Commentary

Dr. Carl Bell’s research broke new ground

Psychiatrist educated the field with his work on gun violence, prenatal alcohol exposure


 

With the heart of a child and the spirit of a warrior, Carl Bell always spoke his truth. And, he did so in his own inimitable way. Sporting his signature dark brown wide-brim leather cowboy hat or NMA (National Medical Association) baseball cap, aviator sunglasses, and accompanying Superman belt buckle, Carl Compton Bell, MD, – psychiatrist, researcher, mental health advocate, father, grandfather, friend, colleague, pioneer, and servant – was driven by a deep commitment to serve others.

Dr. Constance E. Dunlap is a psychiatrist and psychoanalyst in Washington, and a past president of the Washington Psychiatric Society, and clinical professor of psychiatry and behavioral sciences at George Washington University, Washington.

Dr. Constance E. Dunlap

As those who truly knew him can attest, it is not hyperbole to say that Carl Compton Bell was one of the most genuine, brilliant, and humble physicians of our professional community and time.

My collaboration and friendship began with Dr. Bell began during the summer of 2016 as I was preparing for the 2017 Washington Psychiatric Society’s (WPS) Presidential Symposium at Saint Elizabeths Hospital. As president of WPS, I had chosen gun violence as my topic and sought out Dr. Bell because of his work on the South Side of Chicago, where he had devoted himself, becoming an internationally known clinician, researcher, and mental health advocate for those personally affected by violence and trauma. He immediately accepted.

In his presentation, “Gun Violence, Urban Youth and Mental Illness,” he reviewed his research on the neurocognitive behavioral effects of prenatal exposure to alcohol and its relation to the neurodevelopmental dynamics of youth violence, intimate partner violence, and mass shootings. Dr. Bell suggested that the relationship between prenatal exposure to alcohol and the diagnosis of numerous psychiatric conditions had been underestimated in the medical community. He eventually summarized his work in Fetal Alcohol Exposure in the African-American Community, published by Third World Press (2018). This vital resource not only summarizes in plain language the scope of the problem of prenatal alcohol exposure but is a narrative of Carl Bell’s life journey.

After the symposium, he would send articles, while warning, “I can bombard you with stuff.” Sometimes we would not speak for weeks at a time while I digested the resources he had shared. However, whenever I picked up the phone to call and respond to what he had provided, he would answer the phone, “Yessssss?” – as if he were anticipating my call and was ready to address any queries or comments I might have. Even when he were about to board a plane or charting – after making rounds on his patients while listening to the music of James Brown – he would answer the phone, even if only to coordinate a more mutually convenient time to connect.

During the process of digesting the plethora of articles and resources he provided on prenatal fetal alcohol exposure, including the 1996 Institute of Medicine’s report and the American Medical Association’s 2017 resolution supporting the addition of adequate amounts of choline to prenatal vitamins, I found myself immersed in neuroscience topics, such as the role of neuronal acetylcholine receptor subunit alpha-7 in the formation of neurotransmitters, the strengthening of cell membranes, and the promotion of proper brain and spinal cord development. Dr. Bell spoke authoritatively about the neuroscience and the public health implications. One of his mantras was “Where is the data? You’ve got to have data.”

Dr. Altha Stewart, immediate past president of the American Psychiatric Association, shares a light moment with Dr. Carl C. Bell during the gala at the 2019 APA meeting in San Francisco. Courtesy Dr. Constance E. Dunlap

Dr. Altha Stewart, immediate past president of the American Psychiatric Association, shares a light moment with Dr. Carl C. Bell.

The information that he shared became the foundation of the action paper calling for the American Psychiatric Association (APA) to endorse the AMA’s resolution supporting the addition of adequate amounts (450 mg/d for pregnant women) of phosphatidylcholine to prenatal vitamins. The APA Assembly passed this action paper in May 2018.

He was also responsible for a second action paper, “Psychiatric Management of the Impact of Racism on Social and Clinical Events,” which passed at the same May 2018 assembly. Dr. Bell agreed to coauthor this paper, which was only fitting since the paper was a further elaboration of his efforts with the APA Caucus of Black Psychiatrists to implore the APA to acknowledge the deleterious effects of racism on both the victim and perpetrator.

