Henderson and Meyer in correspondence: a transatlantic history of dynamic psychiatry,1908–29

Introduction: Henderson, Meyer and a transatlantic correspondence

The ‘dynamic’ approach of Adolf Meyer, leading figure of North American psychiatry, became incorporated within the British psychiatric profession during the early twentieth century. A century on, the transatlantic movement of dynamic psychiatry from North America to Britain continues fundamentally to inform British clinical psychiatry (Gelder, 1991: 419–435). When a psychiatrist ‘takes a case history, make[s] a life chart … or work[s] in a multidisciplinary team’, they are likely using the Meyerian theory and method; indeed, precisely because the Meyerian method is so ingrained, it is ‘easy to forget … there was a time when things were different’ (Gelder, 1991: 419).

To forget the provenance of a system on account of its familiarity is plausible, but this paper suggests that forgetting may also result from ‘philosophical and methodological issues’ within academic historiography (Wallace, 2008: 3). Ellenberger’s monumental The Discovery of the Unconscious (1970) once dominated historical understanding of dynamic psychiatry, establishing its history as that of a distinctively psychoanalytic psychiatry. However, a different history can be told, one populated by, and of moment to, the Scottish psychiatric profession. This claim echoes scholars who recognize geographical difference in the history of dynamic psychiatry (Tomes, 2008: 658), for example:

The term ‘dynamic psychiatry’ … often carries different connotations in the U.K. and the U.S./Canada. In the former it tends to refer to Adolf Meyer’s ‘psychobiology’ (which Meyer occasionally termed ‘dynamic psychiatry’). In North America, however, it has become interchangeable with ‘psychoanalytic psychiatry’. (Wallace, 2008: 3)

By using the term dynamic psychiatry for Meyer’s ‘psychobiology’ rather than following late twentieth-century North American usage, the present paper seeks to deepen understanding of dynamic psychiatry within Britain. Through analysis of personal correspondence and contemporary psychiatric literature, as well as biographical and autobiographical sources, it focuses on the early career of Dr (later Sir) David Kennedy Henderson. Relying on contemporary correspondence – between Henderson and Charles Macfie Campbell, the early pioneers of dynamic psychiatry in Scotland, and their mentor in North America, the Swiss émigré Meyer – this study breaks from Ellenberger’s narrative. It reconstructs a complex transatlantic history of clinical practices and medical theories, situating the British, and specifically Scottish, pioneers of dynamic psychiatry in the context of North American influences. Encompassing much more than a psychoanalytic orientation, it offers greater appreciation of the role played by Anglo-American professional relations in shaping Scottish psychiatry through to the present era (Double, 2007: 337; Engel, 1977: 135; Pilgrim, 2002).

Recent scholarship captures the significance of Henderson to the history of Scottish psychiatry (Andrews and Smith, 1996; Beveridge, 2011; Davis, 2008; Gelder, 1991; Smith and Swann, 1993). Henderson, having trained with Meyer from 1908 to 1915, was the first psychiatrist fully to embrace Meyer’s dynamic approach in a British mental hospital, and is recognized as fundamental to the establishment of Meyerian psychiatry in Scotland (Pilgrim, 2002: 586). Thoroughly immersed in Meyerian teaching, Henderson’s jointly authored Text-Book of Psychiatry (Henderson and Gillespie, 1927) became the standard text for medical students undertaking postgraduate examination in psychiatry, while his work on Psychopathic States (Henderson, 1939) became world-renowned. Yet with the exception of Henderson’s semi-autobiographical monograph The Evolution of Psychiatry in Scotland (1964), the published record neglects the formative period in Henderson’s training and intellectual development that enabled him to transport Meyer’s dynamic approach to Scotland.

The purpose of this paper is therefore threefold: to deepen an understanding of dynamic psychiatry within a British, and specifically Scottish, context; to fill the gap in scholarly knowledge about the significance of Henderson’s early career; and to emphasize that Henderson’s employment of dynamic psychiatry in Scotland, while pioneering, was fraught with misadventure and opposition. The Evolution, while written to explicate what Henderson saw as the fundamental psychiatric developments of his era, is recognized as a truly credible source only when read against the context of contemporary correspondence records. The Alan Mason Chesney Medical Archives (AMC) at The Johns Hopkins Medical School, Baltimore, Maryland, house a rich deposit of such correspondence. Revealing a range of ambitions, motivations and frustrations that Henderson’s retrospective analysis largely eschews, these transatlantic letters speak more than any ‘official record’ of the daily routines, often mundane events, which shaped his professional outlook.

