Psychiatry at the Extremes

IN MEMORIAM

Psychiatry never does well by ignoring or denying our limitations. Given our work with patients who reflect the extremes of human potential, it is inevitable that the life and death of some of us will seem striking and even sensationalist. I found psychiatrists who recently passed away who fit that profile.

Yet, that by itself does not justify presenting eulogies on them. On the one hand, it would be of questionable taste to write such eulogies, given they traditionally focus on the positive. It could seem lurid or voyeuristic to write about shocking behaviors. One the other hand, there may be much to admire, learn, and even regret from a 20/20 rear-view retrospective. With consideration and compassion, and with empathy for what was suffered and confronted, we mourn these psychiatrists, in alphabetical order.

Murder-suicide: Mark Batory, MD

Though he lived near the Medical College of Wisconsin where I worked, I did not know of Dr Batory until a colleague who knew I wrote these eulogies recently sent me an update about his death on August 22, 2018. New information came to light in September 2019 in an article in the Milwaukee Journal Sentinel titled “A Wauwatosa Psychiatrist was murdered by an estranged boyfriend in a murder-suicide last year, new reports say.” In this update, Karen Pilarski provided new information that answered who shot whom in the murder-suicide involving Dr Batory; it turned out his boyfriend was the aggressor. Money, infidelity, substance use, and domestic abuse were in the mix. Sadly, his 13-year-old son was nearby when the tragedy occurred.

Other than the fact we rarely hear of psychiatrists involved in such tragedies, this is not an unusual event. The newspaper emphasized the dangers involved when a domestic abuse victim wants to leave a relationship. Because there are fewer services for LGBTQ people who are in such situations, a state-wide in initiative, Room to Be Safe was established. It is an “anti-violence program serving survivors of intimate partner, sexual, hook-up, and hate violence . . . designed to advocate for and work with survivors of all violence for individual counseling/advocacy, information and referral, safety planning and support for lesbian, gay, bisexual, transgender, and queer communities in Wisconsin.”

It is unclear whether Dr Batory ever sought help from colleagues, formally or informally, but we do know about the relative lack of self-disclosure by psychiatrists. Hopefully, our Psychiatric Times series of self-portraits will lessen that stigma.

The celebrity psychiatrist: Timothy Benson, MD

The headline in the New York Daily News on September 9, 2019 was, “Britney Spears’ doc dies of reported aneurysm just weeks before judge takes up report on her medical treatment and conservatorship.” We psychiatrists know how hard it is to treat VIPs because of entitlement, countertransference reactions, and the difficulty of keeping confidentiality. Often, they receive as poor care with unlimited resources as the poor do who have inadequate resources.

This case may have been even more challenging due to the involvement of her parents. In 2008, her father took conservatorship of her after Ms Spears was involuntarily admitted to a psychiatric hospital. In addition, there was the cross-cultural relationship of psychiatrist and patient.

Dr Benson had his own website and newsletter. In one of them, “My Story: The Heart to Come from Behind,” he summarized his life story. He described the work ethic of his mother as inspirational. He was a star athlete but later found out that his enormous confidence met its match in medical school. Failing, in a last-ditch effort, he asked for help. That help was not to work harder, as he already had been doing. It was to self-disclose his struggle and use the support of mentors and advisors, the support that came from behind.

Out of his struggles in medical school, he described some life lessons in his “traumatic transition” that he used after his emotional break and subsequent help:

1. What helped you to be successful in the past may not work in the present and future.

2. No matter the success, expect doubt, distraction, and disappointment to come some time.

3. Asking for help is not a weakness, but a way to gain a competitive advantage.

A Playboy model patient: Thomas Burchard, MD

On March 7, 2019, a luxury sports car was found in a desolate area of Nevada and an elderly white male was discovered stuffed in the trunk, dead from blunt force trauma. It turned out to be Dr Burchard, aged 71 years.

A series of clues led investigators to Kelsey Nichole Turner, a 25-year-old model for Playboy and related magazines. Apparently, she was not a patient of his, but he helped pay her rent and other expenses.

At work, he had been a child psychiatrist at Community Hospital of the Monterey Peninsula, where he reportedly performed magic tricks for children. Dr Burchard’s girlfriend described the psychiatrist as "overly compassionate," providing money to other women in financial need.

One must wonder whether his colleagues noticed anything that needed discussion or intervention, and whether Dr Burchard had kept these activities to himself professionally.

A serial killer patient: William J. Crowley, MD

Just imagine if you were the psychiatrist of a patient who not much later became known as one of the most notorious serial killers in history. That was Dr Crowley. His patient was Jeffrey Dahmer. Add on that you might be criticized in court by an “expert witness” for your treatment.

I knew Dr Crowley as he also worked in the Milwaukee area. As far as I knew, he had a good reputation as a solid and kind psychiatrist. However, I did not know he had been working with Mr Dahmer, who, among other horrors, had strangled and dismembered his male victims, wanting “to keep them with me.”¹ Two years after he was put into prison, Dahmer was killed by another prisoner.

