Robert
Raeder

The marathon
is fieldwork.

Running is hard. That's the point. Endurance running stresses metabolism, thermoregulation, and the brain at the same time. It does it fast, outdoors, and at scale.

I study marathon runners with Dr. Jeffrey Brown, lead psychologist for the Boston Marathon. Building on his years of experience at the race, we developed and described a model of psychiatric care for marathon settings and started treating the marathon for what it is: a large, controlled stress test of human systems. We now have data showing that runners with psychiatric diagnoses show different marathon performance patterns and have distinct medical risks.

The short-term goal is practical. Predict and prevent medical encounters. The longer-term goal connects back to my work in metabolic psychiatry. The marathon is a challenge-based assessment of metabolic flexibility and energetic reserve. It lets us ask how metabolic stress is tolerated, adapted to, and in many cases turned into something beneficial for mental health. More fundamentally, however, there's a bidirectional logic here: understanding how to enhance metabolism in high-performance athletes gives us a model for what goes wrong — and how to correct it — in people with metabolic vulnerability and psychiatric illness.