40th Anniversary of “Homosexuality” Being Removed from DSM

Alfred M. Freedman, M.D>
Alfred M. Freedman, M.D.

DSM-II-Homosexuality1December 15th 2013 is the 40th anniversary of the historic event of “homosexuality” being removed from DSM ( Diagnostic Statistical Manual of the American Psychiatry Association )

In 2007 I interviewed Dr. Alfred M. Freedman who had been President of the American Psychiatric Association in 1973 when this event occurred. He described the details of how this resolution was passed by the APA Assembly . The interview was part of  a video podcast series which I was doing at New York Medical College. It was subsequently transcribed in the Journal of Gay & Lesbian Mental Health Volume 13 Number 1 January -March 2009 pages 62-68. The interview is available on the Internet in 5 short segments. Segments  3-5 deal mostly with this issue. In view of the historical significance of this event. I have put links to this interview below:

Interview with Dr. Freedman – Segment #1 – 6 minutes 20 seconds  http://www.youtube.com/watch?v=jhiyDAprlP4

Interview with Dr. Freedman – Segment #2 – 9 minutes 58 seconds http://www.youtube.com/watch?v=smvDA_9GJyE

Interview with Dr. Freedman – Segment #3 – 8 minutes 41 seconds http://www.youtube.com/watch?v=bmtr5kmpBus

Interview with Dr. Freedman – Segment #4 – 7 minutes 59 seconds http://www.youtube.com/watch?v=zLREZflrQrA

Interview with Dr. Freedman – Segment #5 – 4 minutes 24 seconds http://www.youtube.com/watch?v=z5YsWT48lEE

For more information about Dr. Freedman see an earlier blog .

 

Michael Blumenfield, M.D.

mblumenfield@aol.com

 

 

 

Abe Halpern, M.D. (1925-2013)

 

Dr-Abraham-Halpern150My friend and colleague Abe Halpern passed away on April 20, 2013. Abe was a remarkable and unforgettable person. He was a loving and dedicated husband, father, grandfather and and great grandfather.  He also was a skilled forensic psychiatrist and an activist for many the causes in which he deeply cared about.

Abe and I belonged to the same District Branch (Westchester Psychiatric Society) of the American Psychiatric Association and were both on the faculty of New York Medical College in Valhalla, New York, so I had numerous opportunities to see him in action. I also observed him stand up for his beliefs at the Assembly of the American Psychiatric Association where he introduced various resolutions which were passed due to his persuasive advocacy. He was a reader of this blog and was kind enough to frequently make constructive suggestions to me.

 

I had the opportunity to sit and down  and conduct a one to one  recorded interview with Abe where he discussed three topics which were dear to his heart. This interview is presented below in three parts:

Halpern

Part One  – Is there a role for a psychiatrist in the care of a prisoner who is being executed?

Part Two – Is there a role for a psychiatrist in the questioning of a prisoner?

Part Three – Should Marijuana be legalized ?

 

 

Born 2/2/1925. Died 4/20/2013 as a result of an earlier fall. His family emigrated to Canada in 1927. As a teenager, he joined the Royal Canadian Navy serving in both the Atlantic and Pacific theaters during WWII. After the Korean War, he was honorably discharged at the rank of Lieutenant Surgeon Commander. A medical school graduate of the University of Toronto, he practiced psychiatry for over 50 years and was a leader in the subspecialty of forensic psychiatry. Awards from the American Medical Association, American Psychiatric Association, and from many other organizations of medicine reflect a life dedicated to human rights. He marched with Martin Luther King, Jr. in Selma, fought against China’s torture of the Falun Gong and illegal organ transplantation, the misuse of the insanity defense, and forced psychiatric hospitalization without judicial review. He was a national and international leader against the involvement of physicians in capital punishment and also physician participation in coerced interrogations of prisoners. All were subject of his prolific publications. He is survived by his beloved wife Marilyn, and his loved children (and spouses) Howard, Lon (Barbara), Marnen (Herdis), Chaia (Adam), Mark (Tomoko), Emily, and John. He was an adoring grandfather of 11 and great-grandfather of 5.

