You are here: Controversies / Thomas A. Ban: The Ewen Cameron Story.
Saturday, 17.08.2019

The Ewen Cameron Story*

David Healy’s interview of Thomas A. Ban

 

Why did you leave Hungary?

I was on vacation, travelling around in the Balkan countries when the Hungarian revolution began. I flew home from Belgrade when the Russian troops moved out from the city and left before the borders were shut, after the Russian tanks rolled in. I had no clear-cut plans. The reason I left was simply that I wanted to see the world outside the iron curtain and was interested to learn. I left sometime in mid-November and for a period of two months was permanently on the move. But by mid-January 1957 I was in Canada, a fellow at the prestigious Montreal Neurological Institute. Whether I got my fellowship entirely on merit it is difficult to know. As a medical student I won first prize for a work I had done in collaboration with a fellow student on post-traumatic epilepsy. And Penfield apparently was or was made aware of this work. It was certainly a good start for a 27-year-old who had just arrived in the new world. But then I felt that I was really more interested in psychiatry and decided that I should complete my training.

I picked the place Heinz Lehmann was at because I had heard about
his work on chlorpromazine. I went there on 1 July 1958 and within a couple of months I had been involved with him in research on phencyclidine. I also began with my work on conditioning. In those years we still had to write a thesis to get our diploma in psychiatry at McGill. And the title of my dissertation was Conditioning and Psychiatry. I received my diploma with distinction in 1960 and my thesis was published as a monograph in 1964 with a forword by Horsley Gantt, at the time one of the last living pupils of Pavlov.

After spending a year with Heinz Lehmann at Verdun, I was ready to start working with Gerald Sarwer-Foner at the Veterans Administration Hospital but the departmental chairman, Ewen Cameron, was looking for someone with the background I had in conditioning and psychopharmacology and I was asked whether I would be interested in working with him. I was, and after substituting for the chief resident at the Allan briefly I became Cameron’s researcher for the rest of the year. And even after I had received my diploma I continued with Cameron as the junior member of his research team.

What was Cameron like?

He was an independent, goal-directed, well-organized man with exceptional administrative skills. He had studied with Henderson and worked with Eugen Bleuler and Meyer in his formative years but the Cameron I knew was definitely his own man. strong, energetic and decisive with courage to pursue whatever he believed in. They called him ‘chief’ and he called us ‘Docs’ and the nurses ‘Lassies.’ He was the chief, there was just no doubt about this.

In Cameron’s time, the Allan was a truly eclectic place with facilities such as day hospital and specialty clinics, which were very much avant-garde those days and with one of the largest and most respected training programs with residents from all around the world. All of this was of Cameron’s making. What most impressed me was that Cameron ran the largest clinical service with the most difficult patients. Every day he walked around and talked to each patient and every other day we had rounds with him when we sat around a table. I was marginally involved because I was doing the research but still participated with my research patients.

I really think that what happened later was very unfortunate and uncalled for in his case. I cannot help but wonder why it happened in such an underhanded way and after so many years since everything Cameron did was done in the open and with knowledge of his peers.

He kept the cleanest and most precise records I had ever seen with all the information given on each patient to the smallest details. He dictated his notes in front of his team in his characteristic Scottish burr and whatever he dictated was typed in the record by the next day.

Where did all the controversy come from? What did it all mean?

It is somewhat difficult to remember after so many years but over the past 30 years Cameron has been vilified by the press. The difficulties began when it came to light that one of the sources of his funding, however small, was the CIA. The project that started the controversy was part of Cameron’s long-term research programme based on a mixture of psychodynamic principles and learning theory, designed for patients refractory to the traditional approaches to therapy. For Cameron, as for other dedicated researchers in the field of the time, it was never clear where treatment ended and research started. This was certainly the case for ‘psychic driving’, a form of psychotherapy he developed in the early 1950s. By the time I arrived to the Allan he used drugs, sleep, and sensory isolation to loosen, and depatterning to selectively erase pathologic patterns. And this is what created the problem. When Cameron left, his practices were scrutinized - but While all this took place the precarious balance at the Allan Memorial Institute shifted from eclectic to psychodynamic and in the years after the control of a small group of psychoanalysts was strengthened. It was a very closed shop, a fraternity of psychoanalysts.

