Eli Robins

Last updated August 06, 2019

Eli Robins (1921 Texas - 1994 Washington) was an American psychiatrist who played a pivotal role in establishing the way mental disorders are researched and diagnosed today.

A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are medical doctors, unlike psychologists, and must evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments, or strictly psychiatric. A psychiatrist usually works as the clinical leader of the multi-disciplinary team, which may comprise psychologists, social workers, occupational therapists and nursing staff. Psychiatrists have broad training in a bio-psycho-social approach to assessment and management of mental illness.

Early career

Robins finished his medical training and residencies at Harvard, where he worked under biologically-oriented psychiatrist Mandel E. Cohen who would greatly influence his career and with whom he first developed ideas about operational definitions for psychiatric conditions (the theory of operationalization having been recently advanced by Harvard physicist and philosopher of science Percy Williams Bridgman). Robins rejected the then dominant psychoanalysis, having personally undergone it for a year as was the norm in training, describing it as 'silly' (he also had a relative who committed suicide at Harvard-affiliated McLean Hospital while being treated with psychoanalytic methods).^[1]

An operational definition is the articulation of operationalization used in defining the terms of a process needed to determine the nature of an item or phenomenon and its properties such as duration, quantity, extension in space, chemical composition, etc. Since the degree of operationalization can vary itself, it can result in a more or less operational definition. The procedures included in definitions should be repeatable by anyone or at least by peers.

In research design, especially in psychology, social sciences, life sciences, and physics, operationalization is a process of defining the measurement of a phenomenon that is not directly measurable, though its existence is inferred by other phenomena. Operationalization thus defines a fuzzy concept so as to make it clearly distinguishable, measurable, and understandable by empirical observation. In a broader sense, it defines the extension of a concept—describing what is and is not an instance of that concept. For example, in medicine, the phenomenon of health might be operationalized by one or more indicators like body mass index or tobacco smoking. As another example, in visual processing the presence of a certain object in the environment could be inferred by measuring specific features of the light it reflects. In these examples, the phenomena are difficult to directly observe and measure because they are general/abstract or they are latent. Operationalization helps infer the existence, and some elements of the extension, of the phenomena of interest by means of some observable and measurable effects they have.

Percy Williams Bridgman American physicist

Percy Williams Bridgman was an American physicist who received the 1946 Nobel Prize in Physics for his work on the physics of high pressures. He also wrote extensively on the scientific method and on other aspects of the philosophy of science. The Bridgman effect and the Bridgman–Stockbarger technique are named after him.

Move to St. Louis

Robins moved to the psychiatric department at Washington University in St. Louis in 1949, initially as a pharmacology fellow working in the lab of biochemist Oliver H. Lowry, author of the most cited scientific paper ever (on a method for measuring proteins).^[2]

Washington University in St. Louis is a private research university in St. Louis, Missouri. Founded in 1853, and named after George Washington, the university has students and faculty from all 50 U.S. states and more than 120 countries. As of 2017, 24 Nobel laureates in economics, physiology and medicine, chemistry, and physics have been affiliated with Washington University, nine having done the major part of their pioneering research at the university.

Oliver Howe Lowry was an American biochemist. He devised the Lowry protein assay.

Throughout his career he published on brain neurochemistry and histology. He would be author on more than 175 peer-reviewed articles, including on suicide, hysteria, homosexuality and depression.

Neurochemistry is the study of chemicals, including neurotransmitters and other molecules such as psychopharmaceuticals and neuropeptides, that control and influence the physiology of the nervous system. This field within neuroscience examines how neurochemicals influence the operation of neurons, synapses, and neural networks. Neurochemists analyze the biochemistry and molecular biology of organic compounds in the nervous system, and their roles in such neural processes including cortical plasticity, neurogenesis, and neural differentiation.

Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy which looks at larger structures visible without a microscope. Although microscopic anatomy may be divided into organology, the study of organs, histology, the study of tissues, and cytology, the study of cells, modern usage places these topics under the field of histology. In medicine, histopathology is the branch of histology that includes the microscopic identification and study of diseased tissue. In the field of paleontology, the term paleohistology refers to the histology of fossil organisms.

Suicide is the act of intentionally causing one's own death. Mental disorders, including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, and substance abuse—including alcoholism and the use of benzodiazepines—are risk factors. Some suicides are impulsive acts due to stress, such as from financial difficulties, troubles with relationships, or bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide—such as firearms, drugs, and poisons; treating mental disorders and substance misuse; proper media reporting of suicide; and improving economic conditions. Even though crisis hotlines are common, there is little evidence for their effectiveness.

In 1956/57 he conducted a large-scale community-based study of suicides in St Louis which involved detailed structured interviews with people who had been in regular contact with the person beforehand. This has been noted as the first completed example of a practice that was shortly thereafter termed psychological autopsy by researchers in Los Angeles (coiner Edwin S. Shneidman).^[3]^[4]

Edwin S. Shneidman was an American clinical psychologist, suicidologist and thanatologist. Together with Norman Farberow and Robert Litman, in 1958, he founded the Los Angeles Suicide Prevention Center, where the men were instrumental in researching suicide and developing a crisis center and treatments to prevent deaths.

Robins became department head in 1963, despite having early signs of what would later be diagnosed as probable multiple sclerosis. He was married to Lee Robins, a sociologist associate of psychiatry at Washington.

Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. Specific symptoms can include double vision, blindness in one eye, muscle weakness, trouble with sensation, or coordination. MS takes several forms, with new symptoms either occurring in isolated attacks or building up over time. Between attacks, symptoms may disappear completely; however, permanent neurological problems often remain, especially with the advancement of the disease.

Lee Nelken Robins was an American professor of social science in psychiatry and a leader in psychiatric epidemiology research. She was affiliated with the Washington University in St. Louis for more than 50 years from 1954 until 2007.

