May 30, l998
[Fall 1998; Vol.25 No. 2]
Bruce Hershfield, M.D. is a past president of the MPS and is currently an MPS representative to the APA Assembly of District Branches. He is in private practice in Maryland and Pennsylvania.
Dr. Hershfield:” Dr. Sabshin, would you please tell us what you have been doing since you’ve retired?”
Dr. Sabshin: ”I’ve had the good fortune of doing several things, but the major thing that I do is I work three days a week at the University of Maryland. I have a small office next to that of John Talbott. I came to Maryland because I knew John well and he was very eager and nice in helping me to come there. I also have had a very good relationship with Steve Sharfstein and from time to time I will be working at Sheppard Pratt Hospital.”
Since coming to Maryland my major activity has been to do a good bit of thinking about the areas of pharmacotherapy and psychotherapy and their potential integration. I’ve also been working on an encyclopedia related to psychiatry and social and behavioral sciences and that’s been an interesting activity to integrate some of my ideas about where the field is going. I’ve been reviewing textbooks and journals and I’ve come up with a classification of about 170 areas within psychiatry that might merit a section within an encyclopedia and that’s been great fun.”
Q: ”That sounds like a great deal of work.”
A: ”It sounds like a great deal of work, but it’s quite enjoyable. I think I’ve had good fortune, being asked to be the psychiatric consultant to an international encyclopedia on social and behavioral sciences. The work has been primarily to review most of the current textbooks of adult and child psychiatry and to look at the dictionaries, to look at what we do at the Annual Program of the APA, as a stimulus to look and see areas that are current. In any case, that’s been a nice activity.
Next week, I’m going to London to continue some of the work that I’ve been doing in Maryland. I’ll have an office at the Royal College of Psychiatrists and get to know a good deal about the British system. One of my plans, Bruce, is to make some comparisons of the British and U.S. systems.”
Q: ”How long are you going to be in London?”
A: “I’ll be in London for about three and one-half months. When I come back, I’ve been asked to do a presentation about my experience, at Sheppard Pratt. So that’s going to be a good stimulus to clarify what I find. I look forward to that very much.”
Q: “Has retirement presented any surprises for you?”
A: “I think I have a good tendency for mild regression. Without having a good area of work, I probably would regress. By mild regression, I mean I enjoy the resting, I enjoy the good times, I enjoy just being with friends, etc., so that’s nice. I’ve got a good balance of that. As I say, I work at Maryland three days a week, which is about right—what I should be doing with my current energy, my capacity.”
Q: ”You have been doing some teaching.”
A: “I’ve had to limit that. The main teaching I’ve done over the last quarter has been to work with Lisa Dixon on a seminar for residents’ research. She has taken the lead and I’ve assisted her. This takes me back to a seminar that I taught at Michael Reese Hospital back in the l950s. Dave Hamburg and I were the co-teachers. So it brings back nice memories and I enjoy teaching and I’m very pleased with the residency at Maryland, where research is facilitated. Last week I gave a talk to the CAPP medical students at Maryland, which is the special group of medical students interested in psychiatry. I’ve had a marvelous time seeing that generation. Faculty and residents came also, but it was a particularly nice experience for me to be with medical students. I want to make it clear that I’m leaving most of my time to think and write, to go to the library to look over some things that I hadn’t done in a while. I do need to get myself caught up in a few areas of psychiatry that are quite different than what they used to be. It’s a good experience and I hope it goes on for a while.”
Q: ”You’ve had a lot of contacts with Baltimore and with Maryland over the years.”
Q: “Yes, I have, including serving on the Board for Sheppard Pratt for 10 years. I stopped that last year after a good experience with both Bob Gibson and Steve Sharfstein. I learned a good deal about Sheppard Pratt and about the larger context of the area.”
Q: “We’ve found it a good experience in Maryland to be so close to the APA headquarters. I’d like to hear more about where you feel psychiatry is heading.”
A: “I’ve articulated my perspective in a couple of places and most of it stands. It’s changed from my younger days in the field. I’ve tended to emphasize its shift from ideology to a more evidence-based practice, which goes deeper than many, many psychiatrists realize. I think the struggles and the ideological debates among biological psychiatrists, psychologically-oriented psychiatrists, socially-oriented psychiatrists had some hurtful aspects for the field. Also, the definitions of psychopathology and of treatment were difficult in ways that hurt psychiatry. The occasional implication that the prevalence and incidence of mental illness was close to 100% was more hurtful than many people imagined. I was one of the few people who wrote extensively about the policy problems evolving from that kind of a definition. That was one of the reasons that I pushed very hard for DSM and for the guidelines, which is part of the evidence-based practice of today. This was to work on the problems that psychiatry still hasn’t solved. I’m aware of some of the problems of diagnosis and evaluation. Roger Peele has organized a symposium for June 1st in which he asks an interesting question that has intrigued me, ‘What is essential for a psychiatric formulation?’ I intend to start with a sentence that says, ”Orthopedic surgeons don’t do a formulation.’ and by the end of my discussion I’ll explain what that means. We depend heavily on words and a concept of formulation that means that we don’t think that diagnosis is enough. So we need to go beyond that, we need to go beyond differential diagnosis, we need to go beyond. I need in words to explain some aspects of etiology and what the problems really are and what the prognosis is. It’s interesting how we’ve moved to that stage from a formulation of the l960s, a psychodynamic formulation, to a more psychiatric formulation.”
Q: ”What are you looking forward to most, during the next few years of your career?”
A: “I hope I’m well enough to do some writing and in good enough shape to put two things together—an historical review of some of the things that happened during my tenure at the APA and the evolution of clinical therapy—psychotherapy and pharmacotherapy. Because I think most of the future of psychiatric practice depends on developing that idea. I believe that a large component of psychotherapy will be practiced by other types of mental health workers. I also believe that a significant part of the pharmacotherapy will devolve to non-psychiatric medical practitioners. An important area where psychiatrists may be able to contribute and to specialize is the combination, which other mental health workers and other physicians will probably not enter into in the same way. The combination of pharmacotherapy and psychotherapy is still a field that needs development. That’s an area where I think we can do a lot. There may be a reason to choose a specific medication to help the psychotherapy and the sequence may vary. The combination doesn’t have to be simultaneous. The pharmacotherapy may of course make the psychotherapy possible. It may also be used after the psychotherapy to reinforce it. That really interests me and I think I can do something in that area. Particularly in England—I want to see how they handle it there.”
Q: ”I hope that you have a good trip. We’re delighted that you’re in Maryland now.”