Adolf Meyer (1866-1950) was the dominant figure in American psychiatry during the first four decades of this century. He was a major force in molding psychiatry into its current form, but his teachings have become so solidly incorporated into American psychiatric theory and practice that the sweep and depth of his influence are often over-looked. He gave American psychiatry its pluralistic and instrumental orientation; its holistic approach to human problems; its conceptualization of psychiatric disorders, including schizophrenia, as reaction patterns rather than discrete disease entities; its concern with the psychotherapy of the psychoses. His contributions have been eclipsed, but not displaced, by those of Freud and by the ascendancy of psychoanalysis.
Meyer was born in Niederweningen, near Zurich, Switzerland, and emigrated to the United States soon after receiving his doctoral degree in 1892. He filled, in succession, the positions of neuropathologist at Kankakee State Hospital in Illinois, clinical director at Worcester State Hospital in Massachusetts, and chief of the Pathological Institute of New York’s state mental hospitals. He increasingly became convinced that the essential pathology of mental disorders is to be found in the person and not in the brain cells. When the Johns Hopkins Medical School decided to establish a department of psychiatry in 1908, Meyer was the obvious and unanimous choice for the new professorship. He remained at Hopkins until his retirement in 1941, by which time he had long been recognized as the dean of American psychiatrists.
The cultural setting may have determined the orientation of psychiatry in the United States. In a country in which people were undergoing rapid acculturation, the importance of environmental influences upon personality change was more apparent than in Europe. Even though Meyer was a Swiss, he was particularly suited by birth and training to introduce a characteristically American pragmatic, pluralistic, and instrumental approach into psychiatry. He was born into a family that considered itself the spiritual heir of Kleinjogg (Jakob Gujer), a folk philosopher who had practiced and taught an “instrumental” approach to farming and communal living, combating the superstitions and the confining traditional usages of the farmer. Meyer had gained an exceptional grounding in neuroanatomy and neuropathology under Constantin von Monakow and Auguste Forel and, while studying abroad, was attracted by Thomas H. Huxley’s evolutionary and ecological approach to biology and by Hughlings Jackson’s concepts of the integration of the nervous system. Soon after his arrival in the United States he came under the influence of those men who had shaped the American philosophical and sociological tradition—Charles Peirce, William James, John Dewey, G. H. Mead, and C. H. Cooley.
Meyer fused these various influences into a new conceptualization of human behavior, which he termed psychobiology, or ergasiology. He recognized that the Jacksonian concepts of the evolution and integration of the nervous system needed to be extended to include the highest level of integration through mentation: what man thinks affects his functioning down through the cellular and biochemical level, but, conversely, his thinking and feeling can be affected by the functioning of the organism at all levels of integration. Psychobiology offered an approach to the mind–body problem that obviated the need for the unsatisfactory mind–brain parallelism that had directed scientific attention to the study of the brain, to the neglect of the processes of living.
Meyer made a number of fundamental contributions to neuroanatomy and neuropathology, including the discovery of the temporal-lobe detour of the optic radiations, termed “Meyer’s loop,” and his studies of central neuritis and aphasia; and he introduced the construction of plasticine models into the teaching of neuroanatomy. However, he increasingly directed his attention to problems of the essentially human aspects of behavioral integration.
Although Meyer welcomed the development of psychoanalysis and particularly its emphasis upon early childhood experiences and upon the role of symbolization, he considered the focus upon instinctual vicissitudes and unconscious motivations as unduly limited and neglectful of the total person. He increasingly opposed the premature oversystematizations in Freud’s theorizing. Meyer insisted upon studying the problems of human adaptation and integration in their total complexity.
Meyer’s conception of psychiatric disorders as types of reaction patterns that are exaggerations of, aberrations from, or substitutions for, more normal and workable ways of living profoundly influenced the course of psychiatry. He turned away from psychiatry’s efforts to become part of the mainstream of medical science by discovering some unknown biological or neuroanatomical basis for insanity, and chose instead to examine how people’s ways of living and thinking can go astray. Of particular moment was his extension of this reaction-pattern concept to schizophrenia, as outlined in his 1906 paper “Fundamental Conceptions of Dementia Praecox” (Collected Papers, vol. 2, pp. 432-437), which emphasized that schizophrenia can result from deterioration of habit patterns, including habits of thinking. At the time, he stood almost alone in considering that schizophrenia may be a disorder of the personality rather than of the brain or its metabolism. His dynamic concept of schizophrenia also led to his insistence that patients suffering from schizophrenic reactions are amenable to psychotherapy and resocializing measures.
At the Henry Phipps Psychiatric Clinic of the Johns Hopkins Hospital, which opened in 1914, Meyer developed the first significant teaching and research psychiatric hospital that was an integral part of a medical school. It provided the model for medical school teaching and residency training in psychiatry for the next quarter century. A large proportion of the outstanding psychiatric teachers and investigators in the United States and Great Britain trained under Meyer, spreading his orientation throughout the English-speaking world.
