Sunday, 07.03.2021

Martin Kassell: One af a Kind of Psychiatrist by Barry Blackwell

Jay Amsterdam’s comment

 

            Thank you for the opportunity to contribute to your extraordinary biographical commentary on Martin Kassell. I believe that there is some additional, if not more personal, information that can be provided by this admiring student of Martin that will add to the nuanced character of your excellent biographical sketch.

            For example, it is noteworthy that Martin is the oldest living member of the American Psychiatric Association (if not the oldest member of the psychiatric profession writ large) who is still actively working (albeit part-time) at direct patient care, training and supervision of residents and providing clinical consultation to professional colleagues. In essence, he may be the “last soldier standing” who is actively pursuing his profession at almost 101 years of age. We should all be so fortunate and caring!

            In addition to his unsung professional achievements, Martin has held a unique position in my own academic, professional and personal life starting in 1970 when I was a first-year medical student at Jefferson Medical College in Philadelphia (one of the oldest medical schools in the US). I first met Dr. Kassell during my initial months as a medical student when the freshman class was divided up into small teaching groups to learn the preliminary methods of concise clinical and scientific writing. At the time, I knew nothing of Martin’s extensive career in general medicine or that he was on the psychiatry faculty at Jefferson; I only knew that he was a no-nonsense sort of guy who appeared to me to be a formidable, if not fearsome, teacher. It was during this one-credit medical writing course that Martin first taught me about character formation (without my even knowing what that was, or that he was doing so) by critiquing my eight-page medical history of my very first patient interview. He criticized it as being “not pithy enough” in communicating medical facts and impressions. He awarded me an “F” for this effort and told me to resubmit it as a pithier product for a final grade (which I must have passed). However, his lesson was most definitely received and not soon forgotten!

 

            It was about five years later in 1975, having switched my residency in obstetrics and gynecology at Upstate Medical Center in Syracuse, NY, to a residency in psychiatry at Thomas Jefferson University Hospital in Philadelphia, that my residency director (the late  Professor Howard Field) offered me the “opportunity” to take a psychotherapy teaching rotation working directly with Martin Kassell to learn interventional psychotherapy. Still traumatized, to some extent, by my original encounter with the formidable Kassell during my freshman year in medical school, I respectfully declined this generous “opportunity.” Field then, with narrowed eyes and a fixed expression, offered me the delightful choice of either working directly with Kassell or working directly with heroin addicts in the methadone clinic in South Philadelphia. I chose Martin with much trepidation and now, almost 50 years later, without regret!

            It was during this period (just prior to Martin’s departure from Jefferson) that my fellow resident, William (“Billy”) Dubin, and I worked in Kassell’s interventional psychotherapy clinic with patients who had been recently released to the community from the Philadelphia State Psychiatric Hospital (aka “Byberry”).  Billy, now Professor and chair of Psychiatry at Temple University Hospital in Philadelphia, had moved from his home in South Carolina in 1974 to take his residency training in psychiatry at Jefferson and to specifically work under the direct supervision of Martin Kassell.

            Billy and I had affectionately renamed Martin’s interventional psychotherapy group  “The Prolixin Clinic” because almost all of the patients attending the clinic had a diagnosis of either chronic undifferentiated schizophrenia or schizoaffective schizophrenia, and were receiving the long-acting, intramuscular formulation of the drug. This was also the period when tardive dyskinesia was just becoming recognized as a not uncommon, possibly irreversible, side effect of long-term neuroleptic drug therapy.

            Without any knowledge that we might be performing a clinical research study, or that we were circumventing the requirements of a formal research protocol, regulatory oversight, or approved institutional informed consent procedure, Billy and I informally undertook what would now be considered a randomized clinical trial, of sorts. We wanted to see if we could possibly reduce, or even eliminate, the risk of neuroleptic-induced tardive dyskinesia as part of the usual pharmacological care that we were providing to Kassell’s patients. With the patients’ verbal permission (although perhaps not with Martin’s expressed blessing), we reduced the monthly dose of intramuscular prolixin by 50% in every other patient who attended “The Prolixin Clinic.” Our goal was to see if the patients who received lower dose prolixin really needed so much of the drug and whether this reduced dose would result in a lower likelihood of developing tardive dyskinesia and other extrapyramidal side effects. We conducted this clinical experiment for more than a year (by which time Martin had departed from Jefferson and his beloved interventional psychotherapy group). Dubin and I found that the reduction in prolixin dosage was not associated with an increased risk of psychotic relapse and that many of the patients in the lower dose prolixin group reported less akathisia and fewer other extrapyramidal side effects during therapy. In hindsight, perhaps we should have published these findings; however, who knew of such things back in those Halcyon days of residency training.

 

A brief, personal note to a valued mentor and friend:

 

            After almost 50 years of professional association and friendship, I can unashamedly tell you, Martin, that you were always a formidable, albeit caring, mentor and role model to me as a young academic psychiatrist. Now, in the autumn of our professional careers, the long-standing relationship between us has taken on an even more meaningful significance for me. You are, indeed, the “last soldier standing” from my earliest professional years; your teaching has far surpassed that of many (often not so effective) psychiatry mentors and teachers from my youthful Jefferson and Penn days. While I have trace memories of many interesting interactions and conversations with notable psychopharmacology and psychiatry researchers from my academic career, at the end of the day you were one of the few figures who I truly respected and regarded as “formidable” and caring. Your style of teaching (so many years ago in the 1970s) shaped my ability to identify and work with so many academic competitors. Your invaluable, no-nonsense approach to psychotherapy also provided me with the ability to survive in the vortex of the academic jungle.

 

April 18, 2019