Friday, 15.10.2021

Herman van Praag: Religion and Religious identity

Bernard Lerer’s comment

 

        I first met Herman Van Praag in 1974 in Jerusalem. I was in my first year of residency in psychiatry, having recently transferred from internal medicine. Herman was already a renowned Professor of Psychiatry, Head of the Department of Biological Psychiatry at the University of Groningen in the Netherlands. He had come to Hadassah University Hospital in Jerusalem on sabbatical as a visiting professor. We were excited to learn that he had been offered and was considering taking up the position Head of the Department of Psychiatry at Hadassah at the end of his sabbatical year.

        My meeting with Herman in 1974 was also my first meeting with biological psychiatry. After moving from internal medicine, I was somewhat disillusioned with the strong psychoanalytic focus of many of my teachers and supervisors, particularly the ones who were most influential in the department. Herman gave the residents a series of seminars on biological psychiatry and psychopharmacology. I was transfixed by what he taught us. He was a careful and systematic teacher who conveyed a passion for what he was doing. At the time Herman was one of the leading international figures exploring the role of serotonin in depression and antidepressant mechanisms. He taught us the rationale underlying his focus on serotonin and emphasized the need for careful research methodology in obtaining and interpreting clinical samples.

        Herman not only focused on research but outlined his views on clinical issues and taught us a different approach to diagnosis than the one that was accepted at the time. He was then and remained over the following decades iconoclastic on the issue of nosology. He fearlessly butted heads with the nosological (i.e., DSM) aristocracy in several papers that were to follow. In our seminars, Herman strongly promoted the concept of "vital depression" as a core diagnostic entity that predicted response to antidepressant drugs and was associated with biological features. As clinicians in training we were wrestling with the dichotomy of "reactive" and "endogenous" depression that was taught at the time. It simply did not make sense when applied to real patients who showed endogenous features even when there was an obvious trigger. I have used the concept of vital depression ever since even if I have not always applied the specific term.

        All these concepts were entirely new to me and my fellow residents and we hung on to every word. I took detailed notes in a small exercise book which I kept for years and would go back to and consult in preparing my own talks to students. Unfortunately, I have temporarily mislaid that notebook but have not given up hope of finding it again! There is no doubt that Herman had an enormous influence on my career development at a crucial time in my training in psychiatry. My interaction with him was a major factor in encouraging me to follow a research track with a focus on biological psychiatry and psychopharmacology that I maintain until today.

        Herman kindly accepted my invitation to visit my wife, Ziona, and me and have a weekend lunch with us in our small apartment. His wife and son were back in the Netherlands at the time so he came alone. During that visit we saw another side of the sometimes rather formal professor. We learned of his Jewish background, his childhood in pre-World War II Holland, his experience as a boy incarcerated by the Nazis in Auschwitz concentration camp and the fact that he had his bar-mitzvah in the camp. Having lost almost all my father's family in the Holocaust including my grandparents whom I never met, Herman's experiences made an enormous impression on me. Without being religious in a formal sense, it was clear that Herman emerged from his Holocaust experience deeply Jewish. This Jewishness, along with his philosophical bent and love of learning, would gradually emerge over the years in his writing, reaching its peak in the remarkable book, Deference to Doubt (2020).

        For various reasons, Herman did not take up the position as Head of our Department in Jerusalem. He returned to the Netherlands and went on to become Head of the Department of Psychiatry in Utrecht. There he came into head-on contact with anti-psychiatry activists. They targeted his department and Herman in particular because of his biological focus. As part of the anti-establishment ethos of the 60s and 70s, anti-psychiatry was growing in influence. Herman was not content to defend psychiatry against the attacks but took the anti-psychiatry movement on intellectually and published a remarkable paper refuting their key theses (van Praag 1978). He wrote: "The point of crystallization of anti-psychiatry is the labelling theory on the origin of deviant behavior. The scientific status of anti-psychiatry stands or falls with that of the labelling theory." Since this theory had not been formulated in verifiable hypotheses, Herman took it upon himself to formulate "theses" which he then tested against empirically obtained data; the results were largely negative. Herman concluded: "The empirical material does not support the labelling theory, and in many cases even contradicts it. Consequently, anti-psychiatry - as a model to explain the development of psychological disorders - has not a leg to stand on." I doubt that Herman's paper dissuaded many anti-psychiatrists but it certainly influenced young people such as me seeking intellectual support to withstand the persuasive and socially attractive arguments of anti-psychiatry that were a powerful, radical force at the time.

        From Utrecht, Herman went on chair the Department of Psychiatry at Albert Einstein College of Medicine in New York. Many young psychiatrists from the US and other parts of the world went to Einstein for fellowships during Herman's time there. I visited him at Einstein and he received me warmly and we spent a long time talking about psychiatric and non-psychiatric topics. Over the years I continued to meet Herman at scientific meetings and he was always interested in my career and scientific activities. Already at Einstein but even more so after returning to Holland, Herman began to focus on spiritual issues and the interface between psychiatry and religion. A key to understanding his approach was a paper he published in 2003 in Medical Humanities: " Itinerary: Concerning the professional and spiritual objectives of my life" (van Praag 2003). He published many articles and book chapters that have been and still are influential in this area.

        Deference to Doubt, the book for which Herman was honored in Jerusalem in 2019 is philosophical in its focus but written in a way that is intuitive and easy to read. The book tells of the journey of Amos, a young man in Judea at the time of the Jewish Second Temple and his search for answers to challenging religious and intellectual questions. He meets and interacts with key figures of his time from Jesus to Philo the famous Jewish philosopher in Alexandria before returning to his home in Judea. There he continues his life and continues to grapple with the questions to which he has received significant but still limited answers.

        It was my great privilege to chair the session at the International Congress in Spirituality and Psychiatry in Jerusalem in December 2019 at which Herman presented his book. Thereafter my wife, Ziona, and I hosted a dinner in his honor and that of his wife Nelletjie which was attended by former mentees and colleagues from over the years. Herman was an important influence on my development as a psychiatrist at a critical juncture of my career. I deeply admire his contributions and wish him continued health and productivity.

 

References:

van Praag HM. The scientific foundation of anti-psychiatry. Acta Psychiatr Scand. 1978; 58(2):113-41.  

van Praag HM. Itinerary: Concerning the professional and spiritual objectives of my life. Med Humanit. 2003; 29(2):89-96.  

van Praag HM. Deference to Doubt. Urim Publications. 2020.

 

July 30, 2020