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In Memoriam: Steven Southwick, MD

April 21, 2022

The following message to the Yale Department of Psychiatry was written by John H. Krystal, MD, Robert L. McNeil, Jr. Professor of Translational Research; Professor of Psychiatry, Neuroscience, and Psychology; Chair, Yale Department of Psychiatry.

I have the sad task of sharing the news that early this morning (April 20, 2022), we lost our dear friend and colleague, Steve Southwick, MD, Glenn H. Greenberg Professor Emeritus of Psychiatry. As you know, he has been dealing with a long illness. Steve had several recent hospitalizations and he declined rapidly during his most recent hospitalization at YNHH, where he was well cared for by our Palliative Care Team.

I do not think we will soon meet another person like Steve. Steve was the son of Dr. Wayne Southwick, the founding chair of Orthopedic Surgery at Yale. A varsity athlete as a Yale undergraduate, Steve became disillusioned in college. He left college, knowing that he would be drafted and likely sent to Vietnam. Instead, he was sent to Germany as a member of the Military Police. He completed medical school at George Washington and then internship at Johns Hopkins, where he was influenced by Jerome Frank, the author of Persuasion and Healing. He returned to Yale to complete his Psychiatry Residency. I met Steve when he was a PGY2 (I was a YSM3) in 1983. He already had a remarkable capacity for empathy and instinctive psychiatric expertise. I remember that he kept a picture of his beloved daughter, Christina, and a Nebraska Cornhuskers pennant in his office. He began working with Earl Giller and John Mason to study PTSD. Around this time, he began reading the writings of Holocaust survivor, philosopher, and psychotherapy innovator, Viktor Frankl. Frankl’s writings would inform his later work with Dr. Dennis Charney related to resilience.

A pivotal moment in Steve’s career was 1988, when Dr. Charney moved to VA Connecticut as Chief of Psychiatry. Steve deeply respected his older brother Fred, who brought a rare level of commitment to everything he did. In Dr. Charney, Steve found someone who also was fully to committed to the scientific and clinical mission as well as to the people around him. Dr. Charney became a mentor, collaborator, and dear friend. They worked hard and played hard, particularly when kayaking. Steve’s longstanding collaboration with Dr. Charney led to a new vision for human resilience that fully integrated all domains of life, i.e., neurobiology, genetics, development, psychology, physical activity, vocational activity (sense of mission), and spirituality. They had the opportunity to apply this vision to the study of World Trade Center first responders and in other contexts. Their work together generated several landmark peer-reviewed publications and books, including “Resilience: The Science of Mastering Life’s Greatest Challenges,” and “Resilience and Mental Health: Challenges Across the Lifespan,” which Steve and Dr. Charney co-wrote with Brett Litz and Matthew Friedman. They also wrote the landmark paper, “The Science of Resilience: Implications for the Prevention and Treatment of Depression,” published in Science magazine.

Few people appreciate that Steve led a study that provided the first direct link between a neurobiological mechanism and the symptoms of PTSD, published in 1993. The study identified an alteration in the function of the alpha-2 adrenergic receptor in PTSD patients. Steve, Dr. Charney, and I probed this mechanism by evaluating the behavioral and biochemical response to yohimbine, an alpha-2 adrenergic receptor blocker. As this drug was administered, remarkably, patients began to report intrusive thoughts about their traumas, with some patients vividly reexperiencing these memories in the form of flashbacks. This study led to the testing of prazosin for the treatment of PTSD symptoms by Murray Raskind and his colleagues. Prazosin is still used for the treatment of nightmares for some patients.

Steve was also a beloved mentor and supervisor. Many of his mentees have become leaders in the field of PTSD. For example, his mentee, Robert Pietrzak, PhD, now Professor of Psychiatry at Yale, created the National Health and Resilience in Veterans Study, a landmark in the field. In its more than 100 publications, this study has provided unique insights into the longitudinal course of PTSD as well as predictors and modifiers of this disorder. Similarly, Steve was an effective clinical leader at VA Connecticut and a highly valued clinical supervisor for psychiatry residents and other trainees.

Steve’s ability to fully engage in these activities was made possible by a special collaboration that developed between Steve and Linda Vester Greenberg who, of course, is well known as a television reporter and news anchor. As a reporter, she had covered war and other disasters. She understood the detrimental impact of traumatic stress and the importance of the human capacity resilience. Linda and her husband Glenn developed a friendship and collaboration with Steve over several years that led to the creation of the Glenn H. Greenberg Professorship of Psychiatry, PTSD and Resilience, with Steve as the inaugural professor.

Despite his illness, Steve remained an important contributor to our community. Steve retired from full-time work as his illness began to affect his professional life. He also looked forward to spending more time with his beloved wife, Bernadette. Nonetheless, it seemed that every time issues related to stress and resilience arose in the university, Steve was involved. Steve became a critical part of the Yale Healthcare Worker COVID Mental Health Support Task Force which met several regularly and organized assessment, referral, and support activities across the medical school and the Yale New Haven Health System. As if this were not enough, it turns out that Steve was involved in parallel efforts within the Icahn School of Medicine at Mount Sinai. Throughout this period, Steve was actively engaged in treatment. He often was in pain, and he frequently felt debilitated. Yet, his contributions were uniformly hopeful, constructive, and forward looking. We felt more resilient because Steve was there.

The truth was that we all wanted to keep Steve in our lives and in our work for as long as we could. Brilliant, kind, humble, empathic, constructive, selfless, expert, and visionary; he was unique. When Steve retired, we held a celebration for him in a packed room filled with people who loved him. We presented Steve with a proclamation about his career that Senator Blumenthal had read into the record of the U.S. Senate. Of course, Dr. Charney had driven up from New York to celebrate with Steve. At the end, Dr. Charney once again came up from New York to say goodbye to his dear friend.

We have lost Steve. As we console ourselves, our hearts go out to Bernadette and to his daughter, Christina Baker, and grandchildren Avery and Jaxon. Let us commit ourselves to holding a Memorial for Steve and consider whether there might be a way to keep his memory alive in our community.

Submitted by Christopher Gardner on April 21, 2022