Royal Edinburgh Asylum, Morningside, 1907–8

Recalling his medical training between 1901 and 1907, Henderson confessed that his adverse reaction to the ‘warm atmosphere’, the ‘smell of anaesthetic’ and the ‘glittering surgical instruments’ of the operating theatre propelled him towards a career in psychiatry. Fearing the dire consequences of failing in a surgical emergency, Henderson’s interest turned to the vivid case histories presented by Thomas Clouston, the Edinburgh University Lecturer and Physician-Superintendent at the Royal Edinburgh Asylum (REA), Morningside, in his Clinical Lectures on Mental Diseases (Henderson, 1964: 59, 137–8). Despite being warned of the slow professional advancement faced by young psychiatrists, Henderson acquired a letter of introduction to Clouston (p. 136), facilitating his appointment as an unpaid clinical assistant on the staff of the REA (p. 59). Scholars have used Clouston’s Clinical Lectures (Clouston, 1892) to exemplify late nineteenth-century Scottish psychiatry as dominated by a somaticist perspective (Berkenkotter, 2008: 84). For Clouston, ‘mental disease’ was understood as ‘brain disease’ rooted in contemporary understandings of human physiology (Berkenkotter, 2008: 85; Beveridge, 1991: 375; Thompson, 1988: 316). Bringing together ‘evolutionary, degenerationist and criminal anthropological theories’ to account for the aetiology of mental illness, he portrayed mental disorder as the aberrant ‘functioning’ of a complex and highly variable human physiology (Berkenkotter, 2008: 85).

Henderson (1964: 141–2) recalled that, upon entering the REA (often called Morningside), the ‘prestige and eminence’ of Clouston ‘was felt throughout the entire hospital’. Nonetheless, this prestige was waning, Clouston’s reputation becoming merely that of the ‘Grand Old Man’ of psychiatry (Beveridge, 1991: 365, 375). Henderson found that behind the imposing façade of the REA was a dire lack of medical facilities. With no operating theatre, there was little provision for medical emergencies; with no clinical side-rooms or admission units, patients young and old, demented or recovered, quiet or disturbed, were housed indiscriminately (Henderson, 1964: 148). The ‘psychoneurotics’, whose cases attracted emergent psychoanalytic schools on the Continent, were perceived as ‘the particular province of neurologists who treated them in … private nursing homes’ (p. 142). Under such conditions, the work of a junior member of staff could be ‘monotonous’, unscientific and uninspiring (p. 149). Tellingly, the correspondence shows an undercurrent of professional unrest stirring among Clouston’s colleagues. Letters written between Campbell and Meyer reveal that there were spaces within Morningside evading Clouston’s observation and control, ones where dynamic-psychiatric methods began to seep into a Scottish mental hospital.

Morningside consisted of two divisions, with West House for rate-aided and Craig House for fee-paying patients (Davis, 2008: 49–50). Campbell, Clouston’s junior assistant, was consigned the rate-aided patients of West House. Fluent in French and German, Campbell had studied under famed psychiatrists and neurologists such as Franz Nissl in Heidelburg, Pierre Marie in Paris and the (then) lesser-known Meyer in New York, and it was he who introduced Henderson to a more optimistic, dynamic approach to psychiatry (Henderson, 1964: 146–7). Writing to Meyer on 30 November 1907, Campbell expressed his pleasure in having attained one-half of Morningside under his direct observation, but also displeasure at the quality of his superiors’ medical knowledge. Positioning himself as an outsider to the established Scottish psychiatric profession, he identified the hierarchies and barriers, ideological and socio-geographical, obstructing the transatlantic movement of Meyerian psychiatry to Scottish shores.

Rutherford resigned from the Crichton on a pension of £1600; … No one ever accused him of knowing anything about mental disease. Eastbrook, of Ayr, … has got the Crichton post. That left Ayr vacant and two senior men here both applied for it – Rutherford the first assistant and McRae his junior, … McRae has just been appointed … Personally he does not attract me much, … he does not … think that a frank discussion of the subjects which interest us both would be worth having … . (AMC1, 30 Nov. 1907, I/595/1)

Campbell’s relocation to West House coincided with him acquiring Henderson as clinical assistant: ‘I have just got a clinical assistant here and have started him on the case-taking outlines, so for the first time since America was discovered a junior here is learning to make a thorough examination of a case’ (AMC1, 30 Nov. 1907). Presenting Henderson with emerging methods of case note construction, as pioneered by Meyer, a ward round under the guidance of Campbell soon became ‘an exciting adventure’ (Henderson, 1964: 147). Henderson was now taught to think of mental illness in terms of ‘reaction types’ rather than adopting the rigid somatic-pathological diagnostic categories then prevailing in Scotland. Encouraged to note the contents of patients’ utterances and to question the aetiological significance of patients’ social backgrounds, Henderson began to craft case notes along Meyer’s psychobiological lines (p. 147).

Campbell explained to Meyer a significant barrier facing the diffusion of his psychobiological methods: ‘I hand out various things to Dr Clouston from time to time … your article on dementia praecox [underlined], your clinic cases, a type-written record etc. and he is always much interested …’. Yet, questioned Campbell, ‘can we not persuade you to prepare the medical mind for ultimate truth by some tentative formulations or presentation of limited conclusions? … there is such a dearth of good case-material well discussed in our literature …’ (AMC1, 30 Nov. 1907, I/595/1). Despite Meyer publishing extensively, his writings were ‘convoluted, longwinded and esoteric to a fault’ (Double, 2007: 332), and followers were deprived of a single unifying text that could communicate his psychobiology better to sceptical others. If his publications alone were unlikely to transmit psychobiology, then it was instead through his colleagues’ practical application of Meyerian methods that psychobiology would infiltrate Scottish psychiatric practice (Davidson, 1980: 137–8). The need for Scottish psychiatrists to train under Meyer was the logical conclusion drawn by Campbell, and in the following months Henderson became a candidate.

