Melvin Sabshin: A Profile

Bestowed in gratitude in recognition of (his) superb, invigorating leadership of the American Psychiatric Association, his dedication to the principle that the highest quality patient care rests firmly on a true integration of the latest advances in psychodynamic and psychobiological thinking, and his strong advocacy for the scientific validation of what we do--all accomplished with his own consummate grace and elegance.

Thus reads the latest award given to Melvin Sabshin, M.D., just before his full retirement in January from almost a quarter-century of serving as medical director of the 41,000-member American Psychiatric Association.

Given by the American Psychoanalytic Association, this first-ever President's Award is just one of many prizes Sabshin has won over past decades, including the Thomas William Salmon Medal of the New York Academy of Medicine in 1996 and the Distinguished Service Award from the APA 10 years before.

Although Sabshin, 72, retired from his long-held APA position, he did not retire from psychiatry. He accepted a position as clinical professor of psychiatry at the University of Maryland, and will be working on an encyclopedia and other writing projects while remaining active in international affairs.

In a telephone interview with Psychiatric Times, Sabshin, the author of more than 140 scientific reports and coauthor of five books, reminisced about his life and career, and discussed his future plans.

Early Years

He was born in New York City where his father, a doctor, had his office in the house. This influenced Sabshin to practice medicine. "As a kid, I actually went out on house calls with him. He was this great old-fashioned general practitioner who charged $2 if you came to the house and $3 if he went to your home. My mother was very much involved in his work, and it was all quite marvelous."

The young Sabshin attended Townsend Harris High School, a city school that required an entrance examination.

"It was one of the best parts of my education," he said. "I graduated at age 14 and then we moved to Florida, where I graduated from the University of Florida at age 17." He laughed. "I was sort of a fast spurt as a kid."

After receiving his B.S. degree, he went into the United States Army. The year was 1944.

"By this time, I had pretty much decided I really wanted to go to medical school," he said. "We had fun in our family by agreeing I would go to medical school and decide afterwards what I wanted to do. So I was assigned in the army to a hospital in New Orleans and got accepted to Tulane University School of Medicine."

It was during medical school that he moved toward psychiatry.

"There were a lot of things combined in that, including the fact that Robert Heath had come down from New York to chair the department of psychiatry [at Tulane]. He had all sorts of exciting ideas so I applied to stay in New Orleans after medical school."

Sabshin did his internship at Charity Hospital, followed by a three-year psychiatric residency and then a one-year fellowship in psychiatric research at Tulane.

"This was a very exciting time," he said. "Heath had a very interesting department in which there was heavy emphasis on his particular research, which was related to neurophysiological aspects of schizophrenia."

"He did some real pioneering work in that, and the department also had a great psychoanalytic program, which was connected to the program at Columbia University."

After finishing his work at Tulane in 1953, Sabshin went to Chicago, where Roy Grinker, M.D., gave him a research assistantship at Michael Reese Hospital.

"In those days it was a very good hospital," recalled Sabshin, adding that recently the institution has had problems under managed care. "I worked there at the Institute for Psychosomatic and Psychiatric Research and Training, and then became assistant director to Roy, with David Hamburg as the associate director. Grinker himself had been a neurologist before going into psychiatry, and had written a textbook in neurology as well as some of the early books on psychosomatic medicine. It was a great group and those were fun years, with a lot of first-class research done there in psychosomatic contexts."

APA Offers Job

In 1961, Sabshin moved to the University of Illinois where he became professor and chair of the department of psychiatry. In 1967, he took a year's sabbatical as a fellow with the Center for Advanced Study in the Behavioral Sciences in Palo Alto, Calif. In 1973, he became acting dean of the University of Illinois College of Medicine, and in 1974, he was offered and took the position as medical director of the APA.

"I thought it would be very interesting, and I was right," he said of his decision to accept the APA job. "As long as I fully met the responsibilities of being medical director, the job gave me the chance to do almost whatever I chose in terms of the leadership role in this country and around the world."

Sabshin said the APA in 1974 was a strong organization, but needed leadership to forge new activities.

