British Journal of Psychiatry (1990), 156, 288—289

Books Reconsidered

Clinical Psychiatry: W. Mayer-Gross, E. Slater & M. Roth*

At first sight these three authors may seem an un the critique of psychoanalysis, and added the rec
likely trio, but in the event their disparate experience ommended “¿ multi-dimensional approach―,part of
and personalities proved to be complementary and the chapter on ‘¿ epilepsies',
The and the sections on
the end product of their labours was a coherent and anorexia nervosa, anxiety, and hypochondriasis in
harmonious whole. Chapter IV. The whole text was, however, seen and
Willi Mayer-Gross (1889—1961)had been a pro discussed by all three authors. Roth's command of
fessor in Heidelberg, but came to Britain in 1933,one language equalled that of Slater but with a style of
ofseveral eminent continental refugees who enriched distinctive elegance. He was the great drawer
the British psychiatric scene before and after World together of threads from many sources into a rich
War II. He had been a pupil of Kraepelin, Jaspers, tapestry of original thinking, best exemplified in the
and Gruhle, and was a leading exponent of ‘¿ pheno1954 edition by the early exposition of his then
menology', the exact study and precise description of revolutionary but now commonplace separation on
psychic events. Much of the descriptive material in prognostic grounds of the different syndromes of
the book (particularly of the psychoses), which was old-age mental disorder.
such an outstanding feature, emanated from Mayer The Introduction, which firmly wedded psychiatry
Gross but with his English text edited by Slater. to medicine and expressed scepticism about the rel
Eliot Slater (1904—1984)was a commanding evance of sociology and anthropology, aroused most
figure, both physically and intellectually. His main controversy and not a little opposition by its critiques
research interest was psychiatric genetics, although of contemporary schools of psychiatry, particularly
he also made important contributions in neuropsy those of Freud and Meyer. Comments like, “¿ support
chiatry and the neuroses. He first met Mayer-Gross for the [Freudian] theory is won, not by producing
while training in genetics in Germany, and shared his evidence in its favour but by enlarging the circle of
phenomenological approach and Kraepelinian those who believe in it―,and, “¿ Meyer's
enthusiasm in
stance. His style of writing was an extraordinary the fight against Kraepelinian classification led him
amalgam of richness, robustness and precision. to throw out the baby with the bath water―,were not
Slater was responsible for all the genetic sections and intended to be emollient, nor were they perceived as
played the major role in the writing of the contro such. To some they were a clarion call to a more
versial Introduction, with its polemical critique of scientific psychiatry, to others an unbalanced over
psychoanalysis. reaction. As one reviewer remarked, the authors
Martin Roth (b. 1917) trained initially in neurol could not be accused of fence-sitting.
ogy,but developedan interest inpsychiatry partly There were a number of unusual features for a
through the influence of hischief,Russell(later book of the time, including detailed case-taking
Lord) Brain.He attracted the attention of Slater, schemata for ordinary psychiatric, uncooperative or
who was impressed by his 1948 publication in Brain stuporose, and organic patients, chapters on ‘¿ Mental
on hereditary ataxia. Shortly afterwards he went to deficiency', ‘¿ Child
psychiatry' and ‘¿ Administrative
work withMayer-GrossattheCrichtonRoyalHos and legal psychiatry' (both at home and abroad), and
pital, Dumfries. Mayer-Gross was invited to write a an extensive bibliography. Chapters on ‘¿ Sympto
review of old age psychiatry for the 1950 Recent Ad matic psychoses' and ‘¿ Chemical intoxications and
vances series but, finding himself fully occupied in addictions', including reference to amphetamine,
research and lecturing, he asked Roth to take on the morphine, cannabis, and mescaline, have a prophetic
task in his stead (from little acorns .. .). As a result, ring.
Roth was invited to write the chapter in Clinical Psy The 1954 edition is also of interest as a historical
disorder in trauma, infection and document, providing a glimpse of the practice of psy
chiatry on ‘¿ Mental
tumour of the brain' and ‘¿ Ageing and the mental chiatry before the psychopharmacological revol
diseases of the aged'. In addition, he contributed to ution. Recommended treatments now seem crude
and often naive. Thus, paranoid reactions were
London: Macmillan (1954). Secondedition 1960;third edition treated with either superficial psychotherapy or
1969;reprintedwith amendments1977. leucotomy, and depression was treated with ECT or
288
 BOOKSRECONSIDERED 289
awaited spontaneous remission. Agitation or insom danger of becoming isolated from medicine, and
nia might respond to Tinct opii. The conventional their prescription of a return to the bedside and the
treatments for schizophrenia of insulin coma, ECT, discipline of clinical observation, struck a chord in
and leucotomy were described, but the authors were many contemporary seekers after psychiatric truth.
clearly not happy with them, for insulin coma was Translated into many languages, its impact over
called “¿ crude
and empirical― and, referring to leuco seas was no less profound. It brought succour to the
tomy, they remarked “¿ there
is no case for a wholesale beleaguered minority of biological psychiatrists in
handing over of chronic schizophrenics to the knife the USA, and prominent figures such as Robins,
of the surgeon―.The 1960 edition brought the first Guze, Klerman, and Spitzer have acknowledged
mention of the use of neuroleptic and antidepressant their indebtedness. Indeed, a connection can be
drugs and lithium, and by the 1969 edition treat traced from the book's multi-dimensional approach
ments of all kinds had become more numerous and to the development of modern operational defi
sophisticated. nitions of mental disorder, such as the Research
Successive editions saw a toning down of the anti Diagnostic Criteria and DSM—III.
Freudian polemic of the 1954 edition, and by 1969 For over two decades the book was, for many, the
some value was allowed to Freud's contributions in psychiatric bible, and even today it has not lost its
modern psychiatry. By 1969the Schneiderian view of value as an authoritative reference work, for it is still
neuroses as developments from personality devi one of the most frequently cited textbooks in scien
ations, originally propounded by Mayer-Gross, was tific papers. The high esteem in which it was held is
modified to a more syndrome-based approach at the conveyed by E. W. Anderson's review of the 1969
hands of Roth. He also revised the section on para edition: “¿much
So praise has been justly accorded
noid psychosis, extended considerably Mayer-Gross' this book that there is little the reviewer can add. This
chapter on ‘¿ Alcoholism, drug addiction and other is the most outstanding textbook of psychiatry in
intoxications', and added chapters on ‘¿ ExogenousEnglish; certainly the reviewer knows of no other
reactions and symptomatic schizophrenias' and English work of the kind to rank with it. The weight
‘¿ Socialpsychiatry'. of scholarship behind it is in itself impressive. It
It is difficult for young psychiatrists of today to may be said fairly that the book is an outstanding
appreciate the impact this novel, stylishly written contribution to British psychiatry―.
textbook had on those, like myself, who were taking Dare we hope for a fourth edition? Rumour has
their first faltering steps in psychiatry in the l950s. it. . .
For the first time the written text seemed to chime
with everyday clinical experience. The authors' views Acknowledgement
that psychiatry was afflicted by sectarianism and I am indebtedto ProfessorSir Martin Roth for providingmuch
unwarranted attempts to expand its scope and was in background information
on thecompilation ofthetextbook.

Kenneth Davison, Consultant/Lecturer, Department of Psychiatry, University of Newcastle-upon- Tyne