Eulogies for Psychiatrists Who Practiced with the Courage of Their Convictions

In 2021, we lost some excellent psychiatrists who stuck to their convictions and changed psychiatry as we know it.

IN MEMORIAM

Model psychiatrists who not only stuck to their convictions, but proved over time to be right and valuable to psychiatry, are especially important in these divisive times of fake news. Sadly, a group of international psychiatrists who stuck to their convictions passed away in 2021. Here they are, in order of their deaths. Sources, as usual, are public obituaries and personal information.

Jerold Jampolsky, MD: Self-Help for Traumatized Children

Dr Jampolsky died at the age of 95 in Sausalito on January 6, 2021, which so happened to be the same day of the invasion of our country’s Capitol building. Apparently, he was asked how he was doing close to his death and replied, “Still learning,” as should we all.

In 1975, well outside of mainstream psychiatry in terms of supporting self-help and connections to spirituality, he started a center for children with life-threatening illness and other traumas called The Center for Attitudinal Healing. The self-help principle was that sick children could help each other cope. It was a labor of love without fees.

Public recognition, so rare for a psychiatrist, was received by appearing on the Phil Donahue talk show in 1979, then soon after on “60 Minutes” and “Good Morning America.” On the Oprah Winfrey show in 1990, Winfrey said that his work helped her realize that forgiveness is accepting trauma. Dr Jampolsky said that “it means letting go of the past we thought we wanted.”

A little later, Dr Jampolsky also worked to lessen the stigma of people with AIDS, especially children. He helped create an image that was adapted around the world of a child with open arms, which read: “I HAVE AIDS, PLEASE HUG ME, I CAN’T MAKE YOU SICK.”

Related to these aspects of his work, he contributed to 20 books, including Love is Letting Go of Fear.

Weeks before he died, he said to his wife that the children were helping him accept his own death. He had a vision of children reaching down to meet him above a giant lighted spiral of steps leading the way.

Stanford Bourne, MD: Breaking the Silence About Stillbirth

Dr Bourne died on July 30, 2021, at the age of 92.

Back in the 1960s, about 18,000 women a year had a stillborn baby in Britain, but it was typically accompanied by deliberate medical and psychiatric silence. Stillborn babies were removed and disposed of quickly. Brief grieving was not encouraged, but trying for another child was.

Dr Bourne worked at the well-known Tavistock clinic in London. In 1960, a woman he was treating became severely depressed after her baby died. Searching for the best therapeutic approach, he found virtually nothing, concluding that “I slowly realized this was perhaps the most interesting thing I had stumbled upon.”

He decided to canvass general practitioners (GPs) about their experience with stillborns versus those who delivered live and healthy babies. Like his literature research, he found that the GPs did not answer or, at best, gave terse replies. It took years to get this research published. Dr Bourne concluded that stillbirth was not only traumatic for the women, but also secondarily to their doctors, a reaction we now call secondary trauma.

With public and professional outreach, Dr Bourne slowly helped change the practice of midwives and obstetric doctors, allowing parents to hold and name their child, and to follow that with a funeral. In 1992, he wrote the landmark resource book, Psychological Aspects of Stillbirth and Neonatal Death: An Annotated Bibliography.

Dr Bourne’s work with stillbirths led him to a general interest in the psychology and unconscious bias of physicians. He ran Balint groups to help process the stress of GPs and other health clinicians, which was the subject of his 1981 book, Under the Doctor. Today, such discussion groups provide effective support for medical students and physicians burning out, as I learned firsthand by leading such groups in our epidemic burnout era.

Michael Rutter, MD: Changing How Autism Was Viewed

Dr Rutter was a British child psychiatrist who died at the age of 88 on October 23, 2021.

Dr Rutter could be said to be 1 of the founders of modern child psychiatry. He developed the first epidemiology studies in the 1960s and 1970s, which revealed many of the social determinants of mental health, an insight just coming back into focus in the United States.

More specifically, he challenged the previous idea that autism was caused by emotionally distant parents, so-called “refrigerator mothers.” Comparing identical twins, he showed a much higher incidence of autism in them, essentially proving the major genetic component to the etiology. He later also disproved the connection of autism with various vaccines, including the crucial data that the rate went up in countries where the vaccines were stopped.

Dr Rutter wrote over 400 papers and 40 books, including Maternal Deprivation Reassessed, which challenged the attachment theory of the British psychiatrist John Bowlby by claiming that people other than mothers could also be crucial for child development.

