Toward New Narratives of Twentieth-Century Medicine

While there are multiple ways to review the particulars of a book, it often takes years to determine its larger impact. Jack Pressman's 1998 study, Last Resort: Psychosurgery and the Limits of Medicine ¹ may be an exception. While reading through it, I found myself reflecting not just on its presentation of new information but also on its potential for generating new conversations. Probably the most controversial aspect of Last Resort, and that which has received the most attention, is its treatment of psychosurgery and, in particular, of lobotomies. However, I found equally suggestive its comments on the efforts of those interested in mental disorders to collapse the boundaries between different work sites (such as the laboratory, the clinic and the asylum) and between different disciplines (such as physiology, neurology, and psychiatry). Here, by example, Pressman challenges historians of medicine to take a closer look at the ways in which all medical specialties, not just psychiatry, have been reshaped by their interactions with each other, as well as with laboratory scientists, in the twentieth century. ²

In the body of this essay, I attempt to carry Pressman's project forward a bit by seeing what happens when the focal point shifts ever so slightly, from psychiatry to its competitor and collaborator, neurology. Before doing so, however, I want to summarize the key points of Pressman's overview of psychiatry during the first half of the twentieth century. Most innovative is his shift away from the long history of hostility and competition between neurologists and psychiatrists. ³ Without disputing the intensity of this rivalry, especially in the years between 1880 and 1910, Pressman is more interested in the collaborative efforts of the next generation of neurologists and psychiatrists. For psychiatrists, in particular, the years following World War I were exhilarating. Increasingly situated in private practices and research centers rather than large state mental hospitals, for several decades psychiatrists found their relationship to neurologists reversed in a most satisfactory fashion. No longer was neurology the preferred choice for those interested in mental illness. Indeed, while many doctors got board certification in either psychiatry alone or in psychiatry plus neurology, almost none chose neurology by itself. As Pressman notes, although without giving a firm date, once the "reconfiguration of psychiatry was in fact complete," the term neuropsychiatry quietly disappeared. ⁴ (That it has since reappeared is not part of Pressman's story but does suggest the contingent nature of professional triumphs, as well as the continuing complexity of the history that so interests him.)

Here, as in other areas of medicine, the impact of World War I was substantial. After the war, several of those who had been part of the U.S. Army's Department of Neuropsychiatry, most notably Thomas Salmon and Harvey Cushing, tried unsuccessfully to get Rockefeller Foundation funding for a National Institute of Neurology, where they could continue to study nervous and mental disorders, both organic and functional, in a setting where "neurological pathology, anatomy, psychiatry, organic neurology, and neurosurgery can have a home". ⁵ By the late 1920s, Pressman argues, this multidisciplinary impulse had produced substantial institutional change within existing universities and research institutes. For example, at Yale University in 1929, John Fulton assumed the chair of the Department of Physiology, where he centered himself "within a dense network of research-oriented physiologists, neurologists, neurosurgeons, neuroanatomists, and psychiatrists." ⁶ That same year, under Alan Gregg's leadership, the Rockefeller Foundation reorganized so that, for the next fifteen years, it would be able to focus on medicine, and particularly psychiatry. Convinced of the therapeutic potential of laboratory investigations of mental disorders, Gregg then began to fund a number of research centers, most notably the Stanley Cobb group at Harvard University and the Montreal Neurological Institute. Integrative endeavors emerged from specialty groups as well. For...