“BITS AND PIECES OF A PSYCHIATRIST’S LIFE”

By

Barry Blackwell, M.A., M.Phil., M.B., M.Chir., M.D., FRCPsych.

Format and Contents

This is a memoir modeled after Mark Twain’s belief it is best to hit the highlights and omit the tedious interludes of everyday life, an idea he never fulfilled. As such it has an unusual, perhaps unique, format comprised of 31 major themes or PIECES, divided into Preparation, Professional and Personal Life. The 31 PIECES consist of 260 bits of varying length made up of short stories, essays, poems, medical articles and editorials, some previously published in professional or lay journals and books. They include 100 poems that mingle sonnets, haiku, limericks, classical rhyme and meter with contemporary free forms that occasionally mimic the subject – a crumbling Egyptian pyramid; Midwest Flight 105 crashing on the page. The book’s format invites the reader to nibble and not gobble its contents while its 608 pages seek to satisfy the readers head, heart, soul and funny bone.

Subject Matter

PART ONE: PREPARATION

Piece 1. Literary Considerations. The book begins by explaining the format, describing the author’s muse and its midlife evolution from scientific to creative writing

Piece 2. The Blackwell Name. Next comes a genealogy, a toponymic name first mentioned as a village in William the Conqueror’s Doomsday Book (1066). The name is traced from that origin through colorful ancestors from different lineages in Britain and America, dating back to before the Mayflower and leading to a 19^th century migrant dynasty that includes the first woman physician in the world, Elizabeth Blackwell, and the first woman pastor in America, Nettie Brown Blackwell who authored a book challenging Darwin’s assertion that the male was superior to the female of the species. These two women’s spouses and siblings were deeply involved in the emancipation movements for slaves and women.

Piece 3. India.The author’s life story begins in detail at age four in India during World War II until the Japanese conquered Burma and bombed Calcutta leading to the repatriation of women and children by convoy to England, dodging U-boats only to be greeted by German rockets.

Piece 4. Boarding School. Amebic dysentery in India before antibiotics and the blitz in Britain meant that from age 5 to 18 was spent in Indian and British boarding schools, a safe distance from germs and bombs. The rewards and rigors of this life shaped the author’s personality.

Piece 5. In Time of War. Graduation from high school led to drafting into the Royal Army Medical Corps during the Korean War.Trained as a sanitary inspector and equipped with a motorcycle the author was posted to Salisbury Plain, close by Stonehenge. Subsequently an officer in a reserve field ambulance, he served in every rank in the British Army from private to major. This Piece also records the family’s service and sacrifice in two World Wars with reflections on the draft, the ‘right to bear arms’ and a serio-comic reflection on the relative success of Brits and Yanks at disposing of Presidents and Royalty.

Piece 6. Cambridge University. From blue collar origins the first family member to go to university began in profligate style by playing rugby, rowing and carousing before graduating with a mediocre degree. A decade later the prodigal returned, among the first in his class to obtain a doctoral degree (in pharmacology).

Piece 7. Guy’s Hospital. Medical student and captain of the oldest rugby club in the world. Becoming serious about patient care, deciding on psychiatry (paying a price) and publishing a first article (Why Patient’s Come to the Emergency Room) in the Lancet as a first year intern. Reflections of the synchronicity between the author’s career trajectory and the evolving field of psychopharmacology.

Piece 8. The Maudsley Hospital.Six months neurology training was followed by psychiatry at the Maudsley Hospital where, as a first year resident, aged 28, the author discovered and described the life threatening interaction of cheese and the MAO Inhibitors, published in the Lancet. This led to a two year fellowship in animal (rats and cats) and human pharmacology explaining the mechanism of action and variables involved. Residency included multiple publications on a variety of topics including a pioneer effectiveness study on the use of MAOIs and a critical controversial review and study of lithium prophylaxis. Anonymous annotations and leading articles on contemporary psychiatric topics were commissioned by the Lancet.

PART TWO: PROFESSIONAL

Piece 9. Family Practice. Too clumsy to be an animal pharmacologist, more interested in people and reluctant to relinquish the breadth of medicine the author became the junior partner in a suburban London family practice. He continued in research by collaborating with David Goldberg (a contemporary at the Maudsley) on the epidemiology of mental illness in primary care. They used and standardized David’s General Health Questionnaire(GHQ) the first instrument to identify mental illness in primary care, publishing the findings in the British Medical Journal. Together with the time constraints of this type of work came a revived preference for the depth and research opportunities of psychiatry which always co-habits with plenty of medicine.

Piece 10. America. Recruited to be the Director of Psychotropic Drug Research for a pharmaceutical company in Cincinnati, Ohio in 1968 at age 34 the author, his wife and three children migrated to America. This important Piece summarizes the sweeping cultural, political, economic and scientific changes that took place in the next 44 years (1968-2012) that profoundly influenced professional life including the pharmaceutical industry, psychopharmacology, the practice of psychiatry, health care, academic medicine and medical education. The Bits in this Piece describe a long delayed transition from immigrant to citizen, issues with assimilation, the ubiquitous influence of growing economic greed and income disparity on the practice of medicine as well as political gridlock and the constitutional flaws that enable it. All of these have shaped the career success and failures related in ensuing Pieces.

Piece 11. The Pharmaceutical Industry. A two year stint in the research department of a pharmaceutical company provided exposure to the burgeoning industry, the opportunity to meet leading investigators in the field, and to teach medical students and residents one day a week in the strongly psychoanalytic University of Cincinnati Department of Psychiatry. Better still it allowed time to pursue research interests and mentoring with Frank Ayd, a consultant, resulting in co-editing “Discoveries in Biological Psychiatry”,  documenting first person accounts of all the major drug discoveries by the pioneers who made them and leading toinduction into the ACNP (1970).

