Manufacturing depression (13 page)

News of his mother’s suffering was only one of the difficulties that Meyer encountered in his newly adopted country, to which he’d gone only as a last resort. After medical school,
he had wanted to stay on in Forel’s lab
, but he had already shown an independent streak—secretly expanding his thesis research beyond the task Forel had assigned him, setting up a lab in his home to explore a
novel staining technique that the master had resisted, and refusing to become a “militant total abstainer” like his teetotaling professor. Meyer had studied with leading doctors in Paris and London, even met Jean Charcot and Thomas Huxley, but nothing came of his efforts to develop these contacts into the cutting-edge medical career he wanted. His remaining option, to join his physician uncle in his Swiss country practice, was an untenable choice for a brilliant and restless young doctor—especially when across the ocean was a country that, at least by reputation, welcomed the pioneering spirit.

Before he left Europe for America, he wangled an introduction to the great doctor William Osler, visiting England from Johns Hopkins, where he was president. But Osler wouldn’t have him—because, as a chagrined Osler later explained, the man who had introduced him to Meyer was
an “old humbug.”
Then H. H. Donaldson, a Clark University professor, told Meyer that he and the rest of his department were decamping to the University of Chicago, leaving a raft of openings behind. But when Meyer applied, psychologist G. Stanley Hall, Clark’s president and the man who later brought Freud to America for the first and only time, lied and told him no jobs were available. Finally, Meyer decided to follow Donaldson to Chicago and see what happened.

At first, Meyer found only an unpaid fellowship, and he was soon forced into what he had fled Switzerland to avoid: clinical practice. He wasn’t about to give up his laboratory dreams, however.
His office was upstairs
from a shoe store, and his few patients found themselves in a suite so stuffed with preserved brains and vials of chemicals that it looked more like a mad scientist’s lab than a doctor’s office. For a year, he hovered on the periphery of his profession, showing up at scientific meetings and submitting papers about his experiments, until finally Ludvig Hektoen, a professor at Chicago, told him that the institution he had just left—the Illinois Eastern Hospital for the Insane, in Kankakee—was looking for a pathologist. Meyer sent off an application, complete with references from famous doctors in Europe and America, while Hektoen greased the skids
with a letter to Richard Dewey, the hospital’s superintendent. Meyer thought his gamble on America was about to pay off.

Which it did, but not before something else Meyer hadn’t counted on intervened: American politics, in particular the regime change in Washington that swept Grover Cleveland into office for the second time, which trickled down to Springfield, Illinois, where the first Democratic governor in twenty-five years immediately purged Republicans from state government, including the people overseeing the asylums. Dewey lost his job during the same week that Hektoen sent his letter. Back in Chicago, Meyer, unaware of this upheaval, heard nothing. After nearly a month, he decided to take matters into his own hands, got on a train to Kankakee, and knocked on the door of the new superintendent, who hired him on the spot. Meyer was proving himself an excellent fit for America’s can-do economy.

Meyer was eager to work at the Kankakee asylum because it had an ample supply of exactly what he needed: diseased brains and insane people. Back in Europe, Kraepelin was still looking for the pathological anatomy that would anchor his diagnostic scheme. Correlating brain pathology to insanity seemed to be the key to understanding both normal and abnormal mental functioning, and Kankakee, with its busy wards and autopsy labs, offered a perfect opportunity to make those connections, or so Meyer thought.

But he soon developed doubts about the soundness of his enterprise. Part of the problem was purely administrative: a hospital staff “
hopelessly sunk into routine
and perfectly satisfied with it” was not interested in exploring the physiological basis of mental illness. Indeed, they had despaired of even agreeing on their patients’ diagnoses and as a result had developed an “unwillingness to really collect facts needed for diagnostic decisions.” Ten years later, he still complained that

their reasoning for diagnosis
followed rather general impressions than definite and precise statements of fact, and failed
to make a sufficiently clear distinction between what was actually found and what was merely supposed to exist.

