Department of Psychiatry and Behavioral Sciences:
The first 50 years – 1948-1998
The Beginning – The Ripley Era
The UW School of Medicine was established in 1945. Psychiatry was a division of the department of Medicine until October 9, 1948. Frederick Lemere, MD, was appointed head of the Psychiatry Section in the Department of Medicine in 1946 and was elevated to the role of Acting Chair of the department of Psychiatry in 1948. The earliest medical school classes received only one hour of instruction on psychiatric phenomenology. Classes were delivered in Quonset huts near Meany Hall on campus because the medical school had not yet been built. Field trips to Western State Hospital were a favorite experience because students were able to see ‘real live patients.”
The department had no full time faculty prior to April 1, 1949 when Herbert Ripley, MD was appointed the first Professor and Chair. He was joined shortly thereafter by Drs. H. Thomas Holmes and Steven Fleck and by the department’s first psychologist, Dr. Caroline Preston. At that time, the department had no clinical services of its own. Department faculty served as consultants for local Seattle-area inpatient and outpatient services, which were run by the court and King county, respectively.
Dr. Ripley redesigned the medical student lecture programs in the first and second year curriculum. Dr. Ripley instituted post-lecture ‘small group discussions,’ although for some time there were too few faculty members to divide the class into particularly small groups. He also introduced a more psychodynamic orientation to these lectures, influenced by his psychoanalytic training at Columbia University. In 1951, the psychiatry residency-training program began using the Seattle VA Hospital as its chief training site. Dr. Joseph Buchmeier was the chief of Psychiatry at the time. Dr. Merlin Johnson became chief of Psychiatry at the VA in 1955 and was the longest active chief of psychiatry in the VA system when he retired in 1995. With the opening of University Hospital in 1959, the residency program acquired new facilities to expand its inpatient training program. At that time there were eighteen full-time academic faculty and research staff in the department.
Early topics of research interest in the department included suicide and life stress in relation to physical illness. Such luminaries as Drs. Theodore Dorpat and Dr. Ripley conducted landmark work on suicide. Dr. H. Thomas Holmes was active at Firlands Sanitarium, which was a tuberculosis sanitarium at the time, and it was there that he conducted much of his early work on life stress and medical illness. Drs. Holmes, Minoru Masuda and a psychiatry resident, Dr. Richard Raye, extended Selye's laboratory-based work on stress into the community setting and provided the groundwork for psychiatric epidemiology with the development of the Holmes-Rahe scale. This research had an international scientific impact and a prominent public impact, e.g., Dr. Holmes made an appearance on the Johnny Carson Show. In 1952, the department expanded its research program through the work of Dr. Donald Dudley, who studied respiratory physiology and psychiatric illness, and Drs. Dorpat, Neal Ely, and Joseph Verhey who investigated psychiatric aspects of pain. Dr. Joan Jackson, a sociologist, worked with Dr. Preston on early studies of alcoholism, following Alaska Natives hospitalized at Firlands Sanitarium for tuberculosis as they returned to their native villages. Dr. Fleck began studies on the psycho- and socio-dynamics of middle-class unmarried mothers at the Florence Crittenden Home.
Growing the Department
Child Psychiatry. Child Psychiatry had its departmental origins in September 1949 when a Division of Child Psychiatry was established along with a Psychiatric Clinic for Children located on the top floor of the UW Hall Student Health Center. Dr. S. Harvard Kaufman was appointed the Director. He recruited a staff of 3 social workers, 2 psychologists and two other psychiatrists, Drs. Charles Mangham and Alan Lieder. This division struggled with funding problems, however, which eventually left the division staffed by only one part-time child psychiatrist, Dr. Elwood Jones. In 1959, the Child Division moved into the University Hospital as the Child Psychiatry Outpatient department. Dr. Raymond Sobel was recruited to serve as Director and Head of the Division in 1960 and in 1961 the department launched a subspecialty training program in Child Psychiatry and inaugurated the department’s first program on family psychotherapy. Dr. Irving Berlin, who expanded the focus on community programs, succeeded Dr. Sobel in 1965. This was amplified two years later by Dr. E. Mansell Pattison, who started a 4th year residency specialty fellowship in Social and Community Psychiatry.
