Psychiatrists Eric Berger, David Greenfeld, and Monica Kalacznik are retiring on June 30, 2020 after a collective 120+ years of service to the Yale Department of Psychiatry and Connecticut Mental Health Center. We talked with each of them about their careers, changes in the field, and what their work has meant to them over the years.
Eric Berger, MD
There’s no “magic” involved in psychiatry, said Eric Berger, MD, but looking back on his many years at Connecticut Mental Health Center, one mystery remains: how office assignments are made.
“My first office had an analytic couch. It had a tilted head and a pillow. People really used to do that,” he laughed. “I didn’t know what to do with it, so I organized papers on this long, large surface.”
In the late 1970s, Dr. Berger finished his residency at Yale and started a private practice in New Haven. A few years later, life changed when he was asked to work as a psychiatrist at Yale-New Haven Hospital. Rotating through the hospital for about ten years—"pre-managed care,” he said, “before they destroyed the old models and changed the economic scenario”—he got a great deal of exposure to different patient groups and practices, from the “90-day unit” for adolescents and young adults where he served as assistant director, to the geriatric unit, to the old “day hospital” outpatient program. In the mid-1990s, he started working in the outpatient division at Connecticut Mental Health Center (CMHC). He has kept his private practice throughout his career. He has also greatly enjoyed supervising the many Yale Psychiatry Department residents who have rotated through CMHC and served on his team.
“It’s a joy,” he said. “I feel very fortunate to have developed the skills to do it. It’s a good fit for me to be a clinical psychiatrist.”
Now Dr. Berger is closing the door on nearly three decades at CMHC as the attending psychiatrist on Team D. When he started, CMHC teams were diagnosis-based and Team D was the mood disorders team. Over the years, he delved deep into the psychopharmacology of affective disorders. In the recent past, since CMHC stopped organizing its outpatient teams around diagnosis, he has enjoyed working with a wide variety of patients.
Those patients are very different from the people he sees in his private practice, who also need his help but who often can afford to pay out of pocket. The opportunity to serve people in poverty has given his career a meaningful balance.
“I’ve got sitting in front of me an article about privilege,” Dr. Berger said, speaking from his home office on a Zoom call. “The disparities in our society are appalling. The inequality. That’s very important to me personally. I recently read the phrase ‘nobody is better than me, and I am better than no one.’ It’s part of how I try to approach my patients, even though I’m white and privileged. I know there is a knowledge differential, a power differential, but I try to approach everyone with respect, in a dignified way.”
“One of the big challenges for the CMHC outpatient population is, for many, the lack of insight,” he continued. “They get medication, they say they don’t need it, then they get re-hospitalized. Occasionally—and it can take years—patients finally get it. They reach a point where they decide they need medication, and they get on board with that. And their lives can become much more stable and organized at a higher level. It can be very exciting to share that with a clinician or a team when it happens.”
There are disparate theories about why some people are able to gain insight and others struggle so much, he said, but sometimes, an individual relationship can turn things around.
“There will be a chronic patient,” he explained, “and an enthusiastic clinician or a resident will come along and really find a way to develop a relationship with the person and set them on a different course.”
Dr. Berger is no stranger to course-setting himself. A few years ago, a life-threatening illness woke him up to “the question of health-span vs. life-span.”
“How long will I be healthy?” he asked himself. His decision to retire grew out of that moment. As he packs up his CMHC office he’s more gradually winding down his private practice. Today, fortunately, he has his health. He and his wife hope to travel more, although the pandemic has put a damper on their plans for now.
What will he miss most in his retirement? “I’m curious to find out the answer to that,” Dr. Berger chuckled. CMHC, he said, is a “complicated, interesting, wonderful place” where he treasures his day-to-day interactions. “A lot of people spend time behind closed doors,” he observed, “but the hallway interactions, the more informal ways people deal with each other every day – I’ll miss that.”
