It is the beginning of Spring, a time of renewal. What seemed dead comes back to life. The overlapping religious holidays of Passover and Easter have come and gone, and through these holidays, lessons are learned once again.
In a series of eulogies in Psychiatric Times about psychiatrists who have inspired, we have—in addition to honoring them—tried to convey the meaning of their work and their lives.
Perhaps you’ve known psychiatrist colleagues at one time, but later you lost track of them. So, it has been for me with two psychiatrists who died recently. Reviewing their contributions makes them come alive again for me, and hopefully for you. That their contributions center on death seems all the more fitting for this time of year.
Aida McKellar, MD: Deaths with dignity
When I worked in Houston at Baylor College of Medicine from 1977-89, I recall casually knowing Dr. McKellar. She had a reputation of being a good, solid psychiatrist. I didn’t hear anything more about her until the American Psychiatric Association posted their periodic listing of “In Memorium” on April 5, 2017.
Given the availability of Google searches, I wondered if I could find out what she did from the time I left Baylor until her death. The main item I found was a Letter to the Editor that was published online in Psychiatric News on October 1, 2004.1
In the letter titled “Death With Dignity,” Dr. McKellar refers to an article in the Houston Chronicle about McKubwa, an old gorilla.2 “Mac” was euthanized due to his poor health and presumed poor quality of life. Given lethal medication, caregivers stroked him gently until he calmly passed away.
Dr. McKellar wondered why we don’t use this option more often with humans. She also decried the relative lack of comforting care to the dying.
Progress, as she would see it, has been made over the last dozen years. More states and countries make available some form of “death with dignity.” Hospice care has improved and spread. Of course, as often covered in Psychiatric Times,3 there is still controversy of how far to take this option and what the role of physicians and psychiatrists in the process should be, ethically speaking.
I hope her death was as peaceful and comforting as she wanted for other people and animals.
George Palermo, MD: Deaths without dignity
I don’t know the details about how Dr. Palermo died, but I do know firsthand something about how he lived and assessed "deaths without dignity" in others.
He came to Milwaukee and the Medical College of Wisconsin in 1988, one year before I did. He specialized in forensic psychiatry. Prior to that, he worked in his native Italy. As a teenager, he was exposed to the horrors of World War II.
In Milwaukee, he provided psychiatric evaluations in many criminal cases. His personal goal was to understand more about the criminal mind and to prevent or correct such behavior.
His most well-known case was as the court-appointed psychiatrist at the trial of Jeffrey Dahmer, who killed 17 men and boys between 1978 and 1991. As if that wasn’t horrific enough, the later murders apparently involved necrophilia and cannibalism, as well as the preservation of body parts. During much of this period, Dahmer was in treatment. Was he untreatable or, like many criminals, did he fool his clinician?
Dahmer was diagnosed with a variety of diagnoses by different psychiatrists. Dr. Palermo felt he had a serious personality disorder, but was not psychotic and therefore not legally insane. Consistent with that assessment, Dahmer was found to be legally sane at his trial. After a couple of years in prison, like his victims, he met a version of death without dignity—he was beaten to death by another inmate.
A violent, cruel death—especially a lingering one—is a death without dignity when we compare it with death from a terminal illness. Such events are becoming more common. We have a recent example of a man who uploaded a video on Facebook (since removed) his plans to murder an innocent 74-year-old male.4 In the video, the perpetrator says, “Found me somebody I’m going to kill, this guy right here, this old dude,” and he subsequently shot the stranger.” This trend needs the attention of psychiatrists like Dr. Palermo in order to understand and prevent violence.
Though his work dealt with the darkest side of human nature, Dr. Palermo’s character was of the brightest kind. Outside of work, he was usually joyful and he appreciated the beauty of art and culture, especially Italian opera. Before he died, could he have been listening to the last scene from Puccini’s famous opera La Boheme, in which the heroine Mimi calls for her former love, Rodolfo, to come to her as she is dying from tuberculosis. He does, and as they reminisce, she dies peacefully in his arms.
Are there psychiatrists whose lessons you would like to resurrect for us? Let us know, please.
1. McKellar A. Death With Dignity. Psychiatric News. October 1, 2004. http://psychnews.psychiatryonline.org/doi/10.1176/pn.39.19.0390037d. Accessed April 18, 2017.
2. Bryant S. A sad goodbye as sick gorilla is euthanized. Houston Chronicle. May 21, 2004. http://www.chron.com/news/houston-texas/article/A-sad-goodbye-as-sick-gorilla-is-euthanized-1980697.php. Accessed April 18, 2017.
3. Pies RW. Physician-Assisted Suicide and the Rise of the Consumer Movement. Psychiatric Times. August 1, 2016. http://www.psychiatrictimes.com/blogs/physician-assisted-suicide-and-rise-consumer-movement. Accessed April 18, 2017.
4. Sheth S. Search for ‘Facebook killer’ is now a nationwide manhunt. Business Insider. April 17, 2017. http://www.businessinsider.com/manhunt-facebook-homicide-video-ohio-pennsylvania-new-york-indiana-michigan-2017-4. Accessed April 18, 2017.