Wednesday, November 27, 2013

R.I.P. Ivan K. Goldberg, M.D.

Psychiatrist bridged worlds of talk-therapy psychiatry and medication-centered practice

[Edits 11/30/13. Edit 12/2/13. 12/3/13: here is some online obituary information. More edits 12/6/13. Edits 1/22/14.]

I was informed by an e-mail that I received this morning that Ivan K. Goldberg, M.D., had passed away on November 26. According to Linda Boginsky, the longtime arranger of educational lectures for DBSA Morristown Area, the cause was cancer, which had apparently gotten quite pervasive before it was detected (or rigorously treated). He was 79.

Dr. Goldberg was a psychiatrist who had experience in doing medical scholarship (some academic/research articles of his from 1980, in the journal The Lancet, can be found in a PubMed search [End note 1]); serving for many years as a professor in a medical school; serving on the National Institute of Mental Health (NIMH); doing private practice for many years (in Manhattan as well as outside it); and functioning as an advocate for patient self-support efforts, particularly DBSA (Depression and Bipolar Support Alliance). He also maintained a general-information Web site, viewable here.

It was in his patient-advocacy role that I got to see Dr. Goldberg give several of his informational lectures that he routinely gave at DBSA Morristown Area (which had had a previous name prior to late 2002). His lecture service to this group had gone on since 1987, shortly after its inception in 1986 (according to Ms. Boginsky). He also served as the professional advisor to the New York chapter of DBSA in Manhattan, and he had a column in its periodic newsletter.

I was also fortunate to arrange to get him to lecture in Sussex County, N.J., no fewer than three times—in 2003, 2005, and 2006. The first time (2003) was under the aegis of both DBSA Sussex County and NAMI Sussex, and the second times were under NAMI Sussex. Nick Poth, who started the Sussex County DBSA group, had first had Dr. Goldberg speak in Sussex County in about 1992, from what I heard.

The information commonly given on his career in the periodically updated lecture schedule of DBSA Morristown Area has been that he was retired from the faculty of the Department of Psychiatry at the College of Physicians at Columbia University (where he worked for 30+ years); and that he had been on the staff of NIMH. DBSA Morristown Area also noted he had authored Questions and Answers About Depression and Its Treatment (which, as I found, was published by The Charles Press, a small Philadelphia publisher, in 1993), and a second edition was in progress (this was never published, to my knowledge, though a manuscript circulated among close associates).

Dr. Goldberg, who got his M.D. in about 1960, not only kept abreast of most recent medical studies, partly in order to offer patients and the public “the latest science” relevant to psychiatric treatment. He also had trained when psychiatrists were still schooled in Freudian talking therapy, with one result that he could relate an old anecdote from an “old-timer” in the Freudian school who had apparently trained in Vienna (or Berlin--my confusion on which), who once said, “Ach, you Americans say sensitive, when you really should say neurotic.”

Dr. Goldberg maintained a sensitivity to patient perspective—such as self-reports, or the fact that psychiatric issues are first established in doctor assessment by appreciating what a patient has to reveal—that came from his Freudian training. Thus he could not just show an appreciation for how patients interpret their problems (such as along the lines of reports suggesting past trauma), but align this in his own way with the current discipline of medication-based treatment.

To put it in my own terms, Dr. Goldberg didn’t just regard patients as piles of gravel to be assessed by a time-server with an idiot checklist, to be made to toe the line of the prerogatives of Big Pharma; he also took into significant account what a patient had to report as helping define the specific the problem that patient had, and he responded with compassion defining his treatment approach.

A good example of this general approach was shown in his describing the phenomenon of borderline personality disorder, in the first lecture I had him give, with my having requested he address the topic of borderline PD. In the same event, he spoke (conforming with a multi-topic format he frequently used in Morristown) also on other interconnected topics (adding one or two of his own), in the special lecture I set up for him on behalf of DBSA Sussex County and NAMI Sussex at Newton Memorial Hospital, Newton, N.J., on June 6, 2003. (End note 2)

Among other things on borderline PD, he said (and note what he says on interpersonal relations between borderlines and their friends):

The other thing that’s sort of so difficult when dealing with borderline people is their capacity to upset others. As kind of a survival skill...from their early traumatic childhoods, they’ve learned all kinds of emotional techniques that basically get under the skin of other people and make other people sort of impotently furious in many cases. So a good deal of anger is generally expressed by such folks [borderlines]—they can rapidly alternate between loving you and hating you. You have someone who has apparently been your best friend for a long, long time, and then suddenly, over what appears to you to be an absolutely trivial incident,'re at the top of their shit list.

After this statement, he added (with semi-apologetic humor; this paraphrases), “You may not use the term shit list, but I’m from New York, and that’s how we talk.” I have this whole statement and much of the rest of his lecture from June 2003 on audiotape, which of course he knew I was making.

Dr. Goldberg showed a healthy middle ground between talk-therapy sensitivity and medication-related science. He could employ Jewish-related jokes in his lectures, but he was not ethnocentric; he showed good American, science-oriented sense. He seemed quite abreast of “the latest and greatest” findings on what meds worked, or did not, well into his old age.

His healthy alienation from the current U.S. practice of corporate medical marketing was shown in his Web site’s noting that it did not take money from Big Pharma. Also, he remarked (more than once) that the trend of psychiatric medications’ being marketed as Big Pharma does uses the same practice/mentality as the selling of soap.

He even drove himself to Sussex County when he lectured, including the last time he came, in 2006. I last saw him this past June in Morristown, speaking in a DBSA lecture where he shared the stage with Dr. Howard Rudominer.

End note 1.

Enter "goldberg ik" into the search box on PubMed. In results, you should see three studies from 1980, dealing with depression treatment.

End note 2.

Added 12/6/13. Not only did I make an effort to arrange educational lectures within my home county in 2002-07, but corresponding with scholarly psychiatrists was something I'd done for many years. Here is the first letter I received from Ross J. Baldessarini, M.D., a top researcher at Harvard Medical School with whom I corresponded from 1990 through about 2005.