During Dr. Ripley’s tenure as Chair, from 1949 to 1969, the number of residents in training expanded from 2 to 48 and over 200 physicians successfully fulfilled their psychiatric training. The department also established a number of clinical and educational programs for a wide range of post-graduate students and non-psychiatric physicians. A number of faculty members who became leading departmental figures during later decades joined the department during Dr. Ripley’s tenure, including Drs. Hugh Armstrong, Joseph Becker, Doug Bowden, John (Jack) Carr, Hans Doerr, John Hampson , Akira Horita, Merlin Johnson, Nancy Robinson, Maryonda Scher, Ann Streissguth, Brenda Townes, Nathanial Wagner and Bill Womack. Dr. Womack was the first house staff officer of color a the UW Hospital, the first African American resident in the UW Residency and first African American faculty member in the department. Dr. Becker was one of the first researchers in the world to identify marital stress/depression in response to a spouse's health status. He received a grant on this topic in 1982 and this preceded an expanded focus on caregiver research that exists today through the work of Dr. Peter Vitaliano. Dr. Ann Streissguth performed pioneering work on Fetal Alcohol Disorder that has garnered worldwide attention. Dr. Brenda Townes worked with and extended the pioneering neuropsychological work of Lezak. Dr. Hampson, who later became the Chief of UW Outpatient Services, organized a multidisciplinary Gender Identity Clinic that evaluated transsexual candidates for sex change surgery, one of very few institutions in the country to offer this service. This was a precursor for the sexual dysfunction research and training program that was established in the 1970s under the leadership of Dr. Julia Heiman.
Cross-Cultural Psychiatry. During the 1960s, UW School of Medicine Dean George Aagaard established a major collaboration with the University of Malaya (UM). When Singapore seceded from Malaysia, it took the medical school with it (now University of Singapore). Malaysia set out to build a new University in Kuala Lumpur, including a new medical school. UM Dean Danaraj sought an international school with whom to partner to help build its medical school from the ground up. He and Dean Aagaard obtained grants from several international funds to support this initiative, including the China Medical Board, and established a partnership. Faculty from UM who were to be assigned administrative roles came to the UW to train, while UW faculty went to Malaysia to set up programs. The Chair of Psychiatry at U.M, Dr. Tan Eon Sung, visited the Department often and several of his faculty were trained here. Faculty from every department in the U.W. medical school spent time in Kuala Lumpur helping organize the new school and to teach. Of our faculty, Drs. Ned Wagner, Jack Carr, Larry Wilson and Hugh Armstrong spent a year each in Kuala Lumpur setting up a Neuropsychology Lab, Psychology Division, Consultation Services, Outpatient Clinic and Inpatient services while also teaching Behavioral Sciences, Medical Psychology, Consult-Liaison Psychiatry, Psychopathology, Cognitive-Behavioral Therapies. This collaboration lasted into the early 1980’s, by which time the University of Malaya had become a premier medical school in Asia, with one of the most modern and academically oriented psychiatric departments in Asia.
Dr. Ripley remained on the faculty until 1977 as head of the UW Hospital psychiatry consultation/liaison service. He was a clinical supervisor and valued mentor for several of our current senior faculty, including the current Chair, Dr. Richard Veith. He continued to be active in the department after his retirement until he died in 1982.
Drs. Cornelius Bakker and John Hampson headed the department and served as Acting Chairs between 1960 -1972. They guided the department through the expansion of the School of Medicine to include Harborview Medical Center and the completion of the 7 North and 7 East inpatient psychiatry units at the University Hospital. This time period marked a major change in the orientation of psychiatry from a psychodynamic orientation to a focus on community and cross-cultural psychiatry and an emerging emphasis on biological psychiatry and psychopharmacology. During this period and into the late 1970’s, the department’s outpatient psychiatry program was based at a former complex of apartments adjacent to the current University Village shopping mall. The Coach House offered an interesting, if not esthetically pleasing training site. Hallways weaved through treatment rooms and administrative offices had had been configured originally as separate apartments and living spaces. The outpatient child psychiatry clinic was also located there and was overseen during the 1970s by Drs. Herbert Wimberger and Michael Rothenberg. The Behavioral Sciences program run by Dr. Thomas DuHammel at Children’s Hospital did not combine with this clinic to form the Division of Child and Adolescent Psychiatry until the late 1970s. Dr. Rothenberg directed the psychiatry consultation service at Children’s during the 1970s and was a highly visible child psychiatrist in the community. (His notoriety grew substantially in 1985 when he became co-editor of Child and Baby Care with Dr Benjamin Spock.)
