The Best of the Best: Joel Feiner, MD

December 2, 2020
H. Steven Moffic, MD

On the etymology of the "Feinerism."

IN MEMORIAM

Psychiatric Times has published several year-end eulogies in memory of psychiatrists who have passed away. This year is different. Gratefully, I didn’t hear of many psychiatrists that could or should be eulogized. Those we remember tend to be someone well known in our field or by me personally. Over this year of COVID-19, we already covered several others. At times, other publications provide such remembrances, such as one by the American Psychiatric Association Psychiatric (APA), that recently featured a tribute to Patricia Newton, MD.1,2 However, for the APA, one has to be an active member at the time of death for that to be possible. Finally, there seemed to be so much to say about Joel Feiner, MD, a prominent psychiatrist, so a lengthier tribute seems appropriate.

By the time I got to know him in the 1980s, Joel was a renowned community psychiatrist based at Albert Einstein College of Medicine in the Bronx, New York. In fact, he was so beloved by his colleagues that we sometimes compete in sharing his favorite sayings, which became known in some circles as “Feinerisms.” They were that fine.

For instance, right after hearing about his death, I recalled he always emphasized, “It’s the relationship, stupid.”

I’m not sure if the “stupid” was my accurate or false memory, but I know “It’s the relationship” was conveyed by him over and over. Other colleagues recalled that phrase or similar ones. Certainly, I had my own experiences to substantiate that. Once, in my community clinic, I brought in an African-American patient for an evaluation to my office from the waiting room. She began by saying how glad she was I was going to be her psychiatrist. This was before the internet, so I assumed she didn’t know of me beforehand. So, I said I appreciated her feeling that way, but I wondered why, already wondering about any possible cross-cultural meanings. She said: “You were the only one who smiled when they saw their patient.”

Certainly, that relationship “Feinerism” was a distillation of the number of studies that confirmed the importance of the therapeutic alliance. That sort of positive relationship accounts for as much as 40% of the outcome variance in psychotherapy, as well as being crucial for psychopharmacology.3

Joel tried to apply that to all his work settings, but perhaps most meaningfully at the Mental Health Connections of Dallas, where he was clinical and training director in the 1990s. This system connected a 24-bed inpatient unit, an 80-patient assertive community team, and an outpatient psychological rehabilitation program. On describing that program in a lecture at the APA Institute for Psychiatric Services in 1998, he laced his talk with other therapeutic sayings, included in the Table.4

When faced with an ethical dilemma, he described falling back on the Oath of Maimonides, a Jewish philosopher, rabbi, and physician: “May I never see in the patient anything but a fellow creature in pain . . .”

After Mental Health Connections closed in 2001 due to lack of funding, Joel became medical director of the Comprehensive Homeless Center at the Dallas Veterans Affairs Medical Center. Of course, he had more “Feinerisms” of his work there. For example, he said, “We have some very quiet heroes and heroines here—the veterans themselves. Some have been clobbered by conditions they had, through no fault of their own. It’s their ability to keep on that I am in awe of.”

For his retirement, covered by the Dallas Morning News,5 some of his patients gave their own version of “Feinerisms”:

  • “It’s like he’s a little conscience and he’s guiding me.”
  • “As one of the ‘thems’, you really made me feel like a ‘we.’

Not that Dr Feiner was perfect, as one patient noted. Applying for a peer counselor position, he felt like Feiner snapped at him. Joel later apologized to him, and the patient went on to study speech communication and hoped to become a teacher.

The Dallas Morning News article was published on Halloween in 2010. Surely, Joel provided more treats than tricks.

Patient care and collegial relationships came first with Joel, probably at the expense of writing more, but he did still manage to leave us with written lessons longer than his sayings. Many may be surprised that early in his career he wrote a book about childhood fears and anxiety titled Taming Monsters, Slaying Dragons that focused on family therapy.6 Pulling out my old copy and skimming it once again confirmed it would still be of help in these days of children being affected by COVID-19 fears. As he once said,“You can’t say it isn’t a treacherous world, and there aren’t things around us we shouldn’t fear. That’s a part of growing up.”7

Given his landmark work in multidisciplinary community psychiatry, it was fitting that he became president of the American Orthopsychiatric Association from 2000-2001. In his tribute, Ken Thompson MD,8 another prominent community psychiatrist and a student of Joel’s, pulled out more “pithy aphorisms and magic metaphors,” that summarize what he learned from him:

  • “Start where the people are.”
  • “Ride the horse in the direction it’s going.”

By now, it may be apparent that one could teach a whole seminar series based on one of Joel’s sayings. And I’m not only talking about psychiatric education, but life education.

At the same time Joel became president of Ortho, I happened to become president of the American Association for Social Psychiatry. That is where and when we collaborated the most. In an article about the future of community psychiatry, we concluded, “ . . . community psychiatry can be a vehicle for modifying general psychiatry’s propensity towards individualism and reductionism by offering a more holistic and integrative approach to illness and well-being.”9

That prediction came true. Community psychiatrists have been over-represented among recent presidents of the American Psychiatric Association, and our working on teams with limited resources become more and more common after managed care invaded psychiatry.

If it isn’t already apparent that Dr Feiner was among “the best of the best” psychiatrists, don’t just take my word for it. Take what could be deemed the culmination of his career on October 25, 2007, when he was again awarded for being “the best of the best” for the Mental Health Seminar at Grayson Community College in Dennison, Texas. Right before that, he had won the prestigious 2007 Heroes in the Fight award for being the best psychiatrist in Texas from a variety of organizations.

In 1992, Joel ended his bachelorhood and married another well-known psychiatrist, Gail Susan Alexander, MD. She helped care for him over the last 10 years of his life after he received a diagnosis of Alzheimer disease. She was at his bedside when he “peacefully passed.”

What a heroic journey Joel had, “taming monsters, slaying dragons.” He died on September 8, 2020, the day after Labor Day, his labor of love days gone but not forgotten.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric TimesTM.

References

1. D’Arrigo T. Patricia Newton, advocate for Black Psychiatry, dies. Psychiatric News. 2020;55(21):10.

2. Okpaku SO. Tribute to chief Patricia (Nana) Newton. Psychiatric News. 2020;55(21):10.

3. Grodzki L. The path to clinical confidence. Psychotherapy Networker. 2020;44(2): 44-50.

4. Professional News. Building strong relationships with patients critical to success of community treatment. Psychiatric News. November 20, 1998.

5. To homeless veterans, retiring Dallas VA psychiatrist is a hero. Dallas Morning News. October 31, 2010. Accessed December 1, 2020. https://www.dallasnews.com/news/2010/10/31/to-homeless-veterans-retiring-dallas-va-psychiatrist-is-a-hero

6. Feiner J, Yost G. Taming Monsters, Slaying Dragons. Arbor House, 1988.

7. Busico M. Shedding light on the dark and other childhood fears. Chicago Tribune. March 13, 1988. Accessed December 1, 2020. https://www.chicagotribune.com/news/ct-xpm-1988-03-13-8802290448-story.html

8. Thompson KS. Joel S. Feiner, M.D., President American Orthopsychiatric Association, 2000-2001. Am J Orthopsychiatry. March 24, 2010. https://doi.org/10.1111/j.1939-0025.2000.tb04413.x

9. Cohen C, Feiner J, Huffine C, et al. The future of community psychiatry. Community Ment Health J. 2003;39(5):459-471.