We were enjoying a fine dinner in New Orleans during the 29th meeting of the American Academy of Psychiatry and the Law (AAPL), Ezra Griffith, Jacquelyn (Jackie) Coleman and myself. It seems hard to believe now, but the year was 1998. Not really quite sure just how I'd come to be in this distinguished company, I chose to set myself on learning mode. Ezra, meanwhile, lost no time as he began to describe in some considerable detail his vision of what he would like to do with the opportunity if he were to be selected as the next editor of this journal, then and now the signature forensic psychiatry periodical of the day. Back then it had an unassuming title, The Bulletin of the American Academy of Psychiatry and the Law, or simply the cherished AAPL Bulletin.
The AAPL Bulletin had published its first volume in 1973. In addition to the several hundred members of AAPL receiving it automatically, the Bulletin was offered for subscription, probably not without some serious editorial hubris, to approximately 300 law libraries and medical libraries. The Bulletin's Editor, Hebert E. Thomas, rendered AAPL's sincere gratitude for the financial support it was to receive from Pfizer Laboratories for its first year of publication. This grant had the approval of those attending the annual AAPL meeting, and it did come to its end after one year. Back at the time, such support as this must have been felt more like a humanitarian gesture than like a means of enhancing the drug company's bottom line. But now such intriguing complexities of the drug companies' behavior have come to light that the fate of a similar offer of support would not be easy to predict.
Ezra E. H. Griffith, MD
Our conversation during the New Orleans dinner necessarily had to include serious concerns about financing Ezra's vision for The Journal. But we were more focused on its professional attributes. These ranged from the expected sublime to the apparently ridiculous traits of a worthy scholarly journal. Using examples along with arguments, he repeatedly emphasized the importance of seemingly trivial attributes of appearance like color, physical size, quality of paper, and branding. Often enough, these determine the first impressions made by the sponsoring organization. If they fail to measure up, the value of a journal's content is at serious risk of not being recognized. Thus insistence on the appearances engenders quality of the essence. Serious attention to the mission statements of an academic organization and its journal(s), instructions for authors, and similar documentation can be quite rewarding. In the same vein is the editorial office's availability to its journal's readership.
As our exchanges over the dinner progressed, the depth, strength, and precision of Ezra's convictions became more and more clear to me. He already knew that I was prepared to support his ideas because we had been co-leading a journal club for Yale psychiatry residents for several years. We were in the habit of calling upon them to take turns investigating an unfamiliar journal of their own choice and presenting their results. We urged them to identify and evaluate each journal's own self-presentation, its clarity of mission or purpose. We tried to demonstrate the relevance of physical appearance, including how the cover looked, the quality of the paper stock, and the preparation of figures and tables.
Predictably, some of the residents grasped the essence of their task and obviously enjoyed pursuing it, even to the point of interviewing editors briefly by phone. Of course others voiced more skeptical reactions. The three of us around the table knew well that it was at best about the same with the membership of AAPL. There were many well-respected AAPL members who had their good reasons for cherishing the Bulletin as it was and would view almost any proposed change as risky and unnecessary. At the same time we knew that others shared our vision of the need to keep up with the expanding and evolving profession of forensic psychiatry, both within and beyond AAPL's membership. It also helped considerably that the AAPL Newsletter itself was by then in its own right going from strength to strength under the highly capable editorship of Phillip J. Resnick, providing an expanding outlet for interesting and useful content and exchanges on the important sidelines of formal academic presentation.
Subsequent to our dinner discussion, the AAPL Journal's gradual evolution continued at its slow pace, its editorship passing in 2000 from Seymour L. Halleck to Ezra. As the time for his successor, Michael A. Norko, now approaches, Ezra for his part can take a modest and justified pride in The Journal's more than satisfying progress over his tenure as its editor. For our part, we present-day readers have generally grown accustomed to enjoying the many benefits of his ambitious imagination as he sketched them out to Ms. Coleman and me during that evening in New Orleans. The sheer amount of published material contained in each issue has easily more than doubled. Many regular articles appear with one or more invited scholarly commentaries. At least one outside editorial normally opens each issue.
