When other children in post-World War II Brooklyn were dreaming about growing up to be fire fighters, police officers, or baseball players, the future forensic psychiatrist J. Richard Ciccone was planning to be a lawyer. “My father taught me that the law is a noble profession, and it represents an important part of civilization,” Dr. Ciccone reflected in our conversation in his office at the University of Rochester School of Medicine and Dentistry, where he is a professor of Psychiatry and Director of the Psychiatry and Law Program. “Someone who can represent people and their needs while seeking justice is following a very high calling.”
Growing up the son of Italian immigrant parents in a three-story, multigenerational household in Brooklyn, Dr. Ciccone felt drawn to the law as an extension of the order and pride that his father taught him and also of the steadfast care that his mother provided him every day. From an early age, his parents instilled in him the desire to achieve excellence, and their guidance is reflected in Dr. Ciccone's academic and personal life. He graduated from high school at the age of 16 and attended Columbia University on a chemistry scholarship. While other children of his generation rooted for the “wait ‘til next year” hometown Dodgers and Giants, Dr. Ciccone became a life-long New York Yankees fan.
What happened to lead him toward medicine and eventually psychiatry? Uncle Frank. Although he had several uncles who were physicians, it was Uncle Frank, an internist, who took his nephew on house calls. When it came time in college to declare a path of study, Dr. Ciccone had to set law aside, for the time being, and confront the fact that he actually wanted to become a physician. His interest in the law continued, and he decided to pursue two majors: one in chemistry to allow him to keep his scholarship and go to medical school and the other in history. Psychiatry was not a consideration until he “found a home” at the Western Psychiatric Institute during medical school at the University of Pittsburgh. “They had a wonderful library, which was an exciting place to go and just take books off the shelves. It really was an extension of the founding chair of the Department of Psychiatry, Henry Brosin, who had seminars every Monday afternoon for the residents. I took to going to those in my first year of medical school.” Despite the early influence, psychiatry was not an immediate choice, as he first thought about learning psychiatry to augment an internal medicine practice.
Psychosomatic medicine and the mind-body interaction brought him to Rochester, New York, for his psychiatry residency. “George Engel had started working with infant Monica and documented that her gastric secretions changed depending on whom she encountered. Dr. Engel went on to describe the biopsychosocial medical model. It was a marvelous example of what was going on here, and so I came to be near the work of George Engel and John Romano. In addition, Dr. Engel taught me lessons about consulting that have helped me in my forensic work. He helped me frame the consultation question as one that might be answerable and then to provide that answer in language that is understandable and with suggestions that are usable.”
It was Dr. Romano, the founding chair of the Department of Psychiatry at the University of Rochester, who first pointed him in the direction of forensic psychiatry. Of Romano, Dr. Ciccone remembers, “His way of looking at and understanding the complexity that is the human being is something that I carry with me.” At a time when mentors to those interested in the interaction between psychiatry and the law were few, Romano intercepted Ciccone's path at the best possible time. “There came a moment when I asked for his help in pursuing an interest I had in Daniel M'Naughten. I wanted to learn more about what actually happened prior to his killing of Drummond and then what happened in the trial.” Dr. Ciccone was hoping to have a letter of introduction to ease access to some of the primary sources in Great Britain. Romano was surprised and asked the young Ciccone why he wanted to know more. “I told him it interested me. At that, he lit up and became very eager to help.” On that day, he presented Dr. Ciccone with an original printing of the London Times from 1843 discussing the M'Naughten case. “I still treasure it to this day.” The validation Dr. Romano provided opened the door for Dr. Ciccone to research the fact pattern in a careful way that eventually led to his presentation of “M'Naughten: How It All Began” as his American Academy of Psychiatry and the Law (AAPL) President's lecture in October 1987. A print of the speech hangs in Dr. Ciccone's office, and he proudly shows it to each fellow during the course of the fellowship year.
Dr. Ciccone maintained his interest in liaison work and did a chief residency year during which he spent six months in a clinic consulting to courts and six months with Dr. Engel learning consultation-liaison psychiatry. It was clear to him, once he encountered psychiatry and the law, that forensic psychiatry was his primary interest. He continued to value liaison and consultative work and transposed it onto forensic psychiatry. He teaches that, as a consultant, one has to understand the language of the system for which he or she is consulting. The relationship between referral sources and consultant is very important and, “if they know you and know your work, they will more readily consult you for advice, thoughts, and ideas, and more confidently accept your recommendations.”
Like many young physicians in the early 1970s, Dr. Ciccone served in the military, achieving the rank of Lieutenant Commander in the Navy and serving at the Pensacola Naval Hospital in Florida. He speaks humbly, as he usually does of his achievements, about bringing occupational therapy to the psychiatric patients at the hospital, a novel idea in that setting at that time. Although his interest in forensic psychiatry was not yet solidified, he had some gratifying experiences in the Navy testifying at courts-martial.
After his time with the Navy, Dr. Ciccone returned to the University of Rochester in 1974 and began his professional collaboration with Dr. David Barry. It was Dr. Barry who introduced Dr. Ciccone to the Court Clinic (now the Monroe County Socio-Legal Center) and provided him with his first intensive training in forensic psychiatry. He remembers how Dr. Barry induced him to testify in court for the first time. “I had evaluated someone who was in Family Court. David suggested we go up to court to watch some testimony and learn something more about how the courtroom worked. The judge identified David and said to him, ‘I understand that your clinic evaluated Mr. So-and-So and I would like you to come up and testify.' David got up and said, ‘It was done by Dr. Ciccone.' So I was invited up to the stand and maybe that was the best way to dive in, as there was little time for anticipatory anxiety, for obsessive preparation, or for organization of thoughts. I remember surviving it and saying, ‘Well, that wasn't too bad.' Of course I had presented cases to John Romano and testifying was certainly less daunting.”
