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Wednesday, 28.10.2020

Samuel Gershon: Events and Memories

Barry Blackwell’s comments

 

       It is a distinct honor and pleasure to comment on Sam Gershon’s distinguished career in psychiatry. An additional source of information is in an interview with Tom Ban in 1999 for the Oral History of Neuropsychopharmacology (OHP) (Ban 2011).

       In 2013 Sam and I became co-founders, along with Tom Ban, of the International Network for the History of Neuropsychopharmacology (INHN). We then became more closely related and are frequent contributors to the INHN website, inhn.org.

      Sam Gershon was born in Poland and taken to Australia by his immigrant parents when he was two. He went to medical school in Sydney. Following graduation in 1950 and after completing a rotating internship he began his psychiatric residency in 1951 n Melbourne.

      This was shortly after John Cade in 1949 published his discovery that lithium was an effective treatment for the control of acute mania in bipolar disorder. Enthused and eager to learn more, despite being discouraged by Cade (because of lithium’s toxicity) Sam sought a mentor in the University of Melbourne Physiology Department and began research with Edward Trautner which rendered the naturally occurring toxic metallic ion safe to use. This significant historical achievement was the beginning of a life-long career interest in bipolar disorder and its treatment.

       After completing his residency in 1956 he joined the Department of Pharmacology in the Faculty of Medicine at the University, starting as a research fellow and becoming a Senior Lecturer the following year.  His academic career was meteoric; within two years he became acting Chair of the Department and in 1959 he won a competitive Pfizer Scholarship for research overseas.

       Sam spent from 1959-1960 at the University of Michigan working in the Schizophrenia and Psychopharmacology Joint Research Project with the rank of Chief, Psychopharmacology Section and Associate in Psychiatry. During this time lithium had been banned in America by the FDA because of its lethal toxicity when used as a salt substitute in cardiovascular disorders. Sam took the opportunity to explain his research with Trautner, to advocate for the safe use of lithium and to publish a paper with Arthur Yuwiler in 1960 expressing the view that “lithium is one of the few examples of psychopharmacological specificity in psychiatric treatment.” After his scholarship Sam returned to Melbourne and resumed his position as Acting Chair and now, Professor.

       Inevitably, he returned to America in 1963 as Principal Research Scientist (Pharmacology) and Associate Professor (Physiology, Pharmacology and Psychiatry) and Chief, Clinical Research Unit, University of Missouri, Department of Psychiatry.

      Over the next decade Sam would remain a fierce advocate for the safe use of lithium including as an effective remedy and replacement for ECT in recurrent bipolar disorder (Gershon and Trautner 1956), a finding that would later help affirm Mogens Schou’s findings of prophylaxis. Sam was instrumental in persuading the FDA to lift its ban on lithium in 1970, the same year Cade made his first visit to America to receive the Taylor Manor award for his discovery (Ayd and Blackwell 1970) in a presentation during which he denied the death from toxicity of his first lithium patient and failed to mention Sam Gershon and Trautner’s role in rendering the treatment safe.

       In 1965 Sam moved from Missouri to New York University Department of Psychiatry to become Director of the Neuropsychopharmacology Research Unit where he remained until 1979 when he became Professor and Chair of Psychiatry at Wayne State University in Michigan until 1988. Then he made his penultimate academic career move to join Tom Detre at the University of Pittsburgh as Detre’s Associate Vice Chancellor and Vice President for Research  and Research Director for Neurosciences. Over 15 years he directed three different research and training centers; Alzheimer’s Disease (1988-1990), Adolescent Alcohol (1990-1999) and Resident Training (2000-2002).   

       In 2004 he became Emeritus Professor but was clearly not yet ready to retire. So, in 2006 he made his final career move to The University of Miami Leonard M. Miller School of Medicine to become Professor and Vice Chair of Academic Affairs in the Department of Psychiatry.

       This career trajectory reflects both the persona and research intellect that drove it. A close colleague and former student Burton Angrist (2015) describes Sam as “gracious, utterly without pretense, and often hilariously funny. Intellectually his qualities are remarkable astuteness, clarity of thought and a real wisdom complementing his enormous knowledge base.” In his OHP interview Tom Ban asks Sam which is his major contribution. Sam replies, “The most rewarding, really, was to work with young talented people and have a mutual interchange of excitement and growth.”