"It needed a strong government affairs approach," he said. "So we brought in good government affairs people, most notably Jay Cutler, and pushed the organization to be involved in real-world activities, to try to mold legislative and executive aspects of the government at the national and state levels. And on an equivalent basis, we pushed to make the organization stronger in public affairs, which John Blamphin has done. And then we developed an Office of Research, which was a whole new role for the APA. With Harold Pincus as director and Deborah Zarin as associate director, this new office was set up to see that the APA played a role in shaping what research in psychiatry would be in the United States and also around the world."

Another mission important to Sabshin was to see the APA move more into international affairs.

"To accomplish this, we first created an Office of International Affairs, run by Ellen Mercer, who has been very effective. Secondly, we pursued a variety of roles internationally," said Sabshin, who himself was an officer for two terms in the World Psychiatric Association; served as a board member of the World Federation for Mental Health; and became a Distinguished Fellow in the Egyptian, Hong Kong, Royal Australian and New Zealand Psychiatric Associations. He was also made an Honorary Fellow of the Royal College of Psychiatrists and the World Association for Social Psychiatry.

Sabshin also helped form an Office of Education at the APA, which was directed first by Carolyn Robinowitz, M.D., later by Jay Scully, M.D., and now by James Thompson, M.D.

"This office has been a very strong bulwark for education across the United States and indeed, the world," said Sabshin. "So there have been many connections made, and I think American psychiatry has been a benchmark for psychiatry in many countries, which is very important. The APA's involvement in international affairs is reflected by the fact that at our last annual meeting, we had 4,000 registrants who were not citizens of the United States. We've become a very big international influence as well as a large national influence."

Throughout his tenure at APA, Sabshin said that he had the approach of wanting to see psychiatry change to a more "evidence-based psychiatry."

"I wanted it to rely on data rather than opinion or ideology alone," he said. "I think this has been a major development over the past 20 years, and because the field did move in that direction, it was better prepared to deal with the vicissitudes of economic pressures. Still, more needs to happen."

Asked how he feels about his accomplishments at APA, Sabshin said he is "proud and happy."

"It was marvelous to be able to do what I really wanted to do," he said. "I accomplished what I wanted, and I thought it was a good time for me to leave."

Sabshin is also proud that his late wife, Edith Sabshin, M.D., will be honored by a just-formed lectureship at the Institute for Psychoanalysis in Chicago.

"She was a real leader in psychoanalysis, and after she died in 1992 a number of people wanted to do something and contributed money," he said, adding that the couple had a son who is now a neurosurgeon, and that two of his sons four daughters are now in medical school.

Life After APA

Today, Sabshin spends three days a week at the University of Maryland where he has an office next door to John Talbott, M.D., chair of the department of psychiatry and a former APA president.

"I'm meeting the staff and will start teaching and writing, and possibly also play a role at Sheppard-Pratt Hospital," Sabshin said. "I've also just taken on the responsibility to be editor of a new section on psychiatry for an encyclopedia of social and behavioral sciences, a very nice opportunity in that it gives me a chance to review developments in the field. And I'm interested in how pharmacotherapy and psychotherapy can be integrated better, so some of the writing I want to do relates to that, both in this country and internationally."

Sabshin said the Royal College of Psychiatrists of the United Kingdom has offered him office space to do some of this work.

"I'll be in England this summer and have a chance to think about the combination of pharmacotherapy and psychotherapy, an essential part of what psychiatry needs to be thinking about," he said. "It'll also be a nice opportunity to learn more about the British psychiatry system."

Asked what concerns him most about the field of psychiatry in the United States today, Sabshin named managed care.

"There are great pressures to have a more accountable and managed psychiatry, and the impact of managed care has been enormous in causing qualitative changes in the way institutions and individuals practice," he said.

Sabshin stressed that it is not only psychiatry that is affected by managed care.

"In some cases, it's affecting other parts of medicine even more than psychiatry," he said. "The effect of managed care, for example, on hospital-based practices, is enormous, with fewer people now going into anesthesiology and radiology. The effect on psychiatry is also enormous, with many young people feeling unsure of how the field will make out economically and otherwise. This is a period of real uncertainty."

Still, said Sabshin, despite the very real pressures, the United States remains a fountainhead for research in the field of psychiatry.

"I cannot overemphasize the important roles of the National Institute of Mental Health, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism," he said. "It's extremely important that we have such places, and I have high regard for them as the leading institutions of the world."