While researching this topic, I had come across his 1980 article, Racism: A Symptom of the Narcissistic Personality Disorder (J Nat Med Assoc. 1980 Jul;72[7]:661-5), in which Dr. Bell applied psychoanalytic theory to posit that racism is one psychic derivative through which narcissism may manifest itself.

Although he was not formally trained as a psychoanalyst, he had benefited from strong psychoanalytic supervision at the Illinois State Psychiatric Institute, a training program of the University of Illinois at Chicago. He wrote confidently and clearly, applying self-psychology principles. He had the gravitas to write and speak about a range of topics, from neuroscience, psychotherapy, medical management of illness, and mental health advocacy. His 387-page curriculum vitae of 500+ articles, chapters, and books on mental health issues is a catalog of evidence that he had given thought to just about any topic along the spectrum of psychiatry and beyond.

In July 2018, after leaving a performance of “Hamilton” at the Kennedy Center, a lyric from the song “Non-Stop” stayed with me:

Why do you write like you’re running out of time?

(Why do you write like you’re running out of time?)

Write day and night like you’re running out of time?

The pace at which he read, wrote, lectured, researched, collaborated, and served on committees reminded me of the prodigious work of the former Secretary of the Treasury. When I shared this with Dr. Bell, he volunteered that he wrote to clear his mind. I suggested that, like other true writers, it seemed that he had to write. He did not disagree.

Courtesy Dr. Constance E. Dunlap

Dr. Carl C. Bell exchanges greetings with Dr. Captane P. Thomson of Davis, Calif.

But, what was most meaningful about his productivity was his generosity of spirit. Any conversation was an opportunity for him to thoughtfully and respectfully share his knowledge. For example, once, we were discussing a clinical case that included the differential diagnosis of a patient, who happened to be African American, who was having auditory hallucinations. Dr. Bell might have been the first psychiatrist to alert the medical community about the misdiagnosis of schizophrenia among African Americans with bipolar disorder (J Nat Med Assoc. 1980 Feb 72[2]:141-5).

Contrary to my expectation that he was going to remind me of the tendency to misdiagnose, he instead offered, “You know, there are 40 reasons for auditory hallucinations.” Not what I had expected, yet, a response that reflected his continually giving nature and sharing of his abundance of gems. He was always teaching.

I later learned that his workday at Jackson Park Hospital usually ended at 2 p.m. He had treated patients, and supervised medical students and residents there for more than 40 years. The afternoons afforded him time to read, write, listen to music (Ella Fitzgerald), watch movies, and spend time with his adult children, to whom he was quite devoted. Dr. Bell was an avid martial artist and enjoyed sharing this practice with his son, William.

He was a longtime active member of the National Medical Association, recently receiving its prestigious Distinguished Service Award in Hawaii for his “exceptional work in medical service, medical research, and academic medicine.” It would be his last professional talk, though his delivery would belie his numbered days.

He was a former vice president of the Black Psychiatrists of America (BPA) and for 10 years had been the editor of the BPA Newsletter. Conversations were often peppered with anecdotes from time spent with other pioneering ancestors, such as Chester “Chet” Pierce, MD, Jeanne Spurlock, MD, Robert Phillips, MD, PhD, Charles Prudhomme, MD, Frances Cress Welsing, MD, and others. Dr. Bell was at the tail end of a generation of African American psychiatrists who had experienced firsthand the transition from segregation to federally mandated integration of our society.

Dr. Bell and his peers applied their education and training to improve clinical care for all, to decrease health inequities, and to eliminate disparities. It is evident that he loved his people and committed his life to addressing the needs of marginalized communities, those without the benefit of abundant resources, and those disproportionately affected by violence and trauma. As he stated in his last book, Fetal Alcohol Exposure in the African-American Community:

“I should add, my main concern is African American people living within the United States of America where in one community the rate of Fetal Alcohol Exposure is 388/1,000 people. ... However, this problem extends much further. Fetal Alcohol Exposure (FAE) is increasingly being found to (be) problematic in people of color around the world: Native Americans in Canada ... Aboriginal people in Australia ... and various tribes of people on the continent of Africa. ... Lastly, while the problem of Fetal Alcohol Exposure seems to be disproportionately affecting people of color, it also affects people who lack pigment in their skin. For example, FAE is a problem in Russia. From a public health perspective, so often people of color are like the proverbial “canary in a coal mine,” i.e., if there is poisonous gas in the coal mine, the canary will die first, warning the miners that they need to do something about it.”