I never read about Dr Crowley’s death back when he died on May 27, 2018. Maybe it was kept quiet intentionally. The news serendipitously came to my attention only recently.

The case reminded me of a patient I saw in prison and wrote about for Psychiatric Times. My patient, like Dahmer, had necrophilia (a sexual attraction for corpses). I ended up concluding that my patient was “evil” when I couldn’t make a formal DSM-5 diagnosis to explain his isolated behavior, nor did any treatment change his ideation. Perhaps, like Dr Crowley, I feared he would kill someone. Discussing this patient with colleagues and writing about him helped my anxiety and may have provided some legal protection.

Psychedelic warfare: James Ketchum, MD

From 1975 to 1977, I was stationed at Fort McClellan, Alabama, as a psychiatrist straight out of my psychiatric residency. The rumor was it was once a base for chemical warfare research, and the chemicals were buried somewhere near the area. Recently, that curiosity got connected to the reported death of Dr Ketchum on May 27, 2019.

Dr Ketchum hoped that psychedelics could make war less deadly.² If enemy troops could be incapacitated by a water supply tainted with LSD or a cloud of hallucinogens spread over the battlefield, perhaps many lives could be saved. At the time, there were unsubstantiated reports that the Soviet Union was developing chemical warfare.

Dr Ketchum conducted psychedelic experiments on soldiers in Maryland in the 1960s. The program was canceled after Congressional hearings revealed no follow-up for the subjects, many of whom became psychotic. Interestingly, psychedelics are receiving renewed research interest, ranging from potential use in coping with death and dying to treatment of trauma.

Dr Ketchum left the Army and went into civilian psychiatry in the 1970s. He often talked and wrote about the ethical dilemma of whether to choose the presumed interests of the nation over individual citizens and patients.³ That parallels the dual loyalties we often have between patients and the organizations for whom we work.⁴

Videoptaping Holocaust survivors: Dori Laub, MD

Nowadays, it is common for Holocaust survivors to be interviewed and filmed for posterity and to help people understand the Holocaust and prevent it in the future. However, this was not always the case. When Dr Laub began videotaping survivors in 1979, it was rare. He recorded 134 of these taping sessions, concluding that the empathic listening of a psychiatrist was more effective than the journalistic type of interviews that others conducted later.⁵

Born in Romania in 1937, he was deported to the Ukraine in 1942, but survived concentration camps with his mother. Given that he was also a survivor and a witness, interviewing another survivor  evoked the struggle to remember, both for survivors and himself. From their testimonies, he concluded that undue narcissism in leaders must be extinguished, perhaps a warning still relevant today.

He and his mother emigrated to Israel where he attended medical school. He later became a professor of psychiatry at Yale (where I also went to medical school) from 1967 to 1971). One of my classmates conducted some of the earliest Holocaust interviewing for his research project.

In his clinical work, Dr Laub focused on survivors of trauma. He died on June 23, 2018.

Perhaps the ambivalence of Dr Laub about how much he, his interviewees, and patients needed to remember and process is true of all these eulogies. Do we really need to know some of the lurid and sensationalistic details of their lives? Is this more of morbid curiosity or voyeurism than psychological analysis and insight? As Dr Laub did, I end up concluding that there is too much to learn what we can from extreme behaviors of people, including psychiatrists.

Dr Moffic is an editorial board member and regular contributor to Psychiatric Times. He was a tenured Professor at the Medical College of Wisconsin until he retired in 2012. Since then he has functioned as a private community psychiatrist providing pro bono services locally, nationally, and internationally. Currently, Dr Moffic is focused on four major advocacy initiatives: physician burnout, climate instability, Islamophobia, and Anti-Semitism. He is co-editor of Combating Physician Burnout: A Guide for Psychiatrists, with Sheila LoboPrabhu, Richard F. Summers, and Sheila Loboprabhu.

References:

1. Psychiatrist: Dahmer said his life was “falling apart.” The Journal Times. February 6, 1992. https://journaltimes.com/news/national/psychiatrist-dahmer-said-his-life-was-falling-apart/article_3ed180df-0e0d-53fb-8426-e62b864ca4cb.html. Accessed January 3, 2020.

2. Khatchadourian R. Operation Delirium: Decades after a risky Cold War experiment, a scientist lives with secrets. The New Yorker. December 10, 2012. https://www.newyorker.com/magazine/2012/12/17/operation-delirium. Accessed January 3, 2020.

3. Ketchum JS. Chemical Warfare Secrets Almost Forgotten: A Personal Story of Medical Testing of Army Volunteers during the Cold War (1955-1975). Bloomington, IN: AuthorHouse; 2012.

4. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Addison-Wesley, 1997.

5. Laub D, Poldell D. Art and trauma. Int J Psychoanal. 1995;76:991-1005,.