As its regular readers know, their journal's upgrades under Ezra's leadership have been major, in the related aspects of sharp appearance and cogent content. Authors of Reflections and Narratives pieces offer personal reactions to their experiences in practice, sometimes through fiction and poetry. The Analysis & Commentary section is for topical literature reviews with professional discussion. The Legal Digest section offers a means for readers to keep themselves up to date on legal developments, as well as an opportunity for forensic psychiatry and psychology fellows to practice the discipline of legal writing. And importantly The Journal publishes each official AAPL guideline and any of its occasional official position statements formally as a supplement. This feature usefully ensures that all of these important documents will always remain alive for anyone wishing to access them to raise concerns and share suggestions. More recently, the Biography section made its appearance.
Yale Contributions
Ezra joined the Yale Psychiatry faculty in 1977, just as I was beginning my residency. I remember that it was the Reverend Robert G. Anderson, chaplain to the Connecticut Mental Health Center (CMHC), who introduced us, both working at the time on different units housed in the Center. Among Rev. Anderson's several visionary creative projects at the time was a monthly evening interest group. Organized along the lines of a journal club, we met to discuss the spiritual and moral topics of the day. We seriously prepared for each meeting with readings sent out in advance. I recall regularly experiencing an unusually high level of discourse, the group attracting as it did several of Yale's better-known faculty at the time from several departments. This setting offered the two of us an ideal opportunity to open and nurture our relationship.
As I recall hearing it at the time, the Yale Psychiatry Department had recruited Ezra essentially for his promising leadership in the newly fashionable field of public or community psychiatry. This credential referenced his involvement in issues such as the wellbeing of racial minorities and other nondominant groups, the defining characteristics of black psychiatrists, the application of psychiatry to matters of administration, and excellence in pedagogy across the multidisciplinary spectrum, including pastoral counseling. Community psychiatry, then as now, also incorporated many ethics issues under its domain. Fortunately for the two of us, it could also be made to include any subject matter that simultaneously engaged the disciplines of psychiatry and religion, and typically the law as well.
Upon completing Yale's psychiatry residency, I had the great joy of getting to spend the next year as a forensic psychiatry fellow under Howard V. Zonana, who proved to be a reliable encourager of my related interests in practical philosophy and ethics, as well as a superb educator in our relatively new subspecialty. After the forensic fellowship, Ezra arranged for me to work as a member of the Yale faculty under his collegial mentorship. The first project we undertook was defining the therapeutic aspects of a weekday evening worship service in a local black church. Its members had completed questionnaires that we then had to codify, tabulate, and organize into our first published article.1
Then, with the gracious and generous help of a former editor of the American Journal of Psychiatry, Francis J. Braceland, we discovered another topic of interest: the valued but underutilized potential role of psychiatric consultation to support the Roman Catholic Church's marriage tribunals in their search for the truth as it applied to broken marriages. Over a most delightful luncheon in his New England country home, Francis conveyed how gratifying it was for him as a psychiatrist to alleviate the needless suffering of struggling couples in this way. It was also obvious to me that Ezra personally enjoyed seeing his old friend and sharing the experience with me as a newcomer. They also compared mental notes on how the editorship of the American Journal of Psychiatry had gone since Braceland's retirement from that role.
Our studies continued, both jointly and separately. Together we continued working on a variety of connections between religion and healing, including the powerful potential effects of religious garb; on various aspects of new religious movements (NRMs or cults); the legal, religious, and clinical implications of the distinct strata of pastoral counseling; liability issues for religious organizations and their clergy; confidentiality in religious settings; the power of symbolic elements involved in churches' practices; and the hazards facing any clergy who aspire to positions of authority.
In 1986 Ezra joined Yale's African-American Studies Department. This introduced him to a sensible and economical administrative model that he very much admired. It made use of entirely joint appointments, thus nurturing a habit of routinely identifying and utilizing available and compatible resources. These included faculty members of such departments as anthropology, history, art, and English. Ezra enjoyed the rich and challenging learning process, featuring as it often did the repartee of the generations learning from one another through sharing narratives both novel and familiar.
