Stephen Bates Billick, MD: A Journey from the Heartland to the Big City

Eraka Bath

Dr. Stephen B. Billick, the 36th President of the American Academy of Psychiatry and The Law, is an intensely complex and private man, full of youth and optimism. His clean-cut style, warmth, and charm are grounded in old-school Midwestern sensibilities. The youngest of three children, Billick spent his early years on a small farm in Waukesha County in rural Wisconsin, raising chickens and rabbits with his family. His parents were open, adventurous, and scholarly people, years ahead of their time. In the upbringing of their children, William and Esther Billick wove a love of arts, culture, and tolerance into their daily lives.

His father, William Billick, was an attorney and his mother, Esther Billick, read prodigiously and enjoyed oil painting, writing poetry, and pondering philosophical matters. She also canned tomatoes and froze corn on the cob for enjoyment in the winter. Although their son remembers these years fondly, he was also keenly aware of being different from his neighbors, who were predominantly Polish-American, Roman Catholic farmers. Despite playing frequently and often quite harmoniously with the other children in the area, he would sometimes be taunted by them as an outcast for not being Polish or Catholic. His own family had arrived in North America quite early, and his ancestry was traceable to the Baltic rim, North Sea, and British Isles. A strong libertarian and socially progressive strain ran through the generations of his family, and his mother would often remind him that they were “descended from some of Europe's social, political, and religious discontents.”

His interests in the broad cultural diversity of the world developed early. His parents’ interest in other cultures, a rarity at that time, prompted them to drive regularly into Milwaukee to attend many ethnic dinners and feasts. When he was only 12 years old, Billick's mother decided to further her study of oil painting under the tutelage of a noted painter who taught at Mexico City College. Indulgent of his wife and smitten with her indomitable spirit, William Billick took time off from work, packed up the car and drove the family to Mexico City, where they rented a house and spent three months enjoying a completely new culture. On arrival, young Billick quickly made friends with another 12-year-old in the neighborhood, and since Guillermo did not speak a word of English, the highly adaptable Billick, who had had some pre-trip Spanish tutoring, learned to speak Spanish. He would translate for the family in the stores and while grocery shopping. Over the years, the family enjoyed many vacations, traveling to Canada, New Mexico, California, and the East Coast. Billick learned to ride a horse bareback on his aunt's ranch in New Mexico and enjoyed learning about the Native American cultures of the southwest. Despite their worldliness, the family would often go camping, sleeping in teepees that they had made. With his parents, older brother, and sister, he was raised in a warm, close-knit, family-centered environment. Every Thanksgiving would be celebrated at his favorite aunt and uncle's home in suburban Chicago. The family would take advantage of the arts, culture, and the enrichment opportunities that a big city could offer their children, going frequently to the Chicago Art Institute, the Field Museum, and the Museum of Science and Industry.

His favorite uncle had been raised as an Orthodox Jew. While traveling with this uncle on various business trips, young Billick would solicit stories about his uncle's childhood. His uncle's narratives helped to develop Billick's lifelong interest in comparative religions. Indeed, when it became time for him to be confirmed in his church, his parents were open-minded enough to encourage him to visit other religious faiths to see if he was sure of the choice they had made for him. He approached this opportunity with intellectual fervor and curiosity, exploring many religions in depth. With a school buddy, he attended Rosh Hashanah and Yom Kippur services and Seders. He went to mass at the local Roman Catholic Church and visited a wide variety of Protestant Christian faiths. He traveled into Milwaukee for services at the Greek Orthodox Cathedral. He invited Mormon missionaries into his home to explain their faith to the entire family and went to Wilmette, Illinois, to attend Bahai services and learn about the doctrines. He ultimately retained his childhood faith and remained an Episcopalian.

