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| Dr. Bernstine |
There was no worry about access to medical care. No worry about doctor or hospital bills. It was good. But the subject of this story sorely missed having time with his father. You see, his father, Dr. Earl L. Bernstine, a general surgeon, worked “twenty-hour days.” He “covered everything” from the emergency room, to trauma, to orthopedics, to whatever came along. The surgeon’s son, Dr. Earl W. Bernstine (one of a long line of Earls--no Dukes, as far as I can tell), is a recently retired child and adolescent psychiatrist. He was kind enough to stop by to tell me his winding tale.
Earl L. (the surgeon) was, himself, the son of another Earl, Earl H. (a pharmacist). After he served in the Navy in Word War II, he did dental school for a year before transferring to Thomas Jefferson Medical College for a medical degree. He did his internship year in Williamsport, where his family lived, and where his son, Earl W., the future psychiatrist, was born.
He then moved the family to York (wisely equidistant from his wife’s family in Philadelphia and his own) for a surgical residency at the York Hospital. The busy practice that followed left him very little time to spend with his young son.
Earl W. (from here on referred to as simply “Dr. Bernstine”) decided early on that he didn’t want a medical career like his dad. Having “missed” his father terribly, he wanted to make sure he had time to be with his own children. Though some of his high school classmates whose parents were doctors went into medicine (and even returned to York to practice) he purposely steered away from the health field and his hometown.
On to the University of Denver
After struggling in high school, he went to the University of Denver to do political science or practice law. Dr. Bernstine, as a visual learner, had trouble memorizing facts and had to read things over and over; his dyslexia had not yet been diagnosed. On the other hand, he was quite good with numbers. His calculus professor and statistics expert George Bardwell told him that his math notes were “very elegant,” and encouraged him to further his math studies.
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| View of The University of Denver (from the university) |
Dr. Bernstine told me that he “could see numbers in shapes and colors” and “squeeze them through an equation” in his mind (whatever that could mean!) to get the right answer. Realizing his gift, he thought briefly of becoming a theoretical mathematician.
While in Denver, using his skills with numbers, he worked on several local Republican political campaigns (though he was a Democrat, they didn’t mind). He had success and considered doing this as a business.
Return to Pennsylvania
But after two years in Colorado, he decided to return to Pennsylvania. He went to Dickinson College to finish a degree in political science. As a student, he stayed in the family cabin in nearby Pinchot, taught alpine skiing, and “had a motorcycle.”
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| Entrance to Dickinson College campus (from The Edvocate) |
He wanted to support himself financially and he started helping out in his father’s office. As he talked with patients scheduled for minor surgery he saw that what he was doing quickly relaxed them. He realized that this simple act of communicating had an immediate positive effect.
Some of Dr. Bernstine’s skiing buddies were, he said, “male nurses” (an unusual job for men at a time when gender stereotypes were strong and there was widespread homophobia in York). Nursing could be a reasonable career option, he thought.
And in 1979, in the close medical community, York psychiatrist Dr. Kirk Pandelidis offered Dr. Bernstine a test job as a nurse’s aide on the locked psychiatric unit at the hospital. On his first day there, contact with the struggling patients (including one man who asked him if he had brought a screwdriver with him since everyone there had a loose screw) showed him that “we’re all people.” We all hurt; we all cry. He said to himself, “I can do this!”
Through this brief experience, Earl felt, he said, that “the mind is so fascinating.”
Now to Upstate New York, Way Upstate
Anyway, he left York again, this time for nursing school in upstate New York, just twenty miles from the Canadian border. He was one of only three male students. During the summer off he worked on the psychiatry ward in York. He was put on third shift, a time when the visitors and the attending doctors were gone and the nurses took care of most things.
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| Snow-covered SUNY Canton Bridge (Photo by McCluskey Photography) |
When it was quiet, he could study psychiatric diagnosis or pharmacology (psychiatrists, he noted, would soon become “neuropharmacologists” primarily providing medication management rather than in-depth analysis). The opportunity to observe patients for eight hours, seeing how they responded (or didn’t) to medicines, and what side effects occurred, was far more educational than the books (that Earl, a dyslexic, had trouble with).
Dr. Bernstine graduated from the two-year SUNY nursing program in Canton in 1981, and he and his girlfriend (with whom he had been living) “parted ways.” Where would he go next? His classmates were recruited to work in Lubbock, Texas. But a few of his friends in Denver lived in Houston, and he thought that city would be “more fun.”
Though he had no particular interest in treating kids, he landed a job as a staff nurse on one of the first long-term inpatient adolescent psychiatric units in the country. He said that he learned a lot, and as he progressed from staff nurse, to charge nurse, and then to nursing supervisor he gained much confidence.
Nurse-Bernstine soon concluded that as the on-call attending psychiatrists at night would sometimes rely on his observations and suggestions to determine the patient’s acute treatment, he might as well become doctor-Bernstine and do this himself (and get paid for it). Yes, he was ready for medical school.
