As a third-year general psychiatry resident, I developed an interest in pursuing forensic psychiatry fellowship training. I was fortunate to have a forensic psychiatrist as my outpatient caseload supervisor, and he taught me what forensic psychiatry was, what it wasn't, and how it could help me become a better psychiatrist. I first learned of Dr. Frierson when my caseload supervisor was discussing the forensic psychiatry fellowship program he attended at the University of South Carolina School of Medicine (USC SOM). I decided to complete a one-month elective at this program as a fourth-year general psychiatry resident, and I was lucky enough to be selected for a fellowship position the next year. Dr. Frierson was the training director. After completing the fellowship under his tutelage and being his friend for the past fifteen years, it is my pleasure to document his life for the American Academy of Psychiatry and the Law (AAPL) membership.
Richard Lesesne Frierson, MD, (or Rick as he is known to his family and friends) is the first AAPL President born in South Carolina and only one of a handful of AAPL Presidents from the American South. Rick was born to William Robert Frierson, Sr., and Julia Evans Frierson in Sumter, SC, on October 13, 1962 as the second of two sons. His father, a former Navy medic who served in the Pacific theater during World War II, worked as a salesman for the American Bakeries Company. His mother was a civil service employee at a local U.S. Air Force base. Dr. Frierson was born into a privileged family, although not in the traditional sense. His parents were high school graduates who never attended college, but they realized the importance of education and instilled an expectation in both of their sons that they would apply themselves academically to build brighter futures. Much like his parents in their youth, Dr. Frierson's older brother, Robert, was a talented athlete who eventually became the starting quarterback for a high school with more than 2,500 students. Dr. Frierson, perhaps not as athletically inclined (but an avid tennis player in adulthood), and frequently suffering from childhood asthmatic bronchitis, developed an early interest in music and began piano lessons when he was eight years old. His love for music led to participation in his high school band as a clarinetist and his eventual selection as South Carolina's only representative for the John Philip Sousa National High School Honors Band. As was typical of many boys raised in the South, he actively participated in a YMCA church basketball league and Boy Scouts of America, where he attained the rank of Eagle Scout. As his musical talents were blossoming, Dr. Frierson's first exposure to medicine came in the summer between his junior and senior years of high school, when academic excellence earned him an invitation to the Governor's School of South Carolina at the College of Charleston. During this two-month program, he had the opportunity to witness an autopsy at the Medical University of South Carolina. Finding this experience fascinating (as also evidenced by his affinity for the television medical drama Quincy, M.E.), he initially wanted to become a pathologist. Dr. Frierson continued to excel in high school and graduated near the top of his senior class of 800 students.
Richard L. Frierson, MD
Before he could fulfill his dream of being a pathologist, Rick made the “long” trip (approximately 45 miles) from Sumter to Columbia to attend the University of South Carolina (USC) after being offered music and alumni scholarships. Rather than majoring in biology, chemistry, or some other typical premedical field of study, he majored in music (piano). When asked why he chose to major in music, Dr. Frierson replied that he did not want to spend four years in a biology or chemistry lab, and furthermore, “music students were infinitely more fun and entertaining to be around.” His academic excellence in the School of Music earned him membership in the Phi Beta Kappa Honor Society and Pi Kappa Lambda National Music Honor Society. In addition to his piano studies, he was the principal clarinetist in the USC Symphony Orchestra. To complete medical school prerequisites (which did not count toward his 136-hour applied music degree), he frequently attended summer school. He graduated magna cum laude in 1984 with a Bachelor's Degree in Music (BM) and was valedictorian of the School of Music.
After completing his undergraduate education, Dr. Frierson attended USC SOM. He earned the William B. Douglas Medical Scholarship and the Todd Memorial Foundation Scholarship to fund his medical education. The academic excellence that he displayed during his undergraduate career continued during medical school. However, his desire to be a pathologist dissipated during his first-year histology course; staring down the barrel of a microscope was not how he wanted to spend the rest of his life. Dr. Frierson considered a career in pediatrics, which he enjoyed immensely until he was required to spend two weeks in the office of a private pediatrician. He quickly realized that holding down young screaming children so that he could look into their ears was as unappealing to him as staring into a microscope.
It wasn't until his third-year psychiatry rotation that he found his passion. Rick's psychiatric clerkship rotation on an adult inpatient unit at the William S. Hall Psychiatric Institute (a state-run facility on the grounds of the South Carolina State Hospital, the second such hospital in the United States) opened his eyes to the impact that he could make in this field. He was immediately dismayed to realize that persons diagnosed with mental illness were treated in separate systems of “state hospitals,” while persons with medical illnesses are treated at private, academic, or community hospitals. Dr. Frierson believed this double standard was unfair, leading him to realize that society did not truly understand mental illness and likely stigmatized persons with mental illness. That, coupled with seeing patients in the throes of acute psychosis improve with treatment, led him to the conclusion that psychiatry was where he could make a difference. During his fourth year, Rick earned the Joseph Collins Foundation Scholarship (New York, NY), an award based upon financial need, scholastic record and standing, demonstrated interest in arts and letters or other cultural pursuits outside the field of medicine, intention to specialize in neurology, psychiatry, or general practice, and evidence of good moral character. Dr. Frierson graduated cum laude from the USC SOM in 1988 and received the Lange Medical Series Award for academic achievement; he also became the first physician in his family.