By this time, the family had settled in Whitefish Bay, the most prominent suburb of Milwaukee. As a junior high student, Billick was active in the Boy Scouts. He received the God and Country Award and became an Eagle Scout. At school he excelled academically and was socially popular. He enjoyed sports and was an excellent long distance runner on the high school cross country and track teams. But he was disturbed by the reluctance of American society to embrace the Civil Rights movement and improve life for black Americans. Reared with values that promoted tolerance and equality for all people, he could not understand how a country founded on equal opportunity could deny education or jobs to anyone based on skin color. When the Rev. Dr. Martin Luther King, Jr., came to Milwaukee, Billick went with his mother and sister to the Milwaukee Coliseum to hear King and Dr. Ralph Abernathy speak. He remembers being moved by the electrifying oratory and the passion of the crowd and recalls being among only a few dozen whites in an audience that numbered in the thousands. When the sociology teacher at his high school learned that Billick had attended this event, he invited the youngster to be a guest lecturer for a one-hour class. While most of the students were quite receptive, a couple of them were angered and reported the class to their parents. The school vice principal called Billick's parents to warn them of his growing communist tendencies. The vice principal was caught off guard when Billick's parents denied that their son had any interest in communism but affirmed his deep interest in democracy and constitutional law. The parents also castigated the vice principal for his narrow-mindedness.

During his college years, Billick furthered his lifelong interest in politics and participated in the Yale Political Union (YPU), taking the equivalent of a major in political science. In the YPU, he was elected chair of the Progressive Party, a tiny party in the center between the Conservative and Liberal Parties. This position gave Billick an opportunity to meet several of the country's great leaders, such as Ralph Bunche, Roy Wilkins, and others. He also continued his interest in the diverse world, taking a minor in Latin American Studies and traveling to Colombia and Ecuador. During a summer abroad, he visited European countries, as well as Algeria, which did not have diplomatic relations with the United States at the time.

Billick was thrilled to be accepted, in the fall of his senior year at Yale, into the medical school class at the University of North Carolina in Chapel Hill, a perfect place for him to study medicine. It was beautifully rural like his childhood farm community, and it was a vibrant integrated community with a black mayor. At only 85 students, his medical school class was small, providing a great opportunity for class and community fellowship, as well as academic mentoring. Somewhat displeased by the psychiatric teaching (he had planned on being a child psychiatrist and a pediatrician), he was impressed with the depth of humanity of his surgery professors and the sculptural beauty of surgery, which reminded him of the art courses he had enjoyed at Yale. He was ultimately accepted into an ear, nose, and throat residency at the University of California in San Francisco, which required him to have two years of general surgical residency before he began his subspecialty training. He stayed in Chapel Hill for his internship and was very active in the community, but then went off to San Francisco to train in surgery.

In San Francisco, he thought he was in heaven. The ethnic diversity of the city was simply astounding to him and he reveled in exploring the restaurants and neighborhoods. He joined his local church and was elected to its vestry (the governing board). This local church had parishioners from all ethnic and racial groups and was a vibrant congregation. During his second year of surgery, he realized that although surgery would make a great avocation, it was not giving him the sense of fulfillment he was looking for in a medical specialty. He decided to activate his reserve commission in the U.S. Public Health Service and chose active duty. He was promoted to Lt. Commander and was assigned to the U.S. Marine Field Hospital for Vietnamese refugees at Camp Pendleton in Southern California. He was later transferred to an outpatient clinic at the Independence Hall Mall in Philadelphia and worked with the Coast Guard and federal employees. On Tuesdays he would go to the Naval Regional Medical Center in Philadelphia and help in the surgical outpatient clinic. Tired of moving, he decided to pursue psychiatry residency training at the Hospital of the University of Pennsylvania.