On 28 March 1908, Campbell wrote to Meyer asking that his friend and clinical assistant ‘Dr D. K. Henderson’ join Meyer at the New York Psychiatric Hospital. ‘He is bright and intelligent’, wrote Campbell, ‘honest in his work … socially he is a great favourite.’

… we should be much indebted to you if you could train some men for us. As we have no central institute in Scotland which can have some authority over the individual asylums there is really no means of reaching the senior men, … The only hopes lie with the young graduates … I should like immensely to see Henderson spend a year or two with you and then return to till the ground here … . (AMC1, 28 Mar. 1908, I/595/1)

Meyer accepted Campbell’s proposition and, to the latter’s surprise, also offered the position of Senior Clinical Assistant at New York to Campbell himself. ‘I thought’, wrote Campbell, ‘that my path was chosen’, but, after being offered this opportunity to work again with Meyer, he resigned his Edinburgh post (AMC1, 8 Apr. 1908, I/595/3). Accompanied by his new wife, Campbell took the opportunity – before moving to America – to meander his way through Europe, visiting the laboratories of Alois Alzheimer, walking through the Volksgarten of Vienna with Sigmund Freud, and meeting many other psychiatric notables: he was juggling the life of a tourist with that of an aspiring psychiatrist, all during this most eclectic of honeymoons (AMC1, 2 July 1908, I/595/1). This spirit of adventure, of international and interdisciplinary collaboration, also proved infectious to Henderson. Setting sail in autumn 1908, he was reunited with Campbell in Manhattan, forming part of Meyer’s clinical and neuropathological research team.

Wards Island, 1908–11

In 1908 Henderson joined the Pathological Laboratory of the New York State Hospitals, Wards Island. As part of the laboratory’s research team, he assisted Meyer in neuropathological and clinical research on some 4500 patients. Reunited with Campbell, Henderson spent his first year on a female ward of the mental hospital, studying a variety of affective disorders such as schizophrenia, paranoid states, psychopathic states and a number of psychoneurotic patients (Henderson, 1964: 160).

As medical historian Nancy Tomes explains, North American practitioners collectively defined as pioneers of dynamic psychiatry, such as Meyer, Elmer E. Southard and William Alanson White, envisaged mental illness as the ‘interaction of biological, social, and psychological factors’ (Tomes, 2008: 658). Hailed during his lifetime as the ‘Dean of American Psychiatry’, Meyer was instrumental in promoting a new conception of the mind which broke from a prevailing North American ‘extreme somaticism’ (Lamb, 2010: 1–2). He defined mental illness as the ‘cumulative result of unhealthy reactions of the individual mind to its environment’, and thereby replaced the concept of mental illness as disease with that of mental illness as reaction type ‘that required both physical and psychological explanation’ (Double, 2007: 331). Taking as his research field the nexus of patients’ thoughts, feelings and their external world, the inter-relationships in play were to be ascertained through conversation with the patient (Tomes, 2008: 658). The patient’s ‘own language’ and self-appreciation of their illness was considered the source for any ‘advice and further elucidation’ (Meyer, 1957: 156, original emphasis).

To transform individual patient stories into clinically ‘objective’ facts, Meyer’s contribution was to standardize methods of examination and case note-taking procedures (Meyer, 1902/1952: 83–4). At Wards Island, all the potentially relevant factors in a case were to be ‘made objectively evident’ through longitudinal studies of an individual’s ‘life history’. Recorded in ‘uniform and systematic fashion …, [Meyer] provided his students with a basic outline to be followed, specifying the order of procedure … and … actual questions to be put to the patient’ (Leys, 1991: 5–6), a level of procedural detail lacking in other contemporary handbooks on psychiatry. ‘The art of history-taking’, Henderson (1952: xii) observed later when reflecting upon Meyer’s teachings, was ‘invaluable in relation to prognosis, diagnosis and treatment.’ Henderson was also introduced to the staff meeting, a novel clinical practice brought by Meyer from the psychiatric teaching hospitals of Europe (Meyer, 1948: 19). Used as an educational and training exercise, staff meetings entailed a single examining psychiatrist directing questions towards the patient, while a steno-grapher, sitting silently, recorded word-by-word the conversation between patient and practitioner (Scull, 2009). Henderson found the staff meeting a ‘magnificent training system for junior members of staff, not only because of the clinical material but also because of the skilled manner in which it was discussed by the more senior members of staff’ (Henderson, 1964: 160).

Henderson was promoted in 1909 from intern to junior physician. Placed in charge of a ward containing 50–60 beds, he oversaw the care of male patients suffering from organic diseases of the central nervous system. As many lay emaciated, suffering the degenerative effects of syphilitic infection, he learned to correlate disorders of memory, speech and emotion with physical signs of disease. ‘We were taught’, wrote Henderson, how to be ‘good clinical observers, to take careful chronological case histories, to study personalities, to analyse symptoms, and to correlate our findings with aetiological agents’; and when death and autopsy claimed patients’ bodies, Henderson’s investigations continued with pathological examination (Henderson, 1964: 163, 165). Inspired by Meyer’s medical training in German and Swiss psychiatric practice, this correlation of patients’ symptoms, personality and development with a later patho-anatomical examination bridged the gulf between clinical and laboratory research (Lamb, 2014: 37–42).