Before he retires, as part of CMHC’s current re-visioning process, he plans to share his ideas about transformation with the Center’s leadership. Among other things, he noted, in the emergent age of tele-medicine—which has greatly accelerated due to the coronavirus pandemic—“There’s the problem of the lack of internet access and devices among poor people. I hope there’s an aggressive attempt to address that.”
Dr. Berger said he can envision many benefits from increasing virtual practice and de-centering the focus on the building. Much like his old recliner couch, perhaps the building itself is becoming a thing of the past. New tools, he noted, technology and otherwise, “could revolutionize the way we do psychiatry.”
“There are incredible opportunities,” he reflected. “My good friend is a historian and he loves revolutions. He finds them very exciting. I’ll be very interested to see what people make of this opportunity to break the old order.”
David Greenfeld
It was 1968 when David Greenfeld, MD, a young medical resident, moved to New Haven for his residency in the Yale Department of Psychiatry. He started on the inpatient unit of Connecticut Mental Health Center—it was brand new, having just opened in 1966—and during his second year of residency he worked in the outpatient department.
“I promised my wife we’d be here for four years, and then we’d move to California,” he laughed.
Fifty-two years later, looking back on his diverse career serving in multiple roles with a great variety of patients, Dr. Greenfeld said he feels “very fortunate.”
After his residency, he launched a private practice and worked in University Health Services before taking a position, in 1978, as director of the adolescent-young adult unit at Yale-New Haven Hospital. It was a rich and rewarding experience, one he looks back on with great fondness.
“I really loved running that adolescent inpatient unit,” he reflected, noting that intensive psychiatric units like this don’t exist anymore. “It was a one-of-a-kind thing, in the day when insurance companies paid for things and you could keep people long enough to really work with them. The staff was just wonderful. We functioned at a very high level. I miss it. I was fortunate to be part of it.”
Be really open...to what the patient can teach you.
Monica Kalacznik, MD
During those years, out of necessity, he became an expert on eating disorders. He said there was “an epidemic” of sorts: the unit had a waiting list of young patients with eating disorders, and someone needed to take the reins. It was also during this period that he was asked by the Department of Psychiatry to design the psychiatry course for medical students in their first and second years and to give all the lectures. The Department hired an assistant to help him run the unit; that assistant was Dr. Eric Berger, also retiring this month. They’ve remained good friends and for many years crossed paths in the building where they shared a private practice suite.
In 1996, Dr. Greenfeld became the training director for the Department of Psychiatry, then returned to Connecticut Mental Health Center (CMHC), first working part-time in the Acute Services division, and later becoming the medical director at CMHC’s West Haven Mental Health Clinic. A cancer diagnosis in 2001 caused him to step back from his role as medical director, but he later returned and has continued to work with the West Haven team. A few years ago, the team’s move back to the main CMHC building returned him to the place where he began.
Dr. Greenfeld gave up his private practice suite recently, but for a little longer he’ll continue to maintain a private practice, run virtually from his home office. A self-described “old codger,” he said he began to recognize not long ago that he really was the oldest person in the room.
And yet, he’s in the vanguard when it comes to tele-mental health, which is receiving tremendous focus today due to the global coronavirus pandemic. Dr. Greenfeld began using telehealth years ago in his private practice, which he expanded after he got sick. He has long-term patients all over the world whom he sees virtually. He said it’s been extremely gratifying to know that his private practice patients, many of whom he no longer sees, have gone on to live very productive lives.
“There were some people who were really desperate and were heading for, if not suicide, at least a wasted life,” he recalled. “Some of them have done quite well. I can’t say that was true for every patient I had, but it’s nice to have a few.”
“I have been blessed by having work that I really love to do,” he reflected. “I’m giving it up because it’s time. It’s not fair to patients to be this old and having them depend on me. But I’m grieving the loss.”