The University of Pennsylvania was a perfect fit for residency training for Billick, as its faculty included many significant luminaries in mental health whose theories and contributions to psychiatry live on to this day. He was taught cognitive therapy by Aaron Beck, behavior therapy by John Paul Brady, family therapy by Salvatore Minuchin, couples therapy and sex therapy by Ellen Berman and Harold Lief, addiction psychiatry by Charles O’Brien, consultation psychiatry by James Stinnett, eating disorder therapy by Albert Stunkard, and psychoanalytic psychotherapy by Lester Luborsky, Edward Auer, and Edward Foulks. Best of all, early in his PGY-2 year he met Robert Sadoff, a world-renowned forensic psychiatrist and one of the founders of the American Academy of Psychiatry and the Law (AAPL). There was immediate synergy between the two men, and Billick would travel with this new mentor on Tuesdays during the PGY-3 year while Sadoff performed evaluations, testified in court, consulted with judges and attorneys, and browsed rare bookshops. Sadoff has since given his celebrated collection of more than 3000 rare books to the Philadelphia College of Physicians. Billick bought an original copy of Benjamin Rush's 1812 first American textbook on psychiatry. He took a forensic fellowship at the Center for the Study of Social Legal Psychiatry at the University of Pennsylvania, recruiting three part-time additional fellows. He organized a lecture and seminar series, scheduled evaluations, and was named Chief Fellow in Forensic Psychiatry by Sadoff. During an evaluation of an adolescent offender, Sadoff noted that Billick had a gift for relating to juveniles and suggested that Billick go into child and adolescent psychiatry to become a pioneer in child and adolescent forensic psychiatry. Billick looked at various programs and found the residency at New York's St. Vincent's Hospital to have excellent psychotherapy training and also a rotation in the Family Court's Mental Hygiene Clinic.

Although he had expected to return to Philadelphia, after two years in the Big Apple, Billick was hooked. This fish from the little farm had found his ocean. After completing his child and adolescent psychiatry residency, he sold his house in Philadelphia and bought an apartment in New York City. He took a position at Cornell University Medical School as an assistant professor of pediatrics and an assistant professor of psychiatry. After one year, Dr. Joseph English, Chair of Psychiatry at St. Vincent's Hospital, asked Billick to return to begin a child and adolescent consultation service to pediatrics. Soon after, Billick was asked to become the Chief of Psychiatric Inpatient Services. Having four psychiatric teaching units with attending physicians, residents, and medical students provided a wider arena for his academic interests, and he began a long career in mentoring and helping others with scholarly writing, research, and academic presentations. A review of his curriculum vitae demonstrates the intensity and longevity of these endeavors. He has always been a sociable and gregarious person, and he used this attribute to help motivate others in their academic careers. He was appointed the director of medical student education for psychiatry, and he revamped the teaching curricula and clerkships and created an impressive array of fourth-year electives. Several of his students received awards locally and nationally for their research and academic presentations.

It was Sadoff who took Billick to his first AAPL meeting in Baltimore in 1979. Billick joined and began to be active. He has given multiple presentations of scientific research, papers, and symposia yearly at the Annual Meeting, and he has encouraged and helped others to do the same, particularly trainees and early career psychiatrists. He has been a Councilor and Vice President and has twice been Program Chair of the Annual Meeting. As Program Chair, he created the peer review screening of submissions for the Annual Meeting. As the Co-chair and later as consultant to and member of the Education Committee, he helped AAPL to receive continuing medical education (CME) accreditation from the Accreditation Council for Continuing Medical Education (ACCME) on three occasions. He has served on numerous committees, including the Public Information Committee, the Trauma and Stress Committee, the Research Committee, and the Child and Adolescent Psychiatry and Law Committee. When he founded the Child and Adolescent Psychiatry and Law Committee, AAPL did not have a true committee structure or other specialty committee. AAPL used the success of this committee as the prototype for the current committee structure. Billick has also served on the Editorial Board of The Journal and continues as a peer reviewer. Within AAPL, Dr. Billick has received the Red Apple Award (outstanding service award), for his many contributions over the past 30 years of membership.

Billick is a nationally recognized and respected academic psychiatrist and is currently a Clinical Professor of Psychiatry at both New York Medical College and the New York University School of Medicine. In addition, he is a Lecturer in Psychiatry at the College of Physicians and Surgeons, Columbia University. He actively teaches and supervises forensic psychiatry residents in all three programs every week and also gives lectures yearly at the Mt. Sinai School of Medicine.

