On October 22, 1998, a landmark presidential address was given at the opening of the 29th Annual Meeting of the American Academy of Psychiatry and the Law (AAPL) in New Orleans, Louisiana. Renée Binder, MD, the second woman to serve as AAPL President, stood well-prepared behind the lectern on the conference ballroom dais. She posed a seemingly simple yet powerful question that foreshadowed an important question our field would be asked to address over the next several decades: Are the mentally ill dangerous?
I was fortunate to have attended Dr. Binder's presidential address, which provided a historical perspective of how philosophers, researchers, and epidemiologists have attempted to answer this challenging question. But Dr. Binder did not stop there. She had more knowledge to share. Dr. Binder elegantly distilled her research team's work studying violence in persons with mental illness. She ended her address by providing guidelines for future researchers studying the relationship of mental illness to dangerousness.1 As she concluded, I imagine many attendees pondered the following two questions:
How did Dr. Binder gain such extensive knowledge and expertise in forensic psychiatry leading to her AAPL Presidency?
What will Dr. Binder accomplish next?
Dr. Binder's Path to AAPL President
It is no surprise that Dr. Binder became a talented teacher and psychiatrist when reviewing her early childhood years. She was born in Brooklyn, New York, where she grew up as the second of three siblings. Her father was a cantor who taught music in middle school. Her mother worked in the home to help raise her and her siblings and later became a guidance counselor in elementary school. Dr. Binder and her siblings all achieved success in the field of science. Her older sister is a pediatrician who served as Dean of the East Virginia Medical School. Her younger brother pursued the dentistry profession and works in Manhattan.
After completing high school at Sheepshead Bay High School, Dr. Binder went to Barnard College and majored in Art History and Pre-Med. She completed her medical school training at the University of California San Francisco (UCSF) and stayed in San Francisco to complete her internship and residency in psychiatry at Mt. Zion Hospital and Medical Center. During her psychiatry training, she received the American Psychiatric Association (APA) Falk Fellowship as one of only twenty residents throughout the United States to become involved with the APA on a national level.
In 1976, Dr. Binder returned to UCSF where she quickly advanced through the academic ranks from Assistant Professor to Professor of Psychiatry. She is currently a Distinguished Professor, Director of Psychiatry and the Law Program, and Associate Dean in the Office of Academic Affairs, School of Medicine at UCSF. During her tenure at UCSF, Dr. Binder had numerous formative roles that created the foundation for her future in forensic psychiatry. These included Director of Emergency Services, Director of the Crisis Intervention Unit and Psychiatric Intensive Care Unit, and Director of Adult Inpatient Services. In her role as the Director of the Rape Treatment Center at UCSF, Dr. Binder provided care for hundreds of people who had been assaulted and developed an expertise in the psychological sequelae of sexual assault. Utilizing this knowledge, she helped write the initial guidelines for management of sexual harassment allegations at UCSF and consulted on cases involving workplace harassment, discrimination, and retaliation.
Between 1979 and her 1998 AAPL Presidential address, Dr. Binder was a prolific writer with more than 70 publications, including 66 peer-reviewed articles on a range of topics relevant to the practice of general and forensic psychiatry. Her publications reflect her forte in utilizing her leadership positions in clinical settings to produce highly relevant and practical articles on topics such as civil commitment, right to refuse medication, risk assessment of suicide and violence, standard of care, and the effects of trauma.
Dr. Binder did not rely solely on her written word to educate others as during this 19-year period she provided trainings at more than 70 conferences in regional, national, and international settings. Fortunately for AAPL, in 1984 Dr. Binder traveled to the Bahamas to attend her first AAPL meeting. At this meeting, she presented a paper titled “Patient's Rights Advocates in San Francisco.” Dr. Binder recalls that she was greeted very warmly by Jonas and Joan Rappaport and other senior AAPL members, and she has attended every AAPL meeting since. When asked if she had a favorite AAPL meeting, Dr. Binder responded, “I have enjoyed all of the meetings, which is why I keep attending!”
