Neuropsychiatric Consequences of Traumatic Brain Injury

The next article in our series is a 1904 report from Adolf Meyer¹ that proposed that brain trauma from multiple causes could lead to a variety of neuropsychiatric syndromes. Reprinted below are two excerpts, which include his introduction and the first 3 of the 31 cases presented in the full manuscript. The second excerpt, which appears near the end of the manuscript, describes his proposed nosology of posttraumatic “insanity.”

Dr. Meyer is considered one of the most influential leaders in American psychiatry. He was born in Switzerland and received his medical training at the University of Zurich. He completed postgraduate training in England under John Hughlings Jackson and in Paris under Jean Charcot.² He first came to the United States in 1892 and accepted a position as a pathologist at a state mental hospital in Kankakee, Illinois. He moved to the State Lunatic Hospital in Worcester, Massachusetts, where he observed the cases described in the reprinted article. Henry Phipps, a former partner of Andrew Carnegie in the steel industry, gave Johns Hopkins University a grant to build a clinic for the study of mental disorders. In 1913, Dr. Meyer became the first Director of the Phipps Clinic, where he served in his “pivotal professorship” at the Johns Hopkins School of Medicine.³

Dr. Meyer was an advocate of a commonsense holistic view of mental illness. His teaching and written contributions form the basis of the biopsychosocial approach embodied in the current multiaxial nosology of mental illness. The reader will appreciate the careful detail of the case descriptions and his attempt to organize the clinical phenomena in meaningful categories. The second excerpt contains a sentence that summarizes Dr. Meyer's view of his field: “Psychiatry will never progress unless its diagnoses mean to be summaries of the available facts arranged according to their pathological or nosological bearing, instead of the traditional ill-defined terms” (p. 438).