Surname:

Meyer

First name:

Ludwig

Era:

19th century

Field of expertise:

Neurology
Care
Psychiatry

Place of birth:

Bielefeld

† 08.02.1900

German pioneer of non-restraint treatment in 19th-century psychiatry

Ludwig Meyer (1827-1900) was born on 27th December 1827 and grew up in a Jewish family in Bielefeld (Westphalia) as the only child of Ruben and Jeanette Meyer. His father, a mill owner, lost his capital around 1830 for reasons unknown. When Meyer was three years old, the family moved to Paderborn (Burkhart 1991, p. 9). After primary school, he attended an eight-years Jesuit grammar school where he received a classical education. He continued his studies in Hagen to become a building contractor, but changed his plans after five semesters, probably because of bad career prospects (Kayser 2007, p. 39; Meyer 1994).

Early career

In 1848, Meyer began to study medicine and philosophy in Bonn. He was, however, expelled from university the same year for his participation in revolutionary activities in nearby Elberfeld (Wuppertal) (Kayser 2007, p. 39). One of his revolutionary friends was Carl Schurz (1829-1906; c.f. Meyer 1994, pp. 364 f.), who later emigrated to the United States where he made a career in the government. Meyer was arrested and received a five-months jail sentence before he was eventually found not guilty.

From winter semester 1850 to summer semester 1851, he continued his medical studies in Würzburg (Kayser 2007, pp. 39), with a special focus on the theory and practise of topographical anatomy, histology and pathology. The University of Würzburg was known for its strong tradition of studies in psychiatry (e.g., Carl Friedrich Marcus, 1802-1862; c.f. Burkhart 1991, pp. 11 f.).

After Würzburg, Meyer joined Friedrich-Wilhelm-University in Berlin to study physiology, pathology and surgery until 1853 (Kayser 2007, p. 39). His thesis, titled Observationes quaedam in Tuberculosin (Pathological-anatomical findings in lungs from 32 patients with tuberculosis), was presented on 2 October 1852. Meyer was interested in rational clinical experience and patient observation, and strongly opposed speculations for which there was no scientific proof.

1853 was a year of profound changes for Meyer. He converted to Lutheranism and became an assistant physician at the psychiatric ward of Charité Hospital in Berlin (Kayser 2007, p. 39), then lead by Carl Wilhelm Ideler (1795-1860). Financial troubles are said to have been the driving motivation for accepting this position (Kayser 2007, p. 39): given his father’s bankruptcy, Meyer had to fund his studies through loans and earnings from giving lessons, and apparently, it took him many years to pay back his loans (Burkhart 1991, p. 14). In 1859, he married his wife, Anna Meyer (1841-1921); the couple had seven children, two of whom died early. His son Ernst Meyer (1871–1931) became a professor of psychiatry in Königsberg (East Prussia), his grandsons Hans-Hermann Meyer (1909-2000) and Joachim Ernst Meyer (1917-1998) also held professorships in psychiatry, the latter at the University of Göttingen in succession to his grandfather (cf. Lauter 1999; Meyer 1977).

Theory of mental illness

Meyer’s first publication, titled Die Stimmung und ihre Beziehung zu den Hauptfunctionen des Nervensystems (The mood and its relationship with the main functions of the nervous system) appeared in 1854. He was influenced by Spinoza and inspired by literature, referring to Shakespeare as “the greatest psychologist of all times” (Kayser 2007, p. 39). Although being strictly scientific in categorizing various symptoms based on various diagnoses, Meyer was not averse to quoting, for example, Ovid or Cicero.

His assumption was that all humans have a basic temper, and when this temper, for whatever reason, turned bad, the change could become chronic and develop into mental illness. According to him, an inherited predisposition was the main cause that such bad temper, disgruntlement and ill feelings would eventually result in mental illness, especially during phases of sexual reorientation, like puberty or pregnancy (Burkhart 1991, p. 18 ff.). Just one example is the diagnosis of “homesickness”, called “nostalgia” at that time. This was often related to changes within the society, producing situations where, for example, country people had to move to town and work in factories, which, in persons pre-disposed to mental illness, could lead to severe symptoms of mental disease (Burkhart 1991, pp. 24 ff.).

