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Monday, 01.03.2021

Eulogy for Donald Gallant (1929-2020)

By Barry Blackwell and Dan Winstead

 

Prologue

 

         Almost a century has passed since Don Gallant’s life on earth began. He was born in 1929, two decades before John Cade reported the effects of lithium on acute mania, thus ushering in the serendipitous discovery of drugs for all the major psychiatric disorders (Ayd and Blackwell 1970).

         Don’s professional life as a psychopharmacologist began on the eve of this revolution, flourished in its heyday and lasted almost until his death, at a time when the discipline was foundering and almost extinct (Blackwell 2020).

         This essay is neither an “In Memoriam” nor an “Obituary” but a Eulogy (OED: A piece of writing that praises someone highly. Gr. Elegia). Penned at a time when our discipline is in the doldrums and inspiration is a much needed but rare commodity; a time when our parent ACNP organization seriously considered (but rejected) changing its name, exchanging Neuropsychopharmacology for Neuroscience, preserving the acronym.

         The author’s relationship with Don and their mutual desire to commend him as a role model for a struggling discipline evolved from different perspectives over half a century.

         In 1970 Barry Blackwell, a recent immigrant from the UK where he trained at the Maudsley, became a faculty member of the University of Cincinnati Departments of Pharmacology and Psychiatry where Dan Winstead was a resident. This was on the cusp between the hegemony of psychoanalysis over academic psychiatry and the rapid incursion of psychopharmacology and biological psychiatry. Most residents were in analytic therapy with faculty members, yet both faculty and residents were ambivalent about the changing environment; Barry and Dan bonded, collaborated in research and became colleagues and friends. When, in 1980 Blackwell became Chair of Psychiatry at the Milwaukee Campus of the University of Wisconsin School of Medicine he hoped to recruit Winstead. Instead, they went their separate ways and a few years later Winstead accepted an offer as Chairman of Psychiatry and Neurology at Tulane, his alma mater (1987-2009). Don Gallant was a faculty member there and they became friends and colleagues throughout Dan’s 23-year long career as Chairman.

         Barry’s acquaintance with Don and his career accomplishments came about in two ways. First, when Dan, as Chair at Tulane, invited Blackwell to be a guest lecturer, Barry got to know, like and appreciate Don. This was reinforced when Blackwell was interviewed for his own place in the Oral History of Psychopharmacology (OHP) in 2007 at the annual ACNP meeting where he met Tom Ban who recruited  him to become the deputy editor of the 10 OHP volumes. Barry’s task was to edit three of the volumes and to write brief biographies (dramatis personae) of more than 50 interviewees. Volume 4, Psychopharmacology, included Tom Ban’s 48-page interview of Gallant conducted in 2001at New Orleans when Don was 72. The interview is a treasure trove of information, facts and anecdotes told in Don’s inimitable role as a raconteur (Ayd 2011).

 

The Career of Don Gallant: A Role Model for Psychopharmacology

         Don Gallant was a Renaissance man in the several meanings of that term - a person of diverse interests and talents, someone of humanitarian instincts, a role model to remind us of earlier and perhaps better times.

         Born in Brooklyn, NY in 1929 to a middle-class family, Don attended the local Boy’s High School, did well and at age 17 transferred to Tulane University. He intended to study medicine, influenced by a local physician he admired, but instead fell in love with physics under the spell of a department chair who had worked on the atomic bomb and lost several fingers to radiation. Eventually, discouraged by the devastating effects of atomic weapons and seeing no future in the field he transferred back to medicine.

         In his sophomore year he was attracted to Robert Heath, the charismatic Chair of Tulane’s combined Department of Neurology and Psychiatry who Time Magazine had christened “The Gregory Peck of  Psychiatry.”

         When Don decided to consider psychiatry his medical school friends “sent him to Coventry,” accusing him of abandoning medicine. Don had his own doubts about the analytic theories in the discipline, so in the summer of his sophomore year, 1953, he enrolled as an extern at Gowanda State Hospital in Buffalo, NY.

         In his interview, Don recalled that this was “a fascinating but terrifying experience.” On the eve before the advent of chlorpromazine the only treatments were barbaric, including lobotomy, insulin coma, ECT without anesthesia and submersion in ice cold water baths. Nevertheless, “I enjoyed the patients, I had a tremendous empathy for them.”

         Another lesson learned was that Don “could not see schizophrenia as not being on a molecular or metabolic base.” He noted how psychosis in amphetamine addicts closely resembled schizophrenia and concluded that “psychoanalysis was off track.”

