ELMER ERNEST SOUTHARD
E. E SOUTHARD, M.D.
Elmer Ernest Southard is a name that - for some of us - stands alone. He was a great man. He was a genius. He was a pre-eminent American psychiatrist, some of us would say the greatest psychiatrist in world history. He died at 43, leaving little literary estate but an enormous electrical charge, which still pervades the psychiatric world.
I knew Southard for three short years, which I recognize now to have been the most formative and critical of my life, of which he remains the intellectual and professional polestar. In 19171 was an intern in a hospital in Kansas City. War had been declared , and the Navy offered me the choice of going to Boston for psychiatric experience or going on medical duty at a lively, lovely naval station on the East coast. I chose the former. Under the aegis of Dr. Lawson G. Lowrey, a Harvard Medical School colleague, then clinical director, I was put on the staff of The Boston Psychopathic Hospital as an "assistant physician."
I was presented one morning to the chief, Dr. Southard, in his cluttered and crowded office. He shortly took me into a staff-meeting case conference in the library adjoining. A history of the case and a report of examinations made were read by someone. The patient then entered and sat before Dr. Southard, who interviewed him before us in an indescribably poignant and original way. Even the patient became fascinated with the dialogue. That was in 1919. This procedure happened several times each week. I little realized the terrific influence that it had on my life. Recently I conducted a similar staff meeting of a similar composition, in that same pattern and for the same purposes. This patient had recently killed his sweetheart. The court decided it was involuntary manslaughter. What did we doctors think?
Southard was professor of neuropathology and of psychiatry at the Harvard Medical School. He directed the medical work and psychiatric teaching at the hospital and taught a laboratory course for second-year medical students in the Harvard Medical School, nearby. Dr. Harry Solomon, Dr. Oscar Raeder, Dr. Donald MacPherson, and I were all labeled "instructors." It was our duty to help in the teaching of Army medical officers assigned to the hospital for three months of intensive experience before they went abroad and of the second-year students of Harvard Medical School in the weekly neuropathology lectures and laboratory demonstrations by Southard. In the latter course we "assistants" listened to the lecture and then walked about in the laboratory, handing out or retrieving slide material and pointing out to various students what they were supposed to see through the microscope (cellular degeneration, Golgi stains, tract outlines, efferent fibers, etc.). These words and phrases keep drifting back into my mind as I recall my tour of duty in this course, reflecting Southard's glory and erudition.
The inhabitants of the Psychopathic Hospital all had lunch simultaneously - not together, but at five different levels or grades. First, there was the superintendent's service, of the highest-quality food, served privately in his apartment. Second, there was the medical-staff dining room, where most of us ate, including Southard. Third, there was the nurses' dining room, the largest and most plebeian, as it were. If in doubt about one's status, one ate here. Fourth, maintenance workmen, women helpers, and others had their dining room below; the medical students (the lowest form of life, we used to say) ate here, with the most economical meals. The very lowest quality of food went, of course, to the patients, who weren't supposed to have much gustatory discrimination.
The psychopathic hospital idea had been introduced in the United States by Dr. Albert Barrett in Michigan, but Boston thought well of it and under Southard went rather further in its development and support. It was later relabeled the Massachusetts Mental Health Center. It was near the Harvard Medical School, which enhanced its authority. Anyone living in the city of Boston who the police or neighbors or concerned relatives thought might benefit from detention and psychiatric examination was admitted tentatively for 10 days' examination and care. In those days protection of the patient and from the patient were taken for granted to be our (psychiatrists') chief function.
An intensive study of the patient included all the appropriate available laboratory tests, psychological tests (just beginning in those days), social studies of the family and neighborhood and occupational life, and a "mental picture" study by one of the psychiatrists. The total data were presented at the staff meetings generally presided over by Dr. Southard, as described above, with discussion by numerous staff members. After the discussion, the diagnosis and recommendations were announced and the session closed. (The patients were generally transferred within a few more days.) "Alienists" called weekly and with great formality pronounced patients "committable" (insane) or not. "Treatment" meant calming them, with kindness, firmness, seclusion, and hydrotherapy.
Many collateral and accessory features were a part of the program, including the new psychological tests for intelligence measurements and instruction sessions for the Army officers and Harvard medical students. The new antisyphilitic drug "606" had just been made available and was being tried out on dozens of ambulatory patients. No "psychotherapy" had been invented.
To complicate things, the famous and terrible influenza epidemic of 1918 descended on us, and it seemed that half the city of Boston was in the "grip" of "la grippe." Many employees of the hospital were ill, and I was the staff physician assigned to them. My wife was a victim of the epidemic although she rather quickly recovered. Neither Dr. Southard nor I was attacked, but several of the staff died and a good many were prostrated for weeks. There were often serious sequelae, including neurologic and psychiatric disorders, which Southard had proposed that he and I describe in a book, the outline of which - written down by him - I still possess. He suggested a catchy title for it, such as Neuroinfluenza and Influenza and the Psychoses. It never got beyond the earliest notes, but I subsequently published a number of articles on the subject that were planned to be chapters of the book.
