Pathologist of the Mind
Author: SD Lamb
In this most scholarly attempt to ‘rediscover Meyerian psychiatry‘, this book successfully brings to the contemporary public the life and works of one of the giants of the renowned Johns Hopkins Hospital. Describing Adolf Meyer as the most recognizable, authoritative, and influential American psychiatrist in the early twentieth century, the author reviewed how he ‘secured the opportunity to mold the burgeoning specialty around his vision‘, and how he used his influence to entrench psychiatry within ‘science-based medicine‘. Asserting that Meyer wielded ‘disciplinary power and institutional resources…on par with William Osler and William Welch‘, the author lamented the ignorance of Meyer’s work beyond ‘a narrow circle, and she set out to document his clinical practice, and ‘his grand vision’ – ‘to establish the specialty as a clinical science operating like other academic disciplines‘. Whilst the book established that ‘the basic infrastructure for American psychiatry evolved from the concepts and methods’ that Meyer espoused, it nevertheless acknowledged that his attempts to explain them to others was inadequate. With a forensic examination of his theory and practice, the book set out to unravel Meyerian psychiatry, why it appears ‘utterly obscure‘, and more importantly, why it is still relevant today (pages 1-3 and 24).
Meyer’s influential role in defining American psychiatry was a major theme of the book, and the author attributed this partly to ‘his powerful institutional position at Hopkins’. This, the book asserted, enabled him to ‘shape the new psychiatry around his clinical vision’, and ‘to influence medical and public attitudes about psychiatric illnesses and institutions’. The author also attributed his influence to his establishment of the innovative Phipps Psychiatric Clinic, what she said was ‘the first academic institute of its kind in the English-speaking world’, and which she said ‘was destined to play a role in the advancement of psychiatric knowledge and the training of future leaders in the field’. Furthermore, the author noted that the clinic became the first place where ‘mental disorders…would become the subject of serious scientific study, medical training, and treatment efforts’. By providing Meyer access to a large number of the broad range of mental illnesses, the book also showed that the clinic enabled him to follow the full course of these disorders from their earliest phases (pages 99-112).
Although his eminent position at the Johns Hopkins helped to make his views influential, the book went to great lengths to show that his hard-earned pedigree justified the role. In this context, the book pointed out that he had acquired ‘elite training‘ in the ‘clinical-pathological‘ method from several European centres before he migrated to the United States, and that he was exposed to such inspirational clinicians and researchers as Jean-Martin Charcot, Joseph Jules Dejerine, Augusta Klumpke, John Hughlings Jackson, William Gowers, and August Forel. Meyer also had a track record as ‘a modernizer of mental asylums’ before joining the Johns Hopkins, and the book explored his transformational work at three mental institutions which ‘garnered him repute as a scientific reformer, an accomplished neuropathologist and clinician, and a leader within the emerging field of psychiatry’. Some of the asylum innovations Meyer introduced included developing a ‘mimeographed template for recording clinical data’, establishing ‘collaborative clinical practices’, standardising terminologies and clinical procedures, expanding the number of clinical staff, and instituting regular case conferences and teaching sessions. It was therefore not surprising when he was appointed the director of the New York Pathological Institute in 1901, a position which the author said provided him a platform to broaden the geographical spread of his reforms, and to establish ‘the basic infrastructure of American psychiatry in the twentieth century’ (pages 27-28, 34-36, 42-45 and 51-58).
In exploring Meyer’s theory of mental illness, the author acknowledged its complexity in its portrayal of the concept as ‘the conflation of the anatomical, neural, mental, and behavioral as a single, irreducible sensory-motor response‘. Explaining that Meyer’s goal was to use pathology to understand human behaviour, the author described how Meyer himself used it in practice; in this way, she remarked that his clinical approach to patient care was centred on using the ‘the case history‘ to translate the patient’s ‘subjective experience‘ into concrete and sharable ‘objective fact‘. She said this was because Meyer believed the history has the potential to identify ‘causal chains’, and to objectify the patient’s ‘unique life history and social behaviors‘. Similarly, she explored his approach to psychotherapy which, unlike the Freudian, ‘revolved around the patient’s life experiences and adaptive habits‘, and fitted with his belief that ‘a patient’s reaction to environmental demands was of paramount importance’. Importantly, the book maintained that Meyer saw history and therapy as ‘a single clinical enterprise’, and this conformed with his overarching perspective of medicine as ‘the merger of pathology and therapy’. She concluded that Meyer’s ‘two important objectives’ were ‘to apply the methods of general pathology to psychiatric disorders and to practice psychiatry using his instrumentalist concept of psychobiological reactions‘ (pages 21-24, 60-75, 96-97 and 129-139).