Judith Finkelstein Kashtan, MD: A Champion of Women’s Issues

Dr Kashtan died on November 28, 2021, at the age of 69.

Dr Kashtan became known for being a model and trailblazer for women in psychiatry. She was a principled leader of the Women’s Caucus of the American Psychiatric Association (APA) and was especially devoted to the lives of women psychiatrists, trainees, and patients. She was able to advocate for that at the top levels of organized psychiatry as a member of the APA Board of Trustees and the Assembly.

She used a nurturing process with other women psychiatrists. In the Minnesota Psychiatric Society, she set up a potluck dinner at her home to share experiences, clinical opportunities, and how to be tough when necessary, producing a sense of support and camaraderie.

After Dr Kashtan’s death, a Life Tribute supervisee described her teaching over a cup of tea to “sit with their pain” of patients during psychotherapy. The same supervisee felt that nourishment when she in turn came to sit on the APA Board of Trustees.

Harold Eist, MD: Fighting Managed Care with Everything He Had

Dr Eist died on December 16, 2021, at the age of 83.

On the APA Members Listserve, tributes and accolades poured out after Dr Eist’s death was announced. As a president of the APA from 1996 to 1997, and of many other psychiatric organizations, he was a tireless opponent over the intrusiveness of the managed care business and its adverse repercussions on psychiatrists, other physicians, and patients. He also was an advocate for inclusivity and against prejudice of all kinds. No wonder he was selected as Washingtonian of the Year in 1979.

However, my admiration was mixed with disagreement and the experience of what seemed to me to be a public attempt at shaming. Hence, for me, this is a difficult eulogy to write. Dr Eist was a giant in psychiatry, so it might be worse to ignore him. Or is this a unique opportunity to show that 2 psychiatrists with the courage of their differing convictions could both be correct?

Dr Eist and I were both interested in managed care as it emerged, but from different perspectives. Mine was as a participant/observer to learn the most I could about it firsthand. I became medical director in a not-for-profit academic system and wrote a book about it in 1997 titled The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Our own system of care improved the outcome of our public patients. I thought—and still do—that part of what led to the problematic development of managed care—that is, for-profit companies putting profit before quality of care—is that our quality of care clearly had its deficits and we, as a field, were passively supportive of the for-profit private psychiatric hospitals that seemed to unnecessarily extend length of stay, especially for substance abuse.

My disagreement with Dr Eist came to a head when he was the president of the APA and spoke at a WPA conference that I helped put together. Just before my book came out, he called me “evil” publicly in one of his comments. I did receive support from the president of the Wisconsin Psychiatric Association and other colleagues at the time. Years later, Dr East apologized in private to me, which I readily accepted. I found out that he and I shared other things, like similar religious backgrounds, working with the poor, and devoted wives. Perhaps both of our convictions about managed care were right to some extent. Actually, Archbishop Desmond Tutu—who died recently on December 26, was known as the moral compass of South Africa, and led the Trust & Reconciliation process there—sort of told me so. I saw him speak at an international managed care conference in the early 1990s, decrying the emphasis on profit, but praising that it brought more accessible health care to many around the world.

Conclusions

Surely it can be seen from the lives of these psychiatrists that the courage of their convictions led to much good for the field. Indeed, virtually all the major advances in psychiatry were originated by psychiatrists who stood by the courage of their convictions long enough and convincingly enough to finally have them accepted. Take Sigmund Freud for his exploration of the unconscious as played out in psychoanalysis; Abraham Low, who, in the 1930s, began our self-help and recovery movements; Aaron Beck, who developed cognitive behavioral therapy; and even the psychopharmacologists who were criticized by the psychoanalysts. Most of these psychiatrist pioneers, as well as those being eulogized, became involved with the greater society.

In fact, it seems true of most fields that the courage of convictions can lead to significant changes. The crucial question, then, is whether the changes are for the good or not. That may depend on whether they enhance our collective healing, well-being, and human potential for the good. For, say, primal scream therapy and insulin shock, maybe not—although we can still learn from misguided convictions.

Perhaps our own courage is also needed to keep an open mind about what can advance or hinder our field. Sometimes, a promising development can go awry due to hubris or lack of boundaries. Often the test of time is necessary, and the scientific jury is still out here. All of us can play a role in assessing such challenges.

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 Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric TimesTM.