Four days later and just hours before Steve’s memorial service, police announced that the gunman took his own life, bringing enormous relief that the violence had ended and a measure of gratitude that I could begin to grapple with the concept that one of our most dedicated and highly accomplished colleagues would no longer be with us.

Those who already know of Dr. Pitt’s career and are reading this column unlikely need or want a recitation of the many cases he took part in investigating: a look at his website or an internet search will turn up dozens of such “high profile” matters. Instead, I offer my recollections of someone I feel very fortunate to have known. Steve was a native of Detroit, a city I view as so similar to my hometown of Baltimore; the son of a working dad and homemaker mom; a University of Maryland alumnus; my first employer, a mentor, colleague, and kindred spirit.

I met Steve in 1990 when I was a fourth year medical student and he was a fellow in forensic psychiatry at the University of Maryland. Interested in the specialty myself, I shadowed Steve during a one-month elective while he conducted interviews of criminal defendants pleading not competent to stand trial. I remember little of those cases or defendants, but have a very clear recollection of Dr. Pitt from almost thirty years ago. Confident and charismatic, Steve exuded an ease with criminal defendants; a curiosity for the complexities of their behavior and motivations; and an obvious enthusiasm for teaching. After watching just a couple of his interviews, I thought Steve also had a flair for getting and telling a good story. He made this work look fun.

Five years later, having completed the same fellowship, I accepted a position he offered me on one of the forensic units at the Arizona State Hospital in Phoenix, where he served as my first supervisor and an early mentor. Steve was an exceptional role model. Contagious enthusiasm, relentless drive, and intensity of purpose characterized Dr. Pitt’s professional persona. Kindness, generosity, patience, and genuine respect for staff lacking his training and expertise characterized Steve as a human being. He inspired everyone he worked with to do their best and he offered me, a lifelong Baltimorean and newcomer to the Southwest, his insights into the legal and psychiatric communities in Phoenix to help me get started on my career.

I have many fond memories of Dr. Pitt, the professional and Steve, the human being. Working late at the State hospital one evening and forgetting it was a Jewish holiday, I called him at his home when he was having Seder with his family, to rant about a problematic hospital policy as it related to the chaos a sociopath was causing on the GEI/NGRI unit I was assigned. This individual did not belong in a hospital and his NGRI finding was based on no mental disorder other than a paraphilia and several rape charges. After listening to me as I unloaded my frustrations at that inappropriate hour, Steve offered me his restraint, perspective, validation, and dark humor (he knew the patient very well), when he easily could have said, “You think this could wait until tomorrow?”

Dr. Pitt provided that support and levity, and also some much needed competition over eight months leading up to our sitting the ABPN forensic psychiatry board exam together and for the first time in 1998. Dave Coons, M.D., our senior Forensic Consultant at the State hospital, and already board certified through the American Board of Forensic Psychiatry, decided to take the ABPN exam, as well. Off the three of us went to LA, where Steve decided to rent a convertible to drive Dave and me from the airport to the exam: “We are doing this the right way or we aren’t doing it!” On the way back to the airport, drained but exhilarated, Steve and I passed his phone back and forth as we took turns speaking with Dr. Jonas Rappeport, our forensic guru back in Baltimore, to debrief from our ordeal, complain about a few of the questions, and seek Dr. Rappeport’s reassurance on some of our answers. With his absolute authority, Jonas proclaimed, “You passed.” Steve accepted the edict as gospel. I wasn’t so sure.

And with his characteristic charm and playfulness, Steve chatted up the flight attendants on our South West Air flight back to Phoenix, scoring us unlimited peanuts and soda. This was the essence of Steve: he made the exam feel like a grand adventure, a job well-done; and the flight feel like a party, our reward for the hard work. Every moment was something to celebrate. I cherish that memory.

With a generosity and protectiveness of an older brother, Steve came to my aid in small ways and large over the years, even as we no longer worked together, when all I asked was his perspective. I once called him for advice when opposing counsel in a civil case in which I had been retained tried to intimidate the defense experts with a motion demanding disclosure of our personal financial records. “What should I do?” I asked Steve. “Retain your own lawyer” was his response. “Shoot, I really would rather not. It sounds expensive.” By the end of the day, two top-tier attorneys in town called me to tell me that Dr. Pitt had contacted them on my behalf indicating I needed their help. The problem went away within several days of speaking with them. Steve did not have to do that. Asked at other times for advice on complex cases, Steve would listen and inject confidence by saying, “Trust your instincts and do your thing. Just do the thing you were trained to do.”

