Perspectives from a Child Psychiatry Pioneer

A former AACAP president discusses the changes that have shaped child psychiatry, and how leaders can continue to steer the field in the right direction.

In an interview with AACAP President Laurence L. Greenhill, MD, newly appointed president of AACAP, Clarice J. Kestenbaum, MD, reflected on her career in child and adolescent psychiatry, as well as how the field has grown and how its leaders must adapt with the changing times.

Kestenbaum, who served as AACAP president from 1999 to 2000, is professor of clinical psychiatry and director of Training Emerita in the Division of Child and Adolescent Psychiatry at Columbia University College of Physicians and Surgeons. She has focused her career on child development and psychopathology, as well as pediatric patients at risk for schizophrenia and bipolar disorders. A member of the organization since the 1970s, she is pleased with AACAP’s progress, noting that it “has grown remarkably” in recent years.

Kestenbaum received her medical degree from UCLA Medical School and completed her residency in general psychiatry and child and adolescent psychiatry at Columbia. Prior to her arrival at Columbia, she served as director of the division of child and adolescent psychiatry at St. Luke’s-Roosevelt Hospital. She is now a consultant to the Center of Prevention and Evaluation, and was a co-founder of CARING at Columbia, an organization that helps inner city, at-risk children coping with stressors through the arts and literature.

Along the way, Kestenbaum had her share of challenges to deal with, particularly the fact that very few women were accepted into medical schools when she applied, and those who did were forced to deal with sexism on a regular basis. But the California native, who was inspired to become a child psychiatrist after reading Freud’s “Introductory Lectures on Psychoanalysis,” learned early not to take no for an answer, even when her own family tried to convince her not to pursue psychiatry. She become the first woman to get accepted into the VA internship, and at one point faced charges when she refused to leave a surgical room during clinical rounds (after a male supervisor ordered her to go to the nurses’ quarters).

She was involved with a groundbreaking case in which a patient suffering from manic breaks was administered lithium and responded very positively, and explored the treatment of autism at a time when most people simply blamed the mother for the symptoms seen in these children. Kestenbaum also worked on one of the first instruments used to evaluate schizophrenia in children, and spent time with the autistic-savant patient who was an inspiration for the movie Rain Man, helping him to develop reading and writing skills on a fourth grade level.

“Child psychiatry was in its infancy,” she said. “It was a really interesting time.”

Kestenbaum, who has always been active in the community, helped establish a teen pregnancy program and a language learning unit at St. Luke’s, and later initiated the AACAP Task Force on Juvenile Justice Reform. She still enjoys working with children, and encourages psychiatrists and all health care professionals to “love your work,” to “treat the patient as a whole,” and to realize that “every case we see is so interesting.”

In terms of where the field is headed, Kestenbaum offered these insights:

  • Psychiatry needs to be dynamic and team-oriented, with psychiatrists at the center of a hub that includes pediatricians, therapists, and many more health care professionals
  • Telepsychiatry offers “tremendous potential” and should be further explored
  • Psychiatrists should become involved in advocacy at every level, from local to national, and attend meetings and assemblies to encourage new ideas and strengthen the organization
  • Analytics training is a critical part of education
  • New education models that utilize progressive methods should be embraced; just learning medications isn’t enough
  • Psychiatrists have to know pop culture, and understand technologies such social media

Finally, Kestenbaum believes that the media can have tremendous influence in removing the stigma from psychiatric issues. “Anything we can do to increase media exposure is important,” she said. “Psychiatrists need to be seen as helpful people.”

And although the field may change, the demand for talented psychiatrists will never wane, she said. “We may get better treatments, but the need will always be there.”