I recently met a colleague who had been on the Harvard faculty for about twenty years. He finally left about two years ago to go to a state university psychiatry program in the mid-Atlantic region. "I came to Harvard thirty years ago to find an intellectual environment. I found it only after I left."

This experience made me think of a general problem in academic psychiatry, especially in prominent programs. I too trained in the Harvard system and taught within it, and still do to some extent. One of my Harvard teachers was Leston Havens, who used to say: "Be careful about institutions. Between your boss's needs and your eagerness to please, you can create a prison stronger than Alcatraz."
Young psychiatrists make this mistake commonly. It is the problem of institutions - and it is not at all unique to Harvard. The problem is that institutions have their own needs and goals; and these may conflict with the individual person's needs and goals. A young psychiatrist may have new ideas, or need special mentorship to progress to the point of being able to be an independent researcher, or need time to write. But institutions will have their own needs for clinical practice, and sometimes teaching, and what comes last is mentorship or help in advancing one's ideas. I once had a chairman who said that he paid the faculty to see patients, whether clinically or in research studies; they needed to write up their research on their own time - meaning nights and weekends. I have always thought this is one reason why academic writing is so terrible - both in style, and often in substance: It is devalued. No one pays for it. If it doesn't happen, the academic gets the blame for not putting in the extra effort. The institution never gets the blame for not providing the atmosphere where good writing, and good thinking, can happen.