W. Edwin Fann: A History of the Tennessee Neuropsychiatric Institute.

Thomas A. Ban’s comment*

The TNI story: How I saw it

David Healy’s interview of Thomas A. Ban

DH: Talking about tensions between psychiatry and neuroscience prompts me to ask you about your Tennessee experience. When you went there it appears to have been something of a hot bed of psychopharmacology between Fridolin Sulser and Oakley Ray. Is there any reason why this should have been the case?

TB: While Allan Bass was chairman, the Department of Pharmacology of Vanderbilt became one of the tops in the United States. With the help of Frank Luton, the first qualified psychiatrist in the State, a disciple of Adolf Meyer, Bass succeeded in persuading the State of Tennessee to collaborate with Vanderbilt in founding a new kind of facility for research in neuropsychopharmacology. The idea was to have basic scientists and researchers work closely together in it. One of the buildings at the Middle Tennessee Mental Health Institute, the State Hospital serving the area, was dedicated to house the new facility and the Tennessee Neuropsychiatric Institute was opened with substantial NIMH support in the late 1960s. Bass first recruited Jim Dingell, a young pharmacologist who was studying the metabolism of imipramine, and then Fridolin Sulser, a medical doctor with industrial experience who had spent some time with Bernard Brodie at NIH. John Davis, the first clinical director of TNI, got on board somewhat later. Davis, who became well known for his book with Donald Klein on the Diagnosis and Treatment of Psychiatric Disorders [Adults and Children], had David Janowsky working with him, who developed during his short stay at the TNI the cholinergic hypothesis of affective disorders.

Then it just happened that around the same time the Veterans Administration Hospital in Nashville, which was closely affiliated with Vanderbilt, recruited Oakley Ray, a psychologist with a background in brain research. A clear thinker and excellent speaker, Oakley became one of the most popular teachers at the University and gained an international reputation with his timely text on Drugs, Society and Human Behavior. So, by the time of my arrival to the TNI, a couple of years after the exodus of John Davis and his team, Tennessee was a well-known center of neuropsychopharmacology. Of course, it helped Tennessee's reputation that in 1971 Earl Sutherland from Vanderbilt won the Nobel prize for his discovery of cyclic AMP.

DH: Fridolin Sulser became one of the biggest names on the international circuit with his beta receptor down regulation hypothesis.

TB: Sulser was already well known by the time of my arrival at the TNI. He had the reputation of a person difficult to deal with, but he directed the preclinical division of TNI over many years smoothly and efficiently. He is a man with many talents - an accomplished researcher, a skilled politician, a good fund raiser and a persuasive speaker. Fridolin was always enthusiastic about the ongoing research in his laboratory and has never given up his dream to direct a research institute dedicated to neuropharmacology or molecular biology. He shifted the focus from presynaptic to postsynaptic mechanisms in the action of psychotropics - his description of postsynaptic beta receptor down regulation during treatment with antidepressants had a great impact on neuropharmacologic research. After my arrival in Nashville, there were difficulties between Sulser and I, which unfortunately were perceived as a clash between personalities. This distracted attention from the essence of what was going on. The real issue, even if never spelled out clearly, was my position that neuropharmacology and psychopharmacology are two distinct disciplines, which must interact with each other with mutual respect but without either of the two dominating the other. For me, it was obvious that neuropharmacology, which is focused on drugs and deals with the detection of their action and the biological substrate involved in their action, is distinct from psychopharmacology, which is focused on illness and deals with the detection of which psychopathologic symptoms and the identification of which illnesses are affected by psychotropic drugs. But what was obvious to me was not obvious at all to Fridolin. He just could not accept that for psychopharmacology one needs a different training, background and maybe even a different kind of thinking. He just could not see where neuropharmacology ends, and psychopharmacology begins. In retrospect I can see that this was probably not just a blindfold — and that I probably touched one of the unspoken taboos. Because if my position had prevailed, it would have endangered the funding of neuropharmacologic research in many centers in the United States. And you know this whole issue is still not passé. Neuropharmacology is still channeling away funds from mental health and psychiatry. I hope that psychiatry Will be able to put an end to this before being asked to put an end to it by the community.

Fridolin has his neurobiology laboratory these days at Vanderbilt Medical Center in the department of psychiatry. Beta receptor down regulation, a definite step in the chain of events in the brain after the administration of certain psychotropic drugs, did not provide the royal road to the understanding of the pathomechanism of depression but it was picked up by the pharmaceutical industry and turned into the pivotal test in the screening for potential “antidepressants.” The problem with this is that it has led to us being provided with “newer and newer antidepressants” of which one can't clearly be distinguished from the other. But of course, this is far beyond Fridolin's control. It is not his fault — it is psychiatry that is to blame.

*David Healy’s interview of Tom Ban took place on June 3, 1994, in Washington DC. It was first published in Volume I (pages  587-620) of The Psychopharmacologists Interviews by David Healy. Altman An Imprint of Chapman & Hall. London, Weinheim, New York, Tokyo, Melbourne, Madras; 1996.

December 5, 2019