I could be wrong, but this is how I saw it. Cameron had been critical of psychoanalytic theory, rejected what psychoanalysis stood for. Now I am not trying to say that the Cameron affair was created by the psychoanalysts. But I do believe that Cameron’s advocacy that learning might be more important in a broader sense than in the very narrow psychodynamic conceptual framework, contributed to it. It had been convenient for the psychoanalytic group to go along with what was happening and to sit back and listen to the never-ending critical appraisals of Cameron's work by different standards year after year. What is somewhat surprising is that no one ever pointed out that while Cameron’s team was depatterning a patient on one bed, another team on another bed of the sleep room was busy doing anaclitic therapy - one of those therapies based on psychoanalytic theory in which adults are treated as babies.

After all, Cameron’s idea to erase everything one had learned, get rid of the pathologic patterns, create a tabula rasa and try to rebuild things from scratch, program in new behaviour, was not as way out as some people have perceived it. And even if many people had forgotten it conveniently, Cameron had only introduced the term depatterning for a treatment which was in use but referred to as regressive ECT by others. As you know, there were all kinds of treatments in those days – apomorphine-induced vomiting and atropine-induced toxic psychosis were considered to be therapeutic. Insulin coma, and even prolonged insulin coma therapy was still used in the treatment of schizophrenia.

Cameron was of course familiar with all the different types of treatments and to combine pharmacotherapy with psychotherapy was very much in keeping with his general approach. He adopted the concept of psychic defences from psychodynamics but treated psychic defenses as if they would have a biologic substrate. But being Cameron he was impatient, looking for short cuts, trying to speed up the therapeutic process and the idea of using drugs to facilitate psychotherapy had been around for a long time. There had been “psycholytic therapy,” which aimed to activate unconscious, repressed memories, and psychedelic therapy, which aimed to elicit profound cosmic — mystic experiences by the administration of LSD and psilocybin - in fact this had a great many followers for many years. Abram Hoffer, a member of the pioneering team formulating the adrenochrome hypothesis in the early 1950s used psychotomimetics in the treatment of alcoholics. He, later, became well known around the world for promoting megavitamin therapy and orthomolecular psychiatry with the double Nobel laureate Linus Pauling. You know it is interesting that the two Canadian founding members of CINP were Abram Hoffer, who now lives somewhere around Victoria, and Ewen Cameron. Both of them have received excessive attention by the press over the years.

What one reads about Cameron is mainly about ethical issues. It is of course easy to agree that it is wrong to expose patients to treatment without proven efficacy, treatment which is in development, without their knowledge. But the real question is where to draw the line. Because, if one takes it literally none of the psychotherapies had data in support of their efficacy those days. I would question whether such data exist even today. And psychic driving, Cameron’s brand of psychotherapy, was not sufficiently different from the rest that it would have qualified as a different kind of treatment. I spent lots of time with Cameron’s patients, or at least with those assigned to me, and explained just as much about their treatment to them as I was able to comprehend myself and able to get across. And in those times, we had neither ethics committees, nor consent forms. 

How much attention Cameron paid to these kinds of issues, which today would be dealt with by institutional review boards and ethics committees I don’t know. But I do know that he felt comfortable about how things were and fully responsible for what he was doing.

Since Cameron left McGilI almost 30 years have passed and during the years my frustration with him has gone. I was terribly frustrated with my work at the Allan — mainly about trivial matters, like keeping my gadgets in working order. The difficulties interfering with my activities were there day after day and influenced my attitude towards and judgement about the research but even then, the rationale of the treatment, which was at the centre of the research, seemed to me at least as sound as the rationale of most other treatments in those days and Cameron’s speculations were more down to earth than some of the speculations I was exposed to in the seminars I had to attend during my training.

I am now able to look at the research I was engaged with on his team without any emotional-coloring and I feel that whatever was done should have been done better, in a more sophisticated way. He should have been more careful of not confounding matters by tackling too many issues together, trying to get an answer to too many questions simultaneously. There were many questions there with important theoretical implications for psychiatry - like whether the pathologic pattern could be erased by physical means. Because if pathologic patterns could not be erased by depatterning, the most drastic means that could wipe out all that was acquired after birth, it would be very unlikely that these patterns were learned and if that was the case Cameron’s findings would shatter one of the basic premises on which psychodynamics was based.

Another question with important theoretical implications was the one which dealt with the nature of the disorganization induced by sensory isolation or drugs. Because if the nature of the disorganization depends on the disease and not on the person afflicted with the disease, it would imply that the disease process is independent of personality development. But Cameron was not just bluntly entering the psychological-mental sanctuary by physical means, he was also trying to render accessible to scrutiny the detectable changes, if any, displayed during therapy, by the recording of everything for which a gadget was available. The money from the CIA was spent primarily on the development and employment of objective measures. This was something he had been interested in since the early 1930s, when he wrote his text Objective and Experimental Psychiatry.