What the staff really wanted to do was dissect brains, which led Meyer to believe that “
the existence of a pathologist
in a hospital for the insane was a poor remedy for that which was actually needed.”

At a coroner’s inquest, Meyer made clear what he had come to think was a better remedy. He had just presented his analysis of the brain of an inmate (who had died from a heart attack) when a juror said, “
Now, doctor, show us
what you find in the mind.” Meyer responded, “There [are] more mental findings in the history than the brain.” Even if, as one American psychiatrist had put it in 1870, “
mind cannot be diseased
, only body,” it was a mistake to ignore mind; its ravings may have been meaningless in themselves, but, as Kraepelin said, they revealed the nature of the disease that caused them. Doctors should dissect the disease as carefully as the tissue, Meyer thought; especially given the state of knowledge about the brain and the difficulty of neuroanatomical research, this was the more fruitful avenue. Meyer, in other words, meant to spread the Kraepelinian gospel—not only to Kankakee but to all of American psychiatry.

As Meyer taught his colleagues the art of taking patient histories, making close observations of symptoms, course, and outcome, and rendering accurate diagnoses, he ascended the professional ranks and was soon fulfilling his ambition—teaching at the University of Chicago, delivering papers around the country, hobnobbing with politicians responsible for funding his asylums. But he was still deeply troubled by his mother’s depression. He thought of his meteoric ascent and the changes he was trying to make as a response to his “
lasting wish
that I might pay back and give some compensation during her life, something more than gratitude.” The career that he devoted to his mother was more than illustrious. Inspired in part by her recovery, Adolf Meyer changed American psychiatry in ways that he never would have imagined.

*      *      *

While Adolf Meyer was bringing European nosology to the New World, America was working its charms on him. Kraepelin’s therapeutic nihilism, his sense that there was nothing to be done besides diagnosis and segregation, didn’t square well with American sensibilities. John Winthrop’s vision of America as a City upon a Hill, built through individual efforts at self-improvement, had, by the end of the nineteenth century, turned into the dynamic, bustling free-for-all of entrepreneurial capitalism. The pursuit of happiness—in the original, economic sense of that phrase—was turning out to be not the privilege of only a few, but the opportunity and perhaps even the imperative for everyone. The idea that mental illness was forever, that a class of people, by dint of constitution alone, couldn’t improve themselves and would thus be excluded from the hunt for freedom and riches, didn’t square with Thomas Jefferson’s egalitarian promise. It was only a matter of time before therapies evolved to resolve that conflict.

You never know exactly why a person gets the ideas he does, but it is significant that within a couple of years of arriving in Chicago,
Meyer met Jane Addams
. In 1894, he spent a week as her guest at Hull House, where Addams was helping poor people improve themselves. She was also campaigning for the protection of children from exploitative employers, violent parents, and all the other ravages of poverty. A year later, Meyer published a paper in which he raised the question of whether it was really true that parents had to “
accept the disposition
of the child as a gift that must be taken without grumbling”; perhaps, he said, there was a “period of plasticity” during which character was formed. If so, then “
early prevention of danger
,” the phrase he used to title his paper, was possible and even crucial.

The implications of this line of thought went well beyond child-rearing practices. American psychiatry, no less than European, was bound by the conviction that mental illnesses were either endogenous,
an immutable property of the individual’s constitution, or exogenous, the result of damage done by injuries or toxins like alcohol or syphilis. In either case, the disease was the result of impersonal, biological factors. Patients in the grip of insanity were no more responsible for contracting it or for how it made them behave than doctors were for curing it. But if, as Meyer was beginning to think, parents could influence the outcome of their children’s mental lives, then by extension perhaps life events in general could play a role in the development and healing of mental illness.