Rick completed his general psychiatry residency at the USC SOM – William S. Hall Psychiatric Institute in 1992. During his general psychiatry residency, he earned the Joe E. Freed Award for Outstanding Resident Paper and the Outstanding Psychiatric Research Award. His foray into the field of forensic psychiatry was somewhat accidental. During his residency, he worked for a month on an inpatient forensic unit where patients were either civilly committed from jail due to dangerousness to self or others, or were admitted under circuit court order for competency to stand trial restoration. During his fourth year of residency, Rick was undecided about what type of practice setting he would like to pursue after residency. He decided to complete a forensic psychiatry fellowship, mostly because his residency rotation in forensic psychiatry allowed him to see that he could perhaps make an impact in reducing the stigma associated with mental illness by using his training to educate others (courts, legislatures, etc.) about mental illness.
After completing his forensic psychiatry fellowship at USC SOM in 1993, he was hired by the South Carolina Department of Mental Health (SCDMH) to develop an outpatient forensic evaluation service to serve the entire state of South Carolina, a position he held until 1999. Prior to this time, all evaluations for competency to stand trial and criminal responsibility regarding felony-level charges were done on an inpatient basis, which was costly to the SCDMH. (There is no provision for court-ordered competency to stand trial or criminal responsibility evaluations in misdemeanor cases in South Carolina.) South Carolina has a population of more than 5 million, and Columbia is located in the geographic center, less than two and a half hours from any county seat.1 Therefore, it is possible to conduct forensic evaluations in one day. Under his leadership, the outpatient Forensic Evaluation Service flourished and currently conducts more than 1,100 forensic evaluations on felony defendants annually.
During his work at SCDMH, Rick's passion for teaching became evident. He was responsible for all educational activities within the SCDMH Forensic Division, including teaching third- and fourth-year medical students, general psychiatry residents, and forensic psychiatry fellows. Dr. Frierson shouldered a substantial teaching load while conducting court-ordered outpatient criminal forensic evaluations. Due to his teaching skills, he landed the job that was meant for him in 1999: Program Director of the USC SOM Forensic Psychiatry Fellowship. In addition to directing the forensic psychiatry fellowship, he continues to conduct competency to stand trial and criminal responsibility evaluations for the SCDMH. Dr. Frierson also has several other roles at the USC SOM. He is the Alexander G. Donald Endowed Professor of Clinical Psychiatry and Vice Chair for Education in the Department of Neuropsychiatry and Behavioral Science. Rick oversees all medical student education, residency training programs, and fellowship programs. He directs the USC Professional Wellness Program, conducting fitness for duty evaluations on physicians, nurses, and other health care professionals when ordered by their respective licensing boards. He also provides care to inmates at Gilliam Psychiatric Hospital, which is part of the South Carolina Department of Corrections and supervises the forensic fellows when they rotate there.
Dr. Frierson is truly a renaissance forensic psychiatrist, competent in providing a wide array of both criminal and civil forensic services. He has completed more than three thousand criminal evaluations (e.g., competency to stand trial, criminal responsibility, and competency to be executed) for SCDMH; in addition, he also conducts civil evaluations in disability cases and testamentary capacity cases, and performs record reviews in private malpractice litigation, psychological autopsies for the South Carolina Department of Corrections, and violence risk assessments for the teaching hospital at the USC SOM and SCDMH facilities.
However, his most influential role has been as the forensic fellowship program director. He has positively affected the lives of medical students, general psychiatry residents, and forensic psychiatry fellows over the last twenty years. Through his outstanding work ethic and exceptional teaching style, he provides the best possible education, challenges all trainees to maximize their potential, and imparts his experience about how to be an effective teacher. During the fellowship year, his fellows are exposed to a significant variety of cases from which they learn myriad forensic psychiatry principles. Rick prepares fellows to provide effective expert witness testimony and, whenever possible, allows them to attend his trial testimony and depositions. Dr. Frierson sacrifices his free time to carefully review the fellows' reports and provide constructive feedback to help them improve their report writing skills; in addition, he is receptive to the fellows' feedback about the program and incorporates that feedback to improve the fellowship experience for future trainees. USC SOM fellows graduate with increased diagnostic acumen, significantly improved writing skills, and a solid foundation in forensic psychiatry, all of which allows them to tackle any case that comes their way. Rick has been recognized at the university and national levels for his teaching prowess, including receiving AAPL's Award for Best Teacher in a Fellowship in 2006 and the Seymour Pollack Award in 2016 for his distinguished contributions to the teaching and educational functions of forensic psychiatry. He continues to provide mentorship to former fellows when they contact him to discuss difficult forensic cases, and he does not hesitate to provide guidance.
