Is it really possible to do it all? The life and career of Dr. Debra Pinals seem to suggest that it is. Full disclosure: Debra has been my trainee, my fellow, my co-author, and my co-faculty member in the AAPL Forensic Review Course and is someone I love dearly. You must read this biography in that context.
Debra A. Pinals, MD
But let us begin at the beginning.
Debra was born as the youngest daughter in a large family led by two intense, active, and accomplished physicians who, when they visit, inspire and exhaust the Pinals family with their own boundless energy. Her interest in psychiatry is long standing—her mother retrained from pathology to psychiatry while Debra was in her early teens—and Debra's psychiatric residency at the Massachusetts Mental Health Center (MMHC) gave her opportunities to taste and get interested in forensic topics in many clinical and legal contexts, including commitment hearings (she parlayed this interest into a book with Doug Mossman, MD, mentioned later). She recalls one incident:
One of the most memorable cases was a woman with untreated bipolar disorder who had been living homeless in the community; the clinical team had perceived of her as having poor judgment and creating a risk of harm to herself. The patient insisted that the hearing take place in a regular courtroom and appeared in court dressed in a velvet jacket with a velvet black hat with a rose sticking out of it, and proceeded to testify as to why living homeless was a safe option for her. The judge ultimately released her.
Debra was struck and moved by the competing aspects of liberty interests.
She reports that the teaching conferences with a medicolegal focus, which I presented, also had an impact on her growing interest in forensic psychiatry. Her leadership qualities were recognized early, when she was chosen as chief resident at MMHC, after which she departed to the National Institute of Mental Health (NIMH) for a fellowship in schizophrenia research. This fellowship bristled with forensic subtexts in the areas of competence, informed consent, termination of parental rights, and ethics.
One of my close encounters with Debra's abilities was when she was accepted as a Charles C. Gaughan Fellow in Forensic and Correctional Psychiatry. This fellowship, under my direction, was designed to raise the level of service and training at Bridgewater State Hospital, the Massachusetts maximum security institution for the criminally insane: that is, for competence-to-stand-trial evaluations on defendants too dangerous for local venues, for insanity assessments and postinsanity acquittees, and for prisoners experiencing psychiatric decompensation. Although she admitted having reservations about working in such an environment as a woman, she plunged in and did superb, courageous, and sensitive work with a most challenging population. She later described it as a fascinating and fulfilling place to work. She worked there until she was about six months pregnant with her first child.
From Boston she went to Cleveland to work with Philip Resnick, MD, in administrative and clinical functions at a state hospital for the Ohio Department of Mental Health and with Case Western Reserve University. She returned to Massachusetts in 1998, and for 10 years thereafter, served as Director of Forensic Services at Worcester State Hospital and the Forensic Psychiatry Fellowship at the University of Massachusetts Medical School (UMMS), one of only two such fellowships in the state. Today at UMMS, she is Associate Professor of Psychiatry. In 2005, she took on the demanding additional administrative role of Central Massachusetts Area Medical Director for the Department of Mental Health. Three years later she became Assistant Commissioner of Forensic Services in charge of forensic operations, program development, and forensic training for the Massachusetts Department of Mental Health, overseeing quality and services in adult and juvenile court clinics and inpatient forensic evaluations, forensic transition team re-entry services, police-based jail diversion, assessments of individuals with mental illness and problematic sexual behaviors, and interagency collaborations with corrections and youth services. She helped with policy development and consulted on high-risk cases throughout the state as well as those involving complex forensic matters; simultaneously, she served as principal investigator on several federally supported studies regarding offender reentry programs and helped in the development of mental health courts and alternatives to incarceration for veterans in Massachusetts. In addition, in an effort to help support her team, she took on the job of Interim Deputy Commissioner of Clinical and Professional Services/State Medical Director for the Massachusetts Department of Mental Health. Although she ultimately chose to return to her full-time work managing state forensic services, as Interim State Medical Director, she provided clinical oversight during a major realignment of state inpatient services that included opening a new state recovery center and hospital, developed policy, and provided cross-agency psychiatric leadership while health care reform efforts were under way.
Does my title, doing it all, begin to make sense yet?
The Massachusetts Psychiatric Society had this to say about her accomplishments:
The MPS would like to express its appreciation to Dr. Debra Pinals for her dual role for the past 14 months as [Interim] Deputy Commissioner for the DMH and Assistant Commissioner for forensic [services]. Debra has done a yeoman's [sic] job performing both roles with her usual good humor and graciousness….
Buried as subtext in this paragraph within the idea of good humor and graciousness is the point that Debra not only takes on these administrative roles that would paralyze and overwhelm a senior bureaucrat, she makes it look easy.
While engaged in all these pursuits, Debra has also maintained a private practice in forensic psychiatry and at various points has served as an emergency room attending, as an attending at the local women's prison, and as a psychiatrist in multiple clinical settings, providing consultation on matters related to service system delivery, stalking, capacity, and risk management.