In addition to teaching and training, he is active in organizational psychiatry across his different specialties and encourages the many young and early-career psychiatrists whom he mentors to get involved. He is recognized as a Distinguished Fellow of the American Psychiatric Association (APA) and has received the Nancy C. A. Roeske, MD Certificate of Excellence in teaching. He has served on numerous committees within the APA, including the Juvenile Justice Committee (where he was a chair), and as an AAPL Liaison Member and on the Council on Children, Adolescents, and Families. He has been a member of the Committee on Confidentiality and also the Medical Student Education Committee. He has just recently served as an APA/Shire Fellowship Mentor for a general psychiatry resident with an interest in child and adolescent psychiatry.

A Fellow of the American Academy of Child and Adolescent Psychiatry (AACAP), Billick has received the AACAP Outstanding Mentor Award. Within AACAP at the national level, he has served as a research mentor for the James Comer Minority Research Fellowship and for the Jeanne Spurlock Clinical Fellowship. At the local level, he served as President of the New York Council on Child and Adolescent Psychiatry (New York District Branch) and recently received the Wilfred C. Hulse Award for outstanding contributions to the field of child and adolescent psychiatry.

He is a Fellow of the American Academy of Forensic Sciences, serving currently as a member of the Board of Directors and is the recipient of the 2010 Maier I. Tuchler Award. He has been the President of the American Society for Adolescent Psychiatry (ASAP) and was awarded their Herman Staples Distinguished Service Award, as well as the William A. Schonfeld Award for outstanding achievement, excellence, and dedication throughout his career in psychiatry.

He is a Fellow of The New York Academy of Medicine (NYAM) and remains active in this organization, where he is a past chair of the Section on Psychiatry and a member of the prestigious Admissions Committee. The NYAM is one of the oldest honorary medical societies in the United States. It houses one of the largest health science libraries in the world and has the second oldest medical manuscript, an ancient Egyptian papyrus. As a psychiatrist, he was honored to be selected by the NYAM to be a Fellow, and he valued the recognition of distinguished physicians of other specialties. The NYAM is also involved in extensive research into improving urban health, particularly for the poor. He has found good synergy with the aims and goals of the Academy.

In addition to his involvement in academic and organized psychiatry, Billick holds important governmental appointments and positions. He has long been a consultant for the Office of Professional Medical Conduct, Department of Health of the State of New York, and is the Psychiatric Peer Reviewer, Panel of Independent Psychiatrists for the First Judicial Department, Appellate Division of the New York State Courts.

Although extraordinarily busy as an academic psychiatrist, he is a fervent community organizer and remains active in the American Boychoir School (ABS) in Princeton, New Jersey, where he was appointed as a trustee. ABS is recognized as the leading boys’ choir in the United States and one of the top boys’ choirs in the world, performing with major orchestras nationally and internationally. He is also active in his local parish church and has served as a consultant to their choir school, a boarding school for 45 boys modeled on the English choir schools for cathedrals and universities. Although he also sang in both his church choir and school chorus growing up, he had no particular interest in boys’ choirs. When he joined his parish church in New York, he found himself listening weekly to one of the finest men's and boys’ choirs in the world. The boys sing in both the parish men's and boys’ choirs and sing the soprano parts in the musical liturgy. As the only child psychiatrist in the parish, he quickly became a resource for the rector, headmaster, and faculty of the school. Because of his involvement with the parish choir school, he became acquainted with trustees of the ABS. Invited to Princeton for a tour and day with the boys and faculty, he was astounded to find that he was listening to one of the top boys’ choirs in the world. This choir has regularly sung with the Philadelphia Orchestra, the New York Philharmonic, the Boston Symphony, and many other great orchestras and has appeared on national television at the Academy Awards Ceremony. Billick was invited to join the Board of Trustees, for both his expertise in child psychiatry and also for his enjoyment of charitable fundraising. He loved the way these boys, often marginalized in their former schools, became world class performers with great pride and development of excellent self-esteem because of the unique educational opportunity the American Boychoir School offered them.