I don’t know whether he was aware of how sensitive an area he touched in his research. Nor do I know whether he was ready to conceptualize his own findings in the way I was doing. He never acknowledged that the answers to certain questions were already there in the notes he dictated with great regularity on his patients, in the files he was so proud of. One of the patients, whose file I am referring to, was a very severe obsessive-compulsive he depatterned. She was confused and disorientated for days, but in spite of her organic state her compulsive rituals persisted unchanged. Another schizophrenic patient remained unperturbed by prolonged sensory deprivation. She was actually better after she came out of sensory deprivation than when she entered. Such patients opened my eyes to see that some of the things I had been taught might not have been as true as I was made to believe. Whether those cases carried the same message to Cameron, it is difficult to know. He spoke little and even when he did I frequently felt that he said things tongue in cheek. By the time I could have asked him, he had passed away. Cameron died while mountain climbing - he died as he lived.

I joined Vanderbilt in 1976, and we left Montreal and moved to Nashville. Then last fall McGill´s department of psychiatry had its 50th birthday. I was invited to the anniversary celebrations and I assume in consideration of my monograph Psychopharmacology for the Aged, I was assigned to a symposium on psychogeriatrics. When I went back, after being away for almost 20 years, I was struck by what I saw. The department seemed to be frozen in the state as it was in the mid 1970s. It was on my tongue to say that you may argue endlessly about the relationship between mind and body but get rid of the double standards between the biologic and the psychodynamic and get on with treating patients. I left at the end of the meeting contemplating that even if it had been right to criticize Cameron about some of the research he did, the outcome of his departure was devastating. It shifted the department into a psychodynamic mode at a time when the rest of the world was shifting in the opposite way. The department which in Cameron’s time was the heart of Canadian psychiatry was struggling to adapt to the new world. I just cannot help to think that there was something else there and not just the funding from the CIA.

It was all very strange because around 1960/62, Cameron was one of the three or four big names in the world.

He was one of the Nuremberg psychiatrists and one of the psychiatrists who examined Rudolph Hess. He had been president of the American Psychiatric Association and the founding president of the World Psychiatric Association. Cameron was a hardworking and creative man and this was his greatest strength. He was free of prejudices and binding beliefs and had the necessary drive to pick up and explore the possible usefulness in psychiatry of whatever new thing he picked up from the other disciplines. Most people work within someone else’s framework, but Cameron had the imagination to build his own. He had arrived in Montreal, from Albany, in the early 1940s and was facing a society strongly controlled by the Catholic church. But he walked through without paying any attention to this and without ever bending his head. The clergy had no place in the psychiatric hospital insofar as Cameron was concerned. And he succeeded on his own to create the leading department of psychiatry in Canada, a department which was at that time one of the best in the world. No one in those years would have denied that Cameron was a 1 great man. When Ellenberger arrived . . .

Cameron brought Ellenberger there?

Yes, he brought him there in the late 1950s or early 1960s. He was an eclectic and his department clearly reflected this. Regardless of what people say, he cared about his patients and he had an open mind. He was interested in everything new and tried to introduce it in his Institute. Hyden had hardly presented his theory that RNA is the molecular substrate of memory when Cameron picked it up and was ready to start with
a clinical trial employing RNA as substitution therapy in elderly patients with memory impairment. He was ready to build a bridge between molecular biology and clinical psychiatry. And when existential analysis emerged, Cameron without delay hired Henri Ellenberger but he really did not know how to deal with him.

Why not?

Cameron was a pragmatic and Ellenberger was a man of books. He was expected to see patients to generate his livelihood. I assume that the time required for practice was too much of a distraction for him. He was obviously working already on the Discovery of Unconscious, which became a classic by the 1980s. Ellenberger was completely lost in the big machinery of the Allan and found refuge at the university of Montreal, where
he became professor outside the medical field. His story reminds me of the story of Karl Jaspers who exchanged psychiatry for philosophy.

Was there anyone else he brought in like that?

There was Kral, one of the pioneers of psychogeriatrics, best known for separating benign from malignant forgetfulness. He collaborated with us in a project trying to predict therapeutic responsiveness to psychotropics by employing pharmacological load tests. He brought in Eric Wittkower, a leading psychoanalyst, who was involved with research in psychosomatics and cross-cultural psychiatry. One of the first people he brought in was Robert Cleghorn, who succeeded him at the Allan. It was actually
Cleghorn’s team which commissioned the work which found no memory impairment in the depatterned patients by employing the Wechsler Memory Scale. I have not seen the report but I understand that in spite of the findings Cleghorn concluded that patients might still have difficulties with remembering because there are memory problems which are not detectable by the Wechsler Memory Scale.

