BARBARA FISH (1920-2016)
Barbara Fish was an Emeritus Life Fellow of the ACNP, one of only five women to join 100 men as founding members in 1961, and the last surviving woman of that small cohort at her death in 2016. She was a pioneer and role model, a psychopharmacologist and child psychiatrist whose scientific career was described as an inspiration for professional women in Ruth Halcomb’s 1981 book, Women Making It.
Dr. Fish was the only child of a father who was a mechanical engineer who thought “even one child was too much” (Fish, 2008). Nevertheless, they bonded over his dedication to science and Barbara remembered, as a five-year-old, her father explaining the total eclipse of 1925 using a light bulb, a grapefruit and an orange.
Encouraged to study nature and science, she earned scholarships at her high school in the Bronx and Barnard College at Columbia University, graduating summa cum laude and Phi Beta Kappa. Despite quotas for women and Jews, she was admitted to New York University School of Medicine, where she was a contemporary of Max Fink (Fink, 2016), graduating first in her class and winning the Alpha Omega Alpha award for the highest scholastic rating.
Barbara completed internships in medicine and pediatrics before a residency in psychiatry which concluded with two years at Bellevue Hospital as a senior resident under Loretta Bender, looking after 150 psychotic children from the Bronx and Manhattan. She also underwent a training analysis, graduating from the William Alanson White Institute at a time when the only medical treatments for psychotic children were electric shock, phenytoin and diphenhydramine. Even before chlorpromazine, her astute clinical observations in very young children convinced Barbara that, “there was definitely something wrong in the brain in schizophrenia,” manifested by delayed social, physical and language development. These observations included home visits and long-term follow up lasting as much as 50 years.
This led, inevitably, to the first use of the early neuroleptics in children, including randomized controlled trials with chlorpromazine, thiothixene, molindone and trifluoperidol among others. Barbara became the first child psychiatrist and only woman to participate in the NIMH funded Early Drug Evaluation Units, (ECDEU) and their studies (Fish, 1964; Fish, Shapiro and Campbell, 1966; Fish, Campbell and Shapiro, 1969).
In addition to these studies, Barbara raised funds and quickly developed a large fellowship and residency training program at Bellevue that included inpatient and outpatient units with parent and child groups, as well as weekly parties for the children. She was a mentor to a cadre of women in both pediatrics and child psychiatry and an honored leader of the American Academy of Child and Adolescent Psychiatry (Fink, 2016).
In 1970, 15 years after the start of her academic career, Dr. Fish became a Full Professor of Psychiatry at NYU and in 1972 she and her husband moved to California where she became Professor of Psychiatry at UCLA. This marked a significant transition in her interests away from psychopharmacology. “I’d learned what I wanted.” A number of scientific and socio-economic factors contributed to this move. She had listened and disapproved as the head of NIMH spoke to the ACNP, predicting a biologic cure for schizophrenia and approving the closure of State hospitals and inpatient units. This was inflated optimism based on de-institutionalization, prior to the “revolving door” syndrome and realization that drugs, which stifled the positive symptoms of psychosis sufficiently to secure discharge, failed to benefit the cognitive and social deficits necessary to sustain them in community.
Shorter durations of inpatient treatment and fragmentation of care bred an attitude where, “we start to talk about whether a drug works as opposed to really getting to know a child well.” She felt that pharmaceutical companies used financial incentives to divert academic interests away from long term outcome studies. “It’s not where you make money, if you really want to take care of sick people.” Dr. Fish also disapproved of the rigidity and diagnostic parsimony of the DSM system compared to the typology of child development she had so painstakingly developed.
These prescient beliefs clearly influenced how Barbara Fish chose to spend the remainder of her career. She returned to her earlier interest in the phenomenology, natural history, genetics and outcome of childhood onset in schizophrenia seeking funding from NIMH and private sources including the MacArthur foundation, the W.T. Grant Foundation, the Scottish Rite Schizophrenia Research Program and the Dell Martin Foundation, which also endowed a named Chair in her honor. The topics she pursued included risk and protective factors in prognosis, information processing as a risk factor, adult outcome of infants at risk and the effect of early development on personality.
In 1987, Dr. Fish’s lifetime accomplishments led to receiving the Agnes Purcell McGavin award from the APA “for outstanding contributions to the prevention of mental disorders in children, including ground breaking research on the long term outcome of infants born of schizophrenic mothers.”
Max Fink, whose career spans Barbara Fish’s, notes: “We were medial school classmates and ran parallel academic careers … she reflected the enthusiasm for clinical care, emphasis on patients, and the importance of biology that we were taught in an intensive training during World War II years” (Fink, 2016). That triad of components is a shared feature in more than 50 brief biographies (dramatis personae) in the OHP volumes and a dozen lengthy biographies I have contributed to the INHN website. The thrill of prescribing the first effective drugs for previously untreatable disorders, while watching the patients benefit, bred a commitment and enthusiasm that sustained the pioneers, like Barbara, in active careers well beyond three score years and ten. Perhaps it also fueled the courage and independence she displayed in avoiding the kind of economic entanglements with industry that currently dishonor our discipline.
Fish B. Evaluation of psychiatric therapies in children. In: Hoch P, Zubin J, editors: The Evaluation of Psychiatric Treatment. New York: Grune & Stratton; 1964; 202-220.
Fish B. Interview by Marcia Meldrum & Elizabeth Bromley In: An Oral History of Neuropsychopharmacology (Series Ed., Ban TA.), Vol.7 (Ed. Blackwell B). Brentwood Tennessee; ACNP; 2011: 209-225.
Fish B, Shapiro T, Campbell M. Long-term prognosis and response of schizophrenic children to drug therapy in a controlled trial of trifluoperazine. Am.J.Psychiat. 1966; 123: 32-39.
Fish B, Campbell M, Shapiro T, Weinstein J. Preliminary findings on thiothixene in psychotic children under 5 years. In: Lehmann HE, Ban TA. The Thiothixenes. Basel, Karger; 1969; 90-99.
Fink M. In Memoriam. Barbara Fish M.D. Neuropsychopharmacolgy 2016. December
Halcomb R. Women Making It: Patterns and Profiles of Success. New York, Ballantine, 1981.