Philip J. Candilis, MD: The Quiet Revolutionary

• biography
• American Academy of Psychiatry and the Law
• forensic psychiatry
• Philip Candilis

I first met Phil Candilis in Denver during the historic American Academy of Psychiatry and the Law (AAPL) blizzard of 1997. We were both attending as fellow members of the Ethics Committee. Phil would continue as the longest sitting ethics committee member in AAPL’s history, becoming chair some 15 years later. The blizzard stranded us in one of the satellite hotels that was quickly running out of food and drink, but we never ran out of topics for engaging conversation and contagious laughter. Those hotel conversations would become phone calls during the year, dinners with our families at future AAPL meetings, and outings with our kids in conference cities with the best aquariums. For Phil, the professional and personal were always connected in one integrated whole.⇓

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Philip J. Candilis MD

Phil grew up in Washington, D.C., the son of immigrants who fled civil unrest in their native Greece to pursue education and, ultimately, life in the United States. Phil’s parents raised him in a home stacked with the books of prominent Greek thinkers. It was from his mother that Phil learned that Aristotle was both a natural scientist and an ethicist, planting some early seeds of professional interest. Phil’s father, a career government economist, emphasized practical matters, making it clear that philosophy, although fascinating and instructive, was not the best way to make a living!

Phil’s mother taught him to speak Greek but also instructed him to be careful about speaking it in public. Recognizing the anti-immigrant sentiment of the time, Phil’s parents gave him a British middle name in case he ever needed to drop the surname.

It was the tragic predicament of a young cousin, Yanni, that focused Phil’s interests on ethics and research. Yanni was diagnosed with acute lymphoblastic leukemia. His family had exhausted all available treatments overseas and traveled to America for care. Yanni spent eight years at the National Cancer Institute as a patient or, more accurately, a research participant. This did not sit well with the high-school-aged Phil, raising fundamental questions about whether it was right for a child to advance science for future patients rather than obtain treatment (directly) himself. Phil also noticed the different ways that U.S. and Greek culture perceived medical authority (i.e., Greeks being more deferential), enforced research ethics, and communicated with patients. These observations laid the foundation for a life-long interest in research and ethics.

Pursuing a practical education, Phil entered the engineering program at Princeton University, but his heart was elsewhere. Playing piano from a tender age, he became a serious opera singer once his voice became a powerful baritone. During college and after, Phil studied with prominent singers Todd Duncan, George Gershwin’s first Porgy in Porgy and Bess (1935), and Robert Honeysucker (one of Boston’s most beloved artists). Both were noted civil rights figures and outspoken critics of the discrimination faced by African American performers. Duncan, for one, refused to perform at Washington’s segregated National Theatre, forcing the venue to integrate its performances. Honeysucker, too, battled the low-balling of Black performers by collaborating with conductors to press for equal pay. The narratives of their experiences greatly influenced Phil’s outlook.

During his early operatic career, Phil sang roles with local opera companies, appeared as a principal at the Kennedy Center and at Wolf Trap, performed a solo cantata for the Washington Bach Festival, and sang the Christmas service at George Washington’s historic home church. These were the years studying with Todd Duncan, whose inspirational notes Phil preserved, with their drawings of vocal anatomy from the eminent teacher’s visits to Howard University’s College of Medicine. Perhaps music and medicine were a better combination.

Phil never developed a passion for engineering but found the example of one of his professors instructive. His favorite engineering professor traveled to Vietnam to improve conditions after the war and exposed his students to speakers from community engineering initiatives across the United States. It was becoming increasingly clear that Phil would pursue a path focused on people. The passing of his cousin ultimately settled the question of whether to continue engineering or become a physician. The same day he opened his medical school acceptance, Phil received contracts for five operas in the Washington Opera Chorus season, a common path for fledgling operatic careers. Rather than cause the spontaneous combustion of his uneasy parents, Phil took the medical route.

As he prepared for medical school, Phil accepted a job with a survey firm to earn extra cash. The job came with an unexpected bonus: it introduced him to his future wife, Maura. Maura had been working for the prominent D.C. pollster, was a veteran organizer for President Carter and Vice-President Mondale, and was well versed in the intricacies of scientific polling. Phil suddenly found himself intensely motivated to study survey design and analysis. This intersection of personal and professional interests joined Phil and Maura on a shared life-long journey.

Phil’s music continued to overlap with his medical life. Phil provided music and programming for a classmate’s memorial in medical school, for a faculty colleague at the University of Massachusetts Medical School (UMass), and most recently in memory of colleague and friend Douglas Mossman at the Midwest AAPL meetings.

Phil’s opera colleagues took notice of his medical background, occasionally requesting the more powerful prescriptions for performance anxiety, congestion, and cough suppression, which provided an early lesson in boundaries and professional ethics.

