    PETRAN

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    What is this trend with psychodynamics? In many European countries modern psychiatry and clinical psychology is evidence-based CBT/New-Wave-CBT-oriented therapies (DBT, ACT, MBCT etc.). There is a huge success with the anxiety/panic/OCD/Depression disorders (and even personalitybipolar/borderline/psychosis dx lately) and a lot of quality research (e.g. from England with Clark, Salkovskis etc). Why so much emphasis on psychodynamics-a group of theories which have little scientific support and are very questionable in terms of effectiveness? (Maybe some concepts are useful though). The CBT/DBT models are much better connected with the neurosciences as well(e.g. the "unconscious" as automatic/associative overlearning-of the amygdala/limbic structures- rather than the hydraulic repository of wishes and conflicts-which may sound magically attractive but there is no evidence for it whatsoever ). The whole training system sounds like it is more driven by tradition rather than the actual evidence/science.
  25. nitemagi

    nitemagi Senior Member

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    Petran, recognizing the psychology EBT bogeyman (as Yalom calls it), you can dial back your attacks. CBT is equally required in psychiatric training. Here's the full requirements in training.

    Learning psychodynamic psychotherapy doesn't devalue CBT. And if you've done enough CBT you'll recognize its limitations. I did some trainings at the Beck Institute in addition to my residency training, and I noticed how CBT for personality disorders was done for 2,3 or even more years. Which is reminiscent of the critique of psychodynamic psychotherapy and psychoanalysis (that it takes too long). CBT is great if you can find a patient that can tolerate it, and if you have a problem narrow enough to use it on. But learning other therapies doesn't threaten the independence of CBT or other EBT. It just reveals the current dogmatic worship of EBT.

    In Analytic training you still study a lot of Freud -- not because you learn to practice like him (not many ego psychology analysts these days), but because it gives a foundation for all the iterations that came later that are more applicable to a broader patient base. And I'd distinguish that psychodynamics/psychoanalysis as a field is again comparable to judaeo-christianity. Not everyone likes the catholic church, or orthodox judaism. But there have been many iterations that Do have reasonable evidence behind them (see Joseph Weiss, for example) that are markedly driven from say the former drive model of early psychoanalysis. Even Freud wasn't static in his theory (there were many versions - Topographic, structural, etc).
  26. Salpingo

    Salpingo

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    Ah, I see. Re-read the other posts and realized that biological was being used pejoratively. I feel dense.
  27. splik

    splik

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    American Psychiatry has been traditionally very psychodynamically oriented, and much of this has been due to the influence of Adolf Meyer and his psychobiological concept of psychopathology. If Edward Shorter is to be believed, analysis also allowed psychiatrists to move from the asylum and into the office where they could have lucrative private practices. In the 1940s and 50s psychoanalysis was very much in vogue in intellectual circles, and psychiatrists tending to be more intellectual than most physicians jumped on the bandwagon. Despite a Neo-Kraepelinian revival from the 1970s onwards, psychoanalysis has persisted in psychiatry, particularly at Harvard, Yale, Columbia, and Cornell and over the past 10 years there has been an increasingly prominent role of psychotherapy in psychiatric residency training as it has become clear that medication alone is not helpful in most cases.

    Most of the top programs have a very strong psychodynamic bent to this day, and the psychotherapy curriculum appears very heavily oriented to dynamics with some notable exceptions (Michigan, WPIC, UW, UCLA, Penn) where the training appears a bit more balanced although even Penn is quitely heavy on dynamics considering it is the birthplace of Cognitive Therapy (though let us not forget Beck was analytically trained and much of cognitive theory is a rehash on psychoanalytic theories (e.g. manic defence hypothesis, schemas seem remarkably similar to object relations concepts, psychoanalytic theories of BPD align well with what we known about cognitive development and social cognition)

    France is still heavily psychoanalytically influenced, with Lacan being very popular amongst many psychiatrists (apparently he is also popular in Argentina too). The UK is extremely CBT-heavy - Part of the reason is the health service is funded by the state and there is a focus on evidence-based cost-effective time limited therapies. However the government is now supporting training in ISTDP for depression which will be rolled out across the country. That said North London (Freud's final resting place) is home to the Tavistock Clinic, the Institute for Psychoanalysis, the Anna Freud Centre, and hundreds of analytically trained psychiatrists with private practices. There are also psychiatrists who do only psychoanalytic therapy or full blown analysis and never write a single prescription. There are even psychoanalytically run inpatient units such as The Cassell Hospital and even the Maudsley Hospital which is ultrabiological has a psychoanalytically based therapeutic community. So whilst the UK is very much in love with CBT (to the extent in some areas it is the first line treatment for prodromal schizophrenia) there is still analysis there and some of the most famous psychoanalysts were psychiatrists in Britain (Balint, Bion, Winnicott, Bowlby, Laing, Fairbairn) and both Anna Freud and Melanie Klein lived in Britain.

