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an online version of the magazine Winter 2007
Annals of Hopkins
 
 

When Psychiatry Was Very Young

The entrance to Howard Kelly’s house in Bolton Hill.
> In an age entranced with psychoanalysis, Adolf Meyer rejected the idea there is a libidinal undertone to everything. Photograph by the Alan Mason Chesney Medical Archives.

Exactly 100 years ago, Hopkins began treating patients with mental problems. Within a decade, its Phipps Psychiatric Clinic would be attracting dignitaries from around the world.

 

By Janet Farrar Worthington

 

ON THE WINTRY DAY in 1905 when William Osler set sail for England to become Regius Professor at Oxford University, he left behind a 16-year-old hospital in Baltimore that had changed medicine. As the first physician-in-chief at Johns Hopkins, Osler, with three colleagues, had founded a medical center where for the first time teaching and research were truly integrated with patient care. Osler had only one regret: One area of medicine was still unrepresented at Hopkins. “You need a department of psychiatry,” he had advised William Henry Welch, Dean of the Medical Faculty.

Psychiatry was rapidly coming into its own as a  medical specialty by the early 20th century. Conceived a few decades earlier, the field had received its wake-up call in 1894, when neurologist Silas Weir Mitchell  blasted the American Medico-Psychological Association (later the American Psychiatric Association). “We, neurologists, think you have fallen behind us, and this opinion is gaining ground outside our own ranks. Where [are] your careful scientific reports? You live alone, un-criticized, unquestioned, out of the healthy conflicts which keep us up to the mark of the fullest possible competence.”

Now, just as Freud’s and Jung’s work on the unconscious were catching fire in Europe, American researchers were rushing to investigate the causes of insanity and learn more about the brain’s anatomy. Several states already had well-established mental clinics. Meanwhile, the mental hygiene movement, born a few decades earlier, had recently gained a boost from a shocking book called A Mind That Found Itself, by Clifford W. Beers, a recovered asylum patient.

But at Johns Hopkins no psychiatrist yet graced the medical staff. Not until May 1908 did Philadelphia steel magnate Henry Phipps visit the Hospital to inspect the tuberculosis division he’d funded and ask Welch if he needed help sponsoring other projects. Then, on the spot, Welch handed him a copy of A Mind That Found Itself, in which Beers described being knocked around by asylum attendants, laced into a straitjacket, and suffering agonizing pain while locked in an airless, filthy padded cell.

The book, Welch pointed out, had been published with the help of Adolf Meyer, a Swiss-born pathologist and professor of psychiatry at Cornell. Meyer was the world’s first psychobiologist. In an age entranced with Freud and psychoanalysis, he rejected the idea that there was a libidinal undertone to everything. Mental and physical problems, Meyer believed, were inseparable, and biological factors could provide clues to behavior. As director of the Pathological Institute of State Hospitals of New York on Ward’s Island, Meyer had become convinced also that a thorough review of a patient’s history, community, and environment—the patient’s life experience—could offer clues to psychotic reactions.

Welch liked Meyer’s thinking. As a pathologist, he liked the fact that Meyer advocated a review of the life experience of each person whose body and brain came to the autopsy table. Hopkins, Welch said, needed to become a leader in this field of psychiatry, too. Within a month, Phipps had agreed to donate $1.5 million to fund a clinic. And so, exactly 100 years ago this year, Johns Hopkins gained its department of psychiatry. Immediately, Welch set out to recruit Meyer as the first director of the Henry Phipps Psychiatric Clinic. Two years later, he had his man.

The entrance to Howard Kelly’s house in Bolton Hill.
> An architectural gem, the Phipps Clinic featured marble floors, fireplaces—even a pipe organ.

Adolf Meyer and the Phipps Clinic, which opened in 1913, proved a perfect fit. The 44-year-old Meyer never moved again. With his bushy goatee, heavily accented English, and penetrating gaze, Meyer seemed the stereotype of the practicing psychiatrist. Meanwhile, the Phipps, his work space, was an architectural gem with marble floors, gardens, porches, fireplaces, and even a pipe organ. Despite such elegance, Meyer remained adamant that half the clinic’s resources go to serving the poor around the hospital.

“Phipps became his clinical and experimental laboratory in psychiatry and neurology,” wrote A. McGehee Harvey, the legendary Hopkins physician and historian who knew Meyer at the end of his career. “He assembled a brilliant program, carried out over the years by some of the world’s most distinguished scholars. A residency at Phipps became a cherished prize for psychiatrists from all parts of the world.”

Indeed, by the end of the decade, international dignitaries were traveling to Hopkins for psychiatric treatment. One famous vignette recounted a visit in 1919 by Queen Marie of Belgium. Arriving unannounced during a stopover at the Hospital, she was said to have knocked on Meyer’s office door and surprised him meditating on the couch. Explaining that she had wanted to meet him for some time, the lady introduced herself as the queen of Belgium. At which point, Meyer is said to have sat up briskly and asked: “And how long have you felt this way?”  

Zelda Fitzgerald, another famous patient, penned her autobiographical novel, Save Me the Waltz, during several months at the Phipps in 1932. Husband F. Scott Fitzgerald, living in a nearby Baltimore apartment, was meanwhile at work on his own novel, Tender Is the Night—about a psychiatrist married to a wealthy mental patient.

Meyer was the psychiatrist who lured them all. “Meyer’s patient histories were legendary—beautiful, compassionate, and meticulous,” says J. Raymond DePaulo Jr., current director of Psychiatry and Behavioral Sciences and Henry Phipps Professor of Psychiatry. “That’s because he was an astute listener and observer. His questions were so good his format became the standard around the world. We still use it.”

A celebrated teacher, Meyer never came quickly to his conclusion about a mental problem. “The well-trained Meyerian psychiatrist,” DePaulo says, “was someone who could argue for and against any diagnosis in the same patient.” Meyer used the same approach in determining a treatment. “You would pick the one that seemed to suit the patient and the circumstances best,” DePaulo says, “but be prepared to use another if that failed. It wasn’t about doing this kind of psychotherapy, or giving that kind of drug. It was about figuring out how best to help and
continuing to learn.”

That rigor—instilled at the inception of this century-old department by its first director—continues to define the department today, says DePaulo. “This is a tough field. How can we know for sure what’s going to work ahead of time?  It’s a journey. Meyer wanted us to be educated in all aspects but not become true believers in any.”

In the years since Meyer’s death in 1950, the field of psychiatry has developed sophisticated new treatments for mental illness. And yet, Meyer’s mark remains indelible. “Many American psychiatrists today are rejecting fixed, rigid theories and adopting instead a ‘biopsychosocial’ approach,” points out University Professor Paul R. McHugh, chairman emeritus of the Hopkins department. “But the biopsychosocial idea is not new. It is quite simply Adolf Meyer’s concept of psychobiology.” *

 

 
 
 
 
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