Dr. Binder's enthusiasm for AAPL was obvious as she quickly became very active in this organization. Prior to becoming AAPL President, she served on the Public Information Committee, the Education Committee, the Journal Committee, the Association of Directors of Forensic Psychiatry Fellowships Committee (ADFPF), and the Program Committee. She also was appointed Chair of both the Membership Committee and the Program Committee. As a result of her hard work, she served as AAPL Councilor from 1991 to 1994, Vice-President from 1994 to 1995, and President from 1997 to 1998.
As AAPL President, Dr. Binder emphasized the importance of collaborating with other disciplines when doing research and in mentoring new forensic psychiatrists early in their career. Her willingness to reach out and help others has been a well-recognized personality characteristic. Jeffrey Metzner, the 27th AAPL President, summarized her strength in research, teaching, and mentorship as follows:
She has consistently demonstrated her ability to guide and mentor colleagues in a manner that creates consensus in contrast to divisiveness. Her ability to present her research and clinical knowledge in a manner that is clear, concise, and helpful has made her a very sought out educator on a national basis. (Metzner J, personal communication, March 19, 2021).
Dr. Binder's organizational accomplishments were not limited to AAPL. She also demonstrated dedicated service to numerous other professional organizations, including the Committee on Women for the Northern California Psychiatric Association; the APA Committee on Medical Education; the APA Committee on Confidentiality, which she later chaired; the APA Council on Psychiatry and the Law, which she later chaired; the APA work group that developed practice guidelines for the psychiatric evaluation of adults; the APA Task Force on Clinician Safety; the APA Subcommittee on Child Custody Issues, which she chaired; Vice-President and President of the Northern California Psychiatric Society; and the Group for Advancement of Psychiatry Committee on Psychiatry and the Law.
Dr. Binder's awards for her efforts during this period were numerous. A small sample of accolades include her receiving the Women of Achievement Award by the Soroptomist International of the Americas for her outstanding abilities, talents, and contributions to the profession; the World Health Organization Travel-Study Fellowship to Japan for someone who showed the greatest promise of benefiting health programs in the United States; the Visiting Research Fellow to the National Hospital for Nervous Diseases in London; and the Northern California Psychiatric Society President's Distinguished Service Award for skill in building consensus in a diverse organization and for efficient and responsible leadership style.
Dr. Binder's Post-AAPL Presidency Career
By any measure, Dr. Binder would have been considered exceptionally accomplished at the conclusion of her AAPL Presidency in 1998. But she had much more to give in the areas of teaching, research, and leadership. She proved true the adage, “The best is yet to come!”
Within months after concluding her AAPL Presidential address, Dr. Binder became the Director of the UCSF Psychiatry and Law Program, where she established and founded the forensic psychiatry fellowship at UCSF. She efficiently organized the program, obtained contracts, developed a liaison with the University of California Hastings College of Law, and obtained accreditation through the Accreditation Council for Graduate Medical Education (ACGME) for the forensic psychiatry fellowship.
Her inaugural class of forensic psychiatry fellows started on July 1, 2000. When I spoke to former fellows, their comments reflected an appreciation for her dedicated teaching, commitment to excellence, and mentoring. Some representative quotes from her forensic psychiatry fellowship graduates are listed below to illustrate the impact she has had on her trainees.