Between 1908 and 1911 Henderson was anxious to broaden his outlook and he read extensively the works of Freud, Jung and the psychoanalytic schools, while studying the wider psychobiological principles of Meyer. In 1912 Freud and Jung were welcomed to lecture at Clark University, and psychoanalysis was discussed with great interest over the following months (Double, 2007: 335). A number of papers were read out at the Wards Island Psychiatric Society, most notably Meyer’s (1912/1952) paper on ‘A discussion of some fundamental issues in Freud’s psychoanalysis’, prompting discussion of Freud’s sexual theories and the role of dream analysis. Meyer regarded Freud as a ‘detective’ whose ability to ‘unravel’ the ‘strings of events’ that lurked within the dream was quite exceptional. He nonetheless warned that ‘… the whole method can easily be attacked and also discredited by the uncritical use by imaginative and self-sufficient workers … Not everyone is born a detective. Not everybody can venture upon the ground of rather delicate constructions and interpretations’ (Henderson, 1964: 617). With Meyer’s warning in mind, Henderson and colleagues adapted the methods of Freud and Jung, becoming familiar with, but not wholly aligned to, the ‘technique[s] of dream analysis and of word association tests’, while appreciating ‘the validity of mental mechanisms concerned with projection, transference, displacement of affect, and symbolism’ (Henderson, 1964: 188–9; Tantam, 1996: 555). In 1910 Meyer left New York to take up the post of Professor of Psychiatry at The Johns Hopkins University, Baltimore, where he also became Director of the Henry Phipps Psychiatric Clinic upon its opening in 1913. August Hoch, also Swiss, took over the running of Wards Island, then renamed the Psychiatric Institute, and it was under his leadership that Henderson addressed studies of ‘personality’. Integrating clinical methods of Kraepelin, ‘reaction-type’ diagnoses of Meyer and psychoanalytic theorems of Freud and Jung, Hoch encouraged his colleagues to judge how the ‘original make-up, constitution or personality of the individual’ coloured the symptom picture (Martin, 2007: 284).

Henderson began to publish his own clinical findings, in 1911 authoring an article on ‘The diagnosis of cerebral syphilis’ (Henderson, 1911a). Conjoining the teachings of his colleagues with his own observations on syphilitic patients, Henderson portrayed the acute onset of ‘headaches, dizziness, vomiting, sleeplessness, cranial nerve palsies … and hemiplegia’ seen to characterize this diagnosis (Davis, 2008: 105). His next publication, ‘Tabes dorsalis and mental disease’ (Henderson, 1911b), challenged preconceived notions that general paralysis of the insane (GPI) and tabes dorsalis were one and the same disease. This minority stance separated him from his Scottish contemporaries, and in 1921 Henderson would became the first Scottish Physician-Superintendent to introduce the diagnostic category of ‘tabes with psychosis’ to the patient ledger (Davis, 2008: 107–8).

By 1911 Henderson was ‘filled with the confidence born of the effrontery of youth’ (Henderson, 1964: 170). Eager to broaden his outlook, he applied to Emil Kraepelin and to Alois Alzheimer, of the ‘world famous’ Psychiatric Clinic, Nussbaumstrasse, Munich, for a place on the postgraduate autumn course. His application accepted, he journeyed to Baltimore to visit Meyer, where the latter offered him a post at the Henry Phipps Psychiatric Clinic, due to open the following year. The Psychiatric Clinic, which owed its existence to the steel magnate Henry Phipps, was built as the first university psychiatric clinic of The Johns Hopkins University (Lamb, 2012: 1061). Henderson wrote in reply that the urge eventually to return to Scottish soil, to do practical work there, had persuaded him to decline.

Ever since leaving Baltimore I have been carefully considering the proposal … I realise perfectly well the ideal conditions that will shortly exist at Baltimore for psychiatric work, … but I have determined to try my fortune in Scotland. I may be rash – and probably am – to decline such a good opportunity … but … the longer I stay away from Scotland the more difficult will it become ever to get back. I also feel that it is to a certain extent the duty of those of us who have had the good fortune to receive a pretty thorough training in Psychiatry to try to do what we can … to help things onto a better footing because otherwise I don’t see how things can possibly change … the men at home don’t seem to in the slightest degree realise where the defects in their system are. (AMC2, 4 May 1911, I/1659/1)

Bearing close witness to the structural and ideological contexts in which Henderson and his colleagues were operating, the Henderson–Meyer–Campbell letters disclose much about the ‘forces and conditions’ that enabled or constrained their expression of ‘agency’, reform and experimentation (Pitre et al., 2013: 118). The freeing atmosphere of New York and Baltimore contrasted with the stultifying ‘system’ understood to obtain in Scotland, but Henderson still envisaged a return to his homeland. Like Campbell, though, his appetite for experience and understanding pushed him first towards the great psychiatric clinics of Germany.

