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A Eulogy for Daniel Keith Winstead (1944 – 2021)

by Barry Blackwell

 

        Dan and I met for the first time at the University of Cincinnati in 1970 when psychiatry was at a crossroads between the hegemony of psychoanalysis over American academic departments and the burgeoning evolution of psychopharmacology largely imported from Canada and Europe.

        Born 10 years apart in Britain and America, Dan was 26 and I was 36, but our early educational experiences were a mirror image.

        Dan had deferred his military service and distinguished himself with four Research Fellowships from three institutions. Two as a medical student in psychiatry from Hahnemann Medical College, Philadelphia, and Langley Porter Neuropsychiatric Program, San Francisco, and then his M.D. and two Psychiatry Fellowships (including the Beauchamp Award) from Vanderbilt. Nashville.

        In 1968 I migrated to become Director of Psychotropic Drug Development at the Merrell Pharmaceutical Company in Cincinnati, Dan’s home city. Hoping I would help discover new compounds for psychiatric disorders commonly seen in primary care, the contract also gave me one day a week to teach medical students and psychiatric residents at the University of Cincinnati School of Medicine. So, in 1970 I switched roles to join the University as Professor of Psychiatry, Director of the Psychosomatic Unit and Associate Professor of Pharmacology.

        This was the year Dan became a resident.

        As befit Dan’s mature personality and diverse academic accomplishments, our closeness in age and common experiences, Dan sought me out as a supervisor. We bonded and began a lifelong friendship, wives and children included, first in Cincinnati, then between Milwaukee and New Orleans.

        Dan’s training in Cincinnati lasted only three years from 1970 till 1973, divided between adult and child psychiatry fellowships, concluding when he was drafted to the U.S. Army Hospital in Nuremberg, Germany, as a major.

        During our time together I involved Dan as the first author on two research studies, but not appearing in print until after he left for Germany. Between 1970 and 1974 there was a remarkable increase in the use of diazepam (valium) in the United States. Due to industry contacts, I had access to national prescribing data derived from a prescription audit of 400 drug stores throughout the United States (Blackwell 1973).

        Together we discussed and devised an innovative and ethical research study designed to explore how and for what diazepam was used by patients without physician influence. “Diazepam on Demand” received no funding from industry and ran for six months on a psychiatric inpatient unit. The results were published in the Archives of General Psychiatry (Winstead, Anderson, Eilers et al. 1974).

        A second study with the same authors compared patterns of drug use in five city hospitals, (VA, teaching, State and two private institutions). Less innovative and informative the only important finding was a failure to discontinue or titrate a first-choice drug before or after adding a second one.

        During Dan’s time as a military doctor, he produced another 12 publications on a wide variety of topics in both civilian and military journals. He received the Military Commendation medal (1976) and there is little doubt that his time in a large active military hospital enhanced administrative and fiscal skills that later contributed to his success and skill as a Department Chair. 

        Dan had returned from military service in 1976 and had achieved his Boards in Psychology and Psychiatry the previous year. He wasted no time becoming an Assistant Professor at Tulane and Chief of Psychiatric Staff at the New Orleans Veterans Administration Hospital. Three years later he became Director of Consultation Liaison Training at Tulane and Visiting Physician at Charity Hospital.

        Dan and I met as I was about to leave Dayton for Milwaukee where I had accepted another innovative challenge to become the Founding Chair of Psychiatry at a developing Milwaukee Campus for the Wisconsin University Medical School in the downtown Jewish Hospital. Madison needed to expand its urban pool of patients for medical student and resident training in medicine and obstetrics. Part of this plan was to develop a residency training program to supplement a shortage of psychiatrists. I had hoped to recruit Dan as a faculty member, but it was already crystal clear he was destined for a Chair of his own and he had fallen in love with New Orleans, its jazz culture and exotic cuisine. His wife Jenny, a talented teacher in the early grades, had found a position in an elite inner-city school and they had found a home with a swimming pool backing onto the levy.

        So, I settled for less; Dan and I agreed to collaborate as co-authors on an article about our experiences prescribing medications to treat psychiatric disorders in primary care, Psychotropic Drugs; A Biopsychosocial Approach.” It was published in Family Medicine (Winstead, Blackwell and Lawson 1979).

        In a few short years Dan climbed the academic ranks to become an Associate Professor in 1979 and a tenured Full Professor in 1984. During this period our contacts were more domestic than educational but in 1986 Don became acting Chair of the Combined Departments of Psychiatry and Neurology. The following year he was appointed Robert Heath Professor and Chair of a new Department he named, Psychiatry and Behavioral Medicine, the same designation chosen for the first time by Joel Elkes when he moved to Johns Hopkins in 1963.

