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Tuesday, 20.08.2019

EULOGY for PAUL WENDER (1934-2016)

By
Barry Blackwell

            Paul Wender was an iconic figure in psychiatry, recognized for his original, pioneering contributions in two distinct areas. These were epidemiologic genetic research in schizophrenia and Minimal Brain Disorder (MBD), later attention deficit hyperactivity disorder (ADHD), first described in children and then in adults.

      Paul’s collaborative work with Kety and Rosenthal at NIMH and Schulsinger in Denmark established a dramatic difference in the prevalence of schizophrenia between the biological and adoptive families of adopted children with schizophrenia. The publication of these findings (Kety, Rosenthal, Wender and Schulsinger, 1968) also bolstered the conviction for a genetic contribution to etiology at a time when evidence for a defined neurochemical cause linked to treatment specificity was fading fast, despite a Nobel Prize and the catecholamine hypothesis.

       The impetus and timing for Paul’s interest is described in his 2002 interview by Tom Ban for the Oral History of Neuropsychopharmacology (Wender, 2011) and an accompanying brief biography (Dramatis Personae) in Volume 7 (Blackwell, 2011).

      Paul was the child of a psychoanalytically-trained psychiatrist and social worker. While a freshman at Harvard, his father sent him Freud’s General Introduction to Psychoanalysis and Paul recognized the feeble tenets of deductive reasoning. His subsequent psychiatric training at the Massachusetts Mental Health Center was predominantly psychoanalytic where he must have discarded the concept of the schizophrenogenic mother when the German literature convinced him schizophrenia was a biological disorder. So, Paul initiated a seminar devoted to research in schizophrenia with like-minded fellow residents, Eric Kandel, Allan Hobson, Judith Rappaport, Joe Shilkraut and Gerry Klerman (Klein, 2016) which led, at age 29, to his first publication that began, at the editor’s request, with Kraepelin’s prescient quote: “We are always at the beginning.”

       After graduating in 1962, he was drafted during the Korean War and fortunate enough to be posted to NIMH as a Special Fellow in Child Psychiatry. While there he completed his fellowship at Johns Hopkins Hospital. This was the impetus for his interest in MBD and ADHD and what he later described as “the most rapid and striking response to amphetamine.”

       In 1973, Paul left NIMH to become Director of Psychiatric Research at the University of Utah at the age of 39, only 11 years after completing residency. He remained in that position for more than a quarter century and, in 1990, was named Distinguished Professor.  His research on ADHD at Utah was supported by NIMH over 15 years with grants totaling one and a half million dollars with much smaller amounts from the pharmaceutical industry. 

       Known eponymously as the Dean of ADHD, Paul authored two textbooks on the topic, each revised several times, one on children (Wender, 1971) and the other on adults (Wender, 1995). The criteria for DSM III (1980) for both schizophrenia and ADHD were influenced by Paul’s lifetime’s work including “spectrum disorder” for schizophrenia, as well as aspects of ADHD where he advocated for excluding “hyperactivity” for girls and, unsuccessfully, for a  separate adult category.

       Paul was also a senior consultant on the Development of Bio psychiatry Research at McLean Hospital. Altogether, he published seven books and more than 100 scholarly monographs (New York Times, 2016). His honors include the Hoffheimer Award for Research (1974), the William Schoenfeld Award from the American Society of Adolescent Medicine, the Hoffman Medal of the World Federation of ADHD and the Hoch Award from the ACNP.

      During his career, Paul “abjured sitting on Committees and avoided Department Chairmanships,” instead devoting himself to research, teaching and especially clinical practice, which he described as “both a basis for my research and a gratifying and rewarding setting.” He was also active in numerous societies, a board member on several journals and an inspirational teacher.

        A former student (Marquand, 2016), remembers “the sparkle in his eyes as he made a diagnosis… when I think of Paul I think of someone who’s literally there, present and reminding me how important it is to think carefully, lean into new things and be enthusiastic about your work. That’s what good teachers do.”

       A former junior faculty colleague (Gray, 2016) recalls “How he helped me with my first research project. His sharp mind was surpassed only by his keen wit. I am sure he helped countless others along the way. He helped put the University of Utah on the map.”

       Paul died suddenly of a ruptured aortic aneurysm in July 2016, the year Alan Schwartz published his book, ADHD Nation, which, based on investigative reporting, alleges inflated diagnosis and overtreatment of the disorder (Schwartz, 2016).  Paul is characterized as “a firebrand” and we do not know if he saw the book or had an opportunity to respond to this insinuation.  Keith Conners provides corrective insights (Conners, 2017) in a personal communication. Keith was a lifelong colleague and fellow researcher in the ADHD field. He also knows Shwartz well, provided some of the information in the book and encouraged its publication based on his personal regret at having been manipulated by Big Pharma as a KOL and researcher of their products (Blackwell, 2016). He describes his involvement as “a terrible mistake in what has become a tragedy for the profession.” 

      Keith believes Paul agreed that industry made skilled use of complicit academic psychiatrists, but is certain Paul himself was too much of an independent thinker and someone whose research was funded primarily by NIMH, not industry. He regarded Paul “as a brilliant and innovative clinician with a sharp wit and provocative style” whose valid clinical ideas had been misinterpreted by Schwartz. He noted that the book, structured like a novel, almost a detective story and short listed for a Pulitzer Prize, needed a foil for the author’s portrayal of Keith as a sympathetic character.

       This view of Paul Wender is mirrored by his friend and colleague Don Klein in an obituary (Klein, 2016): “Paul’s unique capacity for incisive clinical discovery, acerbic criticism, academic leadership and public advocacy are gravely missed by friends and admirers of his manifold creativity.”

References:

Blackwell B, The Oral History of Neuropsychopharmacology (Series Ed. Ban TA.) Volume 7 (ed. Blackwell B.) in Dramatis Personae Brentwood Tennessee: ACNP; 2011. lxxxiv-lxxxv.

Blackwell B, Corporate corruption in the psychopharmacological industry, on INHN.org. In Controversies; 9.1.2016.

Conners K, Personal communication; 1.26.2017.

Gray D, Memorial website lasting memories.com July, 2016.

Kety SS, Rosenthal D, Wender PH, Schulsinger F, The type and prevalence of mental illness in the biological and adoptive families of adopted schizophrenics. J.Psychiatry Research1968; 6:345-362.

Klein D, Paul Wender Obituary. Neuropsychopharmacology 2016; 41(13); 3128.

New York Times Obituary, August 28, 2016.

Marquand B, Obituary, Boston Globe, August 22, 2016.

Schwartz A, A.D.H.D. Nation. Scribner, 2016.

Wender PH, Minimal Brain Dysfunction in Children. New York: John Wiley Sons; 1971.

Wender PH, Attention Deficit Disorder in Adults. New York: Oxford University Press; 1995

Wender PH, in The Oral History of Neuropsychopharmacology (Series Ed. Ban TA); Vol.7 (Ed.Blackwell B). Interview with Tom Ban: Brentwood Tennessee; ACNP; 2011. 427-438.

Wender PH, in The Oral History of Neuropsychopharmacology (Series Ed. Ban TA). Vol 7 (ed. Blackwell B) in Dramatis Personae: Brentwood Tennessee; ACNP; 2011. lxxxiv-lxxxv.

 

Barry Blackwell

May 05, 2017