Munich, Edinburgh and London, 1911–12

In a letter to Meyer in 1911, Henderson wrote:

…. I have just had the first week of the post-graduate course, and have found it both interesting and disappointing. Kraepelin’s clinics are extremely good in their way. He presents the cases very concisely but in a very cut-and-dried way, and seems to base his diagnosis almost entirely on the symptom picture. Very little weight seems to be laid on the previous constitution of the individual, and even a slight analysis does not seem to be attempted … . (AMC2, 29 Oct. 1911, I/1659/1)

Kraepelin was the outstanding exponent of the symptomatological classification of mental illness. After building a detailed collection of patient case histories, numbering into the thousands, Kraepelin’s classificatory system was founded not only on cross-sectional analyses of his patients’ symptoms, but on longitudinal studies which charted the onset and full duration of a case (Berrios, Lucue and Villagran, 2003: 114). In his Text-Book, Henderson wrote admiringly of Kraepelin, stressing how he enabled the psychiatrist to look past the temporary symptom picture to delimit the underlying disease through a compilation of case studies (Henderson and Gillespie, 1927; see also Henderson, 1964: 173–4). Seen through Henderson’s Meyerian eyes in 1911, however, Kraeplin’s lectures seem to lack nuance, betraying too deterministic a diagnostic picture (Philo and McGeachan, 2014: 564).

Ernst Rüdin, trained under Kraepelin, presented Henderson’s class with the case of a young man diagnosed as dementia simplex. Following the symptomatological diagnostic process of Kraepelin, Rüdin was pessimistic in his outlook, suggesting that the boy would slowly degenerate, first exhibiting alternating states of depression and excitement, before deteriorating further to a state of mental stupor. Henderson judged this conclusion with incredulity:

Rüdin … presents his cases in a very similar manner to Kraepelin, and perhaps the best illustration I could give you of his point of view would be to … cite the first case he presented. The case was that of a boy, 18 years, who had been backward at school, had always been somewhat incorrigible; later showed some slight criminal tendencies (petty thefts), and never learned any definite trade. When 15 years old the boy was described by his parents as becoming dull, and listless, and apparently more unmanageable. Rüdin, therefore, said that the onset was probably of 3 years duration! In the clinic he was quite bright, no disorder in stream of thought, no peculiar ideas demonstrated, and no hallucinations at any time. The case was summed up as one of Dementia Simplex, and the remark was made that he would probably later develop Katatonic features!!! (AMC2, 29 Oct. 1911, I/1659/1)

The simplicity of the method here, Meyer replied, placed too heavy a reliance on hereditary and degeneracy theory: ‘In some respects I envy them for their clean-cut directness but at bottom I would have a bad conscience much of the time …’ (AMC2, 29 Oct. 1911, I/1659/1). In 1906 Meyer defined dementia praecox not as a degenerative disease, but as the progressive maladaptation of an individual constitutionally predisposed to fail under distinct environmental pressures (Gelder, 1991: 422).

Despite such reservations, Henderson furthered his interest in the acute organic reaction types through microscopic study of ‘cerebro-spinal fluids’ from syphilitic patients: ‘I have been working in Alzheimer’s laboratory ever since coming here 5 weeks ago’, he informed Meyer, ‘He spends a long time in the laboratory every day, comes round to each one individually, and is very instructive, and very genial. I like him very much’ (AMC2, 29 Oct. 1911, I/1659/1). Under the tutelage of Alzheimer, Henderson’s pathological studies were accompanied by case reports, produced by Alzheimer, which portrayed the premature senile state eponymously named Alzheimer’s disease. It was then that Henderson learned to correlate the outward signs of the degenerative condition with post-mortem examination of the brain (Henderson, 1964: 172). Connecting his practical skills on the ward – garnered from observation and interaction with living patients – to chemical analysis and post-mortem examination, Henderson’s conjoining of psychological and materialist approaches to psychiatry increasingly took form. ‘The Gem of the Munich Clinic no doubt is Alzheimer’, replied Meyer, ‘whom I consider, without hesitation, the leader of psychiatry in Germany. … As far as actual solid collectivity is concerned he would I believe take a perfectly fair and sensible view of our conceptions if he were exposed to them as much as to Kraepelin’s influence’ (AMC2, 9 Nov. 1911, I/1659/1).

Henderson’s desire to return to Scotland was now about to be realized. After applying to George Robertson for a post at the REA, his request was granted. Henderson informed Meyer of his future plans, and of the responsibilities he was to face (AMC2, 29 Oct. 1911, I/1659/1). Meyer’s reply on 9 November betrayed his opinion of the ‘leading men’ of Scottish psychiatry. Reform, suggested Meyer, would be hard won from those already invested with authority; instead, it was to materialize through a new generation of psychiatrists. ‘The opening in Edinburgh strikes me as most promising, and with your level-head and direct manner you are bound to make an impression, although I am afraid the leading men will indulge in the prayer of the bad boy: “Lord, make me a good boy, but slowly, slowly”’ (AMC2, 9 Nov. 1911, I/1659/1). Robertson had succeeded Clouston in the post of Physician-Superintendent at Morningside (Davis, 2008: 55). Having returned from Munich, Henderson was invited to give his first university lecture on the subject of dementia praecox, and his reading of a paper to the Scottish Division of the Medico-Psychological Association – on ‘Catatonia as a type of mental reaction’ – demonstrated the influence of Meyer’s teachings, including the reaction type classification (Henderson, 1916).

