Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.
Lehmann Collection 16
Neuropsychopharmacology in Historical Perspective.
Heinz Edgar Lehmann
Pioneer and President (1968-1970)*
by Thomas A. Ban
Heinz Edgar Lehmann was born in Berlin on July 17, 1911. The Lehmann’s were a line of physicians and from his early childhood Heinz wanted to become a medical doctor like his father, who practiced minor surgery in their residence in Berlin. His interest in psychiatry developed in his early teens by reading the works of Sigmund Freud.
In 1929, Lehmann started his studies at the University of Freiburg, the alma mater of his father. In 1935 he graduated in medicine from the University of Berlin. Due to his interest in Kretschmer’s work, he spent the second year of his studies at the University of Marburg. He also spent a year studying in Vienna, where he had an opportunity to meet Julius Wagner-Jaurogg, at the time the only psychiatrist to have the Nobel Prize. He also branched off into many other areas of study and when reminiscing about his student years he remembered more seminars on existentialism with Heidegger than any of his courses in medicine. After his graduation, from 1935 to 1936 he did an internship in medicine, surgery and neurology at the Martin Luther Hospital and at the outpatient clinic of the Jewish General Hospital in Berlin.
In 1937 Lehmann emigrated to Canada. After his arrival he worked for three months at the Montreal Children’s Hospital. Then he joined the staff of the Verdun Protestant (Douglas) Hospital (VPH), a large psychiatric inpatient facility on the outskirts of Montreal with which he remained affiliated for the rest of his life. It was during his early years at VPH that Lehmann met his wife, Annette Joyal, a French Canadian, who worked there as a nurse; François, their only child, grew up on the hospital grounds where the Lehmann’s lived.
In spite of his heavy clinical responsibilities during the 1940s, Lehmann always found time to conduct clinical research. To pursue his early interest in the measurable correlates of mental illness, he developed and regularly employed simple psychometric and psychophysiological batteries. He also found time for his numerous hobbies, which ranged from astronomy to the collecting of gemstones.
Fluent in English, French and German, Lehmann closely followed the current psychiatric literature, always searching for new treatments. This led to one of his first publications, a case report on the therapeutic effect of massive doses of nicotinic acid in post-traumatic confusional states.
In 1954, Lehmann was propelled into prominence as the first in North America to publish findings of a replication study on the therapeutic effect of chlorpromazine and one of the first in the world to successfully communicate the drug’s “antipsychotic” effect. Four years later in 1958, he was again first in North America to publish findings of a replication study on the therapeutic effect of imipramine and, again, one of the first in the world to successfully communicate its antidepressant effect. While Lehmann’s contributions were instrumental in clearing patients out of psychiatric wards, in his later years he became increasingly concerned about the growing number of the homeless mentally ill. After he was presented in1992 with the Prix de l’Oeuvre Scientifique of l’Association des Medicins de Langue Francaise du Canada, in an interview he focused attention on the problems created by “deinstitutionalization forced by politicians wanting to save money” without the necessary back-up services in the community.
As a clinician dedicated to his patients, Lehmann maintained that pharmacological treatment needed to be supplemented with psychotherapy and social support. Familiar with all the different languages of psychiatry, from psychodynamics to psychopathology, in his comprehensive approach he combined the best of American and European traditions. He was also constantly striving to replace old beliefs with verified knowledge about mental illness.
Lehmann’s research was instrumental in the birth of neuropsychopharmacology, the reintegration of psychiatry with medicine, and the development of a neuroscience of which psychiatry is a part. As a clinician and teacher, he pioneered a psychiatry in which the biology of the illness, the psychology of the person, and the social situation of the individual were given full and special attention.
In recognition of his distinguished contribution Lehmann received numerous awards and honors. He was presented in 1957 with the prestigious Albert Lasker Award, considered America’s leading prize for medical research and in 1962 with the Stratton Award of the American Psychopathological Association. In 1976 Lehmann became an Officer of the Order of Canada. In 1998 he was presented with the Pioneer in Psychopharmacology award of the 21st CINP Congress in Glasgow. On October 28, 1998, he joined the distinguished company of William Osler, Norman Bethune and others when he was inducted into the Canadian Medical Hall of Fame.
I met Dr. Lehmann on the first day of my psychiatric residency on July 1, 1958. It was about a year after he had received the Albert Lasker Award for successfully communicating the practical significance of chlorpromazine and just about the time he published the first report outside of Europe on the antidepressant effect of imipramine.
Our early interaction turned into a research collaboration which grew over the years into a very close friendship. I learned to know the man, who remained even in his 80s full of youthful vitality and energy and whose curiosity and probing extended to all the different aspects of life but who never owned a car or a house, or for that matter anything of material value. He felt that taking a taxi not only spared him the aggravation of driving, but also allowed him to work in the back seat.