“The whole thing has gotten more interesting the longer I’ve done it,” he added with a laugh. Asked what he would say to the next generation of practitioners, he replied, “Having work that you really love is a very rare privilege in this world. Find the niche that really works for you, then do it! Find the thing where you’re thinking, ‘God, this is terrific, and they pay you for it too.’”
Monica Kalacznik
Monica Kalacznik, MD is a familiar face at Connecticut Mental Health Center. Since joining the ACT Team in 1997, first as staff psychiatrist and later as the medical director, she’s been the team’s steady element across twenty-three years of change, always doing what she does best: working with her colleagues and with the patients others thought were unreachable.
ACT—Assertive Community Treatment—is a specialty within community psychiatry, an intensive approach to working with people for whom the traditional outpatient services model has not been effective. At one point, Dr. Kalacznik also worked part-time with CMHC’s original Outreach and Engagement Team in the 1990’s.
“I’ve done home visits for 23 years,” she reflected, “and I just feel immensely privileged to be let into people’s lives the way that you can when you see them in their homes, in the hospital, visit them in prison—when you follow their lives in the way we’ve been able to do.”
She said one of her patients is currently in the hospital, feeling upset that she is retiring. “I’ve known him for 23 years,” she explained with a hint of sadness. “It’s just amazing to get to know people so well over such a long a period of time.”
Dr. Kalazcnik’s career started in Philadelphia in the 1970s, where she was a mental health worker visiting patients who had recently been discharged from state hospitals in Pennsylvania. It was the period of deinstitutionalization, when large numbers of patients were leaving state psychiatric hospitals for community-based care. “Sometimes I think I did some of my best work then,” she said with a smile. From there, she went to medical school thinking she would do geriatric medicine. “But I fell back in love with psychiatry,” she recalled, “and the stories of people’s lives.”
She completed her residency at Albert Einstein College of Medicine in the Bronx and worked at Queen’s Hospital before moving to Connecticut, where she took a few months off when her son was born before she was offered the job with CMHC’s ACT Team.
“I was thrilled to do home visits again,” she said. “I always found the ACT Team to be the most satisfying, not just for the home visits, but because it’s really a team approach. You can’t do it by yourself. It’s always been interesting to me to work with a true interdisciplinary team.”
The process of building relationships with patients has also been truly meaningful. “I have patients now who have conversations with me who literally used to scream at me when I encountered them,” she said. “The challenge of working with people who were so resistant has been very satisfying. It’s been gratifying to know you can make your way into someone’s life and help them.”
What are the secrets to her success? “I think to meet people where they are,” she explained, “to address what they need at the time, and not impose.”
“I’m a doctor,” she continues, “so certainly I want to give medication to a lot of people who need it, but I think to meet them where they are—if they want housing, or a cup of coffee, whatever it is,” and let the patient be your guide is the winning approach. A role model for how to do this well, Dr. Kalacznik has greatly enjoyed mentoring young psychiatrists and supervising fellows from the Yale Public Psychiatry program. After training at Yale, a number of these doctors have gone on to work at other ACT Teams around the country.
She had planned to return to Pennsylvania in the early months of her retirement, to visit with relatives and knock on doors to get out the vote this fall. Her plan has been “sabotaged by the coronavirus,” she said (“maybe I’ll call people instead,” she added). Writing is her other love. Dr. Kalazcnik is a longtime member of the writing group led by retired psychiatrist John Strauss, MD. “One of my goals is to gather together some of the writing that’s on my computer and scattered about my house,” she said, adding that her fellow writing group members have been cheering her retirement so she’ll have more time to write. Writing, she said, has been very important to her over the years. “It has sustained me through difficult times with some patients.”
“I will miss my team,” she said. “I’ll miss the interaction with the team and the patients.”
For the people on that team, her words of wisdom are simple: “Keep learning.”
“I never feel like an expert, even after all these years,” she reflected. “Be really open to what the other people on the team can teach you, and what the patient can teach you.”