Chapter 03: Some Background on Psychiatry and a Fellowship

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Chapter 03: Some Background on Psychiatry and a Fellowship

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Dr. Baile observes that he has always worked at the interface between psychiatry and medicine. He begins by telling how he met Rob Buckman, who wrote a book on how to break bad news. He talks about working with him to develop videos on communication for the iCARE program at MD Anderson. Next, Dr. Baile gives a brief history of psychiatry, noting that the first generation prior to Freud were neurologists. Freud represented a paradigm shift that had particular impact in the United States, and he notes that he had three psychoanalytic supervisors. Then, in the late 70s and early 80s, the interests of the field returned to neuro-psychiatric discussions and psychoanalysis waned. As an example of the interface between medicine and psychiatry, Dr. Baile explains that breast cancer patients who are particularly traumatized by their cancer often have trauma or abuse in their backgrounds. He talks about the “beauty of being a psychiatrist” and being able to work closely with a patient. Next Dr. Baile discusses his fellowship period at the Laboratory of Behavioral Sciences, Gerontology Research Center, National Institute on Aging, Baltimore, where he worked with Bernard T. Engel (1976-1978). He also talks about working with the The Sexual Behavior Consultation Unit during his residency at Johns Hopkins (1973-1976).

Identifier

BaileW_01_20160823_C03

Publication Date

8-23-2016

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Personal Background; Professional Path; Formative Experiences; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Definitions, Explanations, Translations

Transcript

T.A. Rosolowski, PhD:

Wow, that’s great. Now did your interest in communications start out when you were in Italy?

Walter F. Baile, MD:

Actually, I was chief of Psychiatry here, or the section of Psychiatry for a while. And I met a guy—I was introduced to a guy by Bob Bast [oral history interview]. Do you know Bob?

T.A. Rosolowski, PhD:

I interviewed him.

Walter F. Baile, MD:

And Bob introduced me to this guy called Rob Buckman. And Rob was a medical oncologist who wrote a book on how to break bad news. So he and I became friends, and we got some money from MD Anderson to make videos of communication skills. And that kind of launched my career. So all of those videos are on the ICARE website. And he is the one playing the doctor in all of them.

T.A. Rosolowski, PhD:

Oh, interesting.

Walter F. Baile, MD:

And Rob is not only—he got a PhD in sciences, and an MD. But he also worked with John Cleese. And he had a comedy show in Great Britain that was watched by a lot of people. When he was a resident there.

T.A. Rosolowski, PhD:

How funny!

Walter F. Baile, MD:

So Rob was one of the more funny people.

T.A. Rosolowski, PhD:

It’ll bring a little levity to professional training tapes, you know?

Walter F. Baile, MD:

But he also died tragically.

T.A. Rosolowski, PhD:

Oh, did he?

Walter F. Baile, MD:

From—on an airplane coming back from visiting his mother in London. And he just was found dead in his seat. He had a disease called dermatomyositis, which is an autoimmune disorder. And he had a partial paralysis of his vocal cord, so he was always kind of aspirating. They think that maybe he aspirated something and just kind of stopped his heart.

T.A. Rosolowski, PhD:

Wow. That’s amazing.

Walter F. Baile, MD:

Yeah, but he was well known in oncology for both communication and for some of his research.

T.A. Rosolowski, PhD:

Now where did your interest in oncology begin? I mean, is that what you were focused—yeah, tell me.

Walter F. Baile, MD:

But I’ve always worked at the interface of medicine and psychiatry. So my first job after residency was running the Medical Psychiatry program at a Johns Hopkins affiliate, Baltimore City Hospital. Then after that, I opened a chronic pain clinic at the University of Maryland. Then was recruited to the Moffitt Cancer Center by an old mentor of mine at Hopkins. We opened the new cancer at the University of South Florida. I was the first sort of chair of their Psychiatry. Then—

T.A. Rosolowski, PhD:

Now, because at the time when you were doing this, as we’re looking at the ’70s here—

Walter F. Baile, MD:

Right.

T.A. Rosolowski, PhD:

I mean, as I understand it, psychiatry and the behavioral sciences in general were having to make a case to the medical community, that there should be a connection, or that there was relevance there. Am I stating that correctly? You’re looking like, “No, you’re not stating that correctly.”

