As my summer internship with the Connecticut Mental Health Center (CMHC) was coming to a close, I had the opportunity to interview Dr. Madelon Baranoski: forensic psychologist, professor of psychiatry, director of the CMHC Jail Diversion program, and a chair of the Institutional Review Board (IRB) at Yale Medical School. We met on Zoom. As we ended our introductions and I prepared my first question, Dr. Baranoski beat me to the punch.
“Clayton, how are you doing during this pandemic?” she asked. Dr. Baranoski's dedication to person-centered care was evident from the beginning of our conversation.
Madelon Baranoski was raised in a small farm town by her parents, a teacher and a nurse. Her family valued education, and young Madelon wished to be a math teacher like her father. In her small community, however, “There were certain pathways available to women,” she said. “When I interviewed at college, they told me to consider English—men were math teachers.”
“My entire life has turned on critical instances,” she added. As a high schooler, she had no idea that her first big turn was right around the corner. Dr. Baranoski was waiting for the bus in her school's gymnasium when she stumbled upon a Future Nurses of America meeting. With the Vietnam War recently beginning, Future Nurses offered a full scholarship in exchange for three years of active service. Dr. Baranoski decided to apply for the program, thinking, “If I get in, I’ll do that.” After a few short years, she was off to war.
Her next turning point was at the front lines of Vietnam. A lieutenant came in, his limbs mangled by a mine during a firefight. Dr. Baranoski, then head nurse of the ER in the hospital where she was stationed, was on the scene. The lieutenant’s limbs were unsalvageable, and a quad-amputation was necessary. After the surgery, Dr. Baranoski spoke with the lieutenant the night before his transfer to the recovery hospital in Japan.
“He was worried about what his wife would think. And I had seen him when he first came into the ER,” she recalled. “He was still in his clothes, clearly in pain, but still talking. He was a whole person.”
The lieutenant died within three days of arriving at the recovery hospital, “and I was thinking, ‘How did that happen?’” Dr. Baranoski pondered.
She would find her answer while attending graduate school for pediatric nursing. There, Dr. Baranoski learned about “learned helplessness”: a theory discovered by Martin Seligman where one believes that their actions will make no difference in their life. She was intrigued by the similarities between the lieutenant’s behavior and the symptoms of learned helplessness. Soon, she transferred to psychology. Dr. Baranoski later earned a PhD in this field after studying with Dr. Seligman and completing her dissertation on helplessness in relation to physical changes and cancer development in rats.
After earning her PhD in 1982, Dr. Baranoski enrolled in a two-year postdoctoral study at Yale. She was working at the West Haven Mental Health Clinic when she was assigned to work with a distraught high schooler who would lead her to the final major turning point in her career. Dr. Baranoski said, “I worked with people struggling with mental illness and behaviors that sometimes led to violent outbursts."
“I realized that it was psychiatry that could act before something happened. The law acts after something has happened. Luckily, in our country, you can’t lock someone up for something they might do, but you can intervene before it happens,” Dr. Baranoski explained. She would go on to specialize in forensic psychiatry where preventative care would be a cornerstone of her career.
Dr. Baranoski soon began working with the judicial system. She founded the Jail Diversion program in New Haven as the operation went statewide. In Jail Diversion, a program of the Law and Psychiatry Division at Yale, dedicated social workers and psychiatric nurses work with people who get arrested due to behavior that occurs because of untreated or not fully treated mental illness. The Jail Diversion clinicians interview these arrestees and offer the courts a chance to refer them for treatment, rather than to prison or further prosecution.
The pandemic has hindered this process, however. “A number of courts have closed, and they’re postponing cases. They’re trying to reduce the number of cases coming in to prevent the spread of COVID,” Dr. Baranoski commented.
...the stigma associated with psychiatric disorders is a challenge in research.
Madelon Baranoski, PhD
The psychological tests necessary for Jail Diversion and forensic assessments have also been affected by social distancing. Interviews are currently being conducted over Zoom, but Dr. Baranoski elaborated that “I need to be with a person when I’m doing an evaluation. I can’t do a number of tests over the phone.” She also said it’s difficult to connect with clients through an online format, especially older patients who aren’t accustomed to the necessary technology.
Dr. Baranoski’s work as a psychologist is only one example of her person-centered care. She has also had a long career as a researcher in which she completed multiple studies such as “The Juvenile Offender: Competency to Be Adjudicated in Adult Court.” Her research earned her a chair on Yale’s Institutional Review Board (IRB), the group that evaluates whether a proposed research study is in accordance with the Common Rule, which outlines the government’s standards for protecting human study participants from harms and wrongs. A harm is the destruction of property or negative physical consequences; a wrong is when someone’s rights are violated.
“Our main job is the protection of human subjects,” Dr. Baranoski explained of the IRB. Before a study can commence, she and her colleagues determine if potential risks have been addressed and mitigated and if the study is ethical. The number of IRB submissions has nearly tripled in recent times due to requests to study the effects or treatment of COVID-19. While research is on the rise, so are the potential risks of conducting in-person studies.
COVID, however, only recently became a barrier to research. Dr. Baranoski explained that stigma of selected diseases and legal red tape have hampered scientific development in the past. “Patients with HIV were initially stigmatized and research was hampered. We made progress when we stopped stigmatizing the people and focused on the disease and biology and treatments. Mental health disorders are the same; the stigma associated with psychiatric disorders is a challenge in research.” Dr. Baranoski elaborated.
News outlets and politicians contribute to the problem with their rhetoric around mass shootings. Attributing these crimes to mental illness “raises a lot of stress for people who are suffering from psychiatric disorders,” Dr. Baranoski detailed. “The idea that if you're mentally ill you’re dangerous discourages people who are struggling with symptoms from seeking treatment; they fear being labeled, feared, and ostracized.”
Often, the greatest victims of stigma are those with the least agency. Dr. Baranoski continued, “Stigma can discourage families who are dealing with a child who exhibits some strange behavior from seeking adequate care. They’re scared of having that label placed on their child. Not only do we need to increase access to care, but also increase the acceptability of treatment.”
The nation’s attitude towards certain issues has, at other times, halted research altogether. “The law needs to recognize when science needs a carve-out” regarding special research topics, Dr. Baranoski asserted. She praised the recent approval of ketamine for the treatment of suicidality as a major step forward. That treatment resulted from landmark research within the Yale Department of Psychiatry. But in some areas, progress has been slower. She noted, for example, there’s a big puzzle in how the brain works for those who are sexually deviant. In the United States it’s obviously against the law to own any child pornography, but it’s also against the law to have some of the tools to study the effects of it.
“Canada,” Dr. Baranoski continued, “has a whole center where they look at brain activity when someone is viewing materials that would be considered illegal child pornography here.” The inability to research taboo topics can exacerbate public health issues by not allowing scientists to investigate what causes a problem, or how to solve it. “The law needs to appreciate what science needs. But at the same time, research participants must be protected. Human subjects’ protection must stay in place,” she added.
Dr. Baranoski believes communities need to take preventative care to help at-risk people. “In psychology and psychiatry, you can act before a crime happens,” she reiterated. But in order to help people, scientists need to be allowed to conduct adequate research. The human brain is a challenge to study, and research tools and approaches are needed. Advances in neuroscience and brain research are a central goal and achievement of the Yale Department of Psychiatry.
“There’s no shame in admitting that we’ve all gone through tough times,” she noted. If we follow Dr. Baranoski’s person-centered approach, however, we would be making great strides as a community to normalize mental health care.