Why is getting funds from the CIA such a potent stick to beat people with?

Because it can be implied that CIA-funded studies were used for the development of brainwashing techniques. But of course, the stick was not necessarily used. There were many distinguished scientists who got funds from the CIA. I don’t really know who they were, I read about Harris Isbell, who was director of the addiction research center in Lexington; Jolyon West, who was chairman of the department of psychiatry in Los
Angeles; and Leo Hollister, one of the most prominent clinical psychopharmacologists of the United States. But there were many well-known psychologists too. I read that Hans Eysenck, Carl Rogers and Fred Skinner received funds from the CIA.

But who really knows . . . and, you know, it was never completely clear whether Cameron knew that the source of the money he received for four years or so from the society for the Investigation of Human Ecology was the CIA. I certainly did not. But even if he had known, he would not have cared. Funds from the CIA were just as good for him as funds from anywhere else. But as you say it has been used as a stick to beat him with.

How much do you think it links up with the clash of paradigms with the analysts
on one side and the biological psychiatrists on the other? Someone like Frank Ayd would say that the biological people were seen as being in league with the devil, treating people in this inhuman way - so in a sense maybe the CIA links were just the icing on the cake.

This is exactly how I see it. The CIA link helped to blow out of proportion the criticism of Cameron’s work and to make biological psychiatrists look as if they were treating their patients inhumanely. You should keep in mind that the Cameron affair took place before we began with our struggle to separate facts from beliefs and hypotheses from speculations in psychiatry, just around the time when the different approaches in psychiatry were turned into paradigms and became politicized. The two most influential paradigms were the social and the psychodynamic, one the mirror image of the other.

I felt somewhat lost those days, because paradigms were meaningless words to me. I just couldn’t see why it was so important to choose whether the social creates the psychologic - my indoctrination in Hungary - or the psychologic the social - my indoctrination at McGill. Neither seemed to me to have much relevance to psychiatry but I could see that paradigms are created by social forces and that psychologizing can distract from social problems - that is, that it’s the social structure Which has fostered psychologizing in the US and sociologizing in the UK and that there are vested interests which have sustained the dominance of these approaches.

Absolutely. In England psychopharmacology happened outside of Oxford and Cambridge. It did not happen in the major centres.

It was the same in the United States and Canada. It was not at the Allan Memorial Institute, the primary teaching centre, and not even at the psychiatric units of the Montreal General or the Jewish General Hospitals, but at the Verdun Protestant Hospital, a kind of State Hospital, which served the poor in the English-speaking community of the city. And even at the Verdun, an ambitious Executive Director gave Dr. Lehmann a hard time during the late 1950s. Fortunately, after he had been psychoanalyzed, he moved away from Montreal to higher positions. But, as late as the early 1970s, another ambitious Executive Director succeeded in preventing the implementation of a programme which would have led to a rational use of psychotropics within the framework of a specially designed service structure in the hospital. Everything was in place to go ahead, but he interfered to prevent the shift in the balance between two paradigms, the psychopharmacologic and the social. I presented a brief outline of the proposed programme at the CINP Congress in Copenhagen. There was great interest, but nothing else.

In the majority of the teaching centers of Canada and the United States the psychodynamic approach remained dominant during the 1970s. I assume the same applies to the social approach in the UK. But, you know, in spite of the brutal clashes between their prominent representatives, the social and psychodynamic paradigms are quite close. Both confound the disease with how the person with the disease is interacting with the outside world. And for the drug companies it was more convenient to deal with a profession split by different approaches, entangled in paradigms fighting each other about the acceptance of psychotropic drugs, than to deal with a unified profession, ready to accept that in mental illness, pharmacotherapy is the only rational treatment. A unified profession would not have been happy to stop half-way in developing a psychotropic drug. After establishing efficacy, it would have insisted on identifying the treatment-responsive population. We would not have ended up with nearly 500 semi-finished psychotropics, but only a few with well-defined therapeutic indications.

 

*Extracted from David Haely’s interview of Thomas A. Ban, in June 1994, in Washington, DC, USA. The full interview was published with the title “They Used to Call It Psychiatry,” in The Psychopharmacologists  Interviews by David Healy. London, Weinham, New York, Tokyo, Melbourne, Madrid: Altman, An Imprint of Chapman and Hall; 1996, pp. 599 - 606

August 1, 2019