“The last place I ever thought I would end up after graduating college,” Andrew Pearson ’91 says, “is medical school.”

We both chuckle while he says it, because of how absurd it sounds. As the chief medical officer of the nonprofit The Jewish Board, Pearson now holds one of the most influential and prestigious medical positions in New York City, where he has become a leading voice on hot-button issues like adult and child mental health, homelessness, addiction, and trauma.

But there, right on the bottom on his LinkedIn page, is listed his major at Dartmouth: creative writing. “It’s worse,” Pearson laughs. “My thesis was a book of poetry.”

He had been a devoted English student at Taft, which makes sense considering he was an advisee of Willy MacMullen ’78. After Dartmouth, he applied for a single job out of school: teaching poetry to kids in San Francisco.

Medical school never crossed his mind, even after he left the West Coast and returned to Bethlehem, Pennsylvania, unsure of what to do. He fiddled around with some odd jobs—woodworking, funeral services—and started reconnecting with old classmates, a few of whom were just beginning clinical work in medical school.

Though uninterested in the “science” of medicine, he began to contemplate the “art” and elegance of a field like psychiatry, which seemed to rely more on his ability to listen as well as the possession of emotional empathy.

“Psychiatrists got to spend the most time with patients,” Pearson says. “I really wanted to talk to people and hear people’s stories and listen to them and try to help them feel better internally.”

He especially liked doing volunteer work with children, and he started to see how his poetry background might actually help some young patients.

“There are a lot of parallels between the poetic impulse and psychiatry,” Pearson says. “A lot of times, you’re working with similes and metaphors. Kids often enact their inner lives through their toys or through their play.”

He attended medical school at Temple University, then enrolled in a program at Mount Sinai Hospital in New York, where he could train in medical pediatrics as well as child and adult psychiatry simultaneously. While at Temple, he had worked at Covenant House, a charity serving homeless and at-risk kids.

“I don’t want to sugarcoat it,” Pearson says. “It is brutal work. But I’ve met so many truly amazing young people who are miraculous, talented, sharp, funny, generous, amazing people. They have just been dealt an incredibly [unlucky] hand in life.”

After years of clinical work, Pearson’s position at The Jewish Board now gives him the opportunity to address broader, societal trap doors that can send kids and adults spiraling down darker paths, like those that he calls the “pipeline from foster care to homelessness.”

“Your heart can’t break for the 5-year-old who is molested, then revile the 45-year-old passed out drunk or high on Columbus Avenue at 1 o’clock on Tuesday afternoon,” Pearson says, “because they are [effectively] the same person. That statement isn’t the speculation of a hemorrhaging-heart child psychiatrist; it’s an observation buttressed by mountains of data.

“Maybe if you can do something further upstream to make changes, a kid gets help earlier,” Pearson adds.

On the day I spoke with him late last fall, New York City Mayor Eric Adams had just directed the city’s police and emergency medical workers to hospitalize mentally ill people involuntary. The controversial decision was intended to calm anxious New Yorkers after several high-profile acts of violence on the streets and subway, and the media was abuzz with debate about its effectiveness and morality.

Pearson, who encounters and intervenes with psychotic patients on a daily basis, viewed the mayor’s impulse with skepticism.

“There’s a part of me that does favor being more aggressive about involuntary hospitalization,” Pearson says. “One of the real symptoms of schizophrenia is anosognosia, which is lack of knowledge about one’s condition. People who are schizophrenic think there is nothing wrong with them and the problem is everyone else. That can potentially be dangerous.”

On the flip side, even “as a psychiatrist, it’s very different to predict who’s going to be suicidal or violent,” Pearson says. “The idea that the police are going to be able to discern between those two—how are they going to be able to tell?”

People and politicians demand simple solutions. But Pearson knows that issues like homelessness, addiction, trauma, and mental health rarely present black or white cases. He hopes to better understand and interpret the nuances.

There’s an art to that.