         So, on return to Tulane, he was primed for the career that lay ahead. “It was one of the few places with emphasis on the organic cause of schizophrenia.” Then Don repeats, “my empathy for the patients was very intense.”

         Don’s other reason for choosing Tulane was the unique combination of neurology and psychiatry. He opted to start his first year in neurology and ended as Chief Resident.

         Knowing that Don was already interested in research, Robert Heath invited him to start interviewing the schizophrenic patients he was implanting with subcortical electrodes, a “fascinating incredible experience for a young person not even out of residency.” He spent four months working with Heath, who spent 18 hours daily in his lab, a habit Don would acquire that lasted his entire career.  

         After completing residency Don was drafted into the U.S. Air Force and posted to Clark Air Force Base in the Philippines. From 1959-1961 he was the only psychiatrist and neurologist responsible for 25,000 military personnel, civilians, families and children. In these two years he treated 1,100 patients, including children with attention deficit disorder who he prescribed dextroamphetamine, according to Paul Wender’s protocol, with positive results that “steered me towards psychopharmacology.”

         On returning to Tulane in 1962 Don began the pattern of busy clinical life he would follow for more than 20 years. Never in private practice, he saw more than 10,000 patients during his career. He gave every patient a card with his business and home phone numbers and an invitation to “call any time.” Don did what was unheard of today, including home visits, seeking information and involvement from relatives or work mates to develop support networks designed to deter relapses and encourage compliance – well before that was defined as a concept. “The more eyes you have to help see the world the more valid observations become.”

         Don had a prodigious capacity for hard work and long hours. He rose at 3:30 a.m. to face 18-hour days and what sounds like a seven-day work week. “I think they should have locked me up. I was unbelievably hyperactive.”

         Gallant had multiple roles at different work sites. In the academic program he assisted Robert Heath on his pioneer and controversial work to define EEG patterns and brain-behavioral correlates in schizophrenia using subcortical electrodes. He also worked with psychologist Mel Bishop, learning statistics and becoming co-principal investigator for one of the first Early Clinical Drug Evaluation Units (ECDEU) programs funded by NIMH set up by Jonathon Cole to conduct research on the new compounds developed by industry using standardized protocols and measuring instruments.

         Subjects for these early clinical trials were recruited from five different sites: an outpatient service at Charity Hospital in New Orleans; a schizophrenia research unit at East Louisiana State Hospital (a daily five-hour drive on secondary roads); a 32-bed alcohol and drug abuse unit at Southern Louisiana  Hospital in Mandeville; and the New Orleans Outpatient Alcoholism Clinic. Research at these diverse sites yielded 35 publications in just three years (1963-1965) and contributed to Don’s acceptance as a member of ACNP.

         His work with alcoholics at Charity Hospital particularly interested and shaped him as a clinician. End stage alcoholics, dragged in from the streets, suffering from Wernicke’s encephalopathy, ataxia and ophthalmoplegia responded to intravenous thiamine, ”giving me a wonderful feeling of being a doctor as well as a psychiatrist, and also making me feel the medications had a real definite use.” In this environment, with excellent supervisors of his own, he became a skilled educator. “Medical students Paul Stevens and Peter Rabins published their first articles under my supervision and residents such as Chuck O’Brien went on to become outstanding clinical researchers.” Don also became skilled in group therapy, helpful for alcohol and drug addicts but less so for schizophrenic patients.

         It was at Louisiana State Hospital where Don learned about schizophrenia on the ECDEU Unit, tutored in statistics by Mel Bishop. The unit housed 60 males and 60 females, “unbelievably severely chronic, their mean duration of hospitalization was 22 years, they had not been treated by anyone, just warehoused.” Abandoned by relatives and with almost no verbal output, the rating scales had to be modified to measure behaviors, not speech. It was a population that had almost no placebo response but which responded to medication.

         Under the direction of Jonathon Cole the different ECDEU programs shared data for a period of 16-17 years and Don got to know and collaborate with Heinz Lehmann, George Simpson, Herman Denbar, Sidney Merlis, Sidney Malitz, Sam Gershon and Max Fink, studying the efficacy and side effects of almost all the new antidepressant and anti-psychotic drugs.

         In New Orleans Don began a free clinic in a low income area (the Fischer Project). In addition to treating alcohol and drug abuse he had “some spare time on my hands” so he began a general medical clinic and then hired an African-American woman to pick up school dropouts, based on attendance records, and return them to class.  

