Eulogizing a Psychiatrist Innovator

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COMMENTARY

Dedicated to the American Psychiatric Association

Just the other day, I was looking over the latest In Memoriam listing put out by the American Psychiatric Association. It lists those members whose deaths were reported between October 1, 2017 and March 31, 2018. Someday, I assume that I will be on this list.

Fortunately, the list this time around was not as long as usual. No name caught my attention until one near the end: Walter Weintraub, MD.

At first, I didn’t know why, so I started to google his life. Perhaps serendipitously, I was reminded that he and I wrote a review of the same book for different publications. This was Psychiatric Interviewing: A Primer by Robert Leon, MD. If you’ve read any of my periodic eulogizing columns, you may recall that Dr. Leon was featured in our 2017 year-end eulogies, and that his gem of a book of was discussed.

Searching onward now that I had made the connection, I found his obituary, written by Frederick N. Rasmussen, in the March 30, 2018 issue of the Baltimore Sun. I was then reminded of other collegial connections.

I had long been interested in the influence of one’s cultural background on psychiatric care, especially if that influence was likely to be negative at times. Such culture not only consisted of various ethnicities, but also various socio-economic categories, including the wealthy-otherwise known as VIPs. Dr. Weintraub was a pioneer in his insight, as he presented the paradox of how more wealth often brought poorer psychiatric treatment. In particular, his landmark 1964 article The VIP Syndrome: A Clinical Study in Hospital Psychiatry informed my teaching and clinical work. The transference and counter-transference problem often stemmed from the desire of the VIP to be treated specially and for the clinician to acquiesce to that expectation. Much later, when I wrote blogs for Psychiatric Times on the suicide of Robin Williams, I wondered if he was also treated as a VIP.

In 1970, Dr. Weintraub set up the Combined Accelerated Program in Psychiatry at his academic base, the University of Maryland. It was an innovative program: a select group of medical students were to be immersed in psychiatric educational experiences starting in medical school. At the time, I was in my third year of medical school at Yale, and though I had inspiring psychiatric education there, I probably would have tried to get into Dr. Weintraub’s program instead if it was available when I was applying to medical school.

In 1976, Dr. Weintraub created yet another innovative program that became known as the Maryland Plan. This was an academic and state collaboration designed to improve the care of patients treated in state hospitals. In a way, this was the missing link for the evolution of community psychiatrists like myself, who were treating patients being deinstitutionalized out of state hospitals. This had led to some neglect of those who still needed to be treated in the state hospitals. There is some recognition now that perhaps the pendulum has swung too far from the role of such state hospitals in the spectrum of necessary care for some patients.

Then, in 1980, Weintraub’s book Verbal Behavior: Adaption and Psychopathology was published. It was another in his string of psychiatric innovations. He studied the speech patterns exhibited in presidential press conferences going back to President Eisenhower: his goal was to try to understand the President’s mental health at the time. Among his conclusions:

“What we found was that under anger or strong emotion, language tends to become more simple. Basic words. Profanity tends to be basic and learned early in life. . . The grammar becomes simple. . . We call it regression, a going backwards.”

Sound familiar?! Later, this methodology was applied to foreign leaders and even terrorists, a contribution to the new field of political psychiatry.

And yet, among all these unique innovations, perhaps Dr. Weintraub’s greatest innovative legacy to psychiatry could be a personal one. All 4 of his children became psychiatrists. Surely a world record!

One of the major projects of Anita Everett, MD, APA’s current President, has been to emphasize the need for innovation in psychiatry. In anticipation of hearing about new innovations at our annual meeting in May, we couldn’t do better than to model after Dr. Weintraub, could we?