Friday, May 24

Dr. John A. Talbott, champion of caring for the mentally ill, dies at 88

Dr. John A. Talbott, a psychiatrist who advocated for the treatment of vulnerable populations of the mentally ill, especially the homeless, many of whom were left to fend for themselves on the streets, libraries, bus terminals, and prisons of nation after the mass closures of state psychiatric hospitals – died Nov. 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 pushed to replace America’s decrepit psychiatric hospitals with community-based care. But he became one of the movement’s most powerful critics after a lack of money and political will left thousands of deeply disturbed people stranded without adequate care.

“The chronically mentally ill patient has had his place of living and care transferred from a single miserable institution to multiple miserable ones,” Dr. Talbott wrote in the journal Hospital and Community Psychiatry in 1979.

In a career spanning more than 60 years, Dr. Talbott has held many of the leading 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 major journals—Psychiatric Quarterly, Psychiatric Services, and The Journal of Nervous and Mental Disease—which he was editing when he died.

Dr. Talbott exerted his influence not as a brain or neurological drug researcher, but as a hospital executive, academic, and member of high-ranking committees – including President Jimmy Carter’s Commission on Mental Health – and, above all, through prolific writings . A clear and muscular polemicist, he has written, edited or contributed to more than 50 books.

“I admired him for taking over the Manhattan State Hospital and for his belief that psychiatrists should take on the tough jobs and not just practice private practice on the Upper West Side,” Dr. E. Fuller Torrey, a prominent psychiatrist and founder of the hospital 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 on mentally ill homeless people. The study found that the practice of discharging patients from state hospitals to unprepared communities represented “a grave social tragedy.”

“Hardly any part of the country, urban or rural, has escaped the ubiquitous presence of ragged, sick and hallucinating human beings, wandering the streets of our cities, huddled in alleys or sleeping above vents,” says the relationship. It was estimated that up to 50% of homeless people suffered from chronic mental illnesses.

Six years earlier, Dr. Talbott had published a book, “The Death of the Asylum,” which railed against the now-failed system of state hospitals and the failed policies that had replaced them.

In an interview with the New York Times in 1984, he acknowledged that psychiatrists who had advocated community-based treatment as an alternative to institutions, including himself, bore part of the blame.

“The psychiatrists involved in policymaking at the time certainly oversold community treatment, and our credibility today is probably damaged because of that,” 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 so distinguished as that of Dr. Talbott, but perhaps no one has ever had a most frustrating and disappointing experience.

Dr. Frances, chairman emeritus of Duke University’s department of psychiatry and behavioral sciences, explained in an interview that Dr. Talbott had been a leader in the field of “community psychiatry,” which argued that mental illness was influenced by conditions social. – not just a biological disposition – and that treatments require taking into account the patient’s living conditions and the range of services available.

Community psychiatry was supposed to be the alternative for patients no longer locked up in dilapidated and often abusive state hospitals. A new generation of drugs promised that patients could live at least semi-independently.

“They were working hard to make psychiatry less boring, less biological, less psychoanalytic and more socially and community oriented,” Dr. Frances said of Dr. Talbott and other advocates of community psychiatry.

But high hopes for robust outpatient treatment in a community setting were never adequately realized. The Community Mental Health Act, a 1963 law supported by President John F. Kennedy, called for 2,000 community mental health centers by 1980. Fewer than half of these had opened at that point, as funding had not materialized or had been diverted elsewhere.

At the same time, deinstitutionalization reduced the number of patients in state hospitals by 75 percent, from 560,000 in 1955 to fewer than 140,000 in 1980.

“The disaster occurred because our mental health delivery system is not a system but a non-system,” Dr. Talbott wrote in 1979.

John Andrew Talbott was born 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.

Along with his wife, Dr. Talbott leaves behind two daughters, Sieglinde Peterson and Alexandra Morrel; six grandchildren; and a sister, Cherry Talbott.

He graduated from Harvard College in 1957 and received his medical degree from Columbia College of Physicians and Surgeons in 1961. He did further training at Columbia Presbyterian Hospital/New York State Psychiatric Institute and the Columbia University Center for Psychoanalytic Training andResearch.

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 convincing troops to take their malaria pills.

“The reason they wouldn’t accept them was because a case of malaria was a ticket home,” he later explained. “Then I scared them to death by showing them examples of what malaria could lead to.”

Once he returned home, Dr. Talbott became active in the anti-war movement. He was a spokesman for the anti-war Vietnam Veterans at the 1968 Democratic National Convention in Chicago. The following year he helped organize a protest at Riverside Church in Manhattan where 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 chair of the department of psychiatry at the University of Maryland in 2000 after 15 years, Dr. Talbott devoted himself to a lifelong appreciation of fine dining by contributing to online food sites. In 2006, he opened a blog, John Talbott’s Paris, in which he chronicled the meals he consumed during frequent visits to the French capital.