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The Year Neurology Almost Took Over Psychiatry

The Year Neurology Almost Took Over Psychiatry

In December 1880, the emerging profession of neurology almost absorbed psychiatry, which had established itself four decades earlier. The final confrontation was the culmination of an extremely bitter three-year battle, and the outcome was very much in doubt as representatives of each side prepared to testify before the New York State Senate Investigative Committee on Asylum Management. One possible outcome would be the recommendation that neurologists be given administrative control of the state asylums and, effectively, of psychiatry. Other states watched New York's battle closely and seemed likely to follow its lead.

The events of 1880 and their antecedents are little-known to contemporary psychiatrists and neurologists. Understanding these events, however, is relevant to the present, since psychiatry and neurology are moving ever closer together. Increasing numbers of psychiatrists are also taking training in neurology. In Bethesda, Md., the administrative offices of the National Institute of Mental Health (NIMH) and the National Institute of Neurological Diseases and Stroke (NINDS) share the same building, and some NIMH and NINDS laboratories share common space. Some professionals believe it is just a matter of time before NIMH and NINDS merge into a National Institute of Brain Research. Psychiatry and neurology may ultimately become a single profession.

Like many professional turf battles, the neurology-psychiatry imbroglio was based on big ideas and even bigger egos. The leader of the fledging neurologists was 48-year-old William Alexander Hammond, M.D., a large man, "pompous and arrogantwith a voice so powerful that [he] could be heard upwind in a hurricane" (Haymaker, 1953). Like most of the emerging neurologists of his time, he acquired his skills treating war injuries during the Civil War. He had become Surgeon General of the Union Army, but in 1864 was charged with "irregularities in granting contracts for hospital supplies" and court-martialed (Werman, 1973). He then established a private practice of neurology in New York City, charged high fees and became very wealthy. He was one of seven founders of the American Neurological Association in 1874 and was appointed to the first professorship of nervous and mental diseases in the nation.

The leader of the more established psychiatrists was 51-year-old John Perdue Gray, M.D., known for his 300-pound girth and said by some to be "autocratic," "powerful and manipulative," and "an enduring hater" (Rosenberg, 1968). In 1844, he was one of the 13 founders of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), which later became the American Psychiatric Association. He was also superintendent of the Utica State Lunatic Asylum in New York, editor of the American Journal of Insanity (now the American Journal of Psychiatry) and an advisor to government officials, including President Lincoln.

The battle between the psychiatrists and neurologists was for control of the state insane asylums, with the accompanying patronage system of jobs, and the teaching of mental disorders in medical schools. The psychiatrists claimed that they had been running the asylums for more than half a century and were best qualified to do so. The neurologists countered that the psychiatrists were incompetent, failed to do research on psychiatric disorders and focused almost exclusively on the administrative aspects of their jobs. Furthermore, the neurologists believed themselves to be the true experts on all brain disorders, including various forms of neuroses. Neurologist George Beard, M.D., coined the term neurasthenia in 1869, and many neurologists were practicing forms of what today would be called psychotherapy. In short, the neurologists claimed, "the study of insanity should be considered a subdivision of neurology" (Spitzka, 1878a).

Hammond and Gray initially clashed during the 1871 trial of David Montgomery who was accused of killing his wife. Gray testified that Montgomery, who had epilepsy, was insane at the time. Hammond argued that the defendant was "perfectly sane" and that Gray's testimony was a product of his "want of practical experience with epilepsy or insanity" (Echeverria, 1873). Hammond won the case.

The feud continued to simmer until 1878, when neurologist Edward Spitzka, M.D., a close associate of Hammond's, publicly attacked the psychiatrists. The asylum superintendents, said Spitzka (1878b), were selected "on grounds of nepotism and political favor," showed only "apathy and ignorance manifested by [their]dereliction of scientific duty," and were mostly concerned "over the prizes gained by their hogs and strawberries [from the asylum farms] at agricultural fairs." Spitzka also attacked Gray personally, calling him an "indifferent, superficial man, owing his position merely to political buffoonery" and accused him of having "harmoniously confused, if not falsified, the [asylum's] financial statements."

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