In particular, his involvement with the Department of African-American Studies enabled Ezra to expose and explore more deeply the roots and breadth of his own individual understanding of black identity. In particular, he recently completed a three-month faculty appointment in the University of the West Indies. There he was free to deepen and strengthen some of his lifelong impressions. He also took notes and tested ideas for a possible book through which he expects to solidify some of his current thinking and once more to communicate his most heartfelt ideas old and new.
Ezra's appointment as Director of CMHC in 1989 afforded him a highly exposed stage and useful props for both pursuing and communicating his concerns and ideas. He turned more than a few heads by showcasing the scholarly contributions of the Center's staff members. He did this mostly by using professionally produced and widely distributed booklets. He had no tolerance for those who criticized what he was doing as a pointless squandering of limited resources, diverting them from the Center's mission. On the contrary, from the outset of his directorship Ezra insisted that, rather, this (along with similar measures) constituted essential ways to approach fulfilling the Center's mission. The shining patina of community psychiatry may have dimmed due to the harsh realities of widespread poverty, increasing costs, drug-abuse epidemics, AIDS, and the like, but Ezra would not stand for allowing research and scholarship to lose their relevance. Rather, any adversity would drive him to apply himself and challenge his associates all the more.
In a similar fashion and for similar reasons, Ezra triggered a serious policy priority for upgrading the Center's physical presentation. Here he met with far less opposition, if any. Patients and staff together liked lifting their shared morale. They used practical and inexpensive whiteboards as well as informative and inviting posters. They also contributed suggested ideas for giving the lobby a homier look. Around the Center, sitting areas became more plentiful and inviting. Spaces suitable for quiet reflection and meditation became readily available. Some patients, too, responded by rising to the opportunity they saw to contribute their own forward-looking shaping influences. Ezra's operating principle here was closely akin to his radical approach for editing the AAPL Journal, i.e., looking good goes a very long way toward functioning well. In other words, efforts that seem dedicated purely to appearance, when sustained with skill and care, can directly impact the level of substance itself.
Religious Sources
Ezra's conviction regarding the fundamental powers of attending to appearances derives directly from his primary work addressed to the roles played by religion in psychiatry and law. The first cleric Ezra got to study was his own father, Vincent; the first congregations available for him to study (or at least to observe) were those his father served, first in his native Barbados and then in New York City.2 The move north, a bold and ambitious act on Vincent's part that took two years of separation from his family to realize, took place in May 1956 when Ezra was 14 years old. Although the arrival experience was at first rather disconcerting to him, this feeling was far outweighed by his elation upon having his father back again.
Within a year of Vincent's departure from Barbados with his family, the island saw the return of another cleric of great significance to Ezra, the late Spiritual Baptist Bishop Granville Williams. Political independence came a decade later, allowing diverse churches and related organizations to regain much of their former powerful and colorful cultural influences. Ezra took full scholarly advantage of this opportunity, attending services, interviewing his “informants,” observing everyday public experiences, and pursuing background reading. Rev. Williams encouraged those sources whom he influenced to give Ezra the generous access required for the extensive interviews and observations his scholarly methods involved. Among the results of this work, the most striking to Ezra was the instrumental role of props such as books, candles, bells, water, flowers, and music, but especially the lavish garments used for worship.3 I got to see all of these in colorful, loud, yet prayerful and moving action several years ago when I joined Ezra at his invitation to attend a Spiritual Baptist Sunday service of worship. It was not at all hard to appreciate how one could, independently of ethnic or cultural background, be joyfully drawn into an experience like this, be it for a day or a lifetime career of scholarly work.