The Evolution’s version portrays this period as time spent under the supportive superintendence of Robertson, and Henderson wrote of his ‘intense surprise and delight’ (Henderson, 1964: 180, emphasis added) at receiving an invitation from Meyer to return to North America as Senior Resident Psychiatrist at the Henry Phipps Psychiatric Clinic. The contemporary correspondence, however, shows that soon after Henderson’s arrival at Morningside he was actively engineering his return to Baltimore. On 10 March 1912, Henderson wrote to Meyer:

My short stay in Scotland has already thoroughly convinced me that I am not practically adapted for doing pioneer work, and two or three days ago I told Dr Robertson that I had practically decided to return to America.

I am, therefore, writing this to ask if you can still offer me a position in your clinic …

I have decided to return not so much because things are absolutely impossible but principally because it would take much longer than I had supposed to make much impression … . (AMC2, 10 Mar. 1912, I/1659/1)

Fresh from the Continent and the fertile intellectual grounds of North America, Henderson’s mind was filled with ambition, but these ambitions could only be implemented incrementally in Scotland, proving Meyer right that the ‘leading men’ here would reform ‘slowly, slowly’. Henderson’s aspirations and sense of duty towards psychiatric reform in his own country were deflated. At a time when Meyer was gathering staff for the Phipps, Henderson’s request to rejoin Meyer was readily accepted. With several months to wait before his return to the USA, Henderson travelled to London to work in the chemical laboratories of the neuropathologist Frederick Mott and the chemist Sydney Mann. Henderson found that Mott held a ‘tremendous contempt for British Psychiatry, and now refuses to attend the meetings of the Medico-Psychological Society as he says that they are just pretty much of a mutual admiration’ (AMC2, 28 July 1912, I/1659/1). In private correspondence at least, Henderson had come to reject what he saw as the narrow exclusivity of the British, and more narrowly Scottish, psychiatric profession.

Baltimore, 1912–15

In autumn 1912, Henderson sailed on the Anchor Line’s Columbia and, after a brief visit to Campbell in New York, arrived at the Phipps Clinic. It was officially opened on 16 April 1913, with a ceremony attended by notable practitioners. As Meyer stood among them, he declared the building a ‘true clinic … a hospital for practical work, research and teaching’ (Meyer, 1913: 857). Situated on The Johns Hopkins Medical Campus, the Phipps, in design and situation, functioned not only to provide care to the mentally ill, but also to integrate the psychobiological study of mental illness with hospital medicine. Just months after the opening, Meyer set sail for London and then went on to Switzerland, where he worked alongside Carl Jung ‘perform[ing] word association experiments and discuss[ing] each others’ cases’ (Lamb, 2014: 213).

Overseeing the training of internees and the treatment of the Phipps Clinic’s patients, Henderson remained in regular correspondence with Meyer, reports of patient progression being sent overseas to enable long-distance consultations. In addition to working in the main building, Meyer’s staff took shifts in the psychiatric Out-Patient Dispensary, where Henderson rejoined Meyer’s ‘second in command’, Campbell (Lamb, 2010: 122). Situated in a small building to the rear of the Clinic, this allowed patients not needing institutional care to receive psychiatric help. Working between the Dispensary and the Clinic, Henderson (1964: 188) related how he and his fellow colleagues did not think in terms of ‘sterile concepts of sanity and /or insanity[,] but whole heartedly applied [them]selves to positive, remedial aspects of assisting those who had come for help’. Outwith the hospital Henderson performed ‘social and psychiatric investigation of some of the long term prisoners’ of the Baltimore Penitentiary, stirring his interest in cases that he would later classify as ‘psychopathic states’, a subject on which he gained wide recognition (Petrie, 1939).

While The Evolution tells much of the knowledge learned and experience gained in the Clinic, correspondence between Henderson and Meyer reveals other significant developments in both men’s careers. While Meyer had developed around him a network of colleagues, all employing psychobiological principles, he was at last able to dedicate time to promote his approach abroad. As Henderson took over the running of the Phipps, his relation with Meyer changed from mentor and mentee to equals. By August 1914, Henderson was immersed in his work at the Clinic, his career brimming with possibilities; yet with the declaration of war, feelings of duty once more pulled him to return home. In late 1914, Henderson was informed that the army did not require more medical personnel, and so his return to Scotland stalled until he received news that Landel Rose Oswald, Physician-Superintendent of the (then-named) Glasgow Royal Lunatic Asylum, Gartnavel, was in need of an assistant. In March 1915, Meyer wrote Oswald a letter of strong recommendation; this was accepted, and Henderson set sail again for Scotland (AMC2, 24 Mar. 1915, I/1659/4).

Gartnavel at war, 1915–18

The Phipps was equipped with new technological advances and was situated in the heart of Baltimore city, but the asylum at Gartnavel was in stark contrast. Relocated in 1843 from the inner city, the new site chosen for this asylum lay to the west of Glasgow, in a semi-rural location. The imposing Tudor Gothic style building rose above the landscape, while six-foot high walls encased its perimeter (Snedden, 1993: 30–1). Arriving at Gartnavel, Henderson found the asylum to be poorly staffed, with three men overseeing the treatment of around 250 female and 200 male patients, in sharp contrast to the 60–70 patients at the Phipps (Henderson et al., 1930). Staff deficiencies meant padded rooms and restraining sheets were frequently used, and for those patients deprived of an outdoor ‘pass’, the necessity of using the old airing courts for exercise was considered a ‘particular source of irritation’ (Henderson, 1964: 196–8). Despite material deficiencies, Henderson wrote to Meyer that there was nonetheless ‘any amount of most excellent material’ to explore. Of ‘Dr Oswald’, Henderson reflected that, while his ‘[i]deas are not what one would call especially modern’, he took ‘a tremendous interest in things in general’, ‘very frequently goes around some of the more disturbed wards after 10 o’clock at night’ and ‘has told me that he will be very grateful for any suggestions’ (AMC2, 2 June 1915, I/1659/5).

