Washington People: Kevin Black

Man on a mission

Kevin Black, MD (left), professor of psychiatry, of neurology, of radiology and of neurobiology, talks with Tamara G. Hershey, PhD, associate professor of psychiatry, in the East Building at the School of Medicine. “Kevin loves to develop new methods for neuroimaging and has been on the cutting edge of many new techniques and approaches,” Hershey says. “Kevin also has a strong sense of the clinical relevance of his work and is deeply committed to his patients.” (Credit: Robert Boston)

Kevin Black’s family didn’t have any physicians in it. Well, one of his great-great-grandfathers had a medical license back in the late 1800s but had no formal training — and Black himself wasn’t planning on medical school. But during his first year of college, a teacher helped change his career plans.

“I started out as a piano performance major,” Black, MD, says. “And about halfway through my first semester, the teacher looked at me and said, ‘Kevin, are you failing your other classes, too?’ Ouch!”

Since piano looked to be out of the question, Black switched to math and, from there, transitioned to medicine.

“After that first year of college, I went on a mission for my church, and while I was gone, my dad lost his job,” he says. “He found a new job, but when I came back from Brazil, I realized that I wanted a career with good job security, and I thought medicine might provide that.”

So in addition to math, Black started taking biology, chemistry and physics. He did well and applied for medical school, but he didn’t do it the conventional way. In fact, he only applied to three schools: Johns Hopkins, Stanford and Duke universities. Luckily, Duke accepted him.

“It was a ridiculous strategy, but I got in,” he says.

And it was during medical school that he was drawn to neuroscience.

He says neurology was enjoyable “as long as it dealt with stuff above the neck.” He had saved psychiatry for last, partly because he thought he’d enjoy it, but mainly because the psychiatry rotation was in a hospital about 20 miles away, and his wife, Winona, was in graduate school at the time. He needed to wait until her classes were out for the summer so that he could use the car.

Mood problems and movement disorders

From Duke, Black came to St. Louis for a residency and fellowship, and the now professor of psychiatry, of neurology, of radiology and of neurobiology has been at Washington University School of Medicine ever since.

“When we got here, we had moved, I think, five times in five years of marriage,” he says. “Later, I woke up and thought, ‘Wait a minute! Do I want to live in St. Louis?’ But my colleagues have been so great, and the resources in the neuroimaging lab are wonderful. I really think this is the best place for me to do what I do.”

What Black does is a bit unusual. He’s a psychiatrist, but he works mostly in the Movement Disorders Center. He also does imaging research and sees patients with Tourette syndrome.

“Kevin loves to develop new methods for neuroimaging and has been on the cutting edge of many new techniques and approaches,” says Tamara Hershey, PhD, professor of psychiatry who was a postdoctoral fellow at WUSTL at the same time as Black, working with their mentor Joel S. Perlmutter, MD, professor of neurology.

“Kevin also has a strong sense of the clinical relevance of his work and is deeply committed to his patients,” Hershey says.

One of Black’s first research projects involved a patient he saw during that fellowship. She had Parkinson’s disease, and she was depressed.

“She was sad and weepy and couldn’t sleep,” Black says. “After my evaluation, I presented her case to Joel, but when he went to see her, she was joking, laughing and seemed happy. Joel looked at me as if to say, ‘Right. Really depressed.’ ”

But a bit more investigation revealed that between Black’s initial evaluation and Perlmutter’s follow up, the patient had taken her medication. It turned out that her change in behavior was a side effect of the medicine.

Ever since that encounter, Black has studied the effects of Parkinson’s disease and the drugs used to treat it on mood. Because of his research, the Movement Disorders Center now routinely evaluates mood in Parkinson’s patients along with the assessment of physical symptoms.

His other area of concentration is Tourette syndrome.

“I have family members with tics, and it’s an area that really is fascinating in terms of how much of the tic involves voluntary movement and how much is out of a person’s control,” Black says. “Adults with tics almost always say tics feel volitional, but it’s irrepressible.”

He compares the experience to that of audience members at a classical music concert.

“The audience is perfectly quiet during the performance, but when the conductor puts down the baton, everyone in the whole auditorium starts coughing and clearing their throats and moving around in their seats,” he says. “And you know that for the last 30 seconds, those people were sitting there holding in those noises and movements.

“Having tics is a bit like those last 30 seconds at the symphony. Only you feel that way all day long.”

A number of children develop tics, but they often resolve enough on their own that they aren’t really a problem for the kids and their families.

“We’ve seen several children about one year after their first tic, and the mom and child tell me the tics are gone,” he says. “If we leave the room and use a camera and microphone to watch for about five minutes, we find that they’re still having tics. But they’re able to control it in daily life, so as far as the family is concerned, they’re cured.”

Some researchers have found that when they observe young children in school, as many as half have an idiosyncratic behavior that could be called a tic, but Black says tics are problematic for only about 15 percent of the population.

He is using neuroimaging and other research methods to find out why tics remain a problem for some people but tend to be a transient problem for others.

“I think it’s pretty cool if, within a career, you can have two or three genuinely interesting new ideas,” he says. “And I think our imaging work with Tourette syndrome is one of those. Focusing on tics when they first begin may tell us something about why they start in the first place as well as how to get them to go away.”

Father and bishop

When he’s not seeing patients or doing research, Black still plays the piano from time to time. He also enjoys swimming and riding a bike, but not enough, he says, to do either very often.

The Black family (from left): Elizabeth Rose, Jonathan, Ariana, wife Winona holding Lydia, Kathleen, Kevin, William and Charissa. (Credit: Courtesy photo)

Because of his mission trip to Brazil, he also speaks Portuguese. Plus, he can speak Spanish and even Esperanto, a language proposed as a way to allow people who speak different native languages to communicate.

He is a science fiction fan and has taken a stab at writing a novel himself.

“But my main thing is that I’m a husband and a dad,” he says. “We have seven kids between 25 and 4. I have an amazing wife.”

Another activity involves church. Black and his family belong to the Church of Jesus Christ of Latter-day Saints, commonly known as the Mormons, and he’s an active member.

“We have a lay clergy, so people get called to different positions in the church at various times,” he says. “For five years, I was the bishop for our congregation.”

Five of his seven children live at home, with one away at college at the University of Rochester — studying both music and neuroscience — and another on a mission in Croatia.

Black’s youngest, Lydia, had a health scare not long ago. She’s 4 years old and has Down syndrome, he says. She was very sick about a year ago. She still has a tracheotomy but is pretty much recovered otherwise.

“While she was sick, the people here at the School of Medicine and at St. Louis Children’s Hospital were just awesome,” Black says.

“It reminded me of why I like it here. If I ever went someplace else, I would have to take everybody with me.”

Fast facts about Kevin Black

Born: Nov. 15, 1962, in Provo, Utah
Education: BS, 1986, mathematics, Brigham Young University; MD, 1990, Duke University School of Medicine
Training: Residency in psychiatry, 1990-94, Barnes Hospital/Washington University School of Medicine; Movement disorders and neuroimaging fellowship, 1994-96, Washington University School of Medicine
Family: Wife, Winona; children Charissa, 25; Ariana, 21; Kathleen, 20; William, 18; Elizabeth Rose, 16; Jonathan, 13; and Lydia, 4