Dr. Carl C. Bell displays the APA's Adolph Meyer Award for Lifetime Achievement in Psychiatric Research with Dr. Glenda Wrenn of Atlanta. Courtesy Dr. Constance E. Dunlap

Dr. Carl C. Bell displays the APA's Adolf Meyer Award for lifetime achievement in psychiatric research with Dr. Glenda Wrenn of Atlanta.

However, it would be a profound mistake to conclude that his work was restricted to black and brown communities. Dr. Bell was a Distinguished Lifetime Fellow of the American Psychiatric Association and a Lifetime Fellow of the American College of Psychiatrists. He was a founding member of the board of directors of the National Commission on Correctional Health, and a member of prominent work groups of the National Institutes of Mental Health and the National Academy of Medicine (formerly the Institute of Medicine). And Dr. Bell’s mentees and students transcend generations, race, religions, professional disciplines, and national boundaries.

Because Dr. Bell was grounded and never forgot his roots, it was in these professional society circles that he ensured that clinicians with more privilege and limited or no exposure to communities of color were educated about the needs of those he treated. Without exposure to Carl Bell, it is likely that many of our psychiatric colleagues would remain unaware of both the brilliant dynamic resources and enormous challenges that are found in the black community and communities of color. By sharing his work with the house of medicine, he obviated the excuse of doing nothing because of ignorance.

Joseph Calhoun, whom Dr. Carl C. Bell mentored through the APA’s Black Men in Psychiatry Early Pipeline Program, laughs with him following his Adolph Meyer Award Memorial Lecture at the 2019 APA meeting in San Francisco. Courtesy Dr. Constance E. Dunlap

Joseph Calhoun, whom Dr. Carl C. Bell mentored through the APA’s Black Men in Psychiatry Early Pipeline Program, laughs with him following his Adolf Meyer Award Memorial Lecture at the 2019 APA meeting in San Francisco.

I last saw Dr. Bell in San Francisco toward the end of the 2019 annual APA meeting. He had received the APA’s Adolf* Meyer Award for lifetime achievement. Afterward, I joined him for a dim sum lunch in Chinatown with two of his colleagues and Joseph Calhoun, his mentee in the APA’s Black Men in Psychiatry Early Pipeline Program. As we walked back to our respective hotels, we paused at what is now the Chinese Affirmative Action Center. We learned that this site had been the home of one of Dr. Bell’s former martial arts instructors. As Dr. Bell recounted his martial arts training, the reverence for his sensei was evident in his eyes.

When I reflect on how much I learned from and about Carl Bell in such a short period of time, I realize that he was one of those people who was so present and so astute that he allowed you to know him while he was giving.

So, how do we honor someone who gave so much of himself? When I now think of the lyric from “Hamilton” – “Why do you write like you’re running out of time?” – I realize that we get it twisted when we associate running out of time with our elders and their phase of life. It was not Carl Bell who was running out of time. He had been extraordinarily respectful of the space, time, and energy allotted to him in his lifetime. He would say, “People squander their personal resources.” He certainly had not squandered his.

As we reflect and mourn his passing, we will hear about his candor, authenticity, integrity, discipline, reliability, dedication, and serving spirit. This is called character.

Dr. Bell was beyond generous with his life, and it is going to take decades, if not more, for us to digest the compendium of knowledge that he left behind. I ask you: How will you use that knowledge to advance the causes he so diligently devoted his life to solving?

To Carl Compton Bell, I say, Well done. Thank you. And, rest now my dear brother.

Dr. Dunlap, a psychiatrist and psychoanalyst who practices in Washington, is a Washington Psychiatric Society representative to the APA Assembly, a past president of the Washington Psychiatric Society, and clinical professor of psychiatry and behavioral sciences at George Washington University, Washington. She is interested in the role “difference” – race, culture, and ethnicity – plays in interpersonal relationships and group dynamics.

*This column was updated 9/3/2019.

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