In September 1915 Henderson declared that, while his ‘first impression of the whole situation is a very favourable one’, the desire to do ‘my bit’ was pulling him towards enlistment: ‘The call for more doctors is becoming more and more insistent and I must say I’ve been pretty restless and anxious to join in things for some time back’ (AMC2, 26 Sep. 1915, I/1659/5). Soon after, Henderson enlisted as a wartime psychiatrist, embarking upon a succession of medical military positions, and by 1916 he was writing to Meyer from the Lord Derby War Hospital, Lancashire, from where he admitted ‘[i]t is all pretty miserable and depressing over here. … I have charge of the admission service, and in consequence have had a most interesting and varied experience but the mass of material is so enormous, and they come in such large convoys that the work is almost paralysing’ (AMC2, 11 Dec. 1916, I/1659/6).

With war stretching across Europe, Africa and Asia, soldiers returned with delirium, coma and extreme physical exhaustion due to malarial infection, heat stroke, sandfly fever and influenza. The ‘so called Shell-shocked cases’, remarked Henderson, were of particular interest as it proved almost impossible to distinguish between cases due to ‘psychic conflicts [and/or] to physical factors’ (AMC2, 11 Dec. 1916, I/1659/6). Over the next two years, Henderson used the mass number of casualties passing through his hands to compile clinical records of their cases, and by 1918 he had published records of over 200 cases of ‘Home troops’ suffering psychiatric disorders. He later wrote how, with disappointment, he learned that psychiatrists were ‘regarded with disfavour if not … ridicule’ by ‘service chiefs’ and government, and their methods considered ‘subversive rather than constructive’ (Henderson, 1964: 200–2). Henderson claimed that 30% of casualties passing through the hospital were ‘subnormal, feeble-minded youths’ who should never have been enlisted, and he used their example to stress the value of simple tests of intelligence before enlistment (Henderson, 1964: 209). ‘Malingering’, Henderson wrote, ‘I have only met with in two instances, and these were both cases who probably would be grouped as mental defectives’ (AMC2, 11 Dec. 1916, I/1659/6).

In 1917 Henderson was posted to France as a regimental officer, stationed in the Ypres-Arras Sector. No great battles were fought during this time, but being in the scene of warfare – treading the mud-caked duckboards, surveying a bomb-cratered landscape, living in dug-outs surrounded by the spectre of death – all deepened Henderson’s appreciation of his patients’ experiences (Henderson, 1964: 209–10). By winter 1917, Henderson was posted to Netley Military Hospital in Hampshire where he sorted psychiatric casualties before their distribution to mental hospitals throughout the country. From the special department ‘D Block’, Henderson wrote to Meyer: ‘as our accommodation is only for approximately 140 cases[,] we never have our cases for more than 48 to 56 hours, and in consequence it is almost impossible to do any decent work on them’ (AMC2, 6 Mar. 1918, I/1659/6). The majority of casualties were cases of dementia praecox, GPI or mental deficiency, all of whom, Henderson argued, should never have been enlisted: ‘I wish this old, beastly war was finished, but on the other hand there does not seem to be any possible outcome except to stick it to the bitter end’ (AMC2, 6 Mar. 1918, I/1659/6).

Gartnavel again, 1919–29

In autumn 1919, with Henderson’s war work ending, he approached Meyer again for references, and he applied to a number of Scottish mental hospitals. One by one they turned him down and, after his final failed application to the Royal Murray Asylum, Perth, Henderson expressed exasperation at the dogmatic hold by the ‘great men’ of Scottish psychiatry over his fate.

… I may say at once that the Murray has decided against me, and the post went to Ross … It has been rather a disappointment because Ross is not only my junior in years, but also in graduation, in experience, training etc. The reason given for his appointment is because Brown, promoted to Aberdeen, was a Morningside man, and the Directors thought that Ross [also of Morningside] would be more likely to carry on the policy of Brown. As a matter of fact psychiatric experience and training practically does not count, and the other day Dr Robertson of Morningside told me no doubt the fact that I had written so many papers was against me, and also that it would have been better if I had stuck to one place … The position here now is that practically the only job I can get is to go back to Gartnavel as 1st Assistant – but even that I am not yet sure of. (AMC2, 1 Sep. 1919, I/1659/8, original emphasis)

Henderson seemingly offered too radical a challenge to the status quo. With continuation of method and tradition favoured over international experience and innovation, Henderson’s return to Gartnavel was a last resort. His ambition and no doubt pride dented, he resumed his old position. During those first few months, Henderson’s desire to return to the Phipps reawakened, leading him to write to Meyer asking for employment opportunities, and by late autumn 1919 Meyer had offered Henderson a post. By this time, though, the appeal of Gartnavel had strengthened, and Henderson declined Meyer’s offer: ‘I have failed you so far as America is concerned but I can assure you that I shall try to be true to your teaching and influence’ (AMC2, 14 Nov. 1919, I/1659/8).

