In Memoriam: Their Ethical Ways

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We are approaching Memorial Day in the United States, which is annually observed to honor the men and women who have died while serving in the military. In our own way, psychiatrists serve the country by trying to improve the mental health of our citizens, and to do so by following the highest psychiatric ethics. Some of our leaders who have paved the ethical way have died over the past year. In order of their deaths, here are their eulogies. As always, sources are from public obituaries and/or my own personal information.

Richard S. Epstein, MD

Dr Epstein died on May 8, 2020 at the age of 80.

His career was exemplified by connecting religion, psychiatry, ethics, and the law in both his professional and personal life. Such connections had been unusual in psychiatry ever since Freud claimed that religion was a mass neurosis and was an atheist himself. For many decades afterwards, psychiatrists had a more reduced belief in religion than the public and other medical specialists.

Dr Epstein was different. Like in the Robert Frost poem of the same name, he took the road less travelled. He built his daily life around his commitment to Judaism and was a devoted member of Chabad of Potomac. For example, he spent 8 years handwriting a new Torah, the holy book of Judaism. Every letter had to be perfect. I doubt we could find another psychiatrist who accomplished this painstaking, perfectionistic, and precious task.

His professional complement to Torah study could be many ethics and forensic-based activities, but one in particular stands out because it is a different kind of writing. To address one ethical challenge, that of appropriate boundaries with patients, he wrote a book: Keeping Boundaries: Maintaining Safety and Integrity in the Psychotherapeutic Process.¹

Some of the appreciation for his work can be seen in comments for the Hines-Rinaldi Funeral Home. This unusual one came from a lawyer, who emphasized that Dr Epstein could not help but be therapeutic, even when he was serving as an expert witness:

I was a young lawyer just starting out in the field of personal injury . . . I was introduced to Dr Epstein as a potential expert for my case. . . He has always been more than just an expert to my clients. . . he was such a caring, involved professional. . . there was not a person he encountered, for whom he did not show the ultimate in compassions and empathy.

Frederick King Goodwin, MD

Dr Goodwin died on September 10, 2020 at the age of 84.

His accomplishments were extraordinary. Probably his middle name—King—seemed fitting at times. For instance, he was the first to publish a controlled study on the benefits of lithium and then he became an expert on bipolar disorders. 

Among his leadership positions in many organizations, he was appointed to head the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) in 1988. However, in 1992, as part of his “Violence Initiative,” he used the word “monkey” in a slide and discussion of inner-city youth. Even though his comments may have been misinterpreted, they were interpreted as racist, and he was forced to resign. This was an early example of our current racism challenges in psychiatry.

Later, he was embroiled in another one of our current controversies: being influenced by pharmaceutical companies. He apparently did not disclose his income from some of these companies while hosting the PBS media program Infinite Mind and recommending use of their medications.

From both controversies, he responded with resilience, going from setbacks to triumphs. Here we could see another play on words of his name, that is the good win of his last name.

He later was a psychiatrist to VIPs in Washington DC, but, once again, became involved in legal concerns and closed his clinic. As we know, treating VIPs is not for most psychiatrists and comes with countertransference challenges.

For years, he was a mentor to another very well-known psychiatrist—Nassir Ghaemi, MD MPH—who wrote a loving tribute to him. Clearly, Dr Ghaemi felt that his ethical goods far outweighed any associated lapses.

Gail Barton, MD

Dr Barton died on December 27th, 2000 at the age of 83. She followed the passing of her well-known psychiatrist father, Walter E. Barton, MD.

She had a diverse career with many leadership positions that led her to write textbooks on hospital administration and time-management. In those administrative positions, in male-dominated organizations, she again and again took personal risks in order to champion women’s resources and equality, achieving much success in the process.

That apparent risk-taking for important causes emerged in other psychiatric areas. One of them was pet therapy. Using her own golden retriever, Scrappers, she made the unusual decision to bring pet therapy to various inpatient units, apparently brightening the day for the patients.

Although art therapy has become less common in psychiatry, she championed art in psychiatry in a different way. An artist herself, she served as a President of the American Psychiatric Association (APA) Arts Association.

Carola Eisenberg, MD

Although many of our eulogies have been for psychiatrists who died at an old age, Dr Eisenberg was probably the oldest. She died on March 11, 2021 at the age of 103.

Certainly, human rights are an ethical ideal in medicine. Dr Eisenberg was one of the founders of Physicians for Human Rights (PHR), which documented torture and abuse internationally. To help address that the prevalence of torture, including recovery from the trauma, PHR advocated for asylum in the United States. Dr Eisenberg was a chair of the Asylum Committee. She once was quoted as saying: “I felt it was my moral obligation to do something about it.”

Some of her social consciousness seemed to come from visiting a hospital in her native Argentina as a teenager, where she was shocked to see hundreds of patients chained to their beds. She was descended from socialist refugees from Russia and came to the United States in 1945.

Like Dr Barton, she was also a champion of women’s rights, and was the first female dean of students at the Massachusetts Institute of Technology. She wrote the landmark article “Medicine is No Longer a Man’s Profession” for the New England Journal of Medicine in 1989.² She advocated for women to show their compassion as a strength and urged male doctors to do the same.

No surprise, then, that she received many awards, including the APA Human Rights Award in 2005. She also cofounded the Leon and Carola Eisenberg Award of the Physicians for Human Rights.

The Ethical Ways

There are many ethical challenges to address in our field. Sometimes it is not choosing between an ethical good and ethical bad, but among 2 different goods or 2 different bads. Sometimes, too, minor—and even unconscious—slip-ups can tarnish shining ethical work.

These 4 psychiatrists addressed some of the most complicated and important ethical challenges, often incorporating their own personal moral beliefs into these professional ethical struggles. Moreover, often being among the first to do so, their reputation could be at risk from unanticipated minefields.

Though Dr Epstein wrote much about keeping appropriate clinical boundaries, he also helpfully crossed conceptual boundaries by combining psychiatric, religious, ethical, and legal principles. Dr Goodwin, in his very visible professional and public leadership years ago, ran afoul, perhaps inadvertently, of some of our current ethical challenges surrounding racism and the complicated influence of psychopharmaceutical companies. Both Drs Barton and Eisenberg addressed and overcame the sexism in our field, organizations, and broader society. Both also argued for freedom and human rights for all.

We could do well to learn and model from the lives of these psychiatrist leaders. Let us salute their ethical accomplishments and risk-taking for our causes.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times^TM.

References

1. Epstein RS. Keeping Boundaries: Maintaining Safety and Integrity in the Psychotherapeutic Process. American Psychiatric Association; 1994.

2. Eisenberg C. Medicine is no longer a man’s profession. Or, when the men’s club goes coed it’s time to change the regs. N Engl J Med. 1989;321(22):1542-1544.