Walter F. Baile, MD:

I think that—so it’s very interesting, what happened to Psychiatry. The old psychiatrists in the 1800s, early 1900s, were actually neurologists. They studied a lot of diseases that were caused by syphilis, and other diseases that had psychiatric manifestations. Then things changed with the influence of Freud, major influence, who developed psychoanalysis, and who gathered around him a number of incredibly smart people. And the emphasis became not what you can see, but what you can’t see, but what influences you. That’s when psychoanalysis was born. It was a discovery of the unconscious. So that had a tremendous impact on American psychiatry, much less so in Europe. But Freud came here from Vienna because of the Nazis. The psychoanalytic movement influenced psychiatry training a lot. So a lot of us who trained in the ’70s became psychotherapists. In fact, I had three psychoanalytic supervisors; these were all people who had gone through psychoanalytic training and were in private practice. And I would go their offices and present cases. And they would help me become a better therapist with the patients from the supervision. In fact, it’s really interesting. In one of the psychiatric magazines I picked up, one of my supervisors, Barbara Young, is still living. And she has become a very famous photographer. She always photographed with a Hasselblad. And I remember that going to her house. Then in the late ’70s, early ’80s, that sort of biological psychiatry movement came along. And people became very interested again in diseases, like Huntington’s Disease and Parkinson’s Disease, and all the neuropsychiatric manifestations. And people began to sort of want a more scientific psychiatry. So the psychoanalytic, the influence of psychoanalysis waned a bit, and in some places, it’s waned a whole lot. I have people, colleagues who were young psychiatrists, who’ve never had any training in psychotherapy.

T.A. Rosolowski, PhD:

Oh, really?

Walter F. Baile, MD:

Amazing to me. And the training is in how to give medicines, what medicine to use, and this for depression. I find that very boring. It’s great to see people get better instantly, but it’s much more human and connective and fascinating to help people understand what makes them tick, and why they can work through stuff. I’ll give you an example. There are many women who have—for whom their cancer is very, very traumatic, their breast cancer, for example, and some people who fly through it. And if you take the time to explore the background, these people, just like you’re doing with me, you find that a significant number of them have histories of abuse, often sexual abuse, or parents who were alcoholic, father, alcoholic, physical abuse. So this cancer experience feels to them as if they’re back in the victim role when they were children. Very real. I had one woman say to me, “It took me a long time for me to figure out why I was feeling like I felt when I was six years old.” And you know, that’s the beauty of being a psychiatrist, because you’re able to help people figure out why they’re being troubled by stuff that they can’t understand. And psychiatrists today don’t even bother to ask people about their families of origin, you know? One of my first questions, tell me about your dad. Tell me about your home environment. So you can tell very much from the terrain in which people’s early childhood was laid, whether they’re going to have trouble later on. I mean, think about it. If you had parents who are unstable, well, you’re not going to grow up to be very secure about yourself. And about life. And that kind of insecurity leads people to make bad choices about marriage, your job, and have inferiority complexes and make bad choices, because they think, “Well, who would want me? I’m so flawed.” Plus there’s the guilt that people carry around for being responsible for abusiveness. So there’s a lot of work to be done. So people think, you know, well, it’s just a cancer that knocks people for a loop. It’s the cancer, then, what cancer is on top of.

T.A. Rosolowski, PhD:

It determines their ability to be resilient and just navigate the whole waters of the disease.

Walter F. Baile, MD:

Yeah. Yeah. And to be resilient. Because they’re stuck, and still dealing with the past. So it’s helpful.

T.A. Rosolowski, PhD:

Well, I also, as you were talking, and how surprising it is that young people now being trained in this area aren’t being taught about psychoanalysis or psychotherapy, from one perspective it’s surprising. From the other perspective it isn’t, because how many fields actually do teach their own history? So many of them don’t.

Walter F. Baile, MD:

Right. This—sure.

T.A. Rosolowski, PhD:

Which is sad, because, in fact, every practice builds on the previous one. And there’s always something valuable to take for perspective.

Walter F. Baile, MD:

And I don’t care who you are. People want to be listened to.

T.A. Rosolowski, PhD:

Yep.

Walter F. Baile, MD:

You know? And so the skill of listening and taking an interest in people is very powerful, even if you can’t do anything. People feel validated. And some people who have had abusive experiences in their life, it’s the first time they ever talk about it.

T.A. Rosolowski, PhD:

Interesting.

Walter F. Baile, MD:

Plus I do some couples—work with couples, people who fight with each other, and can’t understand why. That’s very interesting.

T.A. Rosolowski, PhD:

Why did you bring that up?

Walter F. Baile, MD:

Because that’s another fun part of work. Not just helping with trauma, but helping people stop saying things to each other that are wounding, which is my first rule with couples. You can’t talk to each other and say things that are hurtful, because it erodes the trust. And no one will be able to go ahead in a relationship like that. But you can’t stop to repair things, unless you stop the present conflict and damage being done.