Steve and I would meet for lunch on occasion over the years and on one such occasion several years ago, he told me that he met his match and the love of his life, Natalie Collins. His happiness was obvious, while he never conveyed anything other than a deep and ongoing respect for Susie Pitt, the mother of his two sons. I honor that memory.

Over the years, our career paths diverged. Steve did less clinical work and immersed himself in the emotionally hard stuff: criminal evaluations, consultations to law enforcement, threat assessments and the occasional custody evaluation. Dr. Pitt took a deep, personal pride in accepting those tougher cases many of us would prefer to avoid. Notorious, serial, and mass killers were his bailiwick; “high profile” was his playground. Steve was a high-wire act. He relished the action of profiling criminals at large, and the adrenaline of face-to-face encounters with the darkest souls, strained by life’s circumstances to the limits of their coping. The more salacious the charges, the tougher the case or the character in question, the higher the stakes, the better. He seemed to thrive under that pressure and even to revel in the focus of public interest and media attention. The local and national press, with whom Steve had cultivated a relationship of mutualism, appreciated what he offered them, because who doesn’t love a good story and great storyteller?

He left behind many loving friends and loyal associates, as well as a few adversaries and probably many ruffled feathers. Steve was not a fly-under-the-radar kind of guy: he lived in the open with all his ambition, striving, and strong opinions on the surface for everyone to see, like it or not. This is who he was. Each involved in our own practices, our lives got busy, lunches became less frequent, and we sometimes went several years without seeing each other. But I always thought of him during my tougher cases and my calls to him never went to his voice mail. I’d get Steve, busy always; but always available.

Dr. Pitt did not take an easy route. I believe we all have unconscious fantasies which drive our ambition and motivations, and shape our career choices. We are a group of sublimators: rescuers, do-gooders, solvers of mysteries, voyeurs, frustrated lawyers, crusaders against injustices. I like to think of Steve as the guy in the old Western wearing the white hat, keeping the town safe, dragging the bad guys to justice, and earning some glory, even while placing himself in danger. Taking some fire may have been part of the adventure for Steve, or was just a part of the equation. But, I have no doubt Steve knew the risk-reward tradeoff in his choices and was okay with all of it.

I last saw my complicated, esteemed colleague, Steven Pitt, in October 2016 during AAPL’s forensic board review course in Portland, Oregon. For three days, we sat next to each other in the last row, hunched over our white binders, taking notes, drinking coffee, complaining about MOC requirements, fretting over landmark cases, and sharing updates of our lives. He offered to take me to lunch. We walked a meandering mile trying to find the place he had in mind. With only an hour for our lunch break, I suggested asking a local for directions. Steve insisted on using his phone’s GPS: “It will be more fun.” Finally seated and eating, I felt like I was with an old friend, again: Steve, the good listener, the morbid humor, the curious, chivalrous, competitive, caring friend. While walking back to the conference center, we figured out that we were retained by opposing sides in a pending civil case. “Let me know how that one turns out,” he said with a wink. 

In the two weeks since he died, I’ve had quite a few more conversations with Steve. I’ve procured some more of his sage advice and warm support, thanked him for all the memories, reconciled some of my mixed emotions, and promised to let him know how things turn out. Rest in peace, Steve.

With thanks to Drs. Joel Parker, Lisa Jones, Gretchen Alexander, and David Coons for allowing me to reminisce with them as I collected my thoughts.

(Photo credit below: Dr. Pitt and Natalie Collins on "their rock" at Solitude Lake, courtesy of Natalie Collins, Esq.)

As a resident he demonstrated the qualities that distinguished him as a forensic psychiatrist: superior ability to write quality reports, and a compulsive tendency to make sure that every detail was attended to and every important article cited. He had a great sense of humor. His impersonations of our attendings made me laugh until I cried. Steve was also a diehard Michigan State Spartan. As a result, he was always conflicted because he launched his career from the University of Michigan. We had many a spirited discussion about Michigan-MSU football and basketball over the years.