Ethics
Around the time that his directorship of CMHC ended in 1996, Ezra became the chair of its Ethics Committee. He took a systematic approach to this cardinal assignment, putting considerable effort first into articulating the purposes of the committee and then seeking out the individuals and the sorts of deliberations likely to yield the desired results. To do so, he put great emphasis on leading the parties involved in a multifaceted listening experience. As they tried to follow Ezra's attempts to lead, the committee members were not consistently comfortable working with a model based heavily on discovering and trying to comprehend narratives of strangers. Over time, Ezra's model came to exert its influence in a subtle yet secure fashion. This happened as each particular topic found its just and proper place among the committee's collection of narratives, better known as its minutes, archives, and other official records. There they await visits by external reviewers that can occur at any time.
Around the same time, in 1995, Ezra began his 20-year service as ethics committee chair for the Connecticut Psychiatric Society, district branch of the American Psychiatric Association (APA). Membership on this committee under Ezra was a matchless learning experience. Here we repeatedly had to sort among incompatible pieces of competing stories involving high-stakes consequences. The outstanding learning experience for members of this committee was to perform the function of investigating reporter. This meant essentially constructing the initial draft of a forensic report and presenting it to the committee for discussion under Ezra's thespian guidance. We committee members noticed the tendency to experience the committee's work in terms of competing narratives associated with significantly varying degrees of forensic credibility. This reality came sharply to light when, in a moment of truth during one of our meetings, we noticed that more than half of us were forensic psychiatrists. It was not something any of us—including the chair—saw as needing to be corrected. And now, as of this writing, Ezra is undertaking the distinguished position of Ethics Committee Chair for the entire APA.
Forensic Psychiatry
To appreciate Ezra's own continuing story, present and future, in full, it is worth noting that, when Ezra accepted the position of psychiatrics ethics chair at the state level, he was within two years of being elected President of AAPL. As he came to assume the office of its leader, AAPL was experiencing an increasingly intense debate about the fundamentals of its place as a distinct medical specialty.
This debate in AAPL's case ranges from one extreme to the other. Some respected experts take the position that psychiatrists have nothing to contribute to any courtroom proceedings and therefore they ought to be banished from the legal scene altogether, the sooner the better, and never be permitted to return. At the opposite end of the spectrum we hear experts no less respected arguing against allowing any restrictions to limit potential contributions from forensic psychiatric expert consultation or testimony.
As outlined in the descriptions above, Ezra remains widely and respectfully recognized for his emphasis on the importance of the narrative character of psychiatric testimony. This position rests securely on the fundamental insight that the psychiatric report is itself the work-product.4 The narrative meme deeply colors and informs his writing career from end to end, strengthening his audience with a kindly summons to listen ever more deeply and watch more vigilantly.
On the other hand, the closely related theme of performance as a fundamentally necessary aspect of forensic psychiatric practice is more nuanced and complex, and it may even already be on the wane among serious academics and practitioners. For our purposes here, at a minimum forensic reports must be completely free of misspellings, grammatical errors, and the like. Ezra's position would favor going further in the direction of polishing one's act, but the matter now represents a moving target to be followed as one thinks best until further notice.
Emeritus
Ezra retired to emeritus status uncharacteristically quietly from Yale University a few years ago. We might find surprising his almost cat-like sudden quietness—until we learn or remember how he described his entry into academia: he says that one morning he woke up knowing that he would be a professor. That was it.
Ezra is also devoted to his family. His wife Brigitte is a retired virologist, a scientist in her own right. His daughter Veronique is creatively engaged in work combining anthropology and medicine, while his son Pierre is a New York attorney. Ezra is happy with and mighty proud of all three. He sang in church choirs throughout his youth, was a percussionist in Afro-Cuban ensembles, and coached youth soccer teams.
Ezra's two most recent books address the problems and possibilities that our disciplines of forensic psychiatry and psychology are presently confronting. The first5 is an edited work that includes more than 30 contributors and is reviewed in this issue of The Journal. The other6 is an extended solo essay drawing deeply on his own spirituality. The latter volume seems to come straight from his generous heart as well as his energetic intellect. It isn't possible to imagine Ezra as anywhere near the end of all he has to offer. More likely, he will just become easier to keep up with, even as he continues his travels and reflections—with responsibility for the APA Ethics Committee.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2018 American Academy of Psychiatry and the Law