       I learned something of the scope and depth of Sam Gerson’s research accomplishments when I helped document them for INHN in 2015. In addition to lithium they covered a wide range of compounds, therapeutic and toxic. These included succinic acid as a potential antagonist to hallucinogenic drug effects and in schizophrenia; Bemegride’s use and value in attenuating the effects of barbiturate overdose; after World War 2 attempts to find drugs that might attenuate the adverse effects of morphine while retaining its analgesic action; the pharmacologic properties of acridine compounds (THA) in collaboration with the U.S. Army on blocking the effects of psychomimetic drugs; and yohimbine, first in dogs and then humans, as a drug induced form of anxiety with physiological and behavioral effects that were increased by antidepressant drugs, mediated by serotonin.

       Over an extended period in Australia and America Gershon and colleagues tried to unravel the etiology of bipolar disorder using acetylcholine, norepinephrine and serotonin. Their enigmatic findings revealed “the shifting sands of biochemical speculation, a classical example of translational science.”

       Over the course of his career Sam estimated, “perhaps a hundred anti-psychotic compounds have been introduced.”  He catalogues the diverse side effects indicating serious neurotoxicity that raise concerns about “increasing proposals to treat younger and younger children.” The results of his animal studies in rats showed “substantial neural changes in the substantia nigra and striatum which raise the ‘risk-benefit dilemma’.” He cites the Hippocratic Oath, “First do no Harm,” and notes the historical similarity between the initial popularity of insulin coma and anti-psychotic medication contrasted with tardy acknowledgment of their limited benefit and obvious disadvantages.

       Sam’s final foray was in the area of model psychoses inflicted by amphetamine, studying its effects on dopamine, norepinephrine and serotonin metabolism, noting a difference between clozapine and other neuroleptics that indicated an active anti-psychotic action different from effects on dopamine.

      Throughout his career Sam’s research in clinical areas, bipolar disorders, Alzheimer’s disease, alcohol and ageing was funded by the National Institutes. Not surprisingly he was a member of several NIMH committees including Ageing, Scientific Advisory, Bipolar Disorder and Behavioral Sciences Study Section. He was a Fellow or Member of 15 professional or scientific Societies and a reviewer or Board member of 19 professional journals. Sam was founder and Editor in Chief of Bipolar Disorders, An International Journal Psychiatry and Neuroscience and Editor in Chief of Biology of Behavior (a series of volumes).

      During his long and distinguished career Sam Gershom acquired the following honors:

·   Rush Gold Medal Award 1970. American Psychiatric Association

·   Ben Gurion Medal. University of Negrev. 1972

·   Taylor Manor Hospital Award. 1979

·   Gershenson Distinguished Faculty Fellowship. Wayne State University. 1986

·   Mogens Schou Award for Achievement. International Conference on Bipolar Disorders. 2005

There are also two awards named after Sam Gershon:

·   Sam Gershon Junior Investigator Award. International Society for Bipolar Disorders

·   Sam Gershon Medal for Lifetime Achievement in Translational Neuroscience. South Australian Health and Medical Research Institute

       Sam Gershon’s career and accomplishments as a scientist and role model span the entire last half of the 20th Century and beyond, the Golden Years of our discipline. Those of us who know or worked alongside him view Sam as an icon to be revered and treasured, a true man of our times.

 

References:

Angrist B. Comment by Burton Angrist. 1. Studies of amphetamine psychosis: Clinical aspects. Samuel Gerson: Events and Memories. inhn.org.biographies. December 31, 2015.

Ayd FJ Jr, Blackwell B, editors: Discoveries in Biological Psychiatry. Philadelphia/Toronto: J.B. Lippincott; 1970.

Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years. Peer Interviews.  Volume One,  Shorter E, editor. Starting Up. Brentwood: American College of Neuropsychopharmacology; 2011, p. IX.

Cade JFJ. Lithium salts in the treatment of psychotic excitement. Med J. Aust. 1949, 2:349-52.

Gershon S, Trautner EM. The treatment of shock-dependency by pharmacological agents. Med J Aust. 1956; 1(19):783-7.

Gershon S, Yuwiler A. Lithium ion: a specific psychopharmacological approach to the treatment of mania. J Neuropsychiatr. 1960;1:229-41.

 

April 9, 2020