Dr. John A. Talbott, a psychiatrist who championed the care of vulnerable populations of the mentally ill, particularly the homeless – many of whom were left to fend for themselves on the streets, libraries, bus stations and prisons of the country after the mass closure of states. psychiatric hospitals – died November 29 at his home in Baltimore. He was 88 years old.
His wife, Susan Talbott, confirmed the death.
Dr. Talbott was an early proponent of a movement known as deinstitutionalization, which advocated replacing America’s decrepit psychiatric hospitals with community-based treatment. But he became one of the movement’s most powerful critics after lack of money and politics left thousands of deeply disturbed people without proper care.
“The chronically mentally ill patient has had his or her living environment and care transferred from one shabby facility to several shabby facilities,” Dr. Talbott said. wrote in the journal Hospital and Community Psychiatry in 1979.
During a career spanning more than 60 years, Dr. Talbott held many of the leadership positions in his field. He was president of the American Psychiatric Association; director of a large urban psychiatric hospital, the Dunlap-Manhattan Psychiatric Center, on Wards Island; chairman of the department of psychiatry, University of Maryland, Baltimore; and editor of three leading journals: Psychiatric Quarterly, Psychiatric Services, and The Journal of Nervous and Mental Disease — which he was editing at the time of his death.
Dr. Talbott exerted his influence not as a researcher on the brain or neurological drugs, but as a hospital director, academic, and member of prominent committees – including President Jimmy Carter’s Commission on Mental Health – and, in particular, by his prolific writings. A clear and muscular polemicist, he wrote, edited or contributed to more than 50 books.
“I admired him for taking charge of Manhattan State Hospital and for his belief that psychiatrists should take tough jobs and not just practice privately on the Upper West Side.” Dr. E. Fuller Torreya prominent psychiatrist and founder of the Treatment Advocacy Center in Arlington, Virginia, said in an email.
In 1984, during Dr. Talbott’s presidency, the American Psychiatric Association published its first major study homeless people with mental disorders. The study found that the practice of sending patients from public hospitals to poorly prepared communities was “a major societal tragedy”.
“In almost no part of the country, urban or rural, have you escaped the omnipresent presence of ragged, sick and deluded human beings, wandering the streets of our cities, huddled in alleys or sleeping on top of air vents,” the report said. It is estimated that up to 50 percent of homeless people suffered from chronic mental illnesses.
Six years earlier, Dr. Talbott had published a book, “The Death of the Asylum,” which denounced both the failing system of public hospitals and the broken policies that replaced them.
In a 1984 interview with The New York Times, he acknowledged that psychiatrists who had championed community treatment as an alternative to institutions, including himself, bore some responsibility.
“The psychiatrists involved in policymaking at the time certainly oversold community treatment, and our credibility today is probably damaged,” he said.
In an account of Dr. Talbott’s career submitted to a medical journal after his death, a former colleague, Dr. Allen Frances, wrote: “Few people have ever had a career as distinguished as that of Dr. Talbott, but perhaps be that none has ever had a career as brilliant as that of Dr. Talbott. a more frustrating and disappointing one.
Dr. Frances, chairman emeritus of the Department of Psychiatry and Behavioral Sciences at Duke University, explained in an interview that Dr. Talbott had been a leader in the field of “community psychiatry,” in which mental illness was influenced by social conditions. — not just a biological disposition — and that treatments required taking into account the patient’s living conditions and the range of services available.
Community psychiatry was meant to be an alternative for patients who were no longer warehoused in dilapidated and often abusive public hospitals. A new generation of drugs promised that patients could live at least semi-autonomously.
“They were working hard to make psychiatry less cumbersome, less biological, less psychoanalytic and more society and community oriented,” Dr. Frances said of Dr. Talbott and others who championed community psychiatry.
But high hopes for robust outpatient treatment in a community setting have never been adequately realized. The Community Mental Health Act, a 1963 law championed by President John F. Kennedy, called for the creation of 2,000 community mental health centers by 1980. Less than half that number had been opened by then, funding was not available. not materializing or having been diverted elsewhere.
At the same time, deinstitutionalization reduced the number of patients in public hospitals by 75 percent, from 560,000 in 1955 to fewer than 140,000 in 1980.
“The disaster occurred because our system of mental health care delivery is not a system but a non-system,” Dr. Talbott wrote in 1979.
John Andrew Talbott was born on November 8, 1935 in Boston. His mother, Mildred (Cherry) Talbott, was a homemaker. His father, Dr. John Harold Talbott, was a professor of medicine and editor of the Journal of the American Medical Association.
In 1961, Dr. Talbott married Susan Webster, who had a career as a nurse and hospital administrator, after the couple met during intermission at the Metropolitan Opera in New York.
With his wife, Dr. Talbott is survived by two daughters, Sieglinde Peterson and Alexandra Morrel; six grandchildren; and a sister, Cherry Talbott.
He graduated from Harvard College in 1957 and received his M.D. from the Columbia College of Physicians and Surgeons in 1961. He received additional training at the Columbia Presbyterian Hospital/New York State Psychiatric Institute and the Columbia University Center for Psychoanalytic Training and Research.
Drafted during the Vietnam War, he served as a captain in the medical corps in Vietnam in 1967 and 1968. He received a Bronze Star for persuading troops to take their malaria pills.
“The reason they didn’t take them was because a case of malaria was a ticket home,” he later explained. “Then I scared them very much by showing them examples of what malaria could cause.”
After returning home, Dr. Talbott became active in the anti-war movement. He was a spokesperson for Vietnam Veterans Against the War at the 1968 Democratic National Convention in Chicago. The following year, he helped organize a demonstration at Riverside Church in Manhattan at which the names of soldiers killed in Vietnam were read aloud by a procession of speakers, including Edward I. Koch, Leonard Bernstein and Lauren Bacall.
After retiring as chairman of the University of Maryland Department of Psychiatry in 2000 after 15 years, Dr. Talbott always enjoyed fine dining by contributing to online food sites. In 2006 he started a blog, John Talbott’s Parisin which he chronicles the meals he ate during frequent visits to the French capital.