The Journal of the American Academy of Psychiatry and the Law (AAPL) has a custom of publishing a biographical sketch of each of AAPL's presidents. Ordinarily, an appreciative former trainee is the one to undertake this assignment. In the present case, although I have obviously become significantly indebted to Michael Norko, we are essentially contemporaries as forensic psychiatrists. Each of us (independently) chose to begin working at the same institution, Whiting Forensic Institute (WFI) during the month of July 1988, he in the middle of the month and I two weeks later. We both had the title of Unit Chief and were classified as managers in a maximum-security psychiatric hospital operated by the state's Department of Mental Health and Addiction Services (DMHAS). Alumni of Yale's forensic psychiatry fellowship under Dr. Howard Zonana, both of us held faculty positions in Yale's Psychiatry Department. A few years later, we were also part of the last cohort to pass the four-part examination of the American Board of Forensic Psychiatry before it gave way to the American Board of Psychiatry and Neurology, as forensic psychiatry gained subspecialty status.
It took no effort for me to gain an appreciation for the quality of Dr. Norko's character as we shared the excitement of being challenged to work with some of the state's most disturbed and least valued patients and with one of the most diverse of nursing staffs as well. Along with the other four attending forensic psychiatrists, we were a cohesive and even a close-knit working group. We were fortunate to have the skilled and good-humored leadership of Carl C. Chi, PhD, MD, who was our immediate supervisor. We also benefitted from the vision of the able late (and sorely missed) Robert T. M. Phillips, PhD, MD, who ran WFI. It was situated on the campus of the Connecticut Valley Hospital (CVH), the state's first public insane asylum founded during the 1860s. Quite significantly, WFI was run as a separate entity. Dr. Phillips also held the position of forensic director for DMHAS.
Michael Albert Norko, MD, MAR
It was a particular episode early on that impressed me with what I consider to be the capstone of Dr. Norko's character and a key to his practice of forensic psychiatry as a vocation. Within three months of our starting to work at WFI, it came time for the annual AAPL meeting, taking place in San Diego at the Hotel Del Coronado. This happened to be the same place where, as a forensic fellow seven years earlier, I had first come under the spell of APPL's attractions. During that meeting I had stayed with a friend from medical school days who had been living in nearby La Jolla but, unbeknownst to me, he had moved to San Francisco. As a new employee at WFI, I was not yet eligible for any state travel support and therefore was anticipating a substantial hotel bill when Dr. Norko offered to share his room with me. (At the 11th hour, some limited state funds had unexpectedly turned up and were given to him to cover his hotel costs.)
This room-sharing offer, thoughtful, generous, spontaneous, and unexpected though it was, might easily be overlooked or eventually forgotten. Yet, for me, it captures the core qualities that have come over the succeeding years to distinguish Dr. Norko and his work. Unassuming, yet passionate when necessary and compassionate always, he spontaneously employs thoughtfulness to camouflage his generosity and a kind of courage to support his exemplary sense of commitment to his calling, in season and out of season.
Such a description may not seem likely for one who as a child turned up his nose in reply to his mother's suggestion that he might like to be a doctor when he grew up. He said “But I don't want to be around sick people all the time.” No, the young Norko would rather help other people, especially the sick, by doing research to make discoveries that could help them. Quite likely, this was on his youthful mind as he graduated from high school and chose to enroll as a freshman in The Johns Hopkins University where he did very well indeed, graduating with honors and with such national recognitions as Phi Beta Kappa, Alpha Epsilon Delta, and Omicron Delta Kappa (among others!). He did, however, leave Hopkins with a lingering regret that he never fit into his schedule a course by Phillip J. Cunningham, CSP, the Paulist Catholic Chaplain, on Pierre Teilhard de Chardin, the early 20th century Jesuit scientist, theologian, and mystic.
Medical school followed at SUNY Upstate Medical Center where he trained in Syracuse and Binghamton. As a medical student, he experienced more or less the usual reaction of feeling drawn to the allurements of (almost) each successive rotation in its turn until the time for making residency applications coincided with a growing sense of how fascinating it could be to take a potentially deep and expanding part in learning about the mind and the role of the brain. For his internship and residency he chose St. Vincent's Hospital and Medical Center in New York City where he gladly benefitted from the opportunity to work with Dr. Stephen Billick. He then found his way to Yale as a forensic fellow.
We had only four short years under his dynamic leadership, before Robert Phillips bade goodbye to WFI, and Dr. Norko became his successor. (Deborah Scott, LCSW, ably assumed the forensic directorship of DMHAS). Unfortunately, this transition meant for Dr. Norko that he would soon enter a challenging administrative reporting structure. The state's budget slashing in 1995 led to the closing and consolidation into CVH of the state's other two major mental health inpatient facilities, as well as the incorporation of WFI into CVH. The latter drove Whiting in new directions that Dr. Norko thought took it off the track of development that had begun in the mid to late 1980s. After a four-year hiatus, he was coaxed into returning as the Medical Director of the Whiting Forensic Division of CVH.