I have given this background in some detail in order to convey how this extraordinary young psychiatrist, pathologist, professor, and researcher was occupied with thinking and writing and teaching and autopsying (fatal cases from the Massachusetts State Hospitals) and photographing and storing and mounting specimens and meeting with committees and presiding over staff meetings and giving talks to engineers and artists and doctors and state administrators. An intensive mixture of clinical and educational and administrative activity was going on in the hospital of which he was the director.
I didn't see him very often during the first months of our acquaintance, but his presence and example were known to and reverenced by us all. He would occasionally come into the library at night when I was studying and make comments about the books I was reading and ask what I had particularly liked and why. This vignette comes to my mind. "Ah, Regis. I'm glad you're looking at Regis. French, of course. They never quite caught up with the Germans in psychiatry. The tables of contents of French books are always so clear and neat and cover everything - but their indexes are hopeless. With the Germans it's just the opposite. Never try to guess what's in a German text from the table of contents. But their indexes are marvelous."
To Dr. Frederick Gay, who did such a conscientious and dedicated task of collecting descriptions and recollections in his biography, The Open Mind, some years ago, I wrote this: "I was with him as often and as much as possible. Of course, so was everyone else, or at least many of us. But with the clinical work and the teaching and the war and the influenza epidemic and the anti-syphilitic campaign, people were exceedingly busy! I often walked to the streetcar with him when he went home in the evening, and sometimes we went a longer-than-necessary route, or we went downtown to the chess club.
"I recall an exceedingly happy time I spent with him in Philadelphia at the 75th annual meeting of the American Psychiatric Association (which he adjured me to join and always attend). He delivered a brilliant presidential address dealing with different aspects of psychiatry over the preceding seventy-five years, the origins of the Association and the great future possibilities of psychiatry. The address was so many-faceted and so highly erudite that I had the suspicion that few of the audience fully comprehended it. I thought I understood it, having read the manuscript beforehand (and manytimes since). He seemed to me to be writing my life book. My father was with me and he was delighted with Southard; in many ways they were alike. I remember that, busy as he was as president of the Association, a most hectic position especially at the time of the annual meetings, he had lunch or dinner with Father and me once or I believe twice during that week. The generosity of such an act was enormous because, after all, there I was a disciple of his, to be sure, but the youngest one of them all, a mere lad in his eyes.
"The following year, at Atlantic City, my father and I also spent considerable time with Southard. Ernest was fond of good food and we found one of the hotels at Atlantic City especially reputed for it, so he and Father and I went over there and dined together several times. I know that we had many short talks together there. Southard was not a man to have long talks with anyone and much preferred brief, intimate, sparkling, stimulating sessions of five to thirty minutes. Many of the things he said to me (to us) he subsequently put into papers ¿ina they are now well known to those familiar with his works. The famous Dragon Slayers and Grail Seekers metaphor is one example."
I remember something else, however, which I am not sure he ever put into print. We were walking up Washington Street (in Boston) late one pretty, snowy night. We had been at a restaurant in the lower part of town and had talked about, seemingly, everything, as I recall it. It always made me elated to talk with him, and he always seemed somewhat elated himself. We were walking along chatting about various matters when I remember his suddenly stopping and exclaiming, "Do you know, I am increasingly convinced that all the activities of life, all aspects of human existence, perhaps of all existence, can be expressed in terms reducible in essence to 'active' and 'passive'?" (This sounds somewhat trite as I write it now but as he put it that night it was a very vivid, very profound thought and impressed me deeply.) He went on to illustrate it, how first he was speaking and active, and I, passive, listening; then we exchanged roles; how we were active in the sense that we walked and the sidewalk was passive and waited for us to walk on it; how the wind actively blew us about and we actively sought shelters where we could be passive. I can't remember the many details but I remember the idea and I remember how he went on like Oscar Wilde's Dorian Gray, playing with the thought, tossing it up and catching it and rearranging it, then casting it again in various forms. I was told that a few minutes before Southard lost consciousness on his deathbed, when the nurse came to take his temperature he said he guessed it was up to him to get into the passive voice now and let the nurse be active.
Can I convey more precisely what manner of man Southard was? He was of average height or less, rather pudgy, not very muscular, certainly, with a round, rather smooth face, featureless except for a high forehead, a small, neat mustache, and twinkling, penetrating eyes. He laughed easily and lightly but contagiously. He walked with a somewhat ambling and uncertain gait.
So he was not an impressive figure. But his total personality was magical. If his voice was heard speaking in a group, everyone in range turned to listen or gathered closer in order to hear better. His enunciation was clear, his speech soft and rather rapid, and a smile would often flicker over his face as he spoke. Gay well described his "whimsical, bubbling smile as though witnessing some perpetual inner comedy" (page 264). His eyes would sparkle, and his head would find a position appropriate to his phrases. "His discussions, even on serious subjects, were often close to an attitude of playfulness" (Gay, page 264). What would emerge from his mouth, as this etymologist, philologist, philosopher, poet, author, psychologist, pathologist, microscopist, medical researcher, hospital administrator, Harvard professor, chess champion, and psychiatrist talked was sure to be exciting!
