David L. Garver, M.D
A Cutting Edge Researcher in Psychiatry
by Joyce S. St.Clair (Mrs. Harvey R.)

David L. Garver, M.D. was born in 1939, the only child of Ralph and Norma Garver in Dayton, Ohio. There were deep roots in the ministry in his family background, with liberal Quaker/Mennonite leanings. His heritage also included family members who were missionaries in Africa, primarily Nigeria. Dr. Garver said his Dad hoped he would become a "country doctor" in the truest sense of the phrase, but the days of going from house to house to minister to the sick were just about over.

Graduating from Oberlin College, he majored in both philosophy and pre-medicine. He was drawn to both disciplines because both ministry and medicine are caring professions: service to others was the key in each. The tide did not turn toward medicine until his second year at Case Western Reserve Medical School, after his return from a leave of absence to study in the seminary for one year. At the end of that year, Dr. Garver had assessed his relative skills and determined that medicine might be a better career choice.

David met his wife Jan while attending medical school; they married right after his graduation. They went into the Peace Corp and lived in Uganda where their oldest child, Abram, was born. Abram is now 34 and working in Los Angeles as a development officer for executive retirement plans. Their daughter, Elisa is now 32, an actress, and recently married. Elisa was born while David was in residency in Denver.

His saw psychiatry as an opportunity for interpersonal contact with patients and research into their illnesses in order to understand them and to potentially change their lives for the better. Much of Dr. Garver's research in psychiatry has centered on taking empirical data and assembling the puzzle in order to better define and understand mental illness. He has looked at variations in serial brain scans over short and long term periods of time and, for patients who will allow it, has studied the neurochemistry of cerebral spinal fluid that bathe the brain. These studies are containing many clues as to the nature of schizophrenia.

He has over 160 publications and over 160 published abstracts; all of which encompass expanding research over 30 years in the psychiatry profession. He has differentiated a series of psychotic illnesses which have a final common pathway to the symptoms of what today we call schizophrenia (as defined in the DSM IV): schizophrenia is a series of different disorders that end up looking very much alike.

The Garvers came to the Louisville medical community from Dallas three years ago, in part through the highly touted "Brains for Bucks" program at the University of Louisville. In Dallas, he had been the Community Health Trust Professor of Brain Science at the Southwestern Medical Center at the University of Texas.

Dr. Garver's current emphases at the University of Louisville Medical School, Department of Psychiatry is in separating those series of disorders which leading to expression of the schizophrenia syndrome by attempting to define specifically what is wrong neurochemically and anatomically in each of the disorders. One of the disorders, which is presently the major focus of work, appears to occur in about 50% of the schizophrenics studied. In these patients, psychosis exacerbations appear to be associated with activation of an inflammatory process within the brain (as displayed in elevated inflammatory cytokines in the CSF), the swelling of white (myelinated) matter, and the reduction of adjacent ventricle volumes. His working hypothesis is that this inflammatory process is causing disruption of the flow of information through the myelinated fibers from sub-cortical structures such as the thalamus to the cortex and back again. The assumption is that the current anti-psychotic drugs are somehow restoring or repairing the circuitry between the subcortical structures and the cortex. Another effect of this inflammatory process may be the withering of synaptic connections in the cortical gray matter, reducing the cortical gray volumes.

In preliminary data, the newer anti-psychotic drugs appear to increase cortical gray volume and, very likely, the number of synaptic connections. Such enhanced synaptic connections in cortical gray may parallel the enhanced cognitive functions well documented in the newer, but not the older, conventional antipsychotic drugs. Enhanced "executive function" is the bottom line of such cognitive improvements. It is the ability to make observations, to focus upon the relevant information and discard the irrelevant, to weigh evidence, to make decisions, and to put those decisions into action. It is the impairment of "executive function" which disables many schizophrenics - even more than the hallucinations and delusions - from living and acting in the real world. Currently, Dr. Garver and his staff have 20 patients in Louisville. During his nine years in Dallas, he worked with over 100 patients.

In addition, Dr. Garver has been involved in genetic studies to determine where the genes reside that provide susceptibility to schizophrenia. Within 10 years (or less), he hypothesizes, we will know the identity and function of sufficient numbers of schizophrenic susceptibility genes so that we can diagnose and differentiate many forms of the syndrome from these gene chips, instead of depending primarily upon a clinical syndrome diagnosis (DSM). Understanding the function of these susceptibility genes in patients will provide the basis for new, specific treatments, which compensate for those absent or variant gene-induced proteins. As a result, psychiatrists will likely to be able to correct or repair genetic susceptibility, providing reduced morbidity in patients with these diseases.

Dr. Garver shares that psychiatry today is the most exciting field in medicine because we have the tools to accelerate the break-through that will revolutionize our approaches to patient care. He also suggests that psychiatric patient treatment will change dramatically during the next several decades, further stating that only 25% of what he learned in medical school and residency is fully relevant today. He believes that the study of psychiatry is a life-long educational process. If you would like to contact Dr. Garver about his research activities, he can be reached at his office, (502) 852-1123.

David and his wife Jan have many hobbies and interests in life. Together they love the opera, skiing, woodland walking, physical fitness activities, and are active in St. Matthews Episcopal Church. David also plays the organ for further enjoyment.

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