Meet an APA Awardee: Allan Tasman, M.D.

One of Allan Tasman, M.D.’s most vivid clinical memories was an encounter he had many years back while serving as a faculty preceptor at the University of Louisville School of Medicine. He was making rounds at a psychiatry clinic when a resident requested assistance with a female patient—a single African American mother of two—who had been recently diagnosed with paranoid delusional disorder and had been seen at a Louisville

The patient had no history of mental illness, yet a few months before had started to believe people were trying to break into her house and kill her. Antipsychotic treatment wasn’t working, and the resident wondered whether he might need to switch medications.

As Tasman started talking to the woman and receiving clear and compassionate responses to his queries, he suspected that maybe she wasn’t delusional. But what was the problem? She said that nothing in her own life had changed. So, after a brief thought, he asked, “Has anything changed in your neighborhood?”

She replied by asking Tasman if he remembered a recent news reports about a 9-year-old African American girl who had been killed in a shooting. “That girl was my next-door neighbor,” the woman said. “And she was playing on my front porch with my daughter when she was shot.”

Tasman suggested the woman stop taking her antipsychotic altogether—it was only making her groggy—and come visit the clinic once a week for counseling sessions.

A few weeks later, the resident found Tasman and said the woman was doing great, then asked how Tasman had thought to inquire about her neighborhood. “The resident said he grew up in a boring suburban community where nothing ever happened,” Tasman said, “and we would never think to ask a patient about where they were living.”

Tasman, now emeritus professor and Schwab Endowed Chair in Social and Community Psychiatry at the University of Louisville, offered this vignette during his Vestermark Psychiatry Educator Award lecture yesterday, noting how it was a good fulcrum point in his own professional career.

For Tasman, the social determinants of mental health were always front of mind. His parents were children of immigrants who fled Europe following World War I, and several other family members joined over the next decade to escape Soviet pogroms—though not everyone made it. His mother grew up during the Great Depression, one of eight children forced to do what they could to make ends meet as their father was physically unable to work.

Hearing his mother’s stories, as well as those of his father—who was drafted into the Army during World War II and later gave up his dreams of medical school to support his family—made Tasman realize how close he had come to not being born. It also fostered his lifelong wish to help people who were suffering.

Along the way, with the aid of many treasured mentors, Tasman learned to always approach teaching with a sense of humility, to always keep learning himself, and to always put his theoretical knowledge behind his shoulder when talking with patients.

Tasman noted that his memorable clinical experience occurred during the era DSM-IV, which used multiaxial assessments of disorders. Axis IV addressed the environmental and social factors that influence mental health.

Yet even then medical training didn’t emphasize social factors, and with the removal of multiaxial assessments in DSM-5, the importance of social determinants of health waned even further.

Tasman has dedicated a good portion of his career to bringing social determinants of mental health back to the fore, including serving on presidential task force on the social determinants of mental health that Vivian Pender, M.D., established during her APA presidential year. (Tasman is also a past president of APA, serving in 1999-2000. His presidential theme, not surprisingly, focused on bolstering the physician-patient relationship.)

“If you’ve ever known me as your teacher,” Tasman said during his lecture, “you know I like to say to understand a problem, first you have to know the history behind the problem.” ■