The Eisdorfer Era
The second Chair of the department was Carl Eisdorfer, MD, PhD, who served from 1972 to 1981. During this time, the department began another vigorous period of expansion, with the addition of new faculty members and substantial growth in the research programs. Dr. Eisdorfer brought with him from Duke University Vice-Chair, Dr. Robert Friedel, Drs. Hans Doerr, Don Martin, Joan Martin, and Pat Prinz and he recruited a number of faculty members who had a major impact on the department’s subsequent clinical and research trajectory, including Drs. David Dunner, Johan Verhulst, Julia Heiman, and Arthur Kleinman. Dr. Don Martin was one of the first biostatisticians to be on faculty in an American psychiatry department. He and Dr. Gary Cox were the first research methodologists in the department.
WAMI. In 1970, shortly before Dr. Eisdorfer’s arrival, the SOM launched the innovative Washington, Alaska, Montana and Idaho (WAMI) program in which the SOM serves as the medical school for these northwest states (Wyoming was added in 1997 to form WWAMI). The medical student curriculum was organized around an organ systems model. Accordingly, the department conceptualized and organized “Behavioral Systems” courses for the first and second years – an overview of behavioral science contributions to medicine in the first year and a psychopathology course in the second year. Dr. Bakker was the first course chair of Behavioral Systems I. Subsequently, Dr. Carr took over as Chair and Dr. Maryonda Scher assumed the Chair role for the Psychopathology course (Behavioral Systems II). As course chair, Dr. Carr organized the curriculum along with site chairs from all the WAMI university sites to ensure that the students who started their first year of medical school at the outlying sites received the same content and performed equally well on the final exam, which had to be standardized for all sites. Courses were taught by teams of MDs and PhDs (they were called, ‘dynamic duos’). The course was subsequently published into a book, Behavioral Science in Medical Education, and was published by Elsevier.
Community Psychiatry. During this period, the Division of Community Psychiatry established a liaison with mental health agencies throughout the WAMI region. A popular elective rotation for residents in Anchorage was overseen by Dr. Robert Kraus. The recruitment of Dr. Arthur Kleinman expanded the department’s investment in Pacific rim and cross-cultural psychiatry and this was accompanied by the establishment of a faculty exchange program with Hunan Medical College. Drs. Larry Wilson and Robert Fisher developed departmental programs in the Trust Territories of the Pacific and at the Maui Mental Health Center.
Geriatric Psychiatry. In 1975 the division of Geriatric Psychiatry was established with the funding of the Geriatric Research, Education, and Clinical Center (GRECC) at the Seattle and American Lake VA Medical Centers. Dr. Murray Raskind served as the first Director until 1987. This program has provided an enduring focus on geriatric psychiatry research and education in the department. Dr. Raskind moved thereafter to his current role as Director of the UW Alzheimer’s Disease Research Center, Director of the Mental Illness Research, Education and Clinical Center (MIRECC), and Director for Mental Health Services at the VA Puget Sound Health Care System.
Dr. Robert Reichler was recruited to the UW in 1977 to head an integrated Division of Child and Adolescent Psychiatry based at Children’s Hospital. He held this position until 1981, when Dr. Bill Womack was appointed head of the Division. He was succeeded by Dr. Eric Trupin who headed the division from 1987 to 2000, when he stepped down to launch the Division of Public Behavioral Health and Justice Policy, which he heads. Dr. Elizabeth McCauley was Acting Division Head in from 2000 – 2005, at which time the current division head, Dr. Bryan King was recruited.