Now on to Houston, and Medical School
So, at 25, he applied to several programs in Texas. He was accepted to The Texas College of Osteopathic Medicine (TCOM), where they were looking for students with
good interpersonal skills. The “campus was beautiful” and the work was “challenging.”
Dr. Bernstine told me that he was taught that osteopaths have a “different way” of looking at things compared to allopathic (M.D.) doctors (like his father). He said they view all things in the body as parts of a complex system, not in isolation. And that “everything is connected,” he said. He feels that this broad perspective is especially needed in understanding disorders of the mind.
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| TCOM (Photo from TCOM) |
That being done, Dr. Bernstine did three years of psychiatric training at Hershey. This included work in psychotherapy and six months at the Harrisburg State Hospital, formerly called the Pennsylvania State Lunatic Hospital. The sprawling facility housing (yes, simply housing) incurables not capable of living in society closed in 2006 as patients across the country had been slowly “deinstitutionalized” after the very first-ever effective psychiatric medicines were developed in the 1950s and after President Kennedy signed the Community Mental Health Centers Act in 1963.
Dr Bernstine wanted to do general psychiatry, but there was more politicking. You see, Hershey needed to fill their adolescent fellowship slots. And since Dr. Bernstine had insight and skill with kids they “strong-armed” him into taking one of the positions. It turned out that this was a surprisingly nice fit.
Now to York for Practice
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| Dr. Stevens |
But as they required more staff to meet the growing demand for services the costs mounted. Insurance reimbursements (traditionally poor for mental health anyway) did not keep up. Management began cutting. And cutting more. Eventually, the understaffing compromised care too much, and the unit had to be closed. (It was reconstituted later on the 2nd floor of the hospital, but it wasn’t the same.)
Over the years, Dr. Bernstine and his partners treated the full range of child and adolescent psychiatric problems. They “covered everything,“ doing both inpatient and outpatient work, unlike in the current system, where you generally do one or the other. He was a WellSpan outpatient psychiatrist from 1996 until his retirement in 2023 and he spent 13 years as a staff psychiatrist at a facility for long-term treatment of adjudicated adolescent male substance abusers.
Autism and Asperger's Syndrome
I asked him if there was a type of patient that he especially liked to take care of. Without hesitation, he said he enjoyed and was good at connecting with the so-called “Aspies,” the kids with what used to be called Asperger’s syndrome, but is now viewed as the mild end of the broad complex autism spectrum (or, better yet, wheel). We will spend some time with this.
The case study report of four young boys meticulously described by Dr. Hans Asperger in 1944 in Vienna out of more than 200 “difficult children” that he had studied over ten years at the University Paediatric Clinic was his post-doctoral thesis.
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| Hans Asperger (on the left) working with a student in the early 1930s (photo from Pictorial Press) |
But special exceptional talents, such as the ability to manipulate large numbers or remarkable feats of memory might emerge. And (writing in Austria during the German leader’s failed effort to eliminate all undesirables from society) Asperger stated that if these individuals had “normal intelligence” and were treated by an “absolutely dedicated and loving educator” they could find suitable work and “have their place in the organism of the social community,” (Draaisma, p. 313).
(An aside: Well-known Aspergerish autistics likely include Sir Isaac Newton, Charles Darwin, Albert Einstein, Emily Dickinson, James Joyce, Ludwig Beethoven, Bill Gates, Steve Jobs, Thomas Jefferson, Stanley Kubrick, Anthony Hopkins, and Jerry Seinfeld, among many others who have created our world.)
The autistic’s deficits in social interaction, behavior, and communication may be profound but can sometimes be so subtle that they are viewed simply as personality oddities. In addition to the core features, the kids may have sleep problems, gastrointestinal and eating disorders, seizures, anxiety or depression, immune system disorders, and cognitive impairment (apart from that tied to language). And all of these problems may exist to various degrees, as on the proposed autism wheel.
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| The new nuanced complex autism wheel, going beyond the simple linear spectrum (from ablelight.org) |
While we can only guess what’s going on in the mind (the inner experience) of the severely autistic child, those with lesser degrees of autism can introspect and can occasionally tell the psychiatrist (and us) something about what they are thinking and feeling.
(The autistic Temple Grandin said that when she was young she screamed because she couldn't talk. And she thought that it was the tone of the voice, not the words, that carried meaning.)
Dr. Bernstine found that he could connect with the Aspies by showing interest in whatever interested them and that he could thereby gain their trust. He observed and listened carefully and learned to “talk Aspie” (speech that may be monotone, emotionless, robotic, repetitive, arrhythmic, or too loud, etc.). Once the child trusted him he could address specific remedial problems.
This lifelong and varied disorder of brain development and interconnections is much more common than previously thought. It is dependent on a wide variety of poorly understood genetic, epigenetic, and environmental influences (but not the MMR childhood vaccination).
But aggressive and sustained loving treatment may eventually allow the “neuroatypical” child to adapt to the outside so-called "neurotypical" world. A world, to them, that is “relentlessly unpredictable and chaotic, perpetually turned up too loud, and full of people who have little respect for personal space,” (Silberman p. 471).