"In the opinion of many, "says Gay, he was". . . one of the greatest intellects of his generation, or perhaps of several generations . . . All who knew him, and even men who had been with him but a few hours, felt themselves his intimates. The feeling of enthusiasm and devotion that he engendered still persists in his admirers. Great as was his intellect and his power of inspiration, Elmer Ernest Southard was greater still as a human being." (page 263 ff).
Elsewhere Gay recorded, "Southard seldom left anyone, who met him for more than a passing moment, indifferent to him. Caught by his vital individuality and arresting word, they almost invariably went on to an admiration and fondness that was deeply personal. For kindliness and thought of others were attributes that were even more fundamental in him than learning and originality. It would seem unusual that the only child of devoted parents should have shown so early in life so deep a consideration of others ..." (Gay, pp. 267, 268) "(He had) the most marvelous gift of free association that we shall probably ever know. This enabled him to combine apparently meaningless fragments into an intricate and billiant mosaic . . . he adorned everv field that he touched." (Gay, page 269).
Sixty years have passed since I saw this great man for the last time. I remember that snowy day in New York when, after hearing him speak the night before and later conferring with him and two others over a "supper," I waited several hours at the restaurant where we were to meet for lunch. He was going to bring a new friend. The snow continued to pile up and I finally trudged through it to Penn Station and caught my train to Philadelphia. After a few days with colleagues I went on to Washington and arrived early for an appointment with Dr. William A. White, head of St. Elizabeth Hospital, Southard's friend and mine. While waiting, I glanced at a newspaper lying on the table and read the shocking news on the front page.
From that hour my world was changed. 'Dead! Ernest dead? He couldn't be dead. That marvelous, miracle man! Our Southard? Our Ernest? How could we all survive?'
I headed for the depot and caught the next train back to Boston. I found the others. Yes, he was dead. He had died in New York. His family, his coworkers and students, his many friends were groping helplessly for the right words, the right moves, the right rationalizations. We whispered together, in couples and in little groups; we stared at each other; we looked away. I remember one colleague crying and wringing his hands. "I should have helped him more," he kept repeating; "I didn't help him."
A memorial service in Cambridge brought us all together for an hour preceding the imminent, permanent, irreversible dispersal. The encomium by Richard Cabot ceased; the organ played and was silent. The doors were opened, and we rose and slowly departed. We, who had all been so close to our wonderful leader that we seemed scarcely to know each other, were suddenly detached from him and from each other - three or four dozen of us. We said hasty good-byes and separated and scattered to the four corners of the earth. With a few exceptions, we never saw each other again.
But all over the country the essence, the zeal, the fire of Elmer Ernest Southard burned in protected corners, with little attempted replicas of the great light. Each of us tried to reconstruct Ernest Southard and Southard psychiatry in our own lives.
Some disciples stayed East; some went South, and West, and to Canada. He had assured us that there were great days ahead for psychiatry. We wanted to be in a psychiatry like that, not mere neurologists any more, or alienists. Bright white clouds of possibilities built up before us - over the dark skies of his last days and the applications of psychiatry to the suffering of the world, the underprivileged, the hungry, the trapped, the confused, the artists, the statesmen, the prisoners, the wardens, the judges, and governors and senators and engineers and men on the street. We experienced, I believe, something like a Pentecost.
The name of Elmer Ernest Southard is not known widely any more. My fingers ache and grow stiff as I write these words. His writings did not convey his charm or his vision. I have spent some hours reading them. His ideas were often condensed and incomplete. "There are plenty of men to complete things," he assured us.
Asked for its victory, the grave may well say, "Here, then, is my victory; a voice is stilled, and what have you left but memories? A great light shone briefly, but it went out."
There were Southards all around for a few years - big ones and little ones, anonymous - but all revolving, all throwing out sparks. Before Southard, psychiatry was a study of keeping excited people under control and making inactive people more alert. It was our task to protect the public. To apply the psychiatric discoveries and knowledge we gained to the great kingdom of evil, as Southard described it, was a new endeavor, a clean canvas for a new picture. Before us was the great mass of things gone wrong, stupidities and insincerities of arms agreements, wars, population explosion, land exploitation, public dishonesty. There were the problems of the dispossessed, the ill-housed, the ill-fed, the ill-born, the abused, the neglected, the maltreated. There were the problems of leadership failure, diplomatic infidelity, education morass, spiritual dullness. Lessons learned from people called "sick" began to give us new concepts of health as well as ill health. We began to see hospitals as preventive instruments, not custodial or emergency depots.
Are these psychiatric ideas? Yes, as Southard viewed psychiatry and taught so many of us to do likewise. New ideas, new hopes, new objectives - emerging from the madhouse, emerging from the study of the sorrow and pain that most people don't understand. "Had he been vouchsafed another 20 years of activity, observation, interpretation, thought and prophecy, this planet would be a better place to live and many of those who have been thrust upon it would find it easier and pleasanter to live here," wrote Dr. Joseph Collins in the New York Times.
Brooding on the sorrow of our loss, we suddenly hear faint sounds of angel voices far away, growing louder, "joy, thou source of light immortal." Perhaps those voices are not from angels but from the scattered disciples of a prophet.