Developing diagnostic criteria

Robins formed a close working trio with Samuel Guze and George Winokur, and from the late 1950s they developed criteria sets for a 'medical model of psychiatric disorders'^[5] Influential psychiatrist Gerald Klerman approvingly dubbed the approach "neo-Kraepelinian" in 1978. The trio were influenced by the classification system and diagnostic principles of German psychiatrist Emil Kraepelin, and more recently by a textbook Clinical Psychiatry by British psychiatrists, principally Willy Mayer-Gross who had previously worked in Germany at the same institute as Kraepelin.^[1]

Led by Robins, the trio published with several others in 1972 the so-called Feighner Criteria (named after the then junior psychiatrist John Feighner who was lead author on the paper, which would become the most cited in psychiatry). This led through into the Research Diagnostic Criteria developed with Robert Spitzer and others, which ultimately shaped the influential third edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. His wife Lee was also involved in the developments.

Related Research Articles

<i>Diagnostic and Statistical Manual of Mental Disorders</i> guide to grouping mental disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), offers a common language and standard criteria for the classification of mental disorders. It is used, or relied upon, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers together with alternatives such as the ICD-10 Classification of Mental and Behavioural Disorders, produced by the WHO.

Dementia praecox is a disused psychiatric diagnosis that originally designated a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. Over the years, the term "dementia praecox" was gradually replaced by "schizophrenia", which remains in current diagnostic use.

Emil Kraepelin was a German psychiatrist. H. J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Paranoid schizophrenia schizophrenia that involves delusions or auditory hallucinations of persecution or being plotted against without thought disorder, disorganized behavior, or affective flattening

Paranoid schizophrenia is the most common type of schizophrenia. Schizophrenia is defined as “a chronic mental disorder in which a person is withdrawn from reality." Schizophrenia is divided into subtypes based on the “predominant symptomatology at the time of evaluation." The subtypes are classified as: paranoid, disorganized, catatonic, undifferentiated, and residual type. However, they are not completely separate diagnoses, and cannot predict the progression of the disease. The clinical picture is dominated by relatively stable and often persecutory delusions that are usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. These symptoms can have a huge effect on functioning and can negatively affect quality of life. Paranoid schizophrenia is a lifelong disease, but with proper treatment, a person with the illness can attain a higher quality of life.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. The diagnosis is made when the person has symptoms of both schizophrenia and a mood disorder—either bipolar disorder or depression—but does not meet the diagnostic criteria for schizophrenia or a mood disorder individually. The main criterion for the schizoaffective disorder diagnosis is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, psychotic bipolar disorder, schizophreniform disorder or schizophrenia. It is imperative for providers to accurately diagnose patients, as treatment and prognosis differs greatly for each of these diagnoses.

Peter Roger Breggin is an American psychiatrist and critic of shock treatment and psychiatric medication. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with psychotherapy, education, empathy, love, and broader human services.

Robert Leopold Spitzer was a psychiatrist and professor of psychiatry at Columbia University in New York City. He was a major force in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

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Feighner Criteria is the informal name given to influential psychiatric diagnostic criteria developed at Washington University in St. Louis, Missouri from the late 1950s to the early 1970s.

Samuel Barry Guze was an American psychiatrist, medical educator, and researcher. He was an influential psychiatrist and worked at the Washington University School of Medicine in St. Louis for most of his career.

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a mental disorder in children and adolescents that, like bipolar disorder (BD) in adults, is characterized by extreme changes in mood and behavior accompanying periods of depressed or irritable moods and periods of elevated moods called manic or hypomanic episodes. These shifts are sometimes quick, but usually are gradual. The average age of onset of PBD is unclear, but the risk increases with the onset of puberty. PBD is typically more severe and has a poorer prognosis than BD with onset in late-adolescence or adulthood.

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References

1 2 The Making of DSM-III: A Diagnostic Manual's Conquest of American Psychiatry Hannah Decker, Oxford University Press, 13 June 2013. Chapter 3.
↑ A Tribute to Eli and Lee Robins - Citation Superstars. A Citationist Perspective on Biological Psychiatry Institute for Scientific Information, 1989
↑ Assessment and Prediction of Suicide Ronald W. Maris, American Association of Suicidology, Guilford Press, 1992. Chapter 8: Assessment in absentia. Pg 144.
↑ The Question of Suicide: 50 years of research on the mental health issue that was supposedly inscrutable Archived 2016-03-04 at the Wayback Machine By Jim Dryden, Washington Medical School Journal 'Outlook'.
↑ Training at Washington University School of Medicine in Psychiatry in the late 1950s, from the perspective of an affective disorder researcher. Clayton PJ., J Affect Disord. 2006 May;92(1):13-7. PMID 16527361

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[Decker-1] 1 2 The Making of DSM-III: A Diagnostic Manual's Conquest of American Psychiatry Hannah Decker, Oxford University Press, 13 June 2013. Chapter 3.

[2] A Tribute to Eli and Lee Robins - Citation Superstars. A Citationist Perspective on Biological Psychiatry Institute for Scientific Information, 1989

[3] Assessment and Prediction of Suicide Ronald W. Maris, American Association of Suicidology, Guilford Press, 1992. Chapter 8: Assessment in absentia. Pg 144.

[4] The Question of Suicide: 50 years of research on the mental health issue that was supposedly inscrutable Archived 2016-03-04 at the Wayback Machine By Jim Dryden, Washington Medical School Journal 'Outlook'.

[5] Training at Washington University School of Medicine in Psychiatry in the late 1950s, from the perspective of an affective disorder researcher. Clayton PJ., J Affect Disord. 2006 May;92(1):13-7. PMID 16527361