Meyer was ready to answer the nature/nurture question with a resounding “yes.” “
The human organism
can never exist without its setting in the world. All we are and do is of the world and in the world,” he said. And he wanted to leave such hoary philosophical questions—something Meyer associated with his native continent—at that. “
Steering clear of useless puzzles
liberates a new mass of energy,” he said. “The question why is mind mind, and just what it is, can be as little answered as what gold is and why it is, and why it should be so.” In
his newfound pragmatism
Meyer revealed the influence of another Chicagoan, whom he met shortly after Jane Addams: John Dewey, who in turn introduced him to his friends Charles Peirce and William James—whose
Principles of Psychology,
which also rejected nature and nurture as the only possible explanations for human behavior, appeared in 1890. Influenced by this trinity of American pragmatism, Meyer declared that
the job of psychiatrists
was to understand people in their natural setting and help them adapt to it. Exogenous/endogenous, nature/nurture, mind/body—none of these tiresome questions was going to tell us much about life as we lived it, which was as an active force trying to grapple with all the complexities of everyday life.

Meyer’s head was filled with these new ideas when he returned to Europe in 1896.
There he found his mother
recovered from her depression, which now appeared in a new light. Perhaps it had not been the result of a constitutional or anatomical defect, but a reaction—not only to his departure, but to loss. Perhaps her “delusion” that
Meyer was dead was an accurate reflection of her experience, one that made sense of her depression, that provided it with meaning. After all, within a few years, her husband and daughter had died, her son Hermann had moved to the French side of the country, and her remaining son, Adolf, had left for America. Maybe it
felt
to her like Adolf was dead—or maybe, as Sigmund Freud would suggest twenty years later, her depression was her only way of expressing her anger toward him for abandoning her. And perhaps her reactions to her “natural setting” had changed. Perhaps she had, as Meyer would later say, adjusted.

Meyer spared his mother’s psyche too much exposure, so we can’t know these specifics. But we do know that after his visit home, he went to Heidelberg to spend six weeks with Emil Kraepelin, who had just published the fifth edition of his
Lehrbuch.
His sojourn at Heidelberg did nothing to restore his faith in Kraepelinian nosology, and by the time he returned to America he was ready to renounce it. The idea of finding patterns of symptoms was a good one, he said. But all too often, he thought, “
the supposed disease
back of it all is a myth and merely a self-protective term for an insufficient knowledge of the conditions of reaction and inadequacy of our present remedial skill.” Indeed, Kraepelin’s vaunted diagnostic system was filled with what Meyer would come to call “
neurologizing tautologies
.”

Meyer had an idea about how to correct Kraepelin’s error, and it was much more in keeping with life in his adopted home. Instead of relying on a specious classification of diseases, he asked,

can we not use general principles
and valuable deductions without pulling them into the service of a vicious attitude of mind, the attitude of that medical conceit which delights in surrounding the diagnosing and prescribing with a mystic halo so much adored by the patients trained to see wonders in the wise terms? Why not regard the “diagnosis” as merely a convenient term for the actually ascertained facts which…tell a clear and plain story?

In other words, instead of anchoring diagnosis in a yet-to-be-discovered neuroanatomy, why not simply tie it to life as it is lived? Why not move beyond the “appeal to cell-biology and correlation of sciences” and toward the “plain facts of history and the reactions of the patient”?

Meyer wasn’t merely modifying Kraepelin or reinterpreting his statistics. He was repudiating the German master, reversing his dictum to ignore the patient and eschew empathy in favor of a psychiatry that listened, and listened carefully, to the actual experience of his patient. “
There is no advantage
,” he told his fellow doctors, in merely looking for “‘symptoms’ of set ‘disease entities’ that would allow us to dump all the facts of each case under
one term or heading
” [emphasis original]. Searching for pathology, a doctor “surrenders his commonsense attitude” and fails

to view the abnormal
mental trend as a genuine but faulty attempt to meet situations, an attempt worthy of being analyzed as we would analyze the blundering of a distracted pupil, or the panic of a frightened person, or the bumbling of one who reacts poorly in trying to meet an unusual situation.