One of the highlights of my forensic fellowship was the weekly supervision in her office. The supervision meant two very important things to me, one related to the fellowship and one related to my career. On the fellowship side, it was humbling to see an expert educator in action, someone who could distill complex topics (from sexual harassment to medical malpractice) with clarity and precision. On the career side, it was inspiring to see someone be able to effectively juggle several roles and achieve excellence in each of them. Renée is an outstanding clinician, educator, scholar, administrator, and leader. I feel honored to have been in the presence of a quintuple threat! Erick Hung, MD, forensic psychiatry fellow, 2008–2009 (Hung E, personal communication, March 2021)
Dr. Binder has an uncanny ability to distill complex medicolegal or ethics-related problems into the essential elements and provide a succinct yet well-formulated answer. My co-fellow and I looked forward to our weekly supervision because we could rely on not just her expertise but her ability to crystalize the question(s) at hand and convey her wisdom in such a digestible way. It was extremely memorable to navigate the transition to telehealth with the COVID pandemic in the midst of also navigating parenthood with my firstborn child, both during the forensic fellowship year. Dr. Binder was the most supportive supervisor I could ever ask for who truly cared and watched out for her fellows and staff. Even before UCSF, the Department of Psychiatry, and other clinical sites were adapting to the new reality, Dr. Binder sought our input and concerns and adjusted the rotations with our safety in mind. Takeo Toyoshima, MD, forensic psychiatry fellow, 2019–2020 (Toyoshima T, personal communication, March 2021)
My most memorable teaching moments with Dr. Binder are a series of memories that involve her generous inclusion of Takeo and me in whatever case or ethics quandary that had come across her desk that day. She would present us the quandary, listen carefully and thoughtfully to our answers, help us develop our own thoughts on the topic, then share her own insights. She is brilliant and an incredible teacher. She is an extraordinary person and mentor. Ariel Schonfeld, MD, forensic psychiatry fellow, 2019–2020 (Schonfeld A, personal communication, March 2021)
Dr. Binder's enthusiastic reviews are equaled by her enthusiastic approach as the forensic psychiatry fellowship training director. When asked what she enjoyed most in this role, she responded, “I enjoy working with fantastic forensic psychiatry fellows. Each year, I feel that I have taught them well, but also learned a lot from them.” Dr. Binder pursued her own additional learning through studying health policy and management at Harvard School of Public Health and taking a Leadership Program on innovative health care at the Stanford Graduate School of Business. Within a few years of developing her forensic psychiatry fellowship, Dr. Binder was appointed as the President of ADFPF. In this role, she educated forensic psychiatry training directors on evolving standards for accreditation outlined by ACGME.
In addition to both teaching and taking on additional educational coursework, Dr. Binder continued to publish actively with nearly 60 additional articles, approximately 50 in peer-reviewed journals. Her academic work during this phase of her career covers a range of important topics in the field of forensic psychiatry, including violence and suicide risk assessments, liability for the psychiatric expert witness, mental health courts and assisted outpatient treatment for those with mental illness, and sexual harassment, among many others.
Dr. Binder assumed additional leadership roles at UCSF, including service on multiple department and university committees. Since 2004 she has been the Associate Dean of Academic Affairs in the UCSF School of Medicine. From 2008 to 2011, she was the interim Chair of the Department of Psychiatry, where she had the administrative and academic responsibility for a budget of approximately $100 million and 176 paid faculty members.
Dr. Binder remained active in organizational psychiatry at the state and national level. She was elected President of the California Psychiatric Association where she served from 2002 to 2004. She continued to be an important presence at AAPL through her continued presentations and her work as the Chair of the AAPL Awards Committee from 2001 to 2014. She has also been recognized as a role model and mentor for women in the field of forensic psychiatry.
Perhaps in this era of her career, Dr. Binder will be most remembered for her dedicated service to the APA. Her involvement in the APA was impressive, particularly considering all of her other academic duties and responsibilities. Since 1998, she was appointed to the APA Task Force to Prepare the APA Position Statement on Confidentiality; chaired the APA Commission/Committee on Judicial Action; served on and became Chair of the Commission on Public Policy, Litigation, and Advocacy; chaired the Isaac Ray Award Committee; was elected as APA Trustee-at-Large; and served on multiple other task forces and work group appointments. No one was surprised when she was elected as APA President in 2014!
Once again, I had the good fortune to hear another Presidential address by Dr. Binder when she delivered her keynote speech in Toronto, Canada, as the incoming APA President. The theme of Dr. Binder's address was “Claiming Our Future,” a theme consistent with her decades of devoted work that has helped psychiatrists claim their future in clinical care, research, and education. She emphasized the importance of psychiatrists' claiming their role in the provision of psychiatric care in general health care, noting “there is no health care without mental health care” (Ref. 2, p 665). She spoke passionately on the importance of psychiatrists in providing services to those with serious mental illness and to patients who are disenfranchised and marginalized. To help focus attention on the inappropriate criminalization of people with mental illness, Dr. Binder arranged for the APA Board of Trustees to tour San Quentin Prison. She also chaired a congressional hearing on decriminalization and organized an awards benefit to support the judicial initiative of the APA Foundation that included the cast of the popular television show, “Orange Is the New Black.”3
Dr. Binder's other special initiative as APA President was to develop and support telepsychiatry tools for all psychiatrists to expand access to care. She appointed a blue-ribbon Presidential work group of national experts in the field of telepsychiatry, which became a permanent APA committee. Her foresight in this area was visionary, and this committee's work has been essential in educating psychiatrists on how to provide mental health care during the COVID-19 pandemic.