Following further administrative changes four years later, Dr. Norko was surprised and, soon enough, pleased to observe that he was now in a position to reorganize his schedule so that he could have regular blocks of time under his own control. He also began to notice that he had been accumulating some unmistakable signs of a growing intellectual and even spiritual agenda. Since 1995, he had also taken up the habit of attending regular weekend retreats that were readily available in the local area, in particular the Holy Family Retreat Center in West Hartford, where he was enjoying the talks or “conferences” and finding them worthwhile.
Yet these developments left him unsatisfied. He kept experiencing a hunger for further spiritual growth and development. It seemed as if the enjoyment of his religious experiences was making him want still more. Gradually, he came to recognize that securing what he was missing would require more structure than he could ever expect to generate reliably on his own. Somehow, progress was much harder to achieve than he felt it ought to have been, especially so in view of his strong interests, reasonable discipline, and now a more manageable schedule. Yet Dr. Norko kept finding himself postponing the development of his seriously compelling ideas. Instead, they symbolically stood their ground in piles of notes and papers crowding one another about his study. Eventually, his frustration found its way, more or less haphazardly, into everyday casual conversations with various individuals. Before he quite appreciated what was happening, the suggestion surfaced of taking a serious look at the Yale Divinity School (YDS), and upon due reflection Dr. Norko went there to have a discussion with the Dean of Admissions.
The visit turned out to be a breakthrough moment. Dr. Norko quickly discovered that “it looked to me like I could actually do this.” With that, he soon recognized that he also felt attracted to this plan, particularly because of the explicit promise of providing the perfect structure he needed to be legitimately free to pursue and to satisfy some of the interests that he had held in abeyance for so long. He enrolled for two courses per semester and continued at a pace of one or two courses at a time as his work demands permitted, completing the requirements for the Master of Arts in Religion (MAR) degree over the course of the succeeding six years, finishing in 2010. His coursework at YDS permitted him to take up the study of Teilhard de Chardin's work (25 years after the missed opportunity at Hopkins) which lead to significant interest in the work of Georgetown theologian John Haught, himself a serious scholar of Teilhard (among others), who offered esthetic and rational bases for the fundamental harmony that exists between science and religion. The writings of Simone Weil influenced his thinking about compassion in forensic psychiatry. Some of Dr. Norko's published interdisciplinary writing arose from these experiences at YDS.1,–,4
Meanwhile, his career was developing in other significant ways. Primarily, he directed the WFI during the early to mid-1990s. He performed executive and educational duties for CVH and some other related state facilities. He was actively involved with Yale's Law and Psychiatry Division, as Deputy Director of its fellowship program. Yale has recently promoted him to the rank of Professor of Psychiatry. Since 2007, he has been the Director of Forensic Services for DMHAS.
Dr. Norko also has kept up a small private forensic practice. He took on the editorship of the Newsletter of the AAPL for seven years and has been Deputy Editor of the AAPL Journal since 2003. He has taken on his full share of work on the professional committees of AAPL and the American Psychiatric Association (APA), including its Connecticut District Branch. He has done peer reviews for over a half-dozen professional journals and he has worked on the forensic recertification examination committee of the American Board of Psychiatry and Neurology. Of particular note is his current work with two organizations: the Group for the Advancement of Psychiatry, where he is Chair of its Psychiatry and Religion Committee; and the Forensic Division of the National Association of State Mental Health Program Directors (NASMHPD), where he is chair and a past regional representative, secretary, and vice-chair.
Dr. Norko is a distinguished fellow of the APA. He has served and continues to serve on several of the APA's committees and other working groups. He has received multiple diverse awards from a range of organizations for his service to them, including AAPL's “Red Apple.” He has 19 peer-reviewed scholarly papers to his credit along with more than 20 books and book chapters and a further 20 significant scholarly pieces directed to various audiences. His listing of presentations runs beyond 11 pages. One of his recent books5 earned him and colleague Alec Buchanan the coveted Manfred S. Guttmacher Award, given for “outstanding contribution to the literature on forensic psychiatry.”
Dr. Norko's written work coherently reflects and reinforces the qualities of his caring as I have come to appreciate them. Somewhere near the center there lives and thrives a pervasive compassion that gradually becomes obvious through its casual subtlety. A simple act, such as sharing lodging, reflects the same impetus that underlies his unassuming advice to writers of forensic reports: when sufficient evidence and data have been assembled, but before an initial impression has quite formed, there should come a substantial pause to reckon the likely consequences of the report for all the human beings who stand to be affected by its content. His habit of retreats figures here as well, serving, I think, his courage to defend and support what he comes to value as a result of careful and even prayerful contemplation.
