- Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry by S. D. Lamb
Psychiatry, like many other medical specialties, has had a checkered history. Explanations of the etiology of mental disorders during the past two centuries have ranged from somatic to psychological. In the second half of the nineteenth century German science, with its materialistic and positivistic ethos, dominated medical thought. In psychiatry Wilhelm Griesinger proclaimed that mental diseases are brain diseases, a claim that his students (including Theodor Meynert and Karl Wernicke) attempted to validate by conducting research on nerve tracts and brain lesions. That the experimentalism and materialism of German science failed to illuminate mental disorders was largely ignored. Nor did American institutional psychiatrists question the prevailing somatic interpretation of mental disorders.
Within a short time, however, American psychiatry was destined to undergo a profound transformation. This transformation was indissolubly linked with the career of Adolf Meyer, a young Swiss neurologist who migrated to the United States in 1892 and arguably became the most important and influential psychiatrist in the United States until his retirement in 1941. In Pathologist of the Mind S. D. Lamb has written the first comprehensive study of his career covering the period from 1892 to 1917.
At the center of Meyer’s approach was his concept of “psychobiology.” Mental illnesses were not brain diseases; they represented an inability of individuals to adapt to their environment. Rejecting all forms of mind–body dualisms or traditional mechanical views of the nervous system, he believed that mental disturbances were best understood as correctable maladjustment. His institutional affiliations in the United States—first as director of the New York State Pathological Institute and then as the head of the Phipps Psychiatric Clinic and chief of psychiatry at Johns Hopkins—provided him with a foundation to influence the training of younger figures who then helped to reshape American psychiatry.
Yet Meyer’s published works (reprinted in four large volumes between 1950 and 1952), as Lamb concedes, were a “luminous fog” (p. 5) that both colleagues and admirers generally found it difficult to penetrate. Given the problems posed by Meyer’s often impenetrable prose, Lamb has done an admirable job of teasing out his central concepts. Rejecting much of European deterministic psychiatry, Meyer insisted that psychiatry’s most valuable sources of data included “environment, experience, instinct, emotion, cognition, and behavior” (p. 247). The interaction between a human organism and its environment was dynamic and malleable. In this sense he was allied with John Dewey’s instrumentalism.
Meyer, as Lamb aptly notes, was a pioneer in developing a comprehensive case history for every patient. He embraced the instrumentalist faith that history could explain the present. The facts of a patient’s illness could be viewed as a natural experiment, which then permitted the identification of new variables that could modify the patient’s mental disorder. No facts—family background, childhood experiences, schooling, friendships, religious views, work life, behavior, sexual [End Page 617] experiences—could be overlooked in the effort to reconstruct the chain of events that led to a person’s disorder. At the Phipps Clinic the ratio of staff to the clinic’s eighty-eight patients was better than one to two. Yet therapies, though intensive, were not especially novel, and in many ways resembled nineteenth-century moral therapy. Lamb’s descriptions of patient–staff encounters offer insights not generally found in traditional histories.
Despite Lamb’s incisive and admiring study of Meyer, some issues remain. What kinds of individuals—psychotic or neurotic—were admitted to the Phipps Clinic? Were the therapies efficacious for those with severe and persistent mental disorders, as compared with those who were mildly impaired? Could Meyer’s individualistic and labor intensive therapies be employed with a population that included hundreds of thousands of persons with severe disorders? To be sure, Meyer played an indispensable role in developing what subsequently became known as psychodynamic and psychoanalytic psychiatry, which, in the immediate post–World War II...