Phil’s marriage of medicine and music resulted not only in a career sensitive to social concerns but in the freedom to explore individual expression. Because his livelihood did not depend on music, he could take risks, choose his roles, and develop political positions. He joined the musicians’ union, advocating (unsuccessfully) for his residency to join the burgeoning residents’ movement in Massachusetts. With his Arlington, Massachusetts neighbors Nassir Ghaemi (Tufts Psychiatry) and Oliver Freudenreich (Harvard), he founded Citizens for Mental Health, a group that reinforced American Psychiatric Association (APA) and district branch positions at the state house. Because the Arlington state senator and representative were in leadership, there was a sympathetic hearing for, among other things, mental health programs and gay adoption.

Phil’s first experience in applying survey analysis to ethics was a medical school project analyzing the National Institutes of Health (NIH) Durable Power of Attorney (DPA) policy.¹ This was completed in close consultation with Robert Wesley, the lead NIH Clinical Center statistician who would become a family friend and research advisor. DPAs were intended for dementia and other mental health conditions that required monitoring of the research participant’s decision-making. This unique project anticipated tools Phil would design for the APA, in the refugee crisis, and for his current terrorism research group.

Psychiatry came as a natural choice for residency training as the medical specialty unabashedly concerned with patients’ humanity. As part of the residency program at Massachusetts General Hospital, Phil completed a fourth-year fellowship in medical ethics at Harvard. He was particularly inspired by the work of AAPL’s founding members, completing an additional fellowship in Law and Psychiatry at UMass. Phil chose UMass Psychiatry because it was led by Paul Appelbaum, an informed consent pioneer and ethics investigator. As a burgeoning survey designer, Phil also spent several fellowship months with renowned competence scholar Thomas Grisso as he designed the Massachusetts Youth Screening Instrument, now a leading juvenile capacity assessment instrument.²

During fellowship, Phil’s cultural heritage played an important role in his professional development. Fellowship director Ken Appelbaum entrusted him with a poignant refusal of nutrition-hydration case. A young Greek American was refusing to eat and drink following lengthy and unsuccessful rehabilitation for a brain-stem stroke. The “locked-in syndrome” was intolerable for this competent, brilliant, and previously athletic young person. The Greek immigrant family, however, worried about the religious implications of their child’s “suicide.” Phil consulted the Greek Orthodox Archbishop and incorporated elements of cultural assessment and counseling into the capacity consultation, reconciling the family at their child’s end of life. The hybrid clinical-forensic role led directly to a Denver AAPL panel with Richard Martinez of the University of Colorado. The resulting friendship and professional collaboration would produce an influential series of articles,^3,–,6 book chapters,^6,–,9 and a book.¹⁰

Rick and Phil offered ethics analysis that united forensic and humanistic values in forensic ethics. Scholarship at the time was splitting along theoretical lines: principles and narrative. Phil and Rick argued, however, that one could not work without the other, developing a hybrid, cross-cultural model they called robust professionalism.⁸ Drawing on the American Medical Association’s focus on vulnerable people and values, the friends explored the habits and skills of the ethical practitioner alongside the moral relationships inherent to all forensic encounters. The exploration would cement their unified approach, forensic with humanistic values, and influence ideas from future authors on compassion, empathy, truth, and dignity. Rick’s articulation of the goals and purposes of forensic psychiatry flowed directly from this work,¹¹ as did Phil’s identification of human rights as the ideal concept overlying forensic professionalism.¹²

Phil would ride this wave of scholarship to the chair of the ethics committees of AAPL, the Group for the Advancement of Psychiatry (GAP), and the APA. He contributed to APA ethics workgroups and educational initiatives over three decades, led the 2005 AAPL ethics revision, appointed the 2025 task force to revise the ethics guidelines, and drafted a number of papers for GAP’s professionalism and ethics committee.^13,–,16 Asked to join ethicist Dominic Sisti of the University of Pennsylvania in leading the APA’s annual meeting ethics track, Phil would guide ethics content at the annual conference for over 15 years.

As a hospital ethicist for UMass and later Medfield State Hospital, Phil continued to emphasize hybrid forensic and clinical models, using arguments from both arenas to fortify patient care. The unified advocacy easily underscored public sector care as both a legal and ethics imperative. As co-Principal Investigator of a contemporaneous NIH R01 award with sociologist Chuck Lidz, Phil helped design and analyze the first comprehensive look at institutional review board (IRB) decision-making, observing, coding, and evaluating discussions at 10 of the top 25 IRBs in the United States.^17,–,20 The mixed-method quantitative-qualitative design would inform much of his subsequent research.