        Dan was now in a position to influence the direction of his own new department. In five years (1987-1992). I was invited to give four talks in New Orleans or at Tulane on topics of my own. Emotional Disorders in Residency Training (1987), Abnormal Illness Behavior (1988), Chronic Pain Management (1990) and Homelessness and Mental Disorders (1992).

        Meanwhile Dan was busy with his own projects. In those same five years he published 25 papers (double the number I produced); 21 were with fellow faculty. Dan, admired for his generosity, yielded first authorship, often to junior faculty, in 17 (80%) occasions. One third of these publications were on neurologic aspects, all except one in patients with schizophrenia. Despite the change in the name of his department from Psychiatry and Neurology to Psychiatry and Behavioral Medicine, Dan’s interest in the biological domain remained.

        In 2010 I received a phone call from Dan with the intriguing suggestion I take his place as the guest speaker for the graduating ceremony of the charter class of a new psychiatric residency training program at Wright State University, Dayton, OH. The current Chair of Psychiatry, Jerry Kay, had been a resident with Dan in Cincinnati when I was a faculty member and resident supervisor.

        I had designed my talk to confront the anomaly that the pharmaceutical companies had co-opted and corrupted academia and psychiatrists were widely regarded as “pill pushers” (Blackwell 2020; Shorter 2021), but was delighted to learn from Jerry Kay that the Wright State Psychiatry program (and presumably its progenitor at Tulane) had become widely recognized and respected for confronting this false dichotomy with innovative ways to train residents in sophisticated biopsychosocial talent and skills. Jerry Kay and Dan Winstead deserved the credit.

        Family visits to Dan and Jenny in New Orleans included Mardi Gras on several occasions including one in a major thunderstorm that drenched us without dousing our spirits. We also visited the Sculpture Park, the Art Museum and the World War II exhibit. Jazz and elite dining were inevitably included. I remember a visit to Antoine’s Restaurant where we entered down an alley and back door to be welcomed by “Chester,” Dan’s personal waiter. Dan took the opening salvo of his order without a menu or wine list – he had them committed to memory.

        We visited before and after Katrina in 2005, and I admired Dan’s commitment to learning and sharing the lessons of its impact on both his Department (Winstead and Legeal 2007) and the city of New Orleans (Potash and Winstead 2008).

        Sadly, we also witnessed Jenny’s decline into Alzheimer’s Disorder and eventual death, followed by Dan’s admission to assisted living.

        Dan’s closest friend, lifelong colleague and fellow gourmand, Don Gallant, had left New Orleans after his home was destroyed by Katrina and now, he too had died. So, at my last visit with Dan, we agreed we would compose a eulogy to commemorate Don’s extraordinary professional life, his magnificent work ethic and commitment to patient care. Our last task together has been accomplished and published on the INHN website (Blackwell and Winstead 2021).

        Dan and I remained in phone contact and both Kathie and I hoped to see him again. But several days after Hurricane Ida struck on the exact anniversary of Katrina I called to see if he well but there was no answer. Dan was gone.

        Our collaborative, congenial, personal and professional relationship that began in 1970 lasted just over half a century and is now, sadly and abruptly, ended.

 

References:

Blackwell B. Psychotropic Drugs in Use Today: The Role of Diazepam in Medical Practice. JAMA 1973;225(13):163741.

Blackwell B. Treating Depression: An Odyssey. Cordoba, INHN Publisher; 2020.

Blackwell B, Winstead D. A Eulogy for Don Gallant. inhn.org.biographies. January 28, 2021.

Potash MN, Winstead D. A Review of Mental Health Issues as a Result of Hurricane Katrina. Annals of Psychiatry 2008;38:119-24.

Shorter E. The Rise and Fall of the Age of Psychopharmacology. Oxford University Press; 2021.

Winstead DK, Anderson A, Eilers MK, Blackwell B, Zatemba AL. Diazepam on demand. Drug-seeking behavior in psychiatric inpatients. Arch Gen Psychiatry 1974;30(3):349-51.

Winstead D, Blackwell B, Lawson TR. Psychotropic Drugs: A Biopsychosocial Approach. Am Family Physician 1979;19(1):109-14.

Winstead D, Legeal C. Lessons Learned from Katrina: One Departments Perspective.   Acad Psychiatry 2007;31(3):190-5.

 

January 20, 2022