In its biographical sketch of Adolf Meyer, the book tried to resolve or explain what it referred to as the contradictions in his life and works. For example, in exploring his personality, the book portrayed him as ‘often diplomatic and optimistic to a fault’, and highlighted his respect ‘of the social order‘; these character traits may explain why he avoided ‘public controversy of any kind’, and why he was reluctant ‘to interfere with the pursuits of his colleagues’. Probably allied to this was what the author depicted as his ‘indecision in difficult situations’, a trait that may explain allegations made against him elsewhere of ignoring extreme psychiatric eugenic practices. Similarly remarkable was Meyer’s ‘notoriously opaque and indirect‘ communication style, and his ‘inability to explain himself clearly’, features which the author said made his lectures ‘famously indecipherable‘ and made his psychobiology theory appear as ‘convoluted’. The book further attributed the complexity of his concepts to ‘his compulsion to be exhaustive and precise‘; his determination to avoid judgments ‘that might be construed as dogma‘; and his abhorrence of ‘reducing complex phenomena to simplified terms’ (pages 2, 5-6 and 11-14).
In arguing that Meyer’s theory and practice are important to contemporary psychiatry, the author first acknowledged that there is a divided opinion about his legacy; whilst some psychiatrists are ‘lobbying for a reinstatement of Meyerian principles’, she said others are ‘insisting that nothing could be worse for the discipline’. The book nevertheless maintains that, on balance, ‘American psychiatrists are dragging Adolf Meyer back into the campaign trail‘, and it advanced several justifications for asserting that ‘current developments in twenty-first-century psychiatry make the discovery of Meyerian principles timely‘. One of these is the better understanding of the concept of neuroplasticity, an idea that the author said has a direct correlation with Meyer’s emphasis on ‘habit-training‘ as a therapeutic strategy for mental illnesses. For example, she said Meyer believed that ‘requiring patients to talk about thoughts and feelings was…worthless without also insisting that they set and achieve concrete goals‘. The book also also argued that his psychotherapeutic strategy, a treatment approach that was ‘obscured’ by the now discredited Freudian psychoanalysis, is one of Meyer’s major contributions to American psychiatry which should have a place in current practice (pages 219, 232 and 250-261).
This book has succeeded in revealing the life and works of a medical pioneer whose contributions to the development of psychiatry have been buried in the sands of history. In its detailed depiction of his reforming work before and after he joined the prestigious Johns Hopkins Hospital, the book demonstrated the credentials that Meyer brought to academic psychiatry, and by exploring the foundations of his psychiatric concepts, it showed that they are still relevant to contemporary practice. Although these ideas remain difficult to grasp, the book nevertheless made their implications and relevance clear by its detailed portrayal of Meyer’s own practice. In documenting the validity of his unique concepts, built on sound scientific principles, the book explains why his legacy is undergoing a resurgence today. It is unfortunate that the biography conveyed very little of its subject’s personal life, and especially of his attitude to eugenics, nor did it explain why his clinic excluded people of colour.
The principles behind Meyer’s theory and practice remain valid across the range of medical specialties. They symbolise the clinico-pathological basis of forming hypotheses; the rigorous collection, recording, and analysis of clinical data; and the seamless integration of research into clinical care. The book also brought out Meyer’s laudable motivations in reforming inadequate systems, an important lesson to healthcare. Whilst his theory remains difficult to conceptualise, the author shows that it has the potential to reform current psychiatric practice. The book documents how he pursued a selfless ambition to elevate his specialty, a vision worthy of emulation across contemporary medicine, and I recommend it to all doctors.
Publisher, Place, Year: Johns Hopkins University Press, Baltimore, 2014
Number of chapters: 6
Number of pages: 299
ISBN: 978 1421414843
Star rating: 5