Dr. Ciccone attended his first meeting of the AAPL in 1974, where he met Drs. Jonas Rappaport and Robert Sadoff. He found the meeting stimulating, and educationally important. He found it particularly exciting because although there were leaders in the field who were teaching, there was also a “whole host of young psychiatrists with whom I struck up friendships that have lasted more than 30 years. The meeting was in Williamsburg, Virginia, and there were a small number of people so it could be managed within the hotel. The sessions were large-group teaching sessions about writing a forensic report, issues around testifying, and predicting dangerousness.” Dr. Ciccone describes AAPL as a place where he “grew up professionally” and had opportunities to serve the field of forensic psychiatry in a variety of capacities. He was appointed chair of the AAPL Education Committee in 1979 and established the forensic psychiatry course in 1980. He, with a distinguished faculty, taught that course 12 times over the next 11 years. He was President of AAPL from 1986 to 1987 and presided over the adoption of the “Ethical Guidelines for the Practice of Forensic Psychiatry” (1987). He had a role in the creation of the original American Board of Psychiatry and Neurology examination in forensic psychiatry in 1992, and reprised that role 10 years later to help create the recertification examination. He was active in the establishment of criteria for credentialing forensic psychiatry fellowship programs and a consultant to the Accreditation Council for Graduate Medical Education (ACGME). This work has put forensic psychiatry squarely in the mainstream of American medical subspecialties.
From 1993 to 2000, Dr. Ciccone was the Chair of the American Psychiatric Association's Commission on Judicial Action. Initially appointed by the then-President of the APA, Dr. Jack McIntyre, Dr. Ciccone has the distinction of having the longest tenure, seven consecutive one-year terms—the APA constitutional limit for that appointment. During his tenure, the Commission was involved in writing amici briefs in cases including Jaffey v. Redmond, Kansas v. Hendricks, Olmstead v. L.C., Vacco v. Quill, and Pegram v. Hedrich.
When speaking with Dr. Ciccone about his accomplishments, it is easy to be lulled into a sense of understated achievement, as he speaks with humility and has a tendency to spread the credit to his colleagues with such ease as to make it seem that he was but a bystander during the evolution of forensic psychiatry. Looking over his accomplishments, this is clearly not the case. When asked about how it felt to be a subject of this biography, he admitted, “My first reaction was that I don't know that I would have much to say, but then I thought that there are some things I care about, value, and would enjoy sharing.”
Nor is there a sense that he has left anything undone. He hesitates when asked to think of anything that he would do differently in the field of forensic psychiatry, clearly satisfied with the development of the field, especially the proliferation of active forensic psychiatry training programs. He is focused on the future and his designs toward enabling the field of forensic psychiatry to develop more active research. “Forensic psychiatry is built on the foundation of clinical psychiatry. We have a scholarly infrastructure. We have the journals and textbooks in forensic psychiatry. The next step is to develop a robust research capacity.”
Clearly, his professional and personal interests meld easily into each other. He speaks freely of his forensic psychiatry work leading him to visiting professorships in Siena, Italy, and traveling to meetings throughout the world. At any moment, he may recount an adventure with his wife in Italy, France, Scotland, Turkey, Egypt, Belgium, Japan, and many other places.
He met his wife Natalie while working for the New York City Vacation Day Camp between college and medical school. On one particular day teachers from the entire district came together for an orientation. “I had gone out to lunch with two older teachers. When we came back, I saw this very pretty girl. I just decided to go up to her, but as I approached her I became more and more nervous, and all I could do was to ask her what time it was. She told me. Luckily, some five or six weeks later, the district came back together again. These two fellows I had gone out to lunch with spotted me and said there was someone they wanted me to meet. It was Natalie, the girl I had asked the time.”
Dr. and Mrs. Ciccone have three children: Regina, Louis, and Robert. Considering the influence of Dr. Ciccone's father in attracting him to the law, it should be no surprise that he passed that interest on to his own children. All three of his children graduated from law school. When asked if his children are aware of his work, he smiled and said, “Several years ago there was a hubbub around the insanity defense and I remember writing a letter to the editor of the New York Times clarifying Daniel M'Naughten's actions and the outcome of his trial. What made that especially lovely was that my children acknowledged that I had done something useful. It was something that they were proud of. I remember my son Louis calling me after he had seen the letter online before the paper was published the following day. Calls from Regina and Robert followed. They were impressed, and I was pleased.”
In 2008, Dr. Ciccone will welcome the 39th and 40th Charles E. Steinberg Fellows in Psychiatry and the Law to the University of Rochester. When asked if he could choose one lesson for them to take into practice, he paraphrased Dr. Walter Bromberg: “Be scrupulously honest in your work as a forensic psychiatrist.” Dr. Ciccone continued, “Be true to your work that you have done, be clear about its shortcomings, be clear about what you have found, and explain as clearly as you can how you have arrived at your opinions.”
J. Richard Ciccone, MD
- American Academy of Psychiatry and the Law