         “To show how important a small piece of data is, there were two little girls who missed about 20 days of school in a row in the first and then the second grade. Our woman picked them up, returned them to school and within six weeks their grades were jumping up. We learned their father had committed suicide the previous week and their mother had died from cancer the year before. The children were running wild.”

         Don was able to do this work because the ECDEU money subsidized his faculty salary and he was able to avoid private practice. He did this clinic work “Friday afternoons and all day Saturdays.”

         Don made sure the clinic population knew they were not interested in doing research and he used the patient interactions to teach medical students about inner city medicine. “I should have devoted all my time to this in 1975 or so.”

         In his role as raconteur Don tells the following anecdote:

         “In that time there were a lot of knives and only a few guns. Now there are a lot of guns and a few knives. I would make house calls with the African-American president of the local community organization. One time he asked for personal help. His aunt had come from Connecticut where she was in a mental hospital, now she was in his home with a butcher knife in her hand. So I said, ‘yeah, but you’re coming with me.’ So we went into the apartment and there she is, holding a huge butcher knife in her hand saying, ‘I’m going to be killing someone or myself because the voices are telling me to.’ She looked at me and said, ‘Who are you?’ and I replied, ‘I’m a doctor.’ She answered, ‘You’re no doctor, doctors don’t make house calls.’ I cracked up and started laughing. Keith, the president, joined in and she started laughing and put the knife down. That was a wonderful episode, a wonderful scene. I’ll probably remember that on my deathbed. These things were very rewarding and that was the most fun part of what I was doing so it was well worth it.”

         Don followed up, “I sometimes think I should have devoted all my time to psychopharmacology but when I look back I’m very happy I did all that crazy stuff.”

         When during his interview Tom Ban refers to Don’s list of publications and asks if Don also studied sexual behavior he confesses to another aspect of his “mischievous behavior.” He was asked by a popular magazine, Medical Aspects of Human Sexual Behavior, to write two articles, each in return for $250. “That was a good deal of money for an academic.”

         The first article requested was on “Sexual Positions During Pregnancy.” Knowing nothing of this Don decided to make it up and claimed it was the pes caelum position, which meant “foot in the sky.” The editor changed it to “foot on the ceiling” and published it. The second article was on aphrodisiacs, something Dan knew about with research on pipothiazine palmitate, a long-acting drug with a half life of four weeks. When he presented this paper  to  friends and colleagues at an ECDEU conference he embellished it with a false reference to “The Simpson Syndrome,” alleging that the drug was only metabolized in the liver when drinking “First Growth” French Wines. His friend and fellow ECDEU worker, George Simpson in the audience, was an enophile.

         Around 1973 Don’s friend and colleague, Phil May, President of ACNP, asked him to develop a “Statement of Ethical Principles” for the organization. As Chair of the Ethics Committee and working with Bob Force, a lawyer at Tulane, they spent two years working with the membership. Of the 162 members all but one endorsed it. It was the first Ethics code developed by any medical organization and became available in book form as Ethical Issues in Human Research and Treatment. Don would joke that this considerable work might be due in part to “some guilt about my mischievous behavior.”

         Don’s sense of humor and strong ethical core both contributed to his excellence as a teacher.  Tulane University recognized outstanding teachers with The Owl Club annual award which Don won 15 years in a row. In the late 1970s Don became the Director of Medical School teaching in psychiatry. His task was to recruit teaching faculty, many if which had no grant support for salaries and were forced to see private patients. “I felt like a total bully; it was rewarding but also frustrating.” Don’s persistence and hard work was rewarded with the Gloria P. Walsh Award as Teacher of the Year for the entire Medical School.

         Don’s tenure as a teacher at Tulane lasted 40 years and when he retired in 1994 “Tulane was very nice to me.” They made him an Emeritus Professor along with an office and a secretary. But no salary! For three days each week he taught freshman, sophomore and junior medical students as well as first- and second-year residents. His topics included psychopharmacology of anxiety, affective disorders and schizophrenia, also including group therapy, alcohol and drug abuse.

