Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.
Lehmann Collection 6
Neuropsychopharmacology in Historical Perspective.
Heinz E. Lehmann by Edward Shorter*
Heinz Lehmann, director of the Verdun Protestant Hospital in a suburb of Montreal and professor of psychiatry at McGill University, organized the first North American trials of chlorpromazine (Lehmann and Hanrahan 1954), [i]imipramine (Lehmann, Cahn and De Verteuil 1958), and the first trial in which the monoamine oxidase (MAO) inhibitor iproniazid (Marsilid) was shown to be effective (De Verteuil and Lehmann 1958). (Lehmann’s report on iproniazid appeared in January 1958, Nate Kline’s in June, though Kline gets credit for mentioning the effectiveness of iproniazid at a psychiatric meeting the previous year.) Lehmann was a trialists’ trialist.
Heinz Edgar Lehmann was born in Berlin in 1911, the son of a Jewish father and a non-Jewish mother and gained his medical degree at the University of Berlin in 1935, two years after Hitler’s seizure of power (Shorter 2005). He interned at the Jewish General Hospital and the Martin Luther Hospital in Berlin then fled the country. Without any postgraduate training, he took a post in 1937 at the Verdun Protestant Hospital (now the Douglas Hospital), where initially he had, according to one biographer, “a caseload of 600 patients.” He said, “That was my postgraduate training in psychiatry” (Cahn 2001). From 1947 to 1966 Lehmann was clinical director of the hospital, thereafter director of medical education and consultant. He was emerited as professor of psychiatry at McGill in 1981.
In 1958 Lehmann was joined by Thomas Ban from Budapest. Ban became the spark plug that drove forward many of the Verdun Hospital’s trials. “There’s hardly any drug, between 1952 and 1970, that we didn’t do clinical trials with,” Lehmann said in the interview*. In the late 1950s Lehmann and Ban figured among the chief trialists of NIMH’s Psychopharmacology Service Center, established in 1956. Lehmann was actually not a great believer in biological psychiatry, though he was grateful that the drugs were effective. As he remarked in the interview*, he thought there was a “physical substrate” to the psychoses but not to the neuroses. He remained his lifelong a proponent of the virtues of psychotherapy and even psychoanalysis. (He had read Freud’s works while in high school and never lost his enthusiasm for depth psychiatry.) He was skeptical of rating scales and large trials with undifferentiated diagnoses, preferring like many clinicians of his generation, such as Swiss psychiatrist Roland Kuhn (who initially discovered the effectiveness of imipramine), the close observation of individual patients. Yet in an institution such as Verdun, the patients were often very sick, and the effectiveness of the new agents lay at hand, regardless of whatever one thought of psychotherapy for what were then called “the walking wounded.”
Lehmann was also a shrewd nosologist and came out early against the large American overdiagnosis of “schizophrenia” (Lehmann 1969). He coined in 1961 the term “antipsychotic,” a more exact description of the action of the phenothiazines and butyrophenones than “neuroleptic” (Lehmann 1961). Somewhat against his will, he said wryly, he became one of the founders of ACNP.
References:
Cahn CH. Heinz Edgar Lehmann, 1911–1999. Roy Soc Can Proc (6th series) 2001; 12:211–4.
De Verteuil RL, Lehmann HE. Therapeutic trial of iproniazid (Marsilid) in depressed and apathetic patients. Can Med Assoc J. 1958; 78:131–3.
Lehmann HE. New Drugs in Psychiatric Therapy. Canad Med Assn J, 1961; 85:1145-51.
Lehmann HE. Discussion: A renaissance of psychiatric diagnosis? Am J Psychiatry 1969; 125 (Suppl.): 43–6.
Lehmann HE, Cahn CH, De Verteuil RL. The treatment of depressive conditions with imipramine (G 22355). Can Psychiatr Assoc J. 1958; 3:155–64.
Lehmann HE, Hanrahan GE. Chlorpromazine: New inhibiting agent for psychomotor excitement and manic states. Arch Neurol Psychiatry. 1954; 71:227–37.
Shorter E. A Historical Dictionary of Psychiatry. New York: Oxford University Press; 2005, p.160–1.
*Adopted from Shorter E, editor, Starting Up, in Ban TA, editor, An Oral History of Neuropsychopharmacology The First Fifty Years Peer Interviews, Volume One. Brentwood: American College of Neuropsychopharmacology; 2011, pp. xlviii -lxv.
September 24, 2020