He has also been recognized internationally and honored for community involvement. In New York City, he developed an interest in charitable fundraising helping theater groups, dance groups such as Ballet Hispanico, schools, hospitals, geriatric agencies, and other cultural and educational organizations. He has served on several boards and met a wide range of new friends. One friend mentioned a hospital in Jerusalem, the St. John Eye Hospital, that had been founded by the Prince of Wales during the reign of Queen Victoria. Billick was impressed to learn about this new hospital that had treated patients of all faiths, including the Grand Rabbi of Jerusalem among other Jews, Christians, and Muslims. When he learned that the hospital was in severe financial straits and in danger of closing, he decided to raise funds on its behalf. He organized the first fundraising dinner for the hospital in New York City and, to this day, continues his volunteer work by organizing fundraising dinners, concerts, and theater benefits to raise needed funds. Because of his dedication to the hospital and its work for the poor, Billick was appointed a Knight of Justice in the Order of St. John by Queen Elizabeth II. The Order traces its origins back 900 years to the Knights Hospitaller from whom it today derives its inspiration and maxim, Pro Fide Pro Utilitate Hominum (for the faith and in the service of humanity). The Order of St. John is a major international charity, accredited to the United Nations, whose organizations provide first aid, health care, and support services in more than 40 countries around the world. The Order's charitable work is carried out by the St. John Eye Hospital in Jerusalem and St. John Ambulance organizations worldwide, with volunteers and staff of more than 250,000.¹

I first met Dr. Billick while working as a general psychiatry resident at St. Vincent's Hospital in Manhattan. When I told my program director of my burgeoning interest in psychiatry and the law, I was introduced to Dr. Billick and have been fortunate to be one of his students and mentees for the past 10 years. In this time, I have benefited enormously from his expertise and guidance, which have undoubtedly enhanced my professional development in myriad ways. It was thanks to him that I received my first opportunity to write a first-author publication for The Journal on race and spiritualism in the movie, The Green Mile. This publication helped distinguish me as an applicant for the very competitive child fellowship at New York University, which I began as a PGY-4. Throughout my early career, Dr. Billick has been a role model for me and has encouraged my development as an academic psychiatrist. Over the years, we have collaborated on different publications and presentations at several meetings that span our shared interest in child and adolescent forensic psychiatry. Under his tutelage, I have completed two subspecialty fellowships. With his consultation and advice, I have been able to connect my interests in community mental health and love of academic psychiatry and have held two medical director positions working with high-risk youth in the child welfare and juvenile justice system in university-based programs. As an early-career psychiatrist, I can attest to how difficult it is to find a mentor who can assist with one's professional development with the same type of breadth of experience that Billick possesses and openly shares. He has been a perennially accessible and generous resource. A review of his curriculum vitae highlights that this experience is not unique to me. He has coauthored innumerable papers with generations of young psychiatrists who in turn are granted opportunities though their connection to him.

In his limited spare time, Billick has been learning French on his own, with the goal of becoming fully fluent through self-study. He has undertaken the ambitious process of writing a play in French, which at our last conversation was in its fourth draft at 14 pages. He has been elected a member of the consistory of the French Church of the Holy Spirit, a small Huguenot church established in New York in 1628. He continues to travel the world and revel in the wonderful diversity of New York, the United States, and the world of which they are part. Who is he? Well, one clearly has an understanding that he is as diverse as the world he loves and lives in. He retains an air of humility, even with his many professional successes and honors, and loves to tell people, “I’m just a simple farm boy from Wisconsin still picking the manure out from between my toes.” Despite his own diversities, his own complexities, perhaps he is correct. He is a person who loves people, loves the world, and simply wants to make it a better place because he has had a life here.