Schizophrenia Bulletin Advance Access originally published online on July 5, 2007
Schizophrenia Bulletin 2007 33(5):1149-1150; doi:10.1093/schbul/sbm075
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Person-Centered Psychiatric Care: A Tribute to Wayne S. Fenton, MD
2 Division of Adult Translational Research and Treatment Development, National Institute of Mental Health, Room 7113, MSC 9625, Bethesda, MD 20892-9625
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Abstract |
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 Top Abstract |
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Wayne S. Fenton, MD, was an accomplished psychiatric researcher, but his colleagues knew him as an equally talented clinician. This memorial recognizes the personal qualities and professional skills that endeared Wayne Fenton to hundreds of mentally ill persons he treated over the course of his professional career. Among these attributes, deep compassion, sincere respect, and tremendous flexibility were hallmarks of an approach that emphasized collaborative, recovery-oriented therapy. Through his actions and writings, Wayne Fenton influenced a generation of mental health professionals who aspire to similar professional excellence in all aspects of clinical care.
Keywords: schizophrenia / psychotherapy / recovery
My first vivid memory of Wayne Fenton springs from an incident over 2 decades old, an event that took place shortly after I had joined the staff of Chestnut Lodge Hospital. Wayne's office was situated directly across the hall, and with my door open I could observe his comings and goings throughout the day. One particular morning Wayne's door was closed, but muffled sounds of conversation signaled that he was inside, probably seeing a patient. After several minutes, the door opened abruptly, but rather than the usual sight of Wayne leading someone into the hallway, I observed something unexpected. Wayne was backing out of his office, apparently carrying something heavy. As he struggled into the clear, I could see that he was moving a carpet, aided by a young man who was gamely keeping pace. Together they labored down the hallway and disappeared out a side exit.
Several hours passed before Wayne returned. He looked grimy and exhausted as he slumped into his desk chair but smiled brightly when I asked what he and his companion had been doing. Wayne explained that the young man had been discharged from the hospital several days before and was now living with roommates in an apartment. He planned to return to school in a matter of weeks but for now was "getting his feet back on the ground" following an acute episode of schizophrenia. Although no longer psychotic, the young man occasionally experienced unusual perceptions that left him shaken and afraid. He was particularly bothered by a large stain on the rug in his bedroom. The spot seemed to come alive at night and reminded him of visual hallucinations that had preceded his hospitalization. Bad memories and fears of relapse drove the young man to avoid his bedroom and to remain in common living areas until the wee hours. This strategy was disrupting his sleep and causing tension with his roommates. The young man wondered aloud whether he needed additional medication.
Wayne said to me, "I told him, ‘I don't know about more meds, but it's clear we've got to get you a new rug. You've got enough on your plate right now with getting ready for school. You don't need to be bothered by dirty carpets, insomnia, or angry roommates. You pick out something you like and I'll give you a hand with the installation.’ And that's exactly what we did this morning; we installed a new carpet in his bedroom."
I don't know if it was Wayne's sincerity, reasonableness, or enthusiasm that hooked me, but something about his session with this young man made a deep and lasting impression. At the time I knew little about schizophrenia or its treatment, other than the common misconception that little could be done beyond pharmacotherapy. Wayne's approach suggested an intriguing alternative. Although he prescribed medication as needed, his method was much broader and included supportive psychotherapy as well as practical strategies for removing "irritants" like an offending carpet. His deep understanding of human psychology, the nature of schizophrenia, and how these domains interacted came together in a style that acknowledged personhood first, recovery goals second, and disease management third. "Support the individual, smooth the path, treat the symptoms." This is the therapeutic hierarchy I learned from Wayne Fenton.
Over the years, I had many opportunities to observe Wayne work with persons with schizophrenia and to learn from his example. Hallmarks of his approach were genuine respect for patients and their relatives, sincere interest in the individual's aspirations and goals, and a willingness to offer help wherever it was needed, whether this was in the home, at school, or on the job. I heard numerous stories about home-based family meetings, tutoring sessions in the community college library, and therapy appointments conducted during a patient's coffee break. I also learned about therapeutic relationships that lasted for years, spanning life events from adolescence to adulthood. Wayne often commented that, unlike the common cold, no one recovers from schizophrenia within 7–10 days. He firmly believed that long-term recovery requires sustained support from a consistent set of caretakers. He was not, however, an advocate of perpetual therapy. Rather, Wayne was a master of tapering support in step with the person's emerging autonomy, thereby achieving a balance that was both nurturing and empowering.
Wayne's compassion and creativity sparked my initial interest in schizophrenia and encouraged me to think broadly about cognitive, behavioral, and environmental therapies relevant to the disorder. He was an enthusiastic advocate for testing and implementing these approaches at Chestnut Lodge Hospital, and he became a valued contributor to our behavioral rehabilitation and community reintegration programs. Wayne's passion for excellence inspired us to continuously upgrade our clinical programs and educational curriculum based on emerging scientific findings. We were very good and became even better through Wayne's encouragement and support.
In my mind's eye, I can still see Wayne Fenton sitting behind his desk across the hall, sharing insights about the nature of schizophrenia and speculating about better ways to treat this disorder. As his physical example inspired me 2 decades ago, his many journal articles, book chapters, and lectures have touched a generation of clinicians who now carry on his work. We are all diminished by having lost him but enriched for having had the opportunity to learn from him. To continue the work that meant so much to him is the most fitting tribute to Wayne S. Fenton, MD, a gifted psychiatrist, an accomplished researcher, and a righteous man.
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1 To whom correspondence should be addressed; tel: 301-435-0371, fax: 301-443-4611, e-mail: rheinsse{at}mail.nih.gov.
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Acknowledgments |
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The views expressed are those of the author and do not necessarily reflect the official views of the National Institute of Mental Health, the National Institutes of Health, or any other branch of the U.S. Department of Health and Human Services.
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