The Life and Death of Two Psychiatrists

IN MEMORIAM

. . . how to explore the space between the sweetest smile and the saddest tear.
–Jazz Musician Toots Thielemans

In many places this time of the year, foliage is falling and dying. We celebrate this last burst of life by viewing it and exclaiming its beauty whenever and wherever we can.

The season also brings ever-more-popular tricks and treats of Halloween, followed by All Saints Day on November 1, celebrated by parts of Western Christianity. November 2nd is the Day of the Dead, otherwise known as All Souls' Day, a Mexican tradition when ancestors are welcomed back to earth to provide advice and for loved ones to tell their favorite stories about them.

[[{"type":"media","view_mode":"media_crop","fid":"42695","attributes":{"alt":"psychiatry","class":"media-image media-image-right","id":"media_crop_3144556432006","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4643","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"© ChristosGeorghiou/Shutterstock","typeof":"foaf:Image"}}]]As another in our series of eulogies for psychiatrists, we embrace the “Days of the Dead” tradition by telling the stories of two psychiatrists who died recently-one who passed away gently at the end of a long life; the other died violently, much too soon.

What advice would they leave us?

Edwin H. Cassem, SJ, MD

Whenever I think of him, I smile.
–Michael A. Grodin, MD

Perhaps it was symbolic that “Ned” died on July 4th, Independence Day, at the age of 80. In his life and work, he combined the sacred and the secular, the soul and the mind.

His formal name and title make it obvious that professionally he was a rare combination of cleric and physician. In a field that struggles to integrate religion and psychiatry, he was an exemplary model of how to do so. When asked “Are you a priest or a doctor?”, he answered, “It is exactly the same, doctor of body and doctor of feelings and spirit.”

That viewpoint was reflected in a career at Massachusetts General Hospital by being a pioneer on issues on death and dying. Over 40 years ago, he addressed the psychological needs for palliative care and also helped establish one of the first medical ethics consultation committees in the country, known as the “Optimum Care Committee.”

Back in about 1990, when I was asked to form such a hospital ethics committee, I tried to follow his lead and model. As an extension of that over the years, instead of just trying to use the bio-psycho-social model of psychiatry, I tried to advocate for a bio-psycho-social-spiritual model. Following the broader model would certainly be a way of honoring his work.

Caroline Ekong, MD

We are in deep shock and very sad this tragedy occurred.
-father of the alleged perpetrator

All psychiatrists know that despite the rarity of violence on the part of their patients, we are still at risk. We know that we are the victims of more violence from our patients compared with other medical specialists or nurses.¹ Knowing this can paralyze us with fear, so we have to develop a sense for when the risk is higher, but otherwise go about our daily work under the assumption that we are safe.

We also know how difficult it is to predict violence in our patients. When one last saw a patient 3 years ago, in an evaluation ending up as an inpatient commitment due to the judged suicide risk, why would that psychiatrist worry about that patient?

Yet, and little publicized, on October 14, Dr Caroline Ekong, a psychiatrist from Nigeria, was allegedly stabbed to death in her home by such a patient. So far, information suggests that the patient was planning this for a year or so.

In retrospect, a clue of what was to come was his review of Rockford Center, the 118-bed psychiatric hospital, which he posted on November 12, 2014:

The person who imprisoned me was Caroline Ekong, whose ego is so large that she would never be able to admit doing something wrong.²

With the sudden and unexpected nature of her death, what advice would she give us? What advice should we give ourselves? Who would have taken the alleged perpetrator’s online review as a threat?

Given the general violence in the US, along with growing anti-psychiatric rhetoric, more caution is needed. After a request, I once blogged for Mad In America, but then I encountered comments like “Kill all psychiatrists” and “Throw Dr Moffic under the bus.” Fortunately, my wife saw these comments and advised me to stop blogging. I did. Nevertheless, I still try to do what I can elsewhere to resolve lingering resentment against psychiatrists. We should try to be “our brothers’ keepers.”

National Forgiveness Day
What do these two psychiatrists have in common? Is there some place they meet between the sweetest smile and the saddest tear? National Forgiveness Day is the last Saturday in October. This year that happens to fall on October 31st.

Certainly, the Rev Dr Cassem knew of the importance of forgiveness between loved ones before death. Certainly, Dr Ekong would have hoped for forgiveness from a patient she tried to help, as we all would.

The famous harmonica player Toots Thielemans was noted for being able to switch from conveying bittersweet nostalgia one moment to bubbly joy the next. Listen to him, or call up your own memories of losses and successes, as we honor the lives and deaths of these two psychiatrists.

References:

1. Dubin WR, Weiss KJ. Handbook of Psychiatric Emergencies. Torrance, Calif: Homestead Schools, Inc.; 2005.
2. Wilson X. Psychiatrist slaying a shock for industry professionals. The News Journal. October 22, 2015. http://www.delawareonline.com/story/news/2015/10/16/psychiatrist-slaying-shock-industry-professionals/74082364. Accessed October 26, 2105.