Meyer was a man of broad vision, and his energy was sufficient to turn vision into reality. When he retired, psychiatry was on the verge of the vast expansion that followed World War II. Meyer had guided and nurtured it through its immaturity, propounding a psychiatry that had roots in both the biological and behavioral sciences, countering premature theoretical closures by his insistence upon a holistic and pluralistic approach, and fostering a psychotherapeutic approach to the psychoses.
[For the historical context of Meyer’s work, see the biographies ofCooley; Dewey; James; Mead; Peirce. For discussion of the subsequent development of his ideas, seeMental Disorders, article on Biological aspects; Psychiatry; Schizophrenia.]
Collected Papers. 4 vols. Edited by Eunice Winters. Balti-more: Johns Hopkins Press, 1950-1952. → Volume 1: Neurology. Volume 2: Psychiatry. Volume 3: Medical Teaching. Volume 4: Mental Hygiene.
Bleuler, M. 1962 Early Swiss Sources of Adolf Meyer’s Concepts. American Journal of Psychiatry 119:193-196.
Campbell, C. Macfie 1937 Adolf Meyer. Archives of Neurology and Psychiatry 37:715-731.
Ebaugh, Franklin G. 1937 Adolf Meyer: The Teacher. Archives of Neurology and Psychiatry 37:732-741.
Swiss-born American psychiatrist who developed the concept of psychobiology.
Adolph Meyer was born in Niederweningen, Switzerland, and received an extensive medical education in neurology in Zurich, obtaining his M.D. in 1892. He emigrated to the United States in the same year. Beginning in 1893, Meyer worked for several hospitals, including a state hospital in Kankakee, Illinois, as a pathologist, and the New York State Hospital Service Pathological Institute, where he was involved with the training of psychiatrists. Meyer later joined the faculty of Cornell Medical College in New York City, where he served as professor of psychiatry. In 1909 G. Stanley Hall (1844-1924), a prominent psychologist and former student of William James , invited Meyer to Clark College in Worcester, Massachusetts, on the occasion of the college's twentieth anniversary, where he met with Sigmund Freud and Carl Jung .
In following year Meyer was appointed professor of psychiatry at Johns Hopkins University and director of its Henry Phipps Psychiatric Clinic, which became an internationally renowned training center for psychiatrists.
Meyer became so influential in his adopted country that he was known as "the dean of American psychiatry," and his work has had a wide influence on psychiatric theory and practice. In Meyer's view, the diagnosis and treatment of a mental disorder must include a thorough understanding of the patient as a whole person. This approach, which would today be termed "holistic," involved studying the patient from various perspectives— medical, biographical, educational, and even artistic. It was this goal that led him to introduce the use of the individual case history, bringing together in one place information about a patient's physical condition, past history, family life, work situation, and other facts that could be relevant to treatment. Meyer also pioneered in promoting visits to the patient's family in order for the psychiatrist to understand the environment in which the patient lived, and to which he or she would return when treatment was completed.
Meyer believed that the constituent elements of human existence are actively interrelated, from the lowest biochemical level to the highest cognitive level. Arguing that psychological factors may be as important as neuropathology in causing mental illness , Meyer advocated integrating the studies of human psychology and biology into a single system that he called psychobiology. The goal of psychobiological therapy was the successful integration of different aspects of the patient's personality . Steps involved in this psychotherapy included analyzing the psychological, sociological, and biological factors relevant to the patient's illness; working with the patient on a conscious level, staying close to the original complaint; and utilizing a combination of treatment methods satisfactory to both psychiatrist and patient.
Through therapy that addressed both short-term and long-term problems, Meyer's goal was to help the patient adjust as well as possible to life and change. Part of the therapy process consisted of aiding the patient in modifying unhealthy adjustments to his or her situation through guidance, suggestion, and reeducation, which Meyer called "habit training." His emphasis on habits extended to include schizophrenia , which he viewed as caused by harmful habits acquired over a long period of time, in combination with biological factors, including heredity . Neurosis , Meyer believed, differed from psychosis in that only a part of the personality was involved. He viewed neurotic patients as suffering from unrealistic expectations and the inability to accept themselves as they were.
Meyer, together with Clifford Beers , was also a founder of the mental hygiene movement (and the one who suggested its name). The goal of this movement was to educate the public about mental illness and achieve more humane treatment of institutionalized patients. Meyer contributed significantly to the medical literature on psychiatry. His papers were collected and published in Collected Papers (1950-1952).
Casabella, xlvi (1982), 40–7;
A. Meyer (1925);
Neue Frankfurt, iii/9 (1929), 165–82