During her year as APA President, Dr. Binder worked closely with Dr. Saul Levin, the CEO and Medical Director of the APA. Dr. Levin summarized his time with Dr. Binder when she was APA President stating,
Dr. Binder is a “Renaissance” Person, knowledgeable, erudite, runs a perfect meeting that ends on time, and a sense of humor that makes me laugh. We worked well together. She is a mentor, leader, and above all a person who holds a confidence, and one I am proud to call a friend and colleague. (Levin S, personal communication, March 2021)
He also noted that Dr. Binder's collaborative spirit extended even to sharing a restaurant meal. He recalled,
My first dinner with her while on travel, she as the President and me as the CEO, we were in a French restaurant. The waiter took our orders: Renée ordered a large salad, I ordered a ribeye steak; the meal comes, she looks at my steak, as I look at her salad, at the exact same moment she says, “Would you like some of my salad,” as I say, “Would you like some of my steak.” We divided it up, and the rest was history. We were a pair who worked together, and enjoyed each other's company, and had many good meals together while on the road.
In this phase of her career, Dr. Binder continued to receive recognition for her ongoing contributions. In 2003, she received the APA Congressional Health Policy Fellowship to work in the U.S. Senate and consult on health policy. Additional awards included the California Psychiatric Association Award for Contributions and Service, the Distinguished Service on the Center for Judicial Education and Research Faculty presented by the Administrative Office of the Courts, the Dr. J. Elliott Royer Award for academic excellence and significant contributions to the field of academic psychiatry, the Psychiatry Residents Association Award for “Excellence in Teaching,” the Psychiatry Residents Award for Excellence in Didactic Teaching, the AAPL Seymour J. Pollack Distinguished Achievement Award to recognize distinguished contributions to the teaching and educational functions of forensic psychiatry, the UCSF “Champion of Diversity” for commitment and efforts toward achieving diversity in the category of leadership, the AAPL Golden AAPL Award in recognition of significant contributions to the field of forensic psychiatry, a Visiting Professorship at Yale University, and the Isaac Ray Award for outstanding contributions to forensic psychiatry or the psychiatric aspects of jurisprudence.
More than the impressive awards, Dr. Binder has received the respect and admiration from her colleagues and peers. I surveyed many psychiatrists who have worked with Renée as a colleague or student and asked them to provide an adjective to describe her. Not surprisingly, the two most consistent answers were “generous” and “kind.”
When asked if there was an achievement or contribution that she is most proud of, Dr. Binder did not mention one of the accomplishments outlined above. Instead, she responded simply, “My children.” Dr. Binder's son David is a partner in an entertainment law firm in Los Angeles, and her daughter Michelle is a neurologist who has a private practice in the specialty of sleep medicine.
Dr. Binder related that, in addition to her two children and five grandchildren, she is also inspired by her husband, sister, and forensic psychiatry fellows. When not working, Dr. Binder enjoys walking and being outdoors in nature and traveling to Hawaii and Italy. She is very involved in community theater and has played Adelaide in Guys and Dolls and Ado Annie in Oklahoma.
When asked her favorite quote, Dr. Binder cited Hillel the Elder, a religious scholar born in Babylon 2,000 years ago. This quote, taken from Pirkei Avot, reads, “If I am not for me, who will be for me? If I am not for others, what am I? And if not now, when?” In this quote, Hillel teaches that, although we have a primary commitment to ourselves and personal growth, we also have a social responsibility to the community and should not pause in fulfilling this responsibility. Dr. Binder has followed the beautiful wisdom of Hillel's words through her tireless work to help us claim our future in psychiatry and through her insightful leadership to act today so our field may have the promise of a better tomorrow.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
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