Somewhere in the spaces between these activities Debra finds time to write. The classic volume, Stalking: Psychiatric Perspectives and Practical Approaches,1 which she edited, is currently the most useful compendium on this charged subject. A review on Amazon states:
This book stands alone at the forefront of identifying and understanding this disturbing phenomenon. The vast experience of the authors adds a rich clinical component to the empirical data and serves to make the information more approachable and useful for readers. This is a worthy addition to a practitioner's library, and the comfortable writing style allows for a quick referral to specific issues. This book will undoubtedly be viewed as a vital reference for both forensic and general clinicians involved in the assessment and potential treatment of individuals with stalking behavior.
She has also co-authored a book with Douglas Mossman, MD on evaluation for civil commitment,2 has published about 69 articles on forensic topics, has produced recordings, and has written abstracts, reviews, and curriculum materials on a broad array of subjects at the interface of law and psychiatry.
Yet another layer of activity must be addressed: teaching. I have specifically introduced Debra to my female trainees as a role model for their forensic careers. She is a gripping lecturer, as demonstrated annually by her participation in the Forensic Board Review Course to consistently high ratings. She frequently presents lectures, conducts workshops, and appears on panels at American Academy of Psychiatry and the Law (AAPL) meetings. Most recently, she received an educational award from the AAPL Institute to develop a teaching DVD about testamentary capacity that is designed to improve practice on this important evaluation.
Her career trajectory, with its administrative, educational, clinical, and forensic facets, apparently effortlessly accomplished, already features an impressive record of achievements, further itemized in her 32-page curriculum vitae. The thing that makes the average AAPL member's head explode is that this extensive career has unfolded while Debra raised a handful of children, with the unflagging support of her husband, who holds down the fort.
Debra's children might well be described as AAPL babies or its youngest members. Consider:
She missed one meeting because of the birth of one child, but since then, the children have gotten to make special trips to AAPL meetings. A daughter went to Vancouver at the age of three months, and a son traveled at six weeks of age across the country to California. Another child traveled to Chicago at eight months in utero, with Debra torn between the wish to support her colleagues in the Review Course and the need to make back-up plans for a possible delivery, including training a fellow to give one of her lectures if needed.
The awards recognizing her outstanding work began with the 1993 award letter for medical student teaching, bestowed by the Harvard medical students she mentored during their psychiatry clerkship at the Massachusetts Mental Health Center. Similar recognition followed at Case Western Reserve and the University of Massachusetts Medical School. She was voted best teacher in a forensic fellowship at AAPL in 2005, is a distinguished fellow of the American Psychiatric Association (APA), received the APPL's Red Apple award for outstanding service, and was chosen for the Outstanding Psychiatrist: Public Sector Award by the Massachusetts Psychiatric Society.
As one would expect, she has held numerous roles in the Massachusetts Psychiatric Society and the APA, most relating to forensic psychiatry, such as the Council on Psychiatry and the Law. But it is in AAPL itself that she has made her most striking contributions. She has been Councilor, Treasurer, Vice-President, and now, of course, President. She has co-chaired the Education Committee; served as a member of the Law Enforcement Liaison Committee and the Nominating Committee; chaired the Council Task Force to Revise the AAPL Ethics Guidelines; chaired the Task Force of the Education Committee on Maintenance of Certification; served as Annual Meeting Program Chair for the 2008 Seattle meeting; and served as AAPL representative to the Assembly of the APA. Right now, the reader of this biography is probably asking, does this incredibly capable woman ever turn down the invitation to fill a service position? Perhaps not. Driven? Perhaps so. But in the 22 years I have known her, she has never complained. She just does what is needed.
Her astonishing list of accomplishments fails to capture an essential part of Debra's nature: she is great fun to work with. She does not take herself too seriously, displays a cutting sense of humor and whiplash wit, and simply makes you glad to be a collaborator in her wide-ranging enterprises.
Incidentally, she is also a polyglot, speaking French and some Spanish and Hebrew. On top of that, perhaps influenced by the work of her mother and sister, she is a self-taught, serious artist. The walls of her home are brimming with her canvases. All the children are budding artists as well; the family invariably seeks out art museums when traveling. A voracious reader, she sets aside specific time as reading time, when everyone in the family has a quiet time to read. She also teaches her children about giving back to the community, leading them, for example, to a local orphanage to play with the children and involving the kids in projects for a local school for the blind while on vacation.
According to her husband, Debra is the one in charge as organizer and disciplinarian, using, he says, “her forensic skills to get the kids to tell the truth about what happened” in one domestic incident. This biography obviously defies summary, but it may be said in conclusion that, from the President's chair this year, AAPL will be led by a simple force of nature, to its predictable benefit.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2013 American Academy of Psychiatry and the Law
