To the Editor:
We feel it essential to respond to the misapprehensions about Adolf Meyer and his influence on psychoanalysis presented by Dr. Pappenheim in her memoir, “Adolf Meyer and Psychoanalysis in America” (TAP). We were at the Phipps clinic when Dr. Pappenheim arrived and gained a very different opinion of the man and his teachings. Although it was a long time ago, we believe that she had an adequate formal understanding of English at the time, but as B. L. Whorf pointed out, a person cannot understand a language without understanding the culture. It is apparent from her article that Dr. Pappenheim was unfamiliar with the culture of American psychiatry and is still deficient in her knowledge of its history. Unfortunately, we can in a few paragraphs consider only a few of her misconceptions.
Dr. Pappenheim remarks that it took some time for her to understand the meaning of the term “psychobiology” (the term Meyer used alternatively with “ergasiology” for his orientation), which she came to understand was an encapsulation of Meyer's favorite saying, “Body and soul are a unit.” We do not recall Meyer ever saying this, but we are old. The essence of psychobiology, as we and many others understand it, is that organisms are integrated at increasingly complex levels from the biochemical to the cortical, as Hughlings Jackson taught, but Meyer went further and taught that humans are integrated at a symbolic level and that what persons think and feel can affect all lower levels of integration and, conversely, that what happens at the lower levels starting with the biochemical and cellular can affect how persons think and feel. These concepts were combined with Jan Smuts' holism to foster a holistic approach to medicine. The comment that the “life chart he [Meyer] created was the crowning achievement of his teaching” is not only ludicrous but pathetic.
It is necessary to realize that when Meyer went to the Kankakee State Hospital as the neuropathologist in 1892, the era of the moral treatment of insanity had vanished and psychiatrists did little for patients while awaiting a discovery akin to the finding that syphilis caused general paresis. Meyer listened to patients and soon reached the belief that very often patients' psychopathology could be understood in terms of their life experiences. As early as 1895 he wrote that “hereditary factors could be overemphasized as children of abnormal parents are exposed from birth to acquire unconsciously habits of a morbid character.” A similar opinion had been expressed by Esquirol. The Meyer family considered themselves the spiritual heirs of the Swiss folk philosopher Jakob Gujer (Kleinjogg) who, among other things, had taught an instrumental approach to farming, observing what worked and what didn't work, and trying out new ways rather than blindly following tradition, and also emphasized that children became happy and skillful adults only through the example of parents. In the United States, Meyer felt at home with the pragmatic-instrumental orientations of the philosophers Peirce, James, and Dewey, who were interested in improving ways of life through reason and experiment rather than in metaphysics. Meyer soon taught that humans were unique in the possession of language and that their ability to think was their chief means of adaptation—for extricating themselves from predicaments, for altering their environment—and enabled them to project futures toward which they could strive rather than being motivated by bodily needs and desires alone. He roused the psychiatrists at Kankakee to stop waiting for “something else,” to listen to patients' life histories, and to use their minds and those of their patients to overcome faulty “habit patterns” and find new ways of leading their lives. He had, in brief, initiated a genetic-dynamic psychiatry which was so successful in moving psychiatry and psychiatrists out of the doldrums that he moved rapidly to Clark University and Worcester State Hospital, and then to Columbia and the New York State psychiatric system, where he taught in every hospital. In 1909, when Freud gave his Introductory Lectures at Clark, Meyer gave a potentially epoch-making lecture on the potential psychogenesis and treatment of schizophrenic disorders. When the Johns Hopkins Hospital opened, he was the obvious choice for Professor of Psychiatry. There he went about developing a teaching and research psychiatric hospital, and a psychiatric curriculum for medical students that became the model for other schools. It is unfortunate that he had difficulty in expressing himself clearly and in freeing himself from obsessive concerns about being dogmatic. Dr. Pappenheim was far from the only person who had difficulty understanding him.
Meyer welcomed psychoanalysis as another genetic-dynamic psychiatry and was, as we know, one of the founding members of The American. Although it was not widely known, he was thoroughly familiar with Freud's writings. Indeed, when Zilboorg gave several seminars on the history of psychoanalysis at the Phipps Clinic, Meyer not only attended but corrected several of Zilboorg's misquotations and errors concerning the sequence of Freud's writings. However, he turned away from Freud and analysis because of what he considered its premature systematization and increasingly complex metapsychology, as well as because of its initial emphasis on the unconscious sources of rational thought and the belief that human motivations could be traced to vicissitudes of sexual and aggressive drives. Such concepts obviously went counter to Meyer's emphasis on the therapeutic use of mental capacities to bring about changes in patients' outlook and behavior.
It was, however, not Meyer's acceptance and later rejection of Freud and psychoanalysis that is of major importance to American psychoanalysis, but rather that he and his many students had been teaching a genetic-dynamic orientation and had turned away from Kraepelin's rather rigid classification of disease entities; rather than adhering to an organic approach, as was the case in almost all European medical schools, he had prepared the way for the dynamic psychoanalysis which had been considered nonsense by many, if not most, continental professors of psychiatry.
Dr. Pappenheim writes, “Gradually, it dawned on me how much Meyer wanted to be the founder of a new school. Deep inside he knew that he had not … nobody would carry on his teaching.” Meyer did not wish to develop a “school of psychiatry” and indeed avoided it. He did not believe that he had final answers, but he taught an orientation, an approach to understanding patients and human behavior. He did not seek disciples, for he sought students, and he tolerated and even provided different orientations to psychiatry at the Phipps Clinic for his students and himself. “Nobody would carry on his teachings”? Only a large majority of the chairman of departments in the U.S.: Campbell at Harvard, Diethelm at Cornell, Ebaugh at Colorado, Ackerly at Louisville, Jones at Dalhousie, Lyman at Duke, N. Cameron at Wisconsin, etc., as well as Henderson at Edinburgh, Gillespie in London, and Odegard in Oslo. Not all taught Meyerian psychobiology (and some who thought they did, didn't), but all had been greatly influenced by having studied under Meyer.
Dr. Pappenheim provided a sketch of a pleasant but rather limited and even petty man. She was unfortunate. Meyer was highly cultured and a very wise man. His broad and rather diffuse approach did much to prepare American psychiatrists for the more organized concepts of psychoanalysis. His influence did not prevent many of us from becoming analysts, though because of him what some of us learned in psychoanalytic institutes was seasoned by a touch of skepticism.
Ruth Wilmanns Lidz, M.D.
Clinical Professor of Psychiatry Yale University
Theodore Lidz, M.D.
Sterling Professor Psychiatry Emeritus Yale University