 

On May 20th 2013 the Social Psychiatry Committee of the APA awarded Abe Halpern the Humanitarian Award. John Halpern accepted the award on behalf of his father. In the future this award will be named the Abe Halpern Humanitarian Award. Click here to see John’s tribute to his dad on that day

 

 

 

 

My Introduction to Telepsychiatry

The following is an article which I wrote for the current issue of the Forum. This is a publication of the American Academy of Psychoanalysis and Dynamic Psychiatry of which I am the current President.

images-1President’s Message: My Introduction to Telemedicine/Telepsychiatry

By Michael Blumenfield, M.D.

 

There are many psychiatrists and other therapists who have been involved for at least several years with using   computers and video cameras through the Internet to see patients and teach. From time to time over the years I have attended presentations that described the pros and cons of this activity. I recall some of my skeptical colleagues saying until you can smell the patient, they were not getting involved. I always thought that was extreme but recall another statement bandied around that you have to be able to get a very good look into the patient’s eyes in order for this technique to be useful. Still others likened this approach to therapy on the telephone which some favored in rural areas with circumstances where there were no access to in-person therapists.

My interest in this subject was renewed about 3 years ago when I left New York Medical College. I established a practice in Los Angeles and began to explore some new venues. Dr. Elise Snyder asked me if would like to teach and do other activities with the Chinese American Psychoanalytic Alliance program (CAPAChina.org) that used SKYPE and OooVoo to teach classes, supervise therapists, and treat therapists who were in their training program. By this time I had experience using SKYPE communicating with family members and sharing some travel experience live online from far away countries.

CAPA is an extremely well organized program that continues to grow and offers eager Chinese therapists a chance to receive a high-quality two year training program in psychoanalytic therapy. Within a short time after connecting with them, I could not believe that I was sitting in my office talking and interacting with 10-12 Chinese students in three different cities. Needless to say, I do not speak Chinese and to be accepted into the program the Chinese students must be fluent in English.

I was re- reading and discussing some classical psychoanalytic papers which I hadn’t read in many years. I was also learning about some subtle cross cultural concepts. For example, the concept of shame in China is a very important one and is quite different than the concept of guilt which is so important in western culture. I recall one homework exercise I gave the students which was to discuss clinical examples of shame in their therapy work or alternatively from their own life experience. One bright student told how he as a young boy would make up stories of things he said that he did wrong order to show shame which pleased his grandparents and made them very happy.

The opportunity to do one to one supervision and also some individual psychotherapy also revealed new issues reflecting the Chinese experience. For example, a patient after several months in treatment began to mention that when she was five years old, she and her family had to move to the countryside. Her memories about that time seemed to be very benign. Doing some calculations in my mind about the little Chinese history that I did know, I inquired if that wasn’t a difficult time when many people were being punished and treated badly as part of “re-education “ measures. This inquiry led her to begin to rock and back and forth and cry as she recalled that that was a terrible time in the history of her family.

P1000104

       CAPA Graduation Ceremony in Beijing

In other ways the issues of trust, speaking freely and the resistances to doing so are important in therapy but are colored by the Chinese culture and the prevailing changing atmosphere in China. All this was very enlightening to me and emerged from my limited work with CAPA and telepsychiatry. My work with CAPA led to me to going on a CAPA study tour where I was able to lecture in China, meet some the students in person and attend the student graduation program in Beijing.

GlobeHands

Our experience with CAPA led my colleague Dr. Jim Strain and I to set up a non-profit teaching program in Psychosomatic Medicine for third world countries (PSMWW.com). We had decided to do this rather than write a second edition for a large textbook we edited in the above field. We thus far have taught two 8-session courses in South America and in Rwanda via teleconferencing. One of the systems we use allows us to share our computer screen and that makes the projection of PowerPoint sides particularly useful. However the most meaningful part of the teaching is the direct interaction with the students. This exposure, and the nature of the teaching material we have chosen that is greatly influenced by psychodynamic experience, is also proving to be  interesting from a cross cultural point of view.

I had a completely different experience when I signed up to work one half-day a week with the California Telepsychiatry Group (caltelepsych.com/) that is part of American Telepsychiatrists led by Dr. John Schaffer. This group has a contract to provide psychiatric care via video conferencing for several mental health clinics in central California.images-2 They use a system called Web-Ex which seems to be even better than SKYPE and OOVOO. They also have a sophisticated online electronic medical record that I can easily access as well as an online prescribing system called Infoscriber where I can directly prescribe to any pharmacy in California.