Dr. Frierson's impact on the fields of psychiatry and forensic psychiatry has extended beyond the USC SOM, and he has advocated for the profession. In 2008, while serving as President of the South Carolina Psychiatric Association (SCPA), he was confronted with the fact that the Mental Health Parity Act of 2008 was being prevented from passing the U.S. Senate by a South Carolina Senator, Jim DeMint (R). Dr. Frierson organized a concerted effort, including telephone calls, editorials in two of South Carolina's largest papers, and a personal visit to Washington, D.C., to meet with Senator DeMint to persuade him to drop his opposition. Due to these efforts, Senator DeMint eventually allowed the Mental Health Parity Act to proceed to the Senate floor for a vote. Over his career Rick has also advocated for the profession of forensic psychiatry through his work with the National College of District Attorneys (NCDA). Dr. Frierson has delivered more than twenty lectures around the country advocating for the use of qualified forensic experts in criminal prosecution. For his efforts, he received the Stephen L. Von Riesen Lecturer of Merit Award from the NCDA in 2009.
As an academician, Dr. Frierson has authored more than 50 articles and book chapters and has given multiple lectures regionally, nationally, and internationally on various topics. He is co-editor, along with Liza H. Gold, MD, of the American Psychiatric Publishing Textbook of Forensic Psychiatry (third edition).2 Rick also served as an examiner for the American Board of Psychiatry and Neurology's Part II Oral Examinations in Psychiatry for more than thirty exams, and he has been a member of the American Board of Psychiatry and Neurology's committees on recertification in psychiatry and certification in forensic psychiatry for a combined 16 years. Because of his numerous contributions to board certification, he was appointed an Ambassador by the American Board of Psychiatry and Neurology's Maintenance of Certification program in 2016. Rick has represented South Carolina in the Assembly of the American Psychiatric Association (APA), and he has served on the APA Council of Psychiatry and Law as well as the Isaac Ray Award Committee. He is also an active member of the committee on Psychiatry and Law in the Group for the Advancement of Psychiatry (GAP).
Dr. Frierson's contributions to AAPL have been equally remarkable. In his AAPL career, he has served on the program, education, ethics, and nominating committees. He has been a member of the Association of Directors of Forensic Psychiatry Fellowships since 1999, serving as Vice President from 2011 to 2013 and President from 2014 to 2017. Over the years, Dr. Frierson has taken on several leadership roles in AAPL. He was elected Councilor from 2009 to 2012, Secretary from 2012 to 2013, and Vice President from 2013 to 2014. In recognition for his contributions to AAPL, Rick received the Red AAPL Award for outstanding service in 2014. In October, he became the forty-fifth president of AAPL, where he will help us celebrate our fiftieth anniversary in October 2019 in Baltimore.
For all of his accomplishments as an educator and forensic psychiatrist, there is a personable side to Dr. Frierson. He has a good sense of humor and has interests outside of forensic psychiatry. Rick is the piano accompanist and substitute organist at Washington Street United Methodist Church in downtown Columbia. Dr. Frierson is also an avid tennis fan; he consistently plays tennis twice a week and has attended numerous professional tennis tournaments throughout the world, including all four of the sport's Grand Slam events (Australian Open, French Open, Wimbledon, and U.S. Open). His companion (Susan R. Luthren) has been everywhere with him; she keeps him grounded and is a significant and constant source of emotional support. He is fond of travel and possesses basic French conversational skills, and, as might be expected, is also a classical music aficionado. Dr. Frierson enjoys reading fiction in his spare time. He enjoys competing on Words with Friends®; he also dares me to see who is faster in completing the daily New York Times® Mini-Crossword Puzzle (he tends to win on most occasions).
After writing his biography and being a friend for more than fifteen years, I am better able to describe Dr. Frierson as a person. When I was accepted into his fellowship, I had no idea what kind of impact he would have on my career. He has motivated me to perform at the highest level, and has helped me achieve my potential; he continues to mentor and challenge me. I am grateful that he took me into his fellowship and am honored to be able to work with him. In my current academic role, I am emulating his influence by trying to make a difference in others' lives. Despite achieving so much already, I have no doubt there is more to come for Rick. Regardless of whatever else he achieves, I am sure he will continue to positively impact and inspire the work of others in the field of forensic psychiatry throughout the remainder of his career as a teacher, mentor, and advocate for our profession.
- © 2019 American Academy of Psychiatry and the Law