In recent years, his experience of spiritual retreats has evolved; he reached a point at which he began to experience listening to all the talk as an unsettling distraction. He craved silence and quiet reflection, and in longer stretches of a week or even sometimes more. He discovered places that facilitated this approach, made the switch, and was soon meditating at deeper levels and deriving more of the benefits he was seeking. In my view, he was further developing his own conviction that forensic psychiatry is his calling.
As these experiences widened and deepened in response to his open attention, Dr. Norko was able to envision what should be next. Going to divinity school was probably the best example of this process. Current instances include his ambitious plans for his term as AAPL president.
Dr. Norko is convinced that community psychiatry should incorporate significant aspects of forensic psychiatry. His vision applies to the clinical care of all forensic patients, and especially for those housed in corrections department facilities. In fact, he likes to point out forensic psychiatry would not have gained acceptance as a psychiatric subspecialty without having an identifiable patient group. Claiming the prison population was thus a significant step. Unfortunately, at the present time, many of these patients are routinely forced to put up with grossly substandard care. Understandably, most psychiatrists working in prisons are overworked and otherwise poorly supported. Relatively few are present members of AAPL; he is pointedly attempting to persuade them to make AAPL their professional home. He has already established a work group of AAPL committee chairs and correctional liaisons with specific suggestions along this line in anticipation of AAPL's 2017 meeting. The courage of his conviction will likely serve him well. If successful, he foresees great potential for gradually developing studies that could be valuable for confined patients along with others. He is also hoping to work synergistically with his fellow officers of NASMHPD, where he says the ability to attend meetings in person has declined as tighter funding dries up the travel resources for public sector forensic administrators and leaders.
Another example: his courage and energy continue to serve Dr. Norko well at the state capitol. Over the years, he has proposed substantive legislative changes, as well as a good number of editorial revisions for clarity. Currently, two areas have his attention. The first is responding to severe tragedies, including one in Connecticut, he has entered the minefield of gun control legislation. His work is in support of allowing a civil process of temporary gun removal from individuals found to be “at risk of causing serious injury to others or self.” Characteristically, he has involved himself in systematically researching the law's effectiveness: as we know, a challenging area to study. Thus far, he and colleagues from three universities have a paper nearing publication with encouraging data showing an antisuicide effect of the legislation. He sees what has happened so far as offering some hope of a new era where facts may finally win out over prejudices.
The other recent focus of his interest has been a most vexing question: how to address, safely and fairly, the question of what measures to apply to pretrial detainees with serious charges and violent histories, after they have been found incompetent to stand trial and not restorable to competency, despite extended treatment efforts. Some of them may not qualify for civil commitment, leaving an unwelcome choice between safety and civil liberty. Dr. Norko has testified at the state legislature regarding processes for courts to receive periodic reports in the event that a pretrial defendant charged with a serious violence offense is discharged to community-based treatment. Recently, he led a task force of attorneys, judges, and clinicians in a two-year effort to create a more accountable and comprehensive response to this population of individuals who often commit similar violent offenses, thereby testing the patience of the courts. Although the group was unable to achieve consensus and has stopped meeting for now, Dr. Norko hopes to reimagine the possible solutions to this dilemma in the near future. He understands that legislative change can be a very long process requiring steadfast determination, as he described in a recent unique book chapter.6
Looking beyond his presidency of AAPL, Dr. Norko has begun to appreciate that his vocation is already developing further. Principally, he reports recognizing himself now as a mentor for fellows, residents, and medical and other students. He expects, of course, to maintain his involvement in legislative matters and opportunities. He looks forward to offering his seminars in such areas as linking spirituality and psychiatry. For these he typically enjoys working with a hospital chaplain, using substantive core readings, and inviting a broad ecumenical mix of clergy, myself included.
Dr. Norko plays the accordion, very well as I remember from talent shows at WFI, but these days far less often than he would like. For a time he made a family experience of his son's and daughter's piano lessons, enough to play together at several small recitals. His daughter Joanna is now working in property advertising in New York and seeking further opportunities with nonprofit organizations. His son John has become a physician and is now a second-year pediatric resident in Hartford, planning on a hematology-oncology fellowship. One can and should hope for what their future may hold, especially now, as his wife Debra, a pediatrician working for the state children's psychiatric hospital, expects further funding cuts. Yes, she is seriously considering whether her next vocation might have its start in YDS, where she has now entered the Master of Divinity program.
- © 2017 American Academy of Psychiatry and the Law