Dr. Robert Kraus served as Acting Chair from 1979-1980 during Dr. Eisdorfer’s sabbatical. He left the UW in 1981 to become Chair of the Department of Psychiatry at the University of Kentucky. When Dr. Eisdorfer resigned as Chair the faculty had grown to 115 full time faculty members. Faculty were located at the School of Medicine, University Medical Center, Harborview Medical Center, the VA Medical Center and Children’s Orthopedic Hospital. The department also established community psychiatry programs in Alaska and in mental health centers in Bellingham and Olympia. Dr. Eisdorfer left the department in 1981 to serve as President of the Montefiore Medical Center in New York City. In 1986 he moved to the University of Miami where he was Chair of Psychiatry until 2004.
The Long Transition – Jack Carr Years
Jack Carr, PhD, served as Acting Chair for four years from 1981-1985 during the prolonged search for a new chair. During this time, the department restructured itself and emphasized its interactions with regional mental health delivery programs. Dr. Carr had a longstanding commitment to the integration of behavioral and biological sciences in medical education and bio-behavioral research, which were emphasized during his tenure. In 1981 he was one of 6-8 "Founders" of the Association of Medical School Psychologists, a national organization established to represent psychologists working in medical schools and medical education. The organization's mission was to serve as a link between AAMC and the American Psychological Association and inform both organizations as to the contributions psychologists made to academic health care centers. It subsequently became a member organization of AAMC, and a section of Division 12 (Clinical Psychology) of APA. More recently the name was changed to the Association of Psychologists in Academic Health Centers (APAHC). Dr. Carr was elected twice to the presidency of the organization and served on its executive committee for well over a decade. He also had an enduring commitment to training residents and psychology interns in empirically supported treatments for anxiety and depression. His contributions were memorialized an award established in his name in 2000, the John E. Carr Award for Outstanding Achievement in Empirically-Supported Psychotherapies.
Dr. Carr served on a medical student stress committee, appointed by the Dean following a student suicide. He recommended Dr. Peter Vitaliano to head up a major research program investigating stress in medical education, which became a major interdisciplinary project that is still ongoing. This interest in the stress response led to research focused on exploring and defining the specific mechanisms by which behavioral or psychosocial variables interacted with biological processes, especially in anxiety disorders and their treatment.
During Dr. Carr’s term as Acting Chair, the Community Psychiatry Program was reorganized, a King County Task Force on Mental Health was established, and a closer working relationship with State programs was promoted. Shortly after he was appointed, the State experienced a major fiscal shortfall (1981) resulting in a “recall” of budget from the UW to the State. The medical school was hit especially hard and budget cuts were levied proportionate to department size (at the time the Department was second only to Medicine in size). Department finances were doubly hit when the State also summarily terminated two training programs, one in Child Psychiatry and one in Community Psychiatry, as part of their budget cuts. Both programs had supported 6 residency positions, which the Department had to honor as the residents were already on site. Drs. Carr and vice-chair, John Hampson, made numerous trips to Olympia to renegotiate the training contracts, to address DHSH concerns, and to reorganize the training program. They were able to re-establish both training programs and appointed Dr. Eric Trupin to head the community psychiatry program. Dr. Bill Womack continued as Head of the Child Psychiatry program. Also during this time the Department significantly expanded the outpatient center faculty by adding both full and part time physicians and psychologists.
With Dr. Carr’s leadership, the Department weathered the budget crises, retained the full complement of residents, and never lost a faculty position. During this time, many of the treatment and training programs were reoriented more toward provision of community and regional health care services. The department leadership joined with County Executive, Randy Ravelle, to establish a King County Task Force on Mental Health, whose members included citizens from the community as well as UW faculty and public administrators. With Mr. Ravelle’s support, the department opened a new short-term psychiatric ward (in addition to the already existing two inpatient units) at Harborview to accommodate the increasing number of ER psychiatric admissions. Mr. Ravelle’s enthusiastic support was obtained by inviting him to visit the Harborview ER during one weekend.
Also during Dr. Carr’s term, the Department continued and expanded support of the Hunan Medical School affiliation that Dr. Kleinman had begun under Dr. Eisdorfer’s term. Several faculty and residents from Hunan visited the UW annually, and UW residents and faculty were sent to China to teach and establish programs. For example, Drs. Carolyn Preston and Brenda Townes lectured and helped establish geriatric and neuropsychological services there. Dr. Hans Doerr helped further develop neuropsychological laboratory facilities, not only in Hunan but also in several other major Chinese universities. Drs. Carr and Eric Trupin also visited and lectured at Hunan University.
