Abstract
Stanley Cobb was an eminent neurologist that is regarded as ‘the founder of biological psychiatry'. Having studied at Harvard university, Cobb had many varied interests, including ornithology and natural history. Following his undergraduate studies, he travelled widely and incorporated a period of study in Europe. Upon return to America, he was appointed Director of the Harvard Neurological Unit. Following a change of interest from neurology to psychiatry, Cobb was instrumental in establishing psychiatry as a specialty in America. The research laboratory, ‘Stanley Cobb Laboratory for Psychiatric Research' at Massachusetts General Hospital was named in his honour and contribution to the service at the hospital.
Keywords
One author (SV) recently visited Massachusetts General Hospital (MGH), a prestigious hospital enriched in history, which has trained many doctors who have shaped the face of modern medicine. Among these was Stanley Cobb, an eminent neurologist, widely known as ‘the founder of biological psychiatry’, the discipline within psychiatry that relates the biological function of the nervous system to mental health. Having worked in a number of world leading institutions, Cobb contributed vast amounts to driving thinking forward in the many fields in which he became absorbed, from ornithology to human anatomy, neuropathology and psychiatry, bringing together his knowledge of functional and organic disease and linking the two. In recognition of his many achievements, a new laboratory at MGH was named the Stanley Cobb Laboratory for Psychiatric Research. He was known as one of the major forces linking the fields of psychiatry and physiology, and greatly increased the recognition and perceived importance of the former. 1
Cobb’s interest in psychiatry stemmed from his childhood. His mother kept him out of school until the age of eight due to a stammer he had developed at the age of four following the birth of his sister. This became a major handicap for him, having an impact on his social life, and would only improve much later in his life after he was married. However, it gave young Stanley Cobb time to indulge his interest in nature and birds, which he enjoyed with his two boyhood friends while growing up in the countryside. 2 Even as a child he often questioned the origin of his stammer. This curiosity was perhaps the first indication of his future interest in analytic psychiatry.
In 1906 Cobb entered Harvard University as an undergraduate. He was active and well liked as a student, participating in many activities beyond the immediate curriculum, including the Harvard Travelers Club, the American Ornithologists Union and the Boston Society for Natural History. 2 His interest in ornithology was recognised by his seniors during his initial years there. Having obtained a Bachelor of Arts degree, and upon demonstrating knowledge of chemistry and physics, as was the new requirement for entry, Cobb was accepted into Harvard Medical School in 1910. During medical school he became a close friend of Carl Binger (1889–1976) who later also became an eminent psychiatrist. Their friendship and shared interests led them both to pursue careers in neurology and psychiatry. 2
Cobb spent a year working under the pioneering neurosurgeon, Harvey Cushing (1869–1939), at the Peter Brent Brigham Hospital (PBBH) following medical school in 1914. 3 After this appointment Cobb married Elizabeth Mason Almy (1892–unknown) and together they moved to Baltimore where he was to work in physiology and psychiatry for three years. It was an exciting time for him, not only because of his new marriage but also due to the great minds working in the Johns Hopkins Hospital and Medical School with whom he would collaborate. In 1917 Cobb gave up research to focus on work in the psychiatry wards but this period was cut short as he was conscripted into the army in 1918 although soon he returned to America after the Armistice of 11 November 1918. 2
Cobb did not stay in Baltimore for long. The attraction of the neurophysiology department at Harvard and financial pressures attracted him back to Boston, where he was given the opportunity to travel to Europe. From 1923 to 1925 he gained further experience in clinical neurology from world renowned centres including Queen Square in London and with L’Hermite in Paris. 3
On return from Europe, Cobb spent his time developing the Harvard Neurological Unit at Boston City Hospital which soon became recognized as a leading centre in the field of neuroscience where scholars could cooperate in research. He was appointed Director of the unit in 1930 before making his final career move to MGH where he assumed the position of Chief of Psychiatry in 1934 (Figure 1).
4
Photograph of Stanley Cobb from Massachusetts General Hospital historical archives (photograph taken on 1 September 2012).
Change in research interests
Due to what he described as ‘psychological forces within himself’, 2 Cobb changed his clinical interest from neurology to psychiatry with the object of studying both the psychiatric and the physical manifestations of disease. Furthermore, he had become excited by the new trends in fields including the mental hygiene movement and psychoanalysis that had been growing throughout America. Psychoanalysis in particular had helped Cobb previously with his stammer years and so he had insight into its potential benefits for patients. He saw it as an approach to the interrelations of mind, body and environment, and he gave it respect at a time when it was thought to be unconventional and non-academic. MGH was a most conservative institution at the time but, using his influence, he managed to bring such growing fields to the hospital.
