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Pathologist of the MindReview - Pathologist of the Mind
Adolf Meyer and the Origins of American Psychiatry
by S. D. Lamb
Johns Hopkins University Press, 2014
Review by Marina Oppenheimer, LMHC
Apr 28th 2015 (Volume 19, Issue 18)

The Pathologist of the MindAdolf Meyer and the Origins of American Psychiatry by Dr. S.D. Lamb is definitely not a book for everybody.  However, for those of us interested in the subject, this is a book full of interesting information on how Dr. Adolf Meyer, a Swiss neurologist and psychiatrist, set the basis for modern psychiatry in the United States. During the first half of the twentieth century Adolf Meyer was considered the most reputable psychiatrist in the America. Born in Niederweningen, Switzerland, he emigrated to the United States by the end of the nineteenth century and went on to achieve a challenging goal: introducing scientific treatment methods in the American psychiatric units, known at that time as lunatic asylums. The book describes in detail Meyer's efforts between 1892 and 1917 to institute a scientific approach to psychiatry based on his biological conception of mental illness. Meyer's definition of psychiatric disorders had not so much to do with brain diseases but with a failure of the organism to adapt. In other words, the pathological processes underlying a mental disorder were not only related to brain tissue but also to the level of the individual's personal experience. Meyer rejected all forms of mind/body dualism and as such became a forerunner of the twenty first century holistic approach to medicine and mental illness. It is interesting to note that Meyer's mother had a very significant role in her son's professional path. When Meyer left his native Switzerland to come to the Unites States, his mother suffered a nervous breakdown probably due in large part to her personal losses and precarious financial situation. Meyer was convinced that his mother's mental illness had a lot to do with stressful circumstances surrounding his emigration. It was his mother's situation which made him examine the role of personal circumstances and adaptation in the development of psychiatric disorders.

Chapter One deals with Pathology as a Method. Between 1893 and 1908 Adolf Meyer imported to the American asylums scientific methods of treatment. His methods were based on the work of German clinical psychiatrist Emil Kraepelin, the founder of modern scientific psychiatry as well as of psychopharmacology and psychiatric genetics. Meyer's top of the line medical training predisposed him to a working protocol based on pathology: the study and diagnosis of disease. This method became his way of detecting previously unexamined patterns of a disease. Meyer's goal was to adapt this paradigm to psychiatric disorders. In a few words, what Meyer introduced in American asylums was a general pathology of insanity that would allow clinicians to review thousands of observations and compare them in order to reach the causes and effects of diseases. Wilhelm Griesinger, a German neurologist and psychiatrist, had hypothesized that each type of insanity could be traced to a specific cause; for example, a localized lesion in the nervous system.  On the other hand, Karl Wernicke,  a German anatomist, psychiatrist and neuropathologist applied the conclusions reached by master anatomist, Theodor Meynert ("a  closed network of nerves that connect various centers of nervous functions in the brain") to study aphasia, a language disorder. Wernicke had speculated that two areas of the brain were responsible for the dysfunction. On his part, Adolf Meyer also followed Meynert's techniques of brain research. However, these theories were later labeled as "brain mythology" by August Forel, Meyer's mentor in Zurich.  Meyer's point of interest consisted on how to apply evolutionary biology to psychiatry. Under the influence of Forel and his successor, Eugen Blueler, his combination of psychotherapy and scientific research came to be known as the Zurich school of psychiatry. Later, in 1892 Meyer was offered the position of pathologist at the Illinois Eastern Hospital for the Insane at Kankakee, the new state mental asylum. It was at Kankakee that Meyer made a surprising discovery.  On one occasion, when he performed an autopsy on a patient who had suffered from syphilitic lesions on the brain, he asked for documentation on his behavior before death; but his request was met with astonishment and silence. That is how he learnt that the asylum staff usually examined patients just once upon admission. Some patients spent years in the asylum without ever being assessed again. This discovery convinced Meyer that American psychiatry was not based on any scientific method, let alone the clinical-pathological method.  Meyer's focus on the brain induced him to give start to clinical examinations of patients based on a textbook written by Emil Kraepelin. The fact that his mother had succumbed to financial pressures as well as personal losses convinced Meyer that mental disease could not be reduced to brain pathology

