W. Edwin Fann: A History of The Tennessee Neuropsychiatric Institute
Rudra Prakash’s comment
Reflections of and tribute from a trainee
“Let the glory of memorable moments keep shining,
for no one knows when the life may fade away”
An approximate transliteration of a couplet by Dr. Bashir Badr, an eminent Urdu poet.
When my mentor, Tom Ban, asked me to write “something” about Tennessee Neuropsychiatric Institute (TNI), I was overwhelmed by a flood of memories. In what follows, I seek to share some of my reflections as a fellow or trainee.
In August 1980, I arrived as a World Health Organization Fellow to work and learn under the tutelage of Professor Tom Ban. Tom deserves all the credit for setting up an exchange visitor program for the international psychiatrists. This program had the blessings of WHO and Vanderbilt University. In my time period, two Japanese, one Russian and a Greek psychiatrist were my co-visitors, but the above represent only a partial list of umpteen beneficiaries of the program. Over the years, several, exchange fellows trained in clinical research at TNI!
Fortunately, in my Indian psychiatric training I was exposed to three schools of Psychiatry: American (due to my chief mentor, late professor B.B. Sethi - trained at the University of Pennsylvania); British (as my second mentor (Prof. V.R. Thacore - trained in U.K., now living in Australia); and Indian (another key mentor - Prof A.K. Agrawal - an alumnus of the prestigious and premier psychiatry academic center of India – the National Institute of Mental Health and Neuro-Sciences (NIMHANS). The missing pieces were the European and Canadian schools. Tom generously filled that void.
When I landed in the US in 1980, I almost had a professional identity crisis as I was greeted by DSM-III which was radically different from DSM-II that I had grown up with. This is where Tom’s teachings began molding my diagnostic approach, especially as he shared his encyclopedic knowledge of the European scholars and schools - Karl Leonhard and his likes - and challenged me to look beyond the DSM-III. Soon I learned the limitations of DSM for research purposes as it was primarily designed for clinical care. He encouraged me to try Leonhard’s classification to see its value. At my alma mater - King George’s Medical College, Lucknow, India - I directed a Lithium Clinic for more than three years and was interested in pursuing a research career in “Lithiumology.”
While I was looking for research opportunities with lithium in US, I was aware of three challenges: lithium was not patented; it was a new entrant in US market; and had received bad press due to an alarming JAMA publication (Cohen and Cohen 1974) in regard to neurotoxicity reported with a combination of lithium with haloperidol. Here I saw a research opportunity for a preliminary study since we had access to a large number of in-patients at Middle Tennessee Mental Health Institute (MTMHI - formerly Central State Hospital where the TNI was physically located). With strong support from Tom, such a study met my twin goals: lithium related research and application of recently acquired knowledge (from Tom) of Leonhard’s classification. This study is referenced in Tom’s comments (Prakash, Kelwala and Ban 1982).
As I was enjoying the rich academic environment, I soon learned about a sabbatical leave that Tom was going to take to be with WHO! It was a mixed blessing for me - first, it aroused tremendous insecurity about my future; however, at the same time, it gave me an opportunity to grow up. In the second year of my fellowship, I was more involved in clinical care. To me, MTMHI was a goldmine of psychopathology of all sorts and I slowly began leaning toward clinical track.
During my formative period in the US, I feel privileged to have worked with many great people - Bill Guy, PhD, Buddy Wilson, PhD, and Bill Petrie, PhD (we continue to be in touch, locally). And, of course, Surendra Kelwala, MD, who provided all the ethnic support and guidance as needed.
I will like to particularly mention my brief association with the “one and only” Alan D. Bass, visionary, father and cofounder of TNI. He was a distinguished leader in Pharmacology. His vital role in inception of TNI has already been highlighted by other commentators. He was embodiment of nurturance - always positive and helpful. He and I even co-authored a paper! (Prakash, Reed and Bass 1984).
As I understood back then, TNI was conceived as a multifaceted institution where all scientific trajectories met, ultimately to make a positive difference in the lives of the mentally ill. Thus, TNI was a most appropriate site for Research (pre-clinical led by legendary late Professors Fridolin Sulser and Elaine Sanders-Bush; clinical led by Prof Tom Ban) and Education (jointly led by Vanderbilt’s Pharmacology and Psychiatry departments - post doc fellows, psychiatry residents, medical students) - all under one roof! That was the shared dream of the founders.
Perhaps, one of the top five memories of TNI was the Thursday case conference for which Vanderbilt’s Chairman of Psychiatry (Prof. Marc Hollender) and residency program director (Miles Crowder) would drive from Vanderbilt to TNI every Thursday - almost without fail! Hats off! Even after the TNI went defunct, Vanderbilt’s psychiatric affiliation with MTMHI continued up to 2008. Yet another unforgettable memory is a mini reunion of, shall I call, “T NINERS” in 2009 when Professor Ban’s Nashville visit provided a perfect opportunity enjoy pure nostalgia! The Bans and the Sulsers were the guests of honor. As hosts, Reeta - my wife - and I will always cherish the memories of laughter, warmth and some tears, of course, in that evening.
While sadly the TNI is now history, truly, it has been immortalized by the seminal research on its premises and its huge educational role on national and international levels. As an international psychiatrist and a grateful beneficiary, I sincerely thank both the institution and affiliated individuals - most especially Tom (Ban) - for training me and providing some of the fondest memories of my professional career!
As I was writing my closing comments regarding TNI, Tom gave me another shot of exciting nostalgia and shared the news that Olaf Fjetland is around! He is an USAF Vietnam Vet who was an integral part of Ban’s team – I had the pleasure of working with him and knew him as the “Dataman.” Noteworthy is that some credit for catalyzing the introduction of PTSD in DSM-III goes to Vietnam Vets. I have been learning a lot from serving the veterans at the VA for past 12 years.
Cheers!
An indebted and proud alumnus.
References:
Cohen WJ, Cohen NH: Lithium carbonate, haloperidol, and irreversible brain damage. JAMA. 1974; 230(9):1283-7.
Prakash R, Kelwala S, Ban TA. Neurotoxicity in patients with schizophrenia during lithium therapy. Comp Psychiat 1982; 23:271-3.
Prakash R, Reed RM, Bass AD. Combination of phenobarbital and haloperidol in resistant schizophrenia. J Clin Psychopharmacol 1984; 4:362-3.
September 10, 2020