Heinz was brought up during the Weimar Republic, a period of political freedom and cultural creativity to Germany between 1919 and 1933. By the time he received his medical degree, the Weimar Constitution had been wiped out by Hitler and the Nuremburg Law for the protection of German Blood was in effect. Heinz, whose father was Jewish (his mother was Protestant), now faced an uncertain future in Germany and was ready to leave, but Germany did not want to let him out and the United States did not want to let him in. Fortunately, he managed to finagle an invitation for a three week ski vacation in Canada. He arrived in Halifax on New Year’s Day 1937. All he had with him was a $200 camera and a suitcase which contained a complete magician’s kit of tricks – rings, colored handkerchiefs and the like. A puzzled customs officer asked, “Why the hell does a skier need all this?” Heinz, who then spoke hardly any English, calmly replied, “A man’s got to have a hobby!”
Heinz had no formal training in psychiatry. Nevertheless, by 1950 he was the clinical director of VPH. In 1959 he was the keynote speaker of the 115th annual meeting of the American Psychiatric Association; and, by the late 1960s, Heinz ranked among the most prominent living psychiatrists in the world.
In 1971, at age 60, Heinz accepted the chairmanship of the department of psychiatry at McGill but told the Dean that he needed the post as much as he needed a hole in the head. Still, this was the happy ending to a misunderstanding in the early 1940s, when McGill’s department of psychiatry was created, Heinz was told that Ewen Cameron would be chairman, but still a relative newcomer to English he understood that Ewen (you and), i.e., he and Cameron would be.
In 1976 he turned 65 and, as required by law, was formally retired from his posts. However, whenever anyone mentioned retirement to him he retorted, “Retirement is a bureaucratic arrangement, not a state of mind…” To prove his point, he extended his professional activities and put up his personal fight with aging by complementing his favorite sports, like skiing, with scuba diving, and refusing to wear glasses when reading.
It was also in the late 1970s that he started to work in the New York State Office of Mental Health for the nominal fee of $1 a year which he – I understand – never actually received. The ties between Heinz and New York State were extremely strong. Although a Canadian, Heinz was the last survivor of a core group of New York psychiatrists which included Paul Hoch, Henry Brill and Nate Kline. Due to the enormous business New York State represents in psychotropic drugs, the impact of this core group on the development of psychiatry goes far beyond scientific contributions alone. I don’t think that Heinz ever realized the important role he played in this rather heterogenous group.
By December 1998 Heinz was very ill, yet he still managed to attend the Eleventh Annual New York State Office of Mental Health Research Conference and present the annual research awards with his usual wit and humor. Following it, he also attended the annual meeting of the American College of Neuropsychopharmacology in Puerto Rico, an organization of which he was president in the mid-1960s.
Although visibly weak, Heinz went to the sessions in which he was interested and enjoyed discussing whatever he learned. As usual, he had his emerald (part of his gem collection) in his hand while listening to the speakers, but unlike previous occasions, whenever he got bored he would start fondling it, he just left the room.
He was unsteady on his feet and had some difficulty finding places in the hotel; the only thing he complained about was that he could not sleep. He told me that there is a real need for a hypnotic which could make people like him sleep. Walking around the poster session he carefully reviewed every poster which dealt with insomnia and or sleep and brought to the attention of the exhibitors the need for a different kind of hypnotic.
Heinz had lost a lot of weight since the last time I saw him at the end of October, when he was inducted into the Canadian Medical Hall of Fame. He had no appetite but was willing to share with me the main course. One day he went to the beach and it was good to see how much pleasure he got from swimming. For the first time since his arrival, he had a good sleep in the afternoon and at night he seemed to enjoy his cocktail before dinner and his dessert at the end, although we still had to share the main course.
Over the next three months we talked regularly on the phone and he always brought to my attention the need for a different kind of hypnotic. He also complained about hiccups, which he could control by soaking in the bathtub, and restlessness which could not be controlled. One night, just a couple of weeks before he was admitted to the hospital for the last time, he sounded different when I called. He told me that finally he had a good sleep after taking a small dose of olanzapine and that his restlessness was gone. Then, in his usual way, as I heard it from him many times before, he added, “one should look into this matter because surely there are many other people with similar problems who need help.”
I did not look into this matter, but he did. After a few days of taking olanzapine, he stopped taking it for a day to find out whether it was really the drug that worked. All his symptoms recurred and promptly remitted with resumption of olanzapine in a small dose.
Heinz Edgar Lehmann, a pioneer and president of CINP, died on April 7, 1999. Today there are several awards honoring his name, including the Heinz Lehmann Annual Award of the Canadian College of Neuropsychopharmacology, the Heinz Lehmann award for Excellence of the Quebec Psychiatric Association, and the Heinz Lehmann Research Award, established by the New York State Office of Mental Health.
*Thomas A. Ban’s “Heinz Edgar Lehmann Pioneer and President (1968-1970)” was adopted from Ban TA, Healy D and Shorter E, editors. Reflections on Twentieth-Century Psychopharmacology Volume 4 of the series The History of Psychopharmacology and the CINP As Told in Autobiography. Budapest: Animula; 2004, 580-3.
December 10, 2020