Victor W Mark MD, Associate Editor for Behavioral Neurology

Q & A

Tell us about your early background.

I am a first-generation American of Hungarian and Estonian descent. Both of my parents were refugees from Communism in war-torn Europe during the Second World War. They had to flee from the invading Soviets while at the same time trying to find a place to live as they faced the encroachment by the Nazis from the West. My father escaped to northern Italy, where he worked as a chemical engineer; at the end of the war, he emigrated to Chicago, where he got his PhD in chemistry from Northwestern University. My mother and her family were in a refugee camp in West Germany and eventually were sponsored by an Iowa farm family with whom they lived after the end of the war. My mother got her undergraduate degree in biology from Iowa State University. My parents met in Chicago (although they did not know each other’s language, they could communicate with each other in English); they married and resettled in Los Angeles. I was born there in the mid-1950s, the first-born of several more children. The family relocated several times within the United States, so my education was fragmented. We lived in the Western New York region for most of my secondary school education. I was admitted to Cornell University in the mid-1970s and majored in biology, with a concentration in neurobiology and behavior, which set my lifelong research career interests. I obtained my MD degree from Albany Medical College, completed a residency in neurology at New York University, and completed a research fellowship in behavioral neurology at the University of Florida. From that point on, I was dedicated to pursuing a career in research neurology.

What or who motivated you to pursue a clinical or scientific career? How did you get interested in neurology and your subspecialty?

My father was a very successful industrial research chemist, working for several chemistry-oriented companies across the United States. He concentrated on chlorocarbon research to improve the consumer use of plastics. Both of my parents were very science-oriented; they encouraged me to be an inquisitive person and to meet high academic standards.

I contemplated a career in either astronomy (too mathematical for me) or paleontology (it seemed like career prospects would be limited) before I settled on a career in neurobiology because I found the mind fascinating and wanted to understand how it ticks. Although I worked hard to pursue a PhD in neuroscience, I chose to matriculate instead to medical school for career security. From my father’s experience, I knew that a career in scientific research could be precarious, whereas, with a medical degree, I could fall back on clinical practice if the grants became irregular (which they did). What fostered my dedication to medicine was learning of the work of Paul MacLean MD of the NIH, whose evolutionary neurobiology research was highlighted in Carl Sagan’s book The Dragons of Eden. I nearly secured a research fellowship with MacLean, but I missed the deadline for application. I was fortunate to earn a spot in the behavioral neurology research fellowship program at the University of Florida under Professor Kenneth Heilman. The contemporary books by Oliver Sacks MD, the British-American neurologist, showed me the fascination of behavioral neurology, so I settled on a career in that area.

After my fellowship, I coveted a job in academia. Fortunately, there was an opening to run a stroke rehabilitation ward in the Department of Neurology at the University of Maryland School of Medicine in Baltimore. I was promised that I could have all of the behavioral neurology that I could possibly want, and that proved to be true. Unfortunately, I knew nothing about rehabilitation but quickly learned the fundamentals. I then recognized that it would be very important to understand the cognitive foundations for chronic disability following stroke and other brain disorders. As a result, my career since then has been dedicated to neurologic rehabilitation.

Did you have any mentors who guided or inspired you?

I was fortunate to have had several mentors. I was enchanted by the research and popular books of Carl Sagan, who was nominally an astronomer but whose academic interests were far-ranging, including neurobiology. I was fortunate to sit in on many of his lectures at Cornell University. Simultaneously, I had a part-time job under the chairman of Psychology at Cornell, Bruce Halpern. I understood that my job would simply be a lab glassware washer. But he took me under his wing and promoted me to initiate behavioral research in gustatory neuroscience. At my neurology residency at NYU, I followed up on the work by Paul MacLean MD of the NIH, whom I had seen lecture and had toured his lab in Poolesville, Maryland. I was fascinated by his comparative zoological research in neuroscience. I failed to apply in time for a fellowship with him. So I turned to Jason Brown MD, a faculty behavioral neurologist at NYU, to determine where to go for a research fellowship. He taught me to adopt a very skeptical perspective of virtually all received wisdom in neuroscience. That led me to take a 1-year research fellowship under Ken Heilman at the University of Florida, who fostered interdisciplinary collaboration in behavioral neuroscience. Finally, after I bounced around other universities, I ended up at my present job at the University of Alabama at Birmingham (UAB) in the Department of Physical Medicine and Rehabilitation (even though I was not formally trained as a physiatrist). I was encouraged to work in the lab of Professor Edward Taub of the Department of Psychology, who set very high standards for designing clinical trials in neurologic rehabilitation. He taught me to ask careful research questions and demand high standards of evidence.

What do you consider your most significant career achievement to date?

I feel accomplished in having led neurologic rehabilitation trials to improve motor deficits in multiple sclerosis. The trials were highly successful, leaving long-lasting benefits in everyday activities. I am also grateful that my present department welcomes my desire to run a clinical rehabilitation program for functional neurologic disorder. This disease is a type of behavioral neurologic disorder that is very poorly understood. I work hard to improve acceptance by the public and clinicians to treat patients respectfully and validate their personal difficulties.

What are some of your main responsibilities in your role as a neurologist or subspecialist?

I have a lifelong interest in academic medicine. I am a practicing neurologist within an academic rehabilitation department. I use my position to teach residents the fine points of neurologic examination of newly disabled adults. For years, I have been a consultant physician for my department, judging whether patients meet the criteria for admission to the inpatient rehabilitation service. I am an administrator, running the Functional Neurological Disorder Clinic at the Spain Rehabilitation Center at UAB. I have now started a national advocacy task force for functional neurologic disorder to disseminate knowledge for rehabilitation for this disorder. As a researcher, I dedicate myself to developing new forms of neurologic rehabilitation for motor deficits and cognitive deficits for multiple sclerosis.

What are some of the most significant challenges you face as a neurologist?

My greatest challenge is to satisfy my academic department’s requirement for me to fund my salary. I have regularly faced severe pressure to see more patients when the grant funding has been irregular. This has diverted my limited energies from furthering scientific education to increasing my clinical rounds and billing. Academic medicine is more a business than a scholarly endeavor these days. Therefore, I have faced considerable stress balancing the competing and conflicting areas of scientific investigation, teaching, clinical services, and spending time with family. I had to take a medical leave recently to rebalance my life because I was under considerable psychological strain. On my return, my department has recognized the great need for better balance among these different areas, so I have been allowed more latitude to pursue academic interests and push boundaries of knowledge for clinical care.

What do you find most rewarding about your work?

The patients themselves are continuously fascinating. I have the privilege to treat them, while at the same time, I have their permission to conduct very detailed examinations and video recordings of them. They teach me so much more about clinical neurology than I could ever obtain from textbooks or lectures.