American Telepsychiatrists has many other sophisticated features. The sessions take place in a private room in a clinic while I am comfortably in my office in Los Angeles.  I  have a psychiatric nurse present with the patient and/or a translator when needed. While I am doing mainly psychopharmacology, I can refer the patient to individual and group therapy, to primary care physicians, and to substance abuse programs, and I can order lab work, communicate with other health care workers, and send patients directly to the hospital or do anything that I might do from my private office. The psychiatric nurse with whom I work, and the staff, are helpful and supportive. Patients adjust easily to this form of communication and most of them are extremely appreciative of the care that thteleconferenceey are receiving.

Only recently have I considered using telepsychiatry in my private office practice. There were two instances where college students with whom I was working were going back to college and they wanted to continue their sessions while they were away at school. They were very comfortable with SKYPE and one of them used it on his i-phone. The therapy didn’t miss a beat. One session took me zooming from room to room as the student’s roommate had unexpectedly appeared and the patient was trying to keep his therapy confidential.

I started using SKYPE to treat a new patient who was from another city and expected to be traveling to Los Angeles from time to time for occasional face-to-face sessions. Of course resistance and transference issues have to be considered when there is the lack of an in-person presence. Recently a patient being seen through SKYPE asked if I would mind if he lit up a cigarette. That issue hasn’t come up in over 20 years since I removed the ash trays from my office. So while the smoke wouldn’t bother me, of course I had to explore the patient’s state of mind for wanting to light up at that time.

We are becoming more of a global society. AAPDP is having an increasing number of international members. We comfortably travel in airplanes and through the Internet. It seems only logical that we should take our professional lives with us on these journeys.

Alfred M. Freedman (1917-2011)

On April 17, 2011 Alfred M. Freedman died in New York at the age of 94. Dr. Freedman had been the 102nd President of the American Psychiatric Association and also had been the Chairman of the Department of Psychiatry at New York Medical College.

A Gentle Giant in American Psychiatry

On April 17, 2011 Alfred M. Freedman M.D. died in New York at the age of 94. He left behind a wife, two children, two grandchildren, innumerable colleagues whose careers were greatly influenced by him as well as a mental health community with untold numbers of patients most of whom will never know how his career has led to improvements in  their care.

I first met Dr. Freedman in 1980 when he hired me to be on the faculty of New York Medical College. He was at an age at that time when one might mistakenly think he was in the twilight of his great career. He had already edited what was clearly the definitive textbook in Psychiatry. Generations of psychiatrists learned psychiatry and prepared for their board examinations by reading Freedman and Kaplan. New psychiatrists to this day read the later versions of this book which he originated. When I met him, six years previously, he had been elected the 102nd President of the American Psychiatric Association after his name had been placed on the ballot through an unusual membership initiative. After his  arrival at New York Medical College, he built the Department of Psychiatry from a part time faculty to a major institution on both the local and national scene with innovative programs in many areas particularly in substance abuse. He had moved the departmental office to Westchester where I would be working in consultation liaison psychiatry  and integrated the department into Grasslands Hospital which would become known as Westchester Medical Center and the Psychiatry Department as the Behavioral Health Center. He also supported the New York Medical College Psychoanalytic Institute. His welcoming words of advice to me were to tell me that I should always remember that we are team players in this department. While there was never a doubt that he was the leader, he ran the department allowing the Associate Chairs and the division heads to all be creative and reach their full potential. He supported and personally encouraged the most junior faculty members. He was always very generous to his faculty.

I recall at one time when I had developed some expertise and experience in disaster psychiatry he decided to make me the head of a small subdivision in the department, which he called an  “institute” in this area and he insisted that I design some stationery to show this. He gave me the opportunity to write a paper with him in 1984 about depression, which was ultimately translated into German. Having my name on paper with him is one of the very special moments of my career. There are many other colleagues who have similar stories as he always made you feel as if you were an equal working together on the same team. The residents always loved him and he was a role model for every young psychiatrist who trained at any of the hospitals, which were part of the New York Medical College consortium.

Dr. Freedman’s parents where immigrants from Poland and they worked long hours in a small family store to send all their children to college and two of them to medical school. I only now realize that Dr. Freedman was an undergraduate at Cornell at the same time as was my father in law David Groner. It is a pleasing thought to me that somehow their paths may have crossed.

I would like to  reprint a section about Dr. Freeman’s training and early career from a biographical piece written by Dr. Freedman’s friend Dr. Leon Eisenberg on the occasion of Dr. Freedman’s term as President of the American  Psychiatric Association 1973-1974 (Am J Psychiatry 131:7, July 1974) ….