         Don’s attachment to New Orleans was cemented in part by his love of good food, an indulgence he shared with his friend and colleague George Simpson. At the gourmet restaurants they frequented “one third of the staff were former patients of mine.” The raconteur emerges. “I have a cute story to tell you… at Antoine’s one of the waiters knew me very well and had been a patient of mine, sober for about 10 years and working at the restaurant for 50 years. On my next visit with another friend we learned he had been admitted to Tulane Medical Center with a stroke and went to visit him. I thought he was comatose and stuck him with a pin; he didn’t respond and his reflexes were hypoactive. I thought, oh my God, this doesn’t look good and said to my friend, ‘who are we going to get as a waiter tonight?’ Suddenly this fellow sat up and said, ‘What are you talking about, I’m still your waiter.’” It must have been an ischemic episode, not a stroke. Then Don asks Tom, “want another story?” and encouraged to do so he proceeds.  “At an ACNP meeting in the ‘70s I had a paper to present. My wife was to accompany me but our kitchen burns down with a grease fire. I go alone and that night as I’m taking a shower the phone rings. It’s my wife and as we are speaking the operator interrupts to announce an emergency call from the States. ‘It’s one of your patient’s.’ Being a good doctor’s wife she hangs up. It’s a bipolar patient who has relapsed and is drunk. ‘Dr. Gallant how can I thank you? You’ve cured me and I’ve been able to sell 3,000 pairs of shoes this week.’ I was so upset and aggravated that I hung up. I had a bar of soap in my hand and flushed it down the toilet instead of putting it back in the shower. There’s nothing worse than a bipolar patient who relapses on alcohol. They can drive you nuts, I was turned around.”

         Towards the end of their long interview Tom Ban asks some conventional questions. What would Don consider his most important contributions? He replies, “I don’t think I really made any.” On further consideration he mentions his work on committees, the Code of Principles for the ACNP, his teaching awards and outstanding researchers he mentored. When Tom finally repeats the question Don says, “ My contribution to all of my patients was probably the most important in the long run. My main source of pride is having always been available to my patients 24 hours a day, seven days a week, even though it involved thousands and thousands of patients.”

         Asked about awards and recognition Don names the best as the Gold Achievement Award from the American Psychiatric Association. He had to submit all the research he accomplished in 25 years including the number of patients and the methods studied. “I even enclosed my card with my home and work number. The only time I ever cried at an academic award was during that presentation.”

         In addition to other awards already mentioned for teaching Don received the Association of Medical Educator’s Award for substance abuse and the Robert Lancaster Award for his community work.

         Finally, Don is asked about progress in his field of endeavor. He says he is pleased that the neuroscience, the understanding of how drugs work, “is going in a beautiful direction.” But the clinical area is “one big disgusting situation.” He elaborates, “When a doctor gives out his phone number nowadays, the patient almost dies of shock. Because of time restrictions psychiatrists who work at hospitals, most of what they do is dispensing drugs. There’s very little going on between the patient and the doctor. Let me tell you a story. “One of our outstanding residents went to Seattle. He really enjoyed people, enjoyed relating, was very good with psychotherapy and drugs, going to be an outstanding psychiatrist. He signed on with an HMO for three years and… decided he would be mainly a drug dispenser. If the patient needed psychotherapy he’d be seen by a social worker or a psychologist, which was less expensive. That kind of story is really terrible. I would like not to have so many administrators make medical decisions, who have never seen the patient.”

         Asked what changes he would like to see in psychopharmacology Don replies, “I would like to see the next administration re-establish something like the ECDEU units with Federal funding of independent medical school institutions to do well-designed, reliable, honest, well-controlled drug studies with no impact or pressures from the pharmaceutical industry, whose only role should be innovating and supplying new medications.

         “Most of all I would like to see everyone have free access to good affordable medical care.”       

         Tulane was not the end of Don’s lifetime career as a mentor. In 2005 Hurricane Katrina destroyed his home in New Orleans so he and his wife Joyce moved to Memphis. Don became Clinical Professor of Psychiatry at the University of Tennessee College of Medicine Health Science Center where he taught medical students and resident psychiatrist who recognized him as a “master teacher.”

         Joyce died in 2013 after 59 years of marriage. Don followed her on March 11, 2020 aged 90, an iconic pioneer in the field of psychopharmacology, a revered colleague and a role model of an ideal physician to thousands of medical students and psychiatric residents. May he rest in peace and be long remembered.

References:

Ayd FA, Blackwell B, editors. Discoveries in Biological Psychiatry. Philadelphia; J.B. Lippincott. 1970.

Ayd FA, Series Editor. An Oral History of Neuropsychopharmacology. Volume 4 Psychopharmacology, Levine J, editor. Interview of Don Gallant by Tom Ban. Brentwood, Tennessee ACNP. 2011; pp.75-124.

Blackwell B. Treating the Brain: An Odyssey. Cordoba INHN Publications. 2020. In Press.

 

January 28, 2021