European Psychiatry on the Eve of War: Aubrey Lewis, the Maudsley Hospital and the Rockefeller Foundation in the 1930s (review)

In 1937 the Rockefeller Foundation sent Aubrey Lewis, a psychiatrist who just had been appointed clinical director of the Maudsley Hospital in London, to the Continent for a kind of psychiatric Cook's Tour. The idea was to gather information on the best research and patient-care practices in the various lands, with a view to implementing them in Britain generally and at the Maudsley in particular, an institution to that point largely uninvolved in research. Lewis was then to write a report, which would presumably be influential in the Rockefeller Foundation's decision to further support the Maudsley with grants. This book consists mainly of Lewis's report.

Lewis himself was highly research-oriented, had a quick, acerbic mind, and did not suffer fools gladly, all of which are evident in his report—a document that makes for intensely interesting reading. He was writing only for the eyes of the Rockefeller executives, not for publication, and he was quite frank in assessing his European colleagues, many of whom he found to be incompetent and behind the times. Typically, he would arrive in a psychiatric clinic or a mental hospital and would interview in depth all the clinicians he could lay his hands on who had any interest at all in research; he would then in his notes assess the quality of their work and of the individuals personally. He began in Holland and descended through Belgium, France, and Switzerland into Italy; then to Hungary, Austria, a long stay in Russia and Eastern Europe, and Scandinavia; and then home. Lewis, who was Jewish, avoided Germany because, in 1937, he detested the regime. The report itself occupies ninety printed pages. It is not known whether anyone at the Rockefeller Foundation took the trouble to read it, or what impact it had on the Foundation's further grants to the Maudsley.

Throughout, Lewis's comments are arresting. He found Jakob Klaesi in Berne, who popularized deep-sleep therapy, to be "self-centered and talkative" (p. 87). Lewis dismissed virtually all of the research of the Italians as solely aimed at fattening their dossiers for university-lecturer status (lucrative in private practice). In Uppsala, Sweden, he was struck by the number of patients who were boarded-out into private domestic care. At the end of his tour, he found European psychiatry to be a "rather stagnant subject," and commented on the failure of Continental researchers to "see problems that are at once fruitful and attackable" (p. 144). "In some places," said Lewis, who was a big fan of social and community psychiatry, "the predominance of neurology and the extravagances of some psychotherapists seemed to have an almost equal share in delaying the development of the social and psychological side of psychiatry" (p. 146).

Lewis was no big fan of psychoanalysis. Yet neither was he thrilled about the new "physical" therapies that were just being introduced, such as cardiazol convulsive therapy and insulin "shock" therapy. There were at that point almost no innovations in psychopharmacology in view, though Lewis commented that expanding that domain might be a good idea. His vision of the world in 1937 suffered from the usual handicap of inability to see into the future. Yet if he lacked at all in prescience, it was probably in his underappreciation of the importance of the new physical therapies: electroconvulsive therapy would be introduced the following year, the year in which he actually wrote his report—and in Italy, of all places. The success of these new treatments revived interest in therapeutics in psychiatry, and paved the way for the great revolution in psychopharmacology that would take place after the war, a revolution in which the...