During his college years, Sir Arthur Eddington’s lectures briefly inspired thoughts of a career in atomic physics, but the call to medicine could not be denied. Yet those were days when an unofficial “numerus clausus” prevailed in American medical schools: a would-be physician had reason for anxiety about his chances for admission despite impeccable grades and recommendations. The list of schools that rejected our future President is long and distinguished. By great good fortune he applied to the medical school of the University of Minnesota and was accepted.

The early years in medical school were somewhat of a letdown in comparison to the exciting intellectual horizons college had opened. What made them more tolerable were the evenings and weekends he spent as research assistant in neurophysiology with Professor Herman Kabat, work which resulted in his first two publications on experimental shock. Once his clinical rotations began, medical school came to life: he can still recall many of his first cases in medicine and psychiatry. His commitment to care for urban poor led him to take his internship at Harlem Hospital, where he became aware of the problems as well as the challenges in providing medical care to neglected populations. The year also began his love affair with New York City. He enlisted in the Army right after Pearl Harbor and was assigned at the end of his internship to Arthur Mirsky’s laboratories at Miami.

The most important consequence of this duty station stemmed from a routine assignment to accompany a troop train to Colorado Springs. On his return journey he had gotten as far as St Louis, where he found himself momentarily stranded. Just before the departure of the next train, the ticket clerk called him frantically to offer him a last –minute cancellation. On that tain he was introduced to a Miss Marcia Kohl, who was returning to her home in Miami from college in Ann Arbor. Neither one had any difficulty recognizing that his chance encounter had been fated. Within six months, they were married and have remained, happily so, to this day….

Alfred’s army years were completed at the station hospital of the Third Air Force in Gulfport, Mississippi and he was discharged as a major in 1946. He undertook training in pathology at Mt. Sinai Hospital in New York City (1946-1947) in pursuit of a plan to prepare himself for the study of the biological basis of human behavior. He briefly contemplated completing his training in pathology but he left it upon receiving an invitation from Dr. Harold Himwhich, whom he had met when he was a medical student, to join him as a medical physiologist at the Army Chemical Center at Edgewood. His studies of acetylcholine and cholinesterase, with the use of diisopropylfluorophosphate as an enzymatic poison led to significant publications in the American Journal of Physiology and the American Journal of Psychiatry on the mechanisms of convulsions. Satisfying as he found laboratory work to be, he was drawn again to clinical activities and began his general psychiatry residency training at Bellevue Hospital in July 1948. Upon completing his basic training, he joined Dr. Lauretta Bender as a Fellow, then as staff psychiatrist on the Child Psychiatry Unit (1950-1954). From that period stem Alfred Freedman’s important papers on childhood schizophrenia and his first publications on pediatric psychopharmacology.

At that point Alfred faced a major watershed in his career. He had a half-time position on the Bellevue staff and spent half time in practice. Wedded to New York, he saw no immediate openings for a full-time academic career, although he was the author of some 20 publications including the first one on the psychiatric aspects of familial dysautonomia. Fate intervened in the person of Professor Richard Day, who invited him to head a pediatric psychiatry service at Downstate Medical Center, Brooklyn, N.Y.  From ground zero, Alfred built a major unit. In addition to the continuation of his earlier research interests in schizophrenia and pharmacology in childhood, he began a major study on the influence of biological and social factors during pregnancy and the neonatal period of child development. He demonstrated the markedly greater effect of neonatal hyperbilirubinemia on male infants in contrast to female infants. In a series of classic papers, Helen Wortis and Alfred Freedman have portrayed in unforgettable fashion the bitter dregs of life for children reared in urban slums; they have drawn attention to the interactions between biological and social factors that are so powerful that the combined biosocial insults have proved to be multiplicative rather than simply additive in effect. The splendid fulfillment of his tenure at Downstate, though only five years in duration was a tribute to Dr. Day’s judgment in selecting for chief of service a man only three years beyond his residency…

After Dr. Freedman stepped down from Chairmanship at New York Medical College he seemed to be as active as ever. I would frequently see him and Marcia at various gatherings and psychiatric meetings. He was always warm and friendly. He was also quite vigorous and had taken up the cause of human rights, which I know was never far from his heart. During his APA Presidency he had led a delegation to the Soviet Union and had spoken out about the detention of political prisoners in psychiatric hospitals in the USSR. In his later years he became one of the leading spokespersons, along with his friend and colleague Abe Halpern, in advocating that psychiatrists do not take part in execution in any manner and also that psychiatrists do not take part in the interrogation of prisoners. Their well reasoned ethical arguments continues to influence discussion on this very important topic. Dr. Freedman made very important contributions to revising the World Psychiatric Association Code of Ethics. He also received the APA’s Human rights Award. In the course of his academic work and his advocacy of human rights, Dr. Freedman has lectured all over the world.