Steve demonstrated his drive for independence early in his career. He pursued the field of forensic psychiatry after he completed his residency, which was unusual for a Michigan trainee at the time. He trained in a program that emphasized research and treatment of mood disorders, and had no organized training related to forensic psychiatry for residents. His independent bent continued after he left Michigan and completed a forensic fellowship at the University of Maryland under the mentorship of Jonas Rappaport, MD, a man that Steve respected greatly.

Steve spent very limited time working for an employer. He briefly worked at the State Hospital in Pueblo, Colorado, but his independent streak drove him to leave the confines of an institution. He chose to pursue his passion of creating a forensic practice and moved to the Phoenix area. It was at that time, the early 1990s, that he used his skills at forming friendships and developing networks of contacts to build his referral base. Rather than following the easy path of becoming a "court psychiatrist," Steve set up a solo forensic practice and went about contacting numerous attorneys, investigators, and other people involved in the criminal justice system to develop a network. His approach and evaluation techniques were highly successful; he was quickly able to set up his team: S.E. Pitt and Associates.

Steve’s evaluation and writing skills netted him an excellent reputation as a forensic psychiatrist. His extensive professional network and high quality work resulted in him being consulted on virtually every high-profile forensic case in the United States over the last 25 years. Despite his national reputation, he was not boastful, nor one to drop names or discuss cases "out of school."

Steve was a pioneer in the use of videotaped interviews in conducting forensic evaluations. He incorporated the videos seamlessly into his forensic reports and helped the reader use them in the process. As a result, his reports were thorough, well researched, comprehensive, and easy to read. They left the reader with little doubt as to how he formulated his opinions.

Steve's tendency to prepare, almost to a fault, left him in good stead. His preparation and ability to stay on top of the literature were used in each case he took on, as opposed to relying on his "training and experience." This was a key to his success. No attorney was a match for Steve at deposition or at a trial. Here again, his fearlessness paid dividends. He relished the opportunity to provide testimony, seeing it as "going to war," and never intending to lose. He was able to succinctly, clearly and forcefully give his opinions.

In addition to being an outstanding professional, Steve Pitt was an outstanding man. He helped raise two sons who grew into fine young men. He was honest, generous, and always willing to teach. He pushed his colleagues in their professional work, much as he pushed himself, and as a result made the team better. He was a great friend to me.

Steve's untimely death leaves a huge hole in the forensic psychiatric community. He was a significant resource to numerous law enforcement entities throughout the country. Steve's loss in the prime of his career is akin to Earvin "Magic" Johnson being taken from basketball mid-career. He had a lot of championships to win. He will be sorely missed.

to Come

Hundreds of people gathered at a memorial service for Dr. Pitt on June 4, 2018. Son, Asa Pitt, shared:

We can all agree that my Dad was an incredible man . . . I could go on forever about all I learned from him, but here is something I did not want to leave here today without saying, my Father's outlook on life. It was simple, and he said it to my brother [Beau] and me every time he dropped us off at school. He would say, Try your hardest; don't say can't; be nice; and have fun.

Roland Segal, MD, DFAPA

Past President, Arizona Psychiatric Society

Arizona Forensic Psychiatry

Scottsdale Mental Health & Wellness Institute

Our psychiatric community has been profoundly affected by the loss of Steven Pitt, DO, in the recent Scottsdale shootings. We mourn the loss of all of the victims, and our condolences go out to their families and loved ones. 

On a personal level, I have been struggling with my emotions since learning of Dr. Steven Pitt’s death. I am well acquainted with his work and had great respect for him as a professional. In Dr. Pitt, I see a mirror image of myself; we are both forensic psychiatrists, our offices are close to one another, and we even took our dogs to the same veterinarian. I am left with the thought, “This could have been me.” With his death, I am faced with my own fear of leaving behind my two young children, my beautiful and loving wife, and my family, all who mean more to me than my own mortality. It is a reminder of the fragility of life, and how tragedy can happen in an instant. 

Gun violence in the United States results in tens of thousands of deaths and injuries annually. As a society, we have become almost numb to gun violence and mass shootings. We send our children to school in the hopes that they will be safe; we go to work and live our lives, but of course there is evil in the world that we cannot control. Evil. Is there a better word to describe the recent Scottsdale shootings? How do we make sense of such tragedy? And in particular, how can we as experts in the mental health field help others explain such violence and offer solutions when we struggle with the same questions? 