The period from 1900 to 1950 was in general a time of major transition for psychiatry in America. The way patients with mental illness were managed changed forever, with psychiatric units, clinics and psychopathic hospitals set up, and with alternatives to the mental asylums previously used for all patients regardless of their specific conditions. Particular to the Boston scene was Vernon Briggs (1863–1941) who campaigned against the poor treatment of mental health patients after seeing one such patient locked up in jail over a weekend before being seen by the court in 1906. His fight against superintendents of mental hospitals and other opposition over three years led to a psychiatric outpatients department being set up in 1909 at Boston State Hospital. The following years resulted in more arguing and fighting with authorities by doctors including Briggs and Cobb in order to improve different aspects of mental health care, for example removing iron bars from hospital rooms, allowing patients more freedom in their day-to-day activities and reversing the geographical isolation of mental hospitals. 5 Cobb would work within this revolution in the context of psychiatric research and its importance within medicine.
In order to create an environment for psychiatric research at MGH, Cobb required funding and he would achieve it from the Rockefeller Foundation. It enabled him to explore various goals including the ‘teaching of psychiatry to medical students, [explaining] its place in general medicine’. 2 It can be inferred that his major aims were to produce research that integrated the functions of the mind and body, while making psychiatry a respected and integral part of general medicine. It was thought that the most effective way of integrating psychiatry into mainstream activity at MGH was through clinical and laboratory studies carried out in collaboration with members of other departments. The collaborations that would occur were almost certainly aided by the laboratory’s central location within the hospital.
Cobb and his department produced a lot of influential work in these years, including a paper published in the New England Journal of Medicine on shock therapy 6 and work on including mental hygiene in the management of epilepsy. 7 This high volume of research and level of intensity began to affect his health; through the late 1930s he began to suffer increasingly from rheumatoid arthritis, deforming his hands and joints, which meant he was not always as able to work at the rate he once could. Nevertheless he did continue to enjoy hobbies such as painting with watercolours and other activities demanding manual dexterity despite the effects of the disease.
The 1930s and 1940s were times in America when even the term ‘biological psychiatry’ came to mean something very different from before, and became the prominent topic of research and the foundation of treatment. These treatments had increasingly positive outcomes for patients and highlights included the benefits of penicillin in general paresis (1943) and lithium in manic presentations (1949); previous treatments included induction of fever to combat ‘brain infection’, baths and ice towels to calm patients, and these quickly became superseded. Cobb’s body of research was a major part of the drastic emergence of biological psychiatry and improvement of mental health care during this ‘golden age’. 8
Eventually, in 1954 Cobb retired from his position but still remained heavily active in research. It was at this point that a newly founded research laboratory at MGH was named the ‘Stanley Cobb Laboratory for Psychiatric Research’ (Figure 2).
1
Despite suffering from arthritis, he continued to explore his passion for birds, exploring avian neuroanatomy through dissection.
4
Frank Ervin, Director of the laboratory (1962–1972), remarked to author SV that Cobb used to keep a parrot in his office and would often say, with his characteristic smile, that one day he wanted to understand why that parrot could speak.
The Warren Building at Massachusetts General Hospital. The Stanley Cobb Laboratory for Psychiatric Research was situated on the sixth floor of this building. This area has now been converted to offices (author’s photograph, 1 September 2012).
The legacy of Cobb’s work was its vital role in establishing psychiatry as a major specialty and as such it was different from other important research findings. He was instrumental in setting up a psychiatric service at MGH and other institutions quickly followed suit. This was facilitated through local and national publications and presentations and through discussions between students and former staff. 2
The full impact of Cobb’s work could be seen throughout America as slowly there became a widespread acceptance of psychiatry as a respected specialty of medicine. Following this, more investment was made into new forms of psychiatric therapy with reduced numbers of patients becoming hospitalised for long periods (Figure 3). With developments in psychoanalysis, coupled with Cobb’s efforts, there were vast increases in the number of residents and fellows in psychiatry training. The psychiatric service became one of the most important in MG, and is now widely and, entirely appropriately, respected around the world.
Graphs plotted by Cobb himself showing the changes in numbers of patients in psychiatric care and psychiatry courses taken voluntarily by students over the 10 years when he was Head of Psychiatry at MGH. The graphs show an increasing number of patients admitted to psychiatry wards, indicating a greater appreciation for the specialty, and a reduced number of visits over time by patients which suggests a better resolution of their problems. The increasing number of students taking voluntary psychiatry courses demonstrates the emerging interest of the young in the specialty.
6
Footnotes
Acknowledgements
We would like to thank Dr Frank Ervin for taking the time to speak to us and provide us with details that have been central to piecing together Cobb’s story and influence. We also thank Jeffery Mifflin at Mass General Archives for providing copies of original documents.