    Certainly clinical psychology in the UK is almost entirely CBT-based especially at the major places with the exception of UCL.
    Last edited: 02.06.12
  28. splik

    splik

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    Well not necessarily... some people want a program that heavily skews on the biomedical side.
  29. billypilgrim37

    billypilgrim37 Unstuck in Time

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    Some of this distinction is silly. Psychodynamic, in many respects, just means "therapy" on a continuum between expressive and supportive approaches. Psychiatry in general (for some great reasons, with qualifications) has moved towards targeting folks with the level of personality organization that benefit most from therapies on the supportive side. CBT is just a narrow spectrum of supportive psychodynamic psychotherapy. DBT is the same. IPT is the same. Motivational Interviewing is HEAVILY psychodynamically influenced. Restricting yourself to ONLY supportive approaches doesn't make a lot of sense.

    Miller and Rollnick make a point of saying that MI, more than a therapy, is a way of being with a patient. And more than anything, that may be what psychodynamic training gives to a resident. I am a much better medication manager, CBT therapist, and team leader than I otherwise would be because I put a lot of effort into getting rigorous psychodynamic training despite the fact that I'm a resident and fellow at a notoriously "biological" program.
  30. BobA

    BobA Member

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    Originally Posted by OldPsychDoc
    Until the NCAA finally gets off its ***** and institutes a true national playoff system, we'll never know for sure.
  31. NoNoNoNo

    NoNoNoNo

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    How much is that specific to MGH's past vs. analysis and analytic history and training in general?
  32. sluox

    sluox Copier

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    While the gist of your message isn't wrong, I think that even though there is a large element of training in psychodynamic psychotherapy, especially for personality disorders at all of the major centers, the PREDOMINANT thread of "mainstream" psychiatry as propagated from the NIMH roadmaps, etc. are "neuroscientific". It might be a bit simplistic to categorize training as "biologic-heavy" vs. "dynamic-heavy" because compare to programs 30 years ago, ALL psychiatry programs are now PREDOMINANTLY biologic.

    This also makes sense in terms of clinical training. While 30 years ago, MOST of the treatment consistents of psychoanalytic methods, MOST of the treatment today consists of meds + CBT/psychosocial management. While I'd say most psychiatrists think about dynamic issues and use dynamics as a framework to understand the psyche, the field is just very different today, and that fact alone is very much worth emphasizing.
  33. Ibid

    Ibid

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    1. Beamish
    2. Murphy's
    3. Mackeson
    4. Jar of jam with some dog pee mixed in and left overnight.
    5. Guinness

    Not all stout is the same and certainly it doesn't travel well so if you don't live really close to a brewery you are not really drinking the same thing. imo and if your are pouring it out of a can well...
  34. klonopin

    klonopin

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    What I would like to know, even moreso than which biological psychiatry program is ranked #7, #3, or #9, is--how did you get the umlaut to work?
  35. klonopin

    klonopin

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    How much do these distinctions mean in practice? At my program we are absolutely indoctrinated in the psychodynamic view. Many of our didactics are taught by straight-up analysts. As a counterweight we have a CBT "series" and "elective." There's an MI seminar to boot. So you'd think I'd be clear on which was which. Of course, with all this therapy training I can't tell lexapro from loxapine (which for most of 2nd year I thought was an antibiotic), but that's neither here nor there.

    With my therapy patients though, I find myself just muddling through most of the time. Even when I try to really emphasize a certain school, it never works. The patients always mess it up! For example in my "Brief Psychotherapy Clinic" (read: CBT) I had a patient who was referred for depression. So I was supposed to do "CBT for depression." But all the guy really wanted to talk about was his past and his mother! What do you do then???
  36. nitemagi

    nitemagi Senior Member

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    If you're learning to do CBT, you need a supervisor. I'd recommend videotaping sessions and reviewing them with your supervisor. There's an art to learning to redirect patients if you want to do CBT. There's also specific criteria used to define whether a session is CBT or not -- including creating an agenda, getting feedback, etc. The other aspect conceptualization -- There is a Cognitive model (schemas, etc) for conceptualizing a pt., rather than a psychodynamic model. I find it most useful to be polytheoretical, so one can shift between mindsets with a patient and find an alternative approach. Recognize of course that techniques and approaches may be partially independent of the underlying theory. Partially. CBT is currently taught that you can use any technique to intervene, including hypnosis or gestalt therapy (Judy Beck uses Gestalt now in her books), as long as you're conceptualizing the pt. using the cognitive model. There are traditional CBT techniques (like the automatic thought record), but one shouldn't be limited by that.
  37. billypilgrim37

    billypilgrim37 Unstuck in Time

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    Absolutely, though I do think folks overestimate the differences in the two models. A decent chunk of CBT is taking a very narrow portion of the psychodynamic models, renaming some of the concepts, and restricting the use of techniques to current-centered and more directive supportive of approaches. That's not to say CBT isn't a wonderful thing, because it is. It works, quickly.

    Of course, it may just be the brand of psychodynamics I have been taught has expanded to include everything anybody else has ever come up with!
  38. cleareyedguy

    cleareyedguy Junior Member

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    This seems like a ranking of ratio of biological research/teaching to psychodynamic research/writing/teaching, rather than a ranking of programs with real excellence in biological psychiatry.

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