Piece 12. Psychopharmacology: Then and Now.This important Piece includes Bits that cover a fluctuating forty year involvement in drug research, the education of students and residents, the evolution of the ACNP and Big Pharma including innovations and disappointments. These are illustrated with in-depth essays on key events and selected scientists concluding with working under Tom Ban as a volume editor in the Oral History of Neuropsychopharmacolgy (OHP) in time for the fiftieth anniversary of the ACNP (2011).

Piece 13. Psychosomatic Medicine. Abiding interest in the interface of medicine and psychiatry was consummated with a return to academic medicine at the University of Cincinnati including appointments in Psychiatry and Pharmacology as well as Director of the Psychosomatic Unit. With the collaboration of talented nurses and creative psychologists we developed a novel approach to “illness behavior” that challenged the psychoanalytic model and had implications for the evolving field of Behavioral Medicine and Chronic Pain Management.

Piece 14. Medical Education. This Piece covers a twenty year time span (1974-1994) as Chair of Psychiatry at two medical schools with adjunctive appointments in Pharmacology, Medicine and Behavioral Medicine. Wright State University in Dayton, Ohio, (1974-1980) was a brand new medical school, one of over 30 new schools in a nation-wide attempt to train “humanistic” primary care physicians willing to work in underserved areas. Bits in this Piece record the multidisciplinary attempts at innovative curriculum as well as the ultimate failure of the project for reasons not widely recognized in the contemporary attempt to achieve similar goals. The University of Wisconsin Milwaukee Clinical Campus (1980-1994) was an equally ambitious attempt to found an urban campus to train students and residents for the parent program in Madison with the outcome described in Piece 16.

Piece 15. Compliance. This short piece of only three Bits reflects a career long interest in why people often fail to follow medical advice and how to deal with the problem by defining its dynamics and building a therapeutic alliance.

Piece 16. Milwaukee. This covers the time from helping to found the Milwaukee Campus (1980) until retirement (1998). It documents a period of profound change in health care during which five out of six inner city hospitals went bankrupt, sometimes merged and all eventually closed. The Bits include state-wide research on medical residents’ struggles to adopt the physician role, homelessness and mental illness (including a sabbatical at NIMH on a National Task Force), the evolution of the AIDS epidemic, the birth and death of managed care, community activities and the eventual demise of the academic program in psychiatry, later with the entire urban campus, contributed to by the economic management policies of a “not for profit” corporation. (“No Margin, No Mission”).

Piece 17. The Bread and Butter of Psychiatry. This is a collection of five short stories and six poems portraying the nuances of a psychiatrist’s role in combining talk therapy with medication at a time when the profession feels under siege from federal failure to implement guidelines for parity of medical and mental health care allowing insurance companies to deny and erode treatment of this kind.

Piece 18. Spiritual Pilgrimage. This tells of a four year post retirement involvement in a Catholic Seminary studying religion and philosophy in a Master’s program along with male seminarians and middle aged women pursuing the hope of second careers in parishes facing the priest shortage. It employs poetry and a term paper on the “Virgin Birth” to portray the counterpoint between religious faith and scientific skepticism leading to the author’s conclusion he is “spiritually handicapped”.

Piece 19. Good Deeds.  In the time before and after dropping out of the seminary (which soon closed due to impending bankruptcy brought on by the pedophile crisis) the author rescinded the decision to retire from his profession and embarked on four projects that employed a psychiatric background. These were a return to work as the sole psychiatrist staffing four mental health clinics run by Catholic Charities; founding “Faith in Recovery”, a not for profit organization to develop educational and support groups for people and families dealing with mentalillness in faith communities; as a mentor for fifteen years to two men suffering from bipolar disorder with  recurrent psychotic episodes and finally as the only psychiatrist in a women’s prison looking after the half of that population with a mental illness. (2008-2012). Generous remuneration provided help topay for his son’s education as a future family physician.

PART THREE: PERSONAL

Pieces 20 – 31. These final 12 Pieces are devoted to aspects of personal life with bits that include poems, essays and amusing anecdotes. They cover marriage, parenting, divorce, sex, domesticity, hobbies, pets, travel, beauty, ageing and finally life in a retirement community. Some reflect on the interplay of professional and personal life, others are ubiquitous to the human condition viewed through a psychiatrist’s eyes.

EPILOGUE

Apart from the gratification of examining one’s own life a critical question for the author of a memoir is “for who is it intended”?  Other than friends and family perhaps medical students contemplating psychiatry, residents uncertain of what may lie ahead, neuroscience graduates anxious about the future of the field, fellow mental health professionals facing similar challenges, patients who sit on the other side of the desk or lie on the couch, and finally, anyone whose career has been molded by the unpredictable, unanticipated ups and downs of life.

For myself I hope two things are clear to the reader; my career has been devoted to helping those most in need and it was driven by an intense curiosity about the human condition. My entire body of research and writing (Over 200 publications and 4 books) was undertaken to understand and explain to others what I was doing at the time. My salary and the fun of doing it was all it took. None of this was funded by Big Pharma, Foundations or the Federal Government. Almost all of the research  was collaborative with medical students, medical and psychiatric residents, nurses, psychologists, patients, pharmacists, graduate students, pharmacologists, statisticians, internists, an anthropologist, ethicist, sociologist, meditation guru and two drug company detail men (whose careers were not enhanced!). Best of all, much of it was published in leading European and American journals, now buried in long forgotten archives.

Barry Blackwell

November 21, 2013