Dr. Bernstine was careful to absolve the parents (especially the mother) of any blame at all for their child’s condition (the once-popular “cold mother” theory of autism having long since been abandoned).
Neurologist Dr. Oliver Sacks, champion of neurodiversity before there was such a word, writing movingly about autism and the remarkable animal behaviorist Temple Grandin, said:
And yet the parents of an autistic child, who find their infant receding from them, becoming remote, inaccessible, unresponsive, may still be tempted to blame themselves. They may find themselves struggling to relate to and love a child who, seemingly, does not love them back. They may make superhuman efforts and to get through, to hold onto a child who inhabits some unimaginable, alien world, and yet all their efforts may seem to be in vain. (Sacks, p. 248-249.)
Connecting compassionately with frightened tired parents and their autistic child requires lots of skill, as the therapies are arduous and progress is painfully slow. But there can never be too much therapy for these vulnerable children, said Dr. Bernstine.
Elements of Psychiatric Practice
Dr. Bernstine said that timely diagnosis of autism or any of the mental problems that begin in childhood and adolescence is vital. In addition to autism, these problems include major depression, bipolar disorder, anxiety disorders, conduct disorders, learning deficits such as dyslexia, a variety of eating disorders (not just being a picky eater), substance abuse, and gender identity issues, among others. There is plenty to keep the doctor busy.
There are, as yet, no blood tests or imaging studies that can be relied on to confirm most disorders managed by child psychiatrists. So the diagnosis mostly remains a so-called clinical one and may take time to establish with certainty, as the needed DSM-5 criteria gradually emerge.
As physicians observe the patient and collect information from the parents and other family members, the child’s teachers, psychologists, social workers, and other sources (speech, occupational, and physical therapists, etc.), they must also explore the social and cultural contexts to provide a reasoned diagnosis and a comprehensive treatment plan. And as Dr. Bernstine had advised me, “Everything is connected.” An effective child psychiatrist finds the connections. And he is an able communicator who can reassure parents and work well with a diverse team.
Dr. Bernstine enjoyed his varied practice over the years within the growing WellSpan Health System. But after he went through therapy himself during the divorce from his first wife he gained insight into “what makes you a good physician.” After that, he decided to change his practice; he limited the number of new patients he would see and set aside time daily for emergencies; he decided to protect himself.
Outside Interests
Toward the end of the interview, I asked him about his interests outside of medicine. He said he likes outdoor activities such as hiking, bike riding, fishing, and skiing. He walks his three dogs regularly, sometimes at a small hilly county park adjacent to his neighborhood close to the hospital (where I first met him on a daily morning walk as he introduced himself). He has a busy family life, with a son ( Earl J.) from his first marriage, and three adult children of his wife's.
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| Dr. Bernstine and his family |
He joined (of all crazy things) a really good York-Lancaster rugby club when he was 52 (the other members, he said, were half his age). He didn’t play much initially, but he went with them to Nationals as a trainer that first year. He was a starter after that; he was a “small” guy, but he was fast and could reach in to steal the ball from the other team. But it was hard for him to master the intricate playbook.
Through the intense (and dangerous) sport of rugby, Dr. Bernstine lost 60 pounds and kept it off. Despite better nutrition, he had a heart attack three years ago and needed a stent. He is okay now and is looking forward to an active retirement.
What about less physically demanding pastimes? He said he doesn’t read a lot of books but he thought a minute and then mentioned The Alchemist by Brazilian author Paulo Coelho. This short worldwide bestseller tells a story that is a variation on the ancient folk-tale theme that the treasure you dream of, that you seek far and wide is, in the end, found at home. I like that.
References and Readings
1. Coelho, Paulo, (Translated from Portuguese by Alan R. Clarke). The Alchemist; 25th Anniversary Edition. HarperOne. New York, 1993. (Twists, turns, and trials when traveling from Andalusian Spain across the Sahara desert to the Egyptian pyramids and back home.)
2. Draaisma, Douwe, (Translated from Dutch by Barbara Fasting). Disturbances of the Mind. Cambridge University Press, Cambridge, UK, 2009. (Detailed background stories of 13 conditions bearing the names of those that first clearly identified and described them...Parkinson's, Alzheimer's, Tourette's, etc.)
3. Sacks, Oliver. An Anthropologist on Mars; Seven Paradoxical Tales. Alfred A. Knopf. New York, 1995. (Another one of his remarkable explorations into the unending mysteries and strengths of the human brain and spirit.)
4. Silberman, Steven. Neurotribes; The Legacy of Autism and the Future of Neurodiversity. Penguin Random House. New York, 2015. (A lively easily-read "tour de force" history of the condition, its modern understanding, and its immense but often unrecognized societal impact.)
5. Valentine, Vikki and Hamilton, John. "Exploring Language; Temple Grandin on Autism & Language" NPR July 9, 2006. (https://www.npr.org/templates/story/story.php?storyId=5488844)
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| One of my husband's favorite trees in York's Reservoir Park in the spring (Photo by SC) |
By Anita Cherry 12/25/23
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