Phil continued to combine his work as a UMass faculty member with his passion for opera. His performances were generously, and often slyly, covered in the press, with one reviewer describing him as “a physician in real life.”²¹ Phil grew to appreciate work-life balance, applying forensic skills to the assessment and monitoring of physicians in state physician health programs. The risk assessments he conducted at the Massachusetts program would be followed by oversight in the program for Washington, D.C. His scholarship and commentaries on physician health^22,–,25 led him to serve as defense expert in the first ever class action filed against a state medical board and its physician health program.²⁶

Work-life balance also allowed Phil to perform with his daughter Corinne in concert and on a recording of Shaker music, a staple of New England culture. Vocal coach Robert Honeysucker had landed a recording contract with Albany Records and added concerts that featured child and adult soloists. Phil consequently performed with Corinne both on compact disc (CD) and on stage, proudly experiencing it as the highlight of his career. (Phil officially takes no credit for Corinne’s musicianship or her status as a two-time state champion in mock trial.)

After 18 years at UMass, Phil returned to Washington, D.C. to lead the new hard-funded forensic fellowship at Saint Elizabeths Hospital. With the UMass example fresh in his mind, Phil built a program that emphasized education and research. It developed trainees and faculty who achieved national recognition with teaching and research awards from AAPL and the American Academy of Forensic Sciences (i.e., Drs. Ryan Shugarman, Cristina Secarea, Viviana Alvarez-Toro, Kelsey Hobart, and Lindsay Poplinski). The program’s research efforts mirror Phil’s public sector sensibilities, including NIH-funded work on artificial intelligence in marginalized communities, participation in the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 10-state competence restoration learning collaborative, collaboration with NIH Ethics on surrogate decision-makers, and outcomes studies requested by judges and forensic colleagues. Developing a model for analyzing prescription patterns for the U.S. Drug Enforcement Administration, Phil and his fellows have seen their analyses applied to pill-mill cases from Hawaii to Virginia. With senior academic appointments at three medical schools, Phil offers a scientific and humane vision of forensics to residents and fellows across the region.

Upon his return to Washington, D.C., Phil applied his ethics and research methods to global mental health. Washington, D.C. is an international capital, after all. Traveling to Greece with the George Washington University Global Mental Health Program and mentor Allen Dyer, Phil designed projects that explored tensions at the intersection of cultures in the refugee crisis. His development of a Hippocratic Oath for humanitarian aid workers was covered by public radio, while a survey of aid workers offered an empirical (and political) rebuttal to a flawed criticism of the Greek host community.^27,28

In collaboration with the Greek government, and now medical director of his hospital, Phil expanded his international efforts by representing the APA in climate change discussions with Greek authorities. Serving as president of the Hellenic American Psychiatric Association, an international APA affiliate, Phil partnered with Greek public and forensic psychiatrists to collaborate with officials interested in topics as varied as burnout, disaster relief, and risk assessment.^29,30 Phil continues to mentor Greek criminology researchers and collaborate with a Greek Centers for Disease Control group exploring the mental health consequences of disaster.

The work with refugees led to a unique opportunity for Phil and his team. With a team member based in the Middle East, the group designed and published a series of ground-breaking studies of Iraqi terrorists, demonstrating how an empirical agenda could develop from a risk factor analysis into a population comparison, into a latent class analysis, and ultimately into a path analysis describing the empirical trajectory toward violent extremism.^31,–,34 These studies were both empiric and prosocial, motivated not only by a desire to understand extremism and provide data to the national government but to offer opportunities for interrupting radicalization as well.

It was his long-time collaborator and friend Rick Martinez who first called Phil a revolutionary. It was a reaction to the discussion of organizational advocacy among professions like forensic medicine that are historically grounded in neutrality and objectivity; it echoed Phil’s writings on the forensic “revolution” of narrative, professionalism, and compassion. Phil again joined Rick to challenge experts’ ability to remain neutral and avoid the subjective influences of their era and upbringing.^6,35 Far better, they wrote, to acknowledge insidious influences and take steps to address them.

At AAPL, Phil has developed some innovative expressions of this work, from the Reflections and Narrative section of The Journal and the Faces of AAPL newsletter feature highlighting women and minority members to the conference research breakfast and research mentors’ network.

As AAPL president, Phil has been focusing on the epistemology of forensic psychiatry, how experts know what they know. In addition to appointing task forces on research and ethics to advance methods of inquiry, he has been joined by over two dozen colleagues and co-editor Kenneth Weiss to create a unique epistemology text. Supporting rigorous scientific methods and critical thinking, the approach traces how information moves from inquiry to knowledge, fostering truth in an era of misinformation.

With cultural and humanistic influences from childhood, our friend, colleague, and president has built a life of scholarship, service, and continuing contribution to psychiatry and forensics. A family man, physician, ethicist, and musician, Phil is a humanist forerunner for a new age of forensic practice.

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