T.A. Rosolowski, PhD:

Now when you were going through your education and then when you got out—because I noticed, too, you did a fellowship in the Gerontology Research Center. You know, were you kind of looking around for a specialization? Or—

Walter F. Baile, MD:

I didn’t know what I wanted to do when I finished my residency.

T.A. Rosolowski, PhD:

Yeah.

Walter F. Baile, MD:

So this was a fellowship in psychophysiology.

T.A. Rosolowski, PhD:

Oh, interesting.

Walter F. Baile, MD:

Right. So we did biofeedback at that time. So I had two years, I took two years, and I published a couple of papers there, which was nice to do. So it took me two years to figure out what I wanted to do. Then I liked this interface of medicine and psychiatry, because I liked helping the medically ill people cope. So I stayed in—I’ve never been in any other field. I did—so I have a very unique experience. So in my residency at Hopkins, where we had a tradition of really—some incredible traditions of having people in the community who acted as supervisors for the residents—

T.A. Rosolowski, PhD:

Really?

Walter F. Baile, MD:

Well, the psychiatrists who are psychoanalysts.

T.A. Rosolowski, PhD:

Oh, OK.

Walter F. Baile, MD:

We went for supervision. And then we had some very, very good people who supervised us. Rotation through the Medical Psychiatry unit, where you went to see patients on the hospital wards who were having problems in coping. Then Hopkins became very famous for transgender reassignment.

T.A. Rosolowski, PhD:

Oh, yes.

Walter F. Baile, MD:

They had a unit called the Sexual Behavior Consultation Unit, where the residents got to see all these patients who were coming in to be evaluated for gender reassignment, for things of that sort. So that was fascinating. And there were a couple of women there who were sort of master’s level prepared counselors, incredibly mature women in their fifties and early sixties, who had raised their families and they wanted to come back. So they were working in this unit. So I learned to do, from them, some Masters and Johnson therapy. And we had a little private practice for a time helping couples who were having sexual problems, kind of recalibrate their relationship. So that was a lot of fun, and something very different. I had some wonderful educational experiences. Then I went to the Gerontology Research Center. My mentor was one of the most famous psycho-physiologists in the country. And his name was Bernard T. Engel. We did some biofeedback. And we were on the campus of Baltimore City Hospital, that’s where the GRC was located. So I started working with those folks around rehabilitating people from heart attacks. When I finished my fellowship, they offered me a job to continue the work there.

T.A. Rosolowski, PhD:

What were you doing with biofeedback?

Walter F. Baile, MD:

We’re doing biofeedback of premature ventricular contractions, cardiac arrhythmias. And then I got involved with cardia rehabilitation, because there are a lot of psychological issues there with people who had heart attacks from smoking too much, to helping them quit smoking. My first paper ever, my first—I think it was my second paper—was on the relationship between the size of the heart attack and how quickly people resume smoking. So that was very interesting. They had a big smoking cessation research program there, nicotine. So it’s interesting that the main focus of my department, in behavioral science, is smoking now.

T.A. Rosolowski, PhD:

Yeah, it is. Yeah.

Walter F. Baile, MD:

So things come around.

T.A. Rosolowski, PhD:

Yeah, they do. Where did you get that interest with helping people with medical issues cope?

Walter F. Baile, MD:

Well—

T.A. Rosolowski, PhD:

When did you that that was—

Walter F. Baile, MD:

I liked medicine when I was in medical school. I liked all the physiology and things of that sort. I don’t really have much of an affinity for chronic mental illness.

T.A. Rosolowski, PhD:

Mm-hmm.

Walter F. Baile, MD:

You see, it’s nice if you can pick a private practice and only see neurotic people, you know? But I like the tremendous variety of seeing—of not knowing what kind of patients you’re going to see next on the medical services, and what kind of problems they’re going to have. So it’s very challenging figuring out how the medical and the psychiatric interacted to give this person their problems.

T.A. Rosolowski, PhD:

Yeah, it’s a combination intellectual challenge and the medical piece, psychiatric piece, brings together a lot of different things. The interactional piece.

Walter F. Baile, MD:

Sometimes they were quick fixes, you know? Yeah. So I liked the variety. The variety of patients, the variety of possible interventions. The research possibilities that you were able to do with people, looking at some of these interactions between biology and behavior. So that was a lot of fun.

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Chapter 03: Some Background on Psychiatry and a Fellowship

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