It is well known that during Dr. Freedman’s presidency of the APA, homosexuality was eliminated as a designated psychiatric disorder in the official diagnostic statistical manual (DSM). At the time this was a momentous change with far reaching social and legal  implications for people with a homosexual orientation. The beneficial effects is still being played out today as we see the armed forces finally eliminating discrimination of gays and lesbians in the military. Four years ago I had a Podcast on the Internet where I would interview various psychiatrists. During one of his visits to Valhalla (New York Medical College) I invited Dr. Freedman to be my guest on the Podcast. He was then 90 years old and  graciously accepted the invitation.  He shared with me the behind the scenes activities on how he influenced this important event in American Psychiatry. He also spoke of other important issues in his career. I would like to provide the links to the full audio broadcast of that interview and the You-tube video presentation which is divided into segment one, two and three. In it you will hear and see Alfred M. Freedman, a modest, gentle giant of American psychiatry.

Don’t Ask Don’t Tell-Not Psychiatric Topic

There are very few reasons that a psychiatry blog should discuss the recent change in policy of “Don’t Ask Don’t Tell.” After all, homosexuality is not a mental disorder and this is a case of righting a wrong of discrimination and an example of social justice. However, until 1973 American psychiatry considered homosexuality as a psychiatric diagnosis. The behind the scenes story of how the American Psychiatric Association reversed it’s official policy towards homosexuality is explained in an interview that Dr. Blumenfield had with Dr. Alfred M. Freedman who at the time was President of that organization. There are links to a transcript of that interview as well as a 3 part video broadcast on You-Tube or the entire audio of the interview on Shrinkpod which is a podcast.

Recently the US Congress passed a law and the President signed it repealing Don’t Ask Don’t Tell. We are told that it is on fast track for implementation. This means that that another discrimination barrier has been broken and gay Americans will be able to serve our country in the US military as other Americans may do.

There is very little reason that I should have to mention this in a psychiatry blog. After all homosexuality is not a mental disorder. Except perhaps for the fact that Don’t Ask Don’t Tell has caused a great deal of psychological pain to those who have had to hide their identify for fear of being kicked out of the military or  suffering other repercussions. This should not be minimized, but overall it is a discrimination issue and one of social justice but not a significant psychiatric one.

However, it was not always this way. Up until 1973, the psychiatric profession considered homosexuality a mental disorder. There was a DSM code for it. The predominant official psychiatric thinking included various theories how certain types of child rearing may have brought about this sexual orientation. Many psychiatrists believed that therapy could change homosexuality and bring about “normal heterosexuality.”

Obviously there were many psychiatrists and other mental health professionals who did not hold this view. There was an increasing amount of research which did not support it . In fact, some experts believed  that homosexuality was founded on genetic and  biological determinants. There was also a great deal of clinical experience which supported the idea that sexual orientation could not be altered by therapy.

There was an historic meeting of the American Psychiatric Association in 1973 where the APA Assembly debated and passed a position paper stating that homosexuality was not a disorder and an equally historic debate within the Board of Trustees which took this position. It then became the official position of the American Psychiatric Association which has been reflected in subsequent DSM publications.

A few years ago I was broadcasting a podcast on the Internet and I interviewed Alfred M. Freedman who was the President of the American Psychiatric Association in 1973. I asked him about the background and the details of this famous debate. It was a very revealing interview in which he shared with me the behind the scenes activities involved with this event. A transcript of this interview was reproduced in theJournal of Gay & Lesbian Mental Health 13(1) 2009.

Alfred M. Freedman, M.D.

Dr. Freedman was Chairman of the Department of Psychiatry of New York Medical College and hired me on the faculty there in 1980. He is now in his 90s living in Manhattan and still attends meetings of the APA.

I am pleased to be able to provide the links to this video interview which can be seen on You Tube in three sections or heard on Shrinkpod in it’s entity.