Dr. John A. Talbott, a psychiatrist who advocated for the care of vulnerable mentally ill populations, especially the homeless, many of whom were left to fend for themselves on the country’s streets, libraries, bus terminals, and prisons after massive closures by state authorities. psychiatric hospitals – died Nov. 29 at his Baltimore home. He was 88 years old.
His wife, Susan Talbott, confirmed the death.
Dr. Talbott was one of the first to support a movement known as deinstitutionalization, which pushed to replace America’s decrepit psychiatric hospitals with community-based treatments. 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 had his place of living and care transferred from a single lousy institution to several miserable institutions,” Dr. Talbott wrote in the journal Hospital and Community Psychiatry in 1979.
In 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; chair of the department of psychiatry at the University of Maryland, Baltimore; and editor of three prominent journals: Psychiatric Quarterly, Psychiatric Services, and The Journal of Nervous and Mental Disease, which he was editing when he died.
Dr. Talbott was influential not as a brain or neurological drug researcher, but as a hospital leader, academic, and member of top panels (including President Jimmy Carter’s Commission on Mental Health), and especially through prolific writings. A clear and muscular debater, he wrote, edited or contributed to more than 50 books.
“I admired him for taking over the leadership of Manhattan State Hospital and his belief that psychiatrists should take on the hard jobs and not be limited to private practice 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 higher study of the homeless mentally ill. The study found that the practice of discharging patients from state hospitals to ill-prepared communities was “a great social tragedy.”
“Almost a section of the country, urban or rural, has escaped the ubiquitous presence of ragged, sick and hallucinating human beings, wandering our city streets, huddled in alleys or sleeping on vents,” the report says. It was estimated that up to 50 percent of homeless people suffered from chronic mental illness.
Six years earlier, Dr. Talbott had published a book, “The Death of the Asylum,” which criticized both the failed state hospital system and the failed policies that replaced them.
In an interview with The New York Times in 1984, he acknowledged that psychiatrists who had advocated community treatment as an alternative to institutions, including himself, were partly to blame.
“The psychiatrists involved in policymaking at the time certainly overstated community treatment, and our credibility today is probably damaged by 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 had a career as distinguished as that of Dr. Talbott, but perhaps “No one has had a career as distinguished 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,” which held that mental illness They were 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 supposed to be the alternative for patients no longer warehousing in rundown 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 others who championed community psychiatry.
But high hopes for robust outpatient treatment in community settings were never adequately realized. The Community Mental Health Act, a 1963 law championed by President John F. Kennedy, envisioned 2,000 community mental health centers by 1980. Less than half that number had opened by then, as funding did not materialize. or they diverted elsewhere.
At the same time, deinstitutionalization reduced the number of patients in state hospitals by 75 percent, to less than 140,000 in 1980, from 560,000 in 1955.
“The disaster occurred because our mental health service delivery system 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.
Along 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 University in 1957 and received his medical degree from Columbia College of Physicians and Surgeons in 1961. He completed his additional training at Columbia Presbyterian Hospital/New York State Psychiatric Institute and the Center for Psychoanalytic Research and Training at Columbia University.
Drafted during the Vietnam War, he served as a Medical Corps captain in Vietnam in 1967 and 1968. He received a Bronze Star for persuading troops to take his anti-malaria pills.
“The reason they weren’t taking them was because a case of malaria was a ticket home,” he later explained. “Then I scared the shit out of them by showing them examples of what malaria could cause.”
Once home, Dr. Talbott became active in the anti-war movement. He was spokesman for Vietnam Veterans Against the War at the 1968 Democratic National Convention in Chicago. The following year, he helped organize a protest at Riverside Church in Manhattan in which a procession of speakers, including Edward I. Koch, Leonard Bernstein and Lauren Bacall, read aloud the names of soldiers killed in Vietnam.
After retiring as chair of psychiatry at the University of Maryland in 2000 after 15 years, Dr. Talbott had a lifelong appreciation for fine dining by contributing to online food sites. In 2006, he started a blog, John Talbott’s Parisin which he narrates the meals he ate on his frequent visits to the French capital.