The Tucker Era
In 1985, Gary Tucker, MD was appointed Chair. His primary academic interests included neuropsychiatry and psychophysiology. He served as Chair from 1985-1997, which represented a period of major growth in the department and the maturation of a large number of junior faculty to their current senior faculty ranks.
Spokane Track. In 1992, with the encouragement of Dr. Johan Verhulst, who was the psychiatry residency-training director, the Department established a satellite residency training program for 3rd and 4th year resident training in Spokane. This program has resulted in nearly 50% of the residents who received training in the Spokane track staying in Eastern Washington, which was a major strategic objective of this initiative.
Dr. Tucker resigned as Chair in 1998, took sabbatical leave for one year, and moved into Emeritus Professor status on his return. In this capacity he continued to contribute to the department by running the ECT service at UWMC. He also remained actively involved in scholarly writing, teaching, and clinical supervision. The department established a career-teaching award in his honor in 2005. Sadly, Dr. Tucker passed away on December 6, 2006 following a prolonged period of illness. On September 7, 2007 the department held a celebration of his life and his many contributions as a mentor, skilled clinician, inspired teacher, pioneer in neuropsychiatry, and university department Chair. Friends and colleagues attended this celebration from across the country. A collection of remembrances of his life and career from friends and colleagues can be read here.
In 1998, Dr. Richard Veith was appointed the department’s 4th and current Chair. He is a Seattle native who began medical school at the UW in 1970, where he also did an internship in Internal Medicine and residency in Psychiatry. He joined the UW faculty in 1977 as an investigator in the GRECC program at the VA. He was appointed GRECC Director in 1987 and was promoted to Professor in 1989.
Residency and Advanced Specialty Training Programs. The department has been fortunate to have a series of excellent training directors. This current training director Dr. Deborah Cowley became the Director of the Psychiatry Residency Training in 1997 and was subsequently appointed Vice-Chair for Education in 2006 to oversee the department’s diverse training activities and programs. Prior training directors have included Drs. Peter Maxim, John Bokan, and Johan Verhulst. Dr. Cor Bakker served as the first Spokane Track residency director followed by the current training director, Dr. Matt Layton, MD, when he retired in 2005. Under Dr. Cowley’s leadership and with the tremendous help of Dr. Larry Dewey, chief of Psychiatry at the Boise VA, the Idaho Track residency-training site was established in 2007. Dr. Dewey is the first Idaho Track training director. The department supports advanced specialty fellowship training and added qualifications in Addictions Psychiatry, Child and Adolescent Psychiatry, Forensic Psychiatry, Geriatric Psychiatry and Psychosomatics (Consultation/Liaison Psychiatry). There is an array of post-doctoral training fellowship programs supported by the faculty, e.g., laboratory based neuroscience training, health services research, addictions.
Psychology Internship Program. The multi-departmental University of Washington Psychology Internship program was founded in 1961 with the goal of providing excellent clinical, didactic, and research training firmly rooted in the scientist-practitioner tradition. The program has been continuously accredited by the American Psychological Association since 1965, and has built a strong national reputation as a leading medical school-based internship, providing training in general adult psychology, general child psychology, and behavioral medicine/health psychology. Many former graduates of the program are on our current faculty. Dr. Joan Romano has been the Training Director since 2003. Prior training directors have included Drs. Ned Wagner, Wilbert E. Fordyce, Jack Carr, Joseph Becker, Nancy Robinson, Albert Carlin, Elizabeth McCauley, Karen Schmaling, and Alex Tröster.
The department conducts its training, clinical and research activities at Harborview Medical Center, VA Puget Sound Health Care System, Seattle Children's, Seattle Cancer Care Alliance, University of Washington Medical Center and at our satellite residency programs in Spokane and Boise. Links to these sites, the current program leaders and the department’s major divisions can be explored elsewhere on this website.
(This history was excerpted in part from, "Fulfilling the Dream: A History of the University of Washington School of Medicine, 1946-1988”, published in 1990 by Clement A. Finch, M.D. Drs. Merlin Johnson and John Hampson had provided Elements of the department history in 1988.)