Gun violence, mass shootings, and serial shootings often lead to sensational news stories nationwide, but to the victims of such shootings and their loved ones, the results are much more personal. Steven Pitt was more than just a forensic psychiatrist who worked on high profile cases. I had the opportunity to attend Dr. Pitt’s funeral along with several other APS members. It brought tears to my eyes when his sons spoke of their father. Dr. Pitt was a giant in the field of forensic psychiatry, but he was a dad, a brother, a husband, a friend, and a son. Those speaking at his memorial painted a picture of Dr. Pitt as passionate about the work and getting it right, focused on on living his life and enjoying every minute. To devote any time to worries over what might or might not come to pass would have run contrary to his love for what he did, the people he cared about, and the life he wished to live. His brother Darryl, reflecting back, shared at the memorial “While he would not wish ill on anyone, Steve would have enjoyed this case, albeit from a different perspective.” Further, he shared that in a past discussion with his brother on any risk inherent in the work, Dr. Pitt’s response included “Stuff happens, Bro.”

I am proud to be a member of the Arizona Psychiatric Society. I am proud that we support each other professionally and personally.    I have heard some physicians say that this is the reason they do not want to do forensic work, but statistically such tragedies are exceedingly rare. 

The US Department of Labor put out a study indicating that there were 5,190 work related fatalities in 2016. Most of those fatalities (40%) were related to traffic accidents, followed by 13% by falls, 11% were a result of an accidental trauma by an object/equipment, and 9% were homicides (792 fatalities). 

Occupations that involve transportation and material movement have the highest rate of fatal injury (15.4), followed by construction work (12.4), building and grounds keeping (6.6), protective services -- law enforcement and fire fighters (8.4), and so on. Healthcare practitioners and technical occupations were rated together at 0.7. [These rates are a number of fatal injuries per 100,000 FTEs]. Business, engineering, education, library, and office occupations that were found to be “safer” than healthcare with rates of 0.5 and less.

In 2012, Dr. Kelen and colleagues collected and reviewed data related to US hospital-based shootings from 2000 to 2011. They found 154 hospital-related shootings (14 per year).  Forty-five percent (45%) of the victims were perpetrators themselves (self-inflicted), 20% of the victims were hospital employees, 5% were nurses (7) and 3% were physicians (4).

Dr. Knable with Sylvan C. Herman Foundation reviewed homicides of US mental health workers from 1981 through 2014. He identified 33 homicides among mental health workers (39.8% were case workers, 30.3% psychiatrists (10 in the span of 33 years), 15.1% were social workers, 6.1% were psychologists, 6.1% were nurses, and 3.0% were other physicians). Dr. Knable also looked at homicides of all the US physicians from 1981 and 2017. He found 31 cases (39% of victims were psychiatrists (12 cases in 36 years), 22% were other specialties, 16% primary care doctors, and 13% were OB-GYNs). 

Dr. Knable concluded that among the perpetrators, about 68% were in psychiatric treatment, 55% were a current or former patient, 48% were previously charged with a criminal offense, 39% were non-compliant with treatment, 23% had a prior involuntary hospitalization, and 16% diagnosed with schizophrenia.

In summary, any premature end of life is a tragedy and is devastating to the community, family and friends of all individuals. However, statistically speaking, being a psychiatrist – even a forensic psychiatrist -- remains safe. Compared to 5,190 occupational fatalities a year, one to two healthcare providers are fatally injured on a job yearly; one US psychiatrist is fatally injured on the job every three years. 

We mourn the loss of Dr. Steven Pitt, Dr. Marshall Levine, Veleria Sharp, Laura Anderson and the other victims of this evil crime. Our hearts and prayers are with their families and loved ones.

Dedicated to the memory of Steven Pitt, DO.

Jack Potts, MD, Forensic Committee Chair

APS Past President

Forensic Psychiatrist

Fellow forensic psychiatrists, please let me know if you are interested in joining the Forensic Committee. The Committee is convening this summer to work on Rule 11 (competency restoration) issues. Please let me know if you are interested in joining us to work on this Committee focusing initially on restoration to competency standards, ethical issues, etc. E-mail Teri (teri@azmed.org) who will be glad to share my contact e-mail and cell number with you. For background on the Rule 11 issues, provided here is a Memorandum prepared by Dr. Joseph Bloom, who is contributing to the Committee and this work group.