Chapter Two, Mind as Biology, deals with Meyer's belief that mental activity should be viewed as a biological function evolved in synchronization with bodily processes on the road towards adaptation. He coined the term psychobiology to express the oneness of body and mind. According to Meyer psychobiology had to do with the organism failure to adapt. The works of Charles Darwin brought forward the idea of progressive evolution of living organisms and became increasingly important in European and American scientific communities. Gradually Meyer adopted the evolutionary model proposed by John Hughlings according to which the brain had structures organized according to their evolutionary status. When one of most the evolved structures was injured, the less evolved structures took over and generated symptoms.  Epileptic and aphasic patients were an example of injured evolutionary structures. Later Meyer conceptualized the brain as consisting of areas of neurons involved in the same specialized function: the sensory neurons, the motor neurons, and the neural chains that connected them. No doubt about it, psychobiology was a departure from orthodoxy: its goal was to study mental disorders in living patients using the methods of pathology.  It's interesting to notice that within the psychobiological framework no mental state was inherently pathological. "Whenever the functions and the organ of behavior become morbid or sick", Meyer explained, "it is because one or the other of the adaptive functions becomes unruly, unable to balance, over-assertive or too little assertive." In other words, every manifestation of psychopathology was at the same time organic and functional.

Chapter Three, Unique Soil in Baltimore , describes how on April 16, Meyer, the Henry Phipps Psychiatric Clinic at John Hopkins Hospital Director, explained to an audience of one thousand that a "unique soil (was) created in Baltimore" by building "an institute representing a true clinic." Between 1913 and 1917 the Phipps Clinic admitted patients from all walks of life with a wide range of complaints and symptoms, with an average length of stay of fifty six days. Patients perceived their condition as an illness treatable by medical experts working in a modern hospital. The clinic had a very specific treatment protocol. Upon admission every patient was prescribed three days of bed rest while he or she was closely monitored for suicidal tendencies. However, this admission period was completely different from what came next. During the rest of the hospitalization, patients were encouraged to reenact current situations from their daily life. Admission notes on every patient were extremely detailed and Meyer put great emphasis on the rapport between clinician and patient. The clinic's specific objectives were two: apply the methods of pathology to psychiatry, and interpret psychiatric disorders as psychobiological reactions.

Chapter four, The Meyerian Case History, describes in detail what Meyer understood as charting.  A well done case history described the patient's life line so that "every step is like an experiment telling us the story." After biographical data were obtained from the patient, family and friends were also interviewed so as to put together the most precise picture of the patient's life outside the hospital. Such a detailed description of the patient's months or years before admission allowed the clinician to understand what had precipitated the breakdown. Phipps' psychiatrists focused mainly on the patient as a product of his or her early environment.

Chapter five, A Wonderful Center for Mental Orthopedics, talks about how the Phipps Clinic was run simultaneously as a laboratory to identify pathological processes and as a medical protocol on how to modify them. Meyer called his therapeutic strategy "habit training". Its goal was to restore the fitness of the personality and increase its adaptation skills. The mind was considered an instrument of biological adaptation that should generate responses that as William James had stated, moved the individual towards survival. It can be said that the Meyer's doctrine of habit forming was the start of what we now call occupational therapy.  Daily tasks provided the opportunity for the clinic staff to observe symptoms that could not be detected by the clinician in private practice. It was hypothesized that working on arts and crafts or farming would rebalance the brain. This kind of therapy as well as exercise gradually replaced rest in the treatment of mental disorders. On the other hand, recreational activities were included to encourage social interactions while singing, dancing, or playing games.

Chapter five, Subconscious Adaptation, deals with psychotherapy and psychoanalysis. Staff at the clinic used psychotherapy as "ventilation" which was combined with the clinician's analysis of the patient's biography and the patient's insight of his situation. Like Freud and several others, Meyer thought that symptoms and abnormal behaviors were the result of instinctual conflicting impulses. Disorders like schizophrenia, dementia praecox, or depression were in fact disorders of habit developed when psychobiological responses were inadequate. As a result, the first step consisted in finding out what had been the original faulty reaction that perpetuated the pathological pattern of behavior. Meyer always cautioned his staff to view their patients as dynamic, never as fixed organisms.

The book concludes with a quote of Louis Hausman who stated that Meyer lifted neuroanatomy out of the adolescent category of brain centers and tracts, and gave it a live dimension: that of functional development without which the nervous system cannot be understood. In the same venue, the DSM V includes a "hybrid" model for some disorders. The rationale for the hybrid offered by John Oldham, a psychiatrist involved with DSM V revisions, could be related to Meyer's psychobiological paradigm: "Personality types, traits, and disorders are on a continuous spectrum, much like blood pressure and hypertension. Too much of a useful, adaptive trait may become a problem."

Note: The book includes photos and case histories.

         

© 2015 Marina Oppenheimer

 

Marina Oppenheimer, LMHC


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