Gartnavel, against all odds, was then considered a ‘good sturdy environment’ for cultivating Meyer’s dynamic approach (AMC2, 28 Nov. 1919, I/1659/8). After falling ill in 1919, Oswald was prevented from taking an active role in the management of the hospital, and so Henderson’s chance of promotion became a real possibility. He acted as Physician-Superintendent in 1919–20, after which Oswald publicly announced in the hospital’s Annual Report how ‘[i]t was a comfort to me to know that Dr. Henderson was available to carry on my work, which he has done with great ability and success’ (Oswald, 1920: 24). Praised by Oswald, Henderson achieved greater security in his chance of succession, and Oswald’s early retirement in 1921 saw Henderson rise to Physician-Superintendent, at last gaining the authority to implement his years of training upon the ‘virgin’ territory of Scottish soil. He began to embed a dynamic approach at the hospital: ‘The training of medical staff’ centred around the ‘clinical meeting’; case note-taking procedures followed Meyer’s psychobiological principles; and clinical activities revolved around the construction of ‘case record[s]’ (Henderson, 1964: 216–17). Gartnavel’s resident medical officers were exposed to Meyer’s reaction-type diagnostic groupings, Kraepelin’s disciplined clinical teaching, Hoch’s personality studies, and the work of Freud, Jung and others.

Henderson wrote publicly about the nationwide state of psychiatric classification, describing each mental institution as ‘a law unto itself’: ‘[I]n consequence’, he reported, there was ‘no uniformity’ in classificatory schemata (Henderson, 1922: 15). Such a bold condemnatory statement reflects the drive for diagnostic uniformity which Henderson urged throughout his career, and the success of his jointly authored Text-Book of Psychiatry for Students and Practitioners (Henderson and Gillespie, 1927) attested to the application of a dynamic approach in pursuit of such a goal. Written by Henderson and his Phipps-trained colleague R.D. Gillespie, the Text-Book became the standard reading for postgraduate students of psychiatry in Scotland (Gelder, 1991: 419–35). Henderson subsequently became Professor of Psychiatry at Edinburgh University (1932–54), and as his career progressed the Text-Book was republished in nine further editions. Its contents, consisting of history-taking outlines, reaction-type classifications, case history construction and aetiology, echoed Meyer’s psychobiology; and the authors, writing of their indebtedness to Meyer, acknowledged their ‘“dynamic” view’ in close alignment with the Phipps School (Henderson and Gillespie, 1927: viii).

Conclusions

When reflecting on the significance of the Henderson–Meyer relationship to this transatlantic movement of dynamic psychiatry, it is clear that Meyer, despite lacking a textbook from which to promulgate his ideas, transmitted psychobiology through a small but internationalizing network of students and colleagues. At a time when materialist approaches dominated British psychiatry, the letters exchanged between Henderson, Campbell and Meyer evidence the outsider’s struggle for power and recognition, and it is therefore a history of such power/knowledge struggles that this conclusion addresses. Contrasting the tempered portrayal of early twentieth-century Scottish psychiatry offered in The Evolution, these letters expose the energy and frustration that accompanied Henderson’s early career. They uncover the strength of feeling evoked by expansion of knowledge and expertise, as too by the stunting of confidence and ambition. Penned during a time of professional success for Meyer but uncertainty for Henderson, they attest to relations of authority, influence, self-interest and deference.

The letters also disclose the personal characteristics, professional interests and institutional spaces that drew clinicians together to form a ‘school’ of psychiatry extending across the Atlantic. Meyer wrote of the influence from Britain early in his career, quoting among others Clouston, Hughlings Jackson and Alexander Bruce. ‘Meyer’s teachings took root in Britain’, hypothesizes Gelder (1991: 419–35), because ‘many of his ideas had originated there’ (Gelder, 1991: 490). That Meyer’s dynamic psychiatry also travelled back to the UK has been demonstrated throughout this paper, and was to an extent formalized in how Campbell, Henderson and the latter’s students went to study and work with Meyer at Wards Island and then the Phipps: ‘Long before any other centre in Great Britain began to stir in response to the remarkable things which were being done on the North American continent, he [Henderson] began to send his young men to train with Adolf Meyer …’ (Cameron, 1965: 468).

Having influenced successive generations of Scottish psychiatrists such as Angus MacNiven and Thomas Ferguson Rodger (Phelan, this issue), and through them R.D. Laing, the conjoint legacy of Henderson, Meyer and their dynamic approach continues to be felt in Scotland, not least at present-day Gartnavel (Beveridge, 2011: 200–2, 249). The correspondence exposes this otherwise hidden story – with its counter-narrative of ambition, patronage, struggle and rejection – and tells much more about both the transatlantic frame for Scotland’s psychiatric history and its uniquely Scottish uptake of dynamic theory and practice. It places historians of Scottish psychiatry in a firmer position from which to challenge established historiographies of dynamic psychiatry, asserting the significance of transatlantic relations for past, present and maybe future psychiatric practice.