His finalist year: 1974
His finalist project: Writing a computer program to image the structure of different compounds based on their chemical name
What led to the project: In the early 1970s Michael First's Philadelphia-area high school (Cheltenham High School in Wyncote) purchased some computer terminals and subscribed to a local time-sharing service. As a student there, he loved the challenge of trying to program on these early machines, and he hunted around for practical applications.
After taking chemistry, one came to him: The names of chemical compounds usually follow a protocol that relays a lot of information about their composition and structure. (For instance, 1,1-dichloroethene, or C2H2Cl2, consists of two carbon (C) atoms joined by a double bond, with one carbon connected by single bonds to two chlorine (Cl) atoms, and the other attached in the same way to two hydrogen (H) atoms.)
He wrote a computer program that would analyze the name of a given compound, and produce a picture of the structure from that name. He entered his program in the 1974 Westinghouse Science Talent Search and was named a finalist.
The effect on his career: First went to Princeton University to study computer programming, graduating in 1978. He'd always been interested in medicine, as well, so he decided to become a doctor who also knew how to write computer code, and enrolled in the University of Pittsburgh School of Medicine.
He considered going into internal medicine, but "felt like it would get routine very quickly," so he chose psychiatry, where "no two cases are ever the same," he says. "It was so much more complicated, and so much more intellectually appealing."
He was particularly interested in the work of Robert Spitzer of Columbia University, who pioneered the use of computers to help make psychiatric diagnoses. First went to New York–Presbyterian Hospital/Columbia University Medical Center for his residency in 1984, and has been working in Columbia's Department of Psychiatry ever since.
What he's doing now: First isn't doing much actual programming anymore—"I just had to pick one field or another," he says—but he's spent much of his career applying computer programming concepts to psychiatry. He's the lead author of the questionnaire used by researchers to probe psychiatric symptoms, known as the Structured Clinical Interview (SCID) for DSM-IV-TR (aka the Diagnostic and Statistical Manual of Mental Disorders, used to classify mental illnesses). Just as First's old computer program took an input of a chemical name and analyzed the parts to produce a structure, SCID—"the most widely used psychiatric research diagnostic interview," Spitzer says—helps use the available data to reach a diagnosis.
First continues to enjoy the intellectual appeal of difficult cases. For instance, he recently served as an expert witness for the defense in the death penalty phase of Zacarias Moussaoui's trial. After Moussaoui —the so-called "20th hijacker" of the 2001 World Trade Center attack—pled guilty in 2005 to several terrorism counts related to the September 11 attacks, the court needed to determine if he was mentally ill. First stood outside Moussaoui's jail cell for five hours trying to interview him. Moussaoui refused to cooperate, but First wound up diagnosing him with schizophrenia after examining Moussaoui's writings and interviewing his guards and his family—several of whom also suffer from the disease.
First was confident in the diagnosis, but he notes that it also raises difficult questions. For instance, if someone simply has extreme ideas, he asks, "Can you call that psychotic or not?"
He has also become a leading expert on an extremely rare condition called body integrity identity disorder, which is characterized by a desire to become disabled, often by becoming an amputee. First says it's similar to the more commonly known gender identity disorder, in which people feel their bodies are the wrong gender, and sometimes have sex-change operations to ameliorate the problem. Because body integrity identity disorder is so rare, First used the Internet to find enough people who feel they were born with a limb they weren't supposed to have to make actual progress on studying the disorder.
Some people who suffer from the disorder and have surgery to become amputees "no longer have the obsession," First says, and hence are—in a sense—cured. "It's totally amazing to try to understand it."