Barry Blackwell's reply to Edward Shorter's comment

I thank Ned Shorter for his informative and kind response to my essay as well as correcting an historical error regarding the Ford dynasty. I regret blaming the son for the sins of the father when his only fault was as a designer – although attitudes can travel down the generations. But good history and biography should shun such speculations. I apologize.

With regard to the walls that contemporary editors erect to preserve their reputations and revenue stream, I believe Ned is partly correct as a very recent experience in attempting to get a letter published in JAMA reflects, although I am an 81 year old has-been, not a neophyte. (This exchange with the JAMA editorial board, involving lithium, will be posted shortly on INHN). My youthful experience with the Lancet was more nuanced.

The Editors first became acquainted with me as a medical student when they published a provocative letter to them about “Human Relations in Obstetrics” over my own name and hospital designation. When I took my final exams six months later this cost me an additional six months training in obstetrics before graduation.  (My Memoir, “Bits and Pieces of a Psychiatrist’s Life” tells this in detail). As a first year house officer at Guy’s Hospital, I sent them an article based on my rotation through the Emergency Room, “Why Patient’s Come to an Emergency Room.” To my surprise, the Lancet published it. So I was not entirely unknown to the editorial staff when I started at the Maudsley and sent them my letter about cheese. Our relationship developed further; while still a registrar they invited me to contribute anonymous editorials and annotations on topics of their choosing. Every few months, the Deputy Editor, Ian Munroe, rewarded me with lunch at the Athaneum – where Aubrey Lewis would sometimes sit in front of the fire, reading the Times as we passed by. He never seemed to notice, nor said a word.

I suspect Ned may be right about Gerald Samuels. Later, in America, I invited a drug representative from Roche to co-author a paper titled “Diazepam on Demand” published in the Archives of General Psychiatry. Rather than help his career, I fear it may have damaged it. Despite everything I did to acknowledge Gerald Samuel’s support, nothing placated him; he vented his anger towards me for many years – perhaps a displacement of his employer’s displeasure at mixing sales with science and its impact on his own career.

Next, the situation at the Maudsley in 1962 was very different from that in America. When Sir Aubrey Lewis offered me the chance of working with Ted Marley in animal pharmacology, it was a unique situation, not a regular post to be filled. Nobody preceded or followed me, it was tailor made to fit a specific opportunity. The same might have been the case earlier with the basic science support for Philip Connell’s discovery of amphetamine psychosis. After I moved to America in 1968, I became aware of the way research opportunities were advertised and applied for, funded and farmed out by NIMH. I never took advantage of these opportunities or found a mentor to facilitate them. As told in my memoir, I engaged in many different research projects throughout my career in a variety of areas, most published in leading journals. Not a single one was supported by Government or Foundation support. Like much research in Britain and Sam Gershon’s experience in Australia, it was all part of the job description and university salary, the way it had been at the Maudsley.

Ned Shorter’s last comment is germane. There seems to be a certain lack of curiosity in medical training today, perhaps because technology wraps a blanket of pseudo-certainty over clinical details that stifles the impulse to ask questions beyond the obvious. Productivity requirements, massive student debt, lucrative procedures and simple greed may do the rest. There is no time or energy for enquiry. I wish there were a way to have residents and research fellows read and respond to INHN.

Barry Blackwell

August 27, 2015