Meyer was strongly convinced that mental illnesses, at least in many cases, could be cured, and that a diet, an occupation, good sleep and a friendly environment were important steps on the way to recovery (Burkhart 1991, p. 33).

Medical career

From 1855 to 1857, Meyer was employed as a second assistant physician at the newly opened Westpreußische Heil- und Pflegeanstalt (West-Prussian Mental Hospital) in Schwetz (nowadays Ṡwiecie, Poland; Meyer 1994, p. 364 f.). There he worked as a surgeon, without any opportunity to engage in research (Burkhart 1991, p. 41).

The clinic had 200 places and was located in a rural area where many people were uneducated, where prejudice and fears were widespread, and where those considered mad were treated badly, kept in chains and hidden away. In this setting, treatment at the clinic was not aimed at curing the patients. Humoralism was a still-prevailing concept of disease, and Meyer had to work hard to make both medical professionals and ordinary people change their views on mental disorder. He believed that mental illness was comparable to other diseases in terms of diagnosis and treatment, and he discerned two major groups of mental patients: 1. Those with normal mental activity, whose frame of mind was altered and suppressed due to external disturbance; 2. Those with deficits in intelligence, judgement or memory caused by brain damage.

In 1858, Meyer became a consultant physician at St. Georg Hospital in Hamburg with the main task to reform mental care (Burkhart 1991, p. 55; Kayser 2007, p. 40). Meyer (1897, p. 2) also held lectures on the importance of avoiding constraint and restriction in treating the mentally sick, stating that such treatment only provoked false symptoms and that, rather than being caused by the disease as such, the patients’ behaviour was a reaction to the oppressive treatment. He also believed that physical constraint was unworthy of a civilized nation like Germany. In 1861, Meyer travelled to England to study non-restraint methods, a principle introduced by the English psychiatrist John Conolly (1794-1866), according to whom patients should not be treated using constraint and punishment (Meyer 1994, pp. 364 f.; Kayser 2007, p. 40).

Implementation of non-restraint in Hamburg

When Meyer was appointed director of the new Friedrichsberger Irrenanstalt outside Hamburg in 1864, he introduced non-restraint principles, and the hospital became the first clinic in Germany using these new methods. He also advocated medical ethics in psychiatry and suggested that the Hippocratic principles be introduced and binding for all physicians working in this field (Meyer 1863; Kayser 2007, p. 40). His positions were met with reluctance and opposition by many other German psychiatrists – and Meyer struggled hard to overcome the still-prevailing “demonic-moral” views on mental illness, which, based on Western Christian tradition, conceptualised mental disorder as a punishment by God or as the work of evil spirits (Burkhart 1991, p. 86).

An anecdote has it that Meyer sold no-longer-used straitjackets on a Hamburg market place (Meyer 1994, pp. 364 f.; Kayser 2007, p. 40). Meyer (1897, p. 4) himself reported that he decided to abandon all coercive means in summer 1865, when the keepers at his clinic were unable to control a raving woman. He ordered her straitjacket to be removed “... and, lo and behold, things went much better and even isolation ... was being applied less often. ... To avoid all temptation, I had all coercive means for sale (ca. 150 straitjackets).” (our translation).

Four years later, the renowned psychiatrist Wilhelm Griesinger (1817-1868), then director of the psychiatric clinic at Charité Berlin, suggested introducing the non-restraint system throughout Germany. This proposal provoked a heated debate with conservative colleagues and eventually failed (cf. Sammet 2000, pp. 181 ff.). Together with Ludwig Meyer and Carl Westphal (1833-1890), Griesinger founded a new journal, the Archiv für Psychiatrie und Nervenkrankheiten (Archive of Psychiatry and Nervous Diseases), in 1867.

Meyer was said to have approached his patients with curiosity and humour: “The way in which the patients’ case files were written ensured their personal and moral integrity and dignity … As a method of clinical observation, the psychiatric abnormities were not classified according to in psychopathological categories but in a context of psychological understanding” (Burkhart 1991, p. 158 f.; our translation). When Meyer intervened with someone, he did so in a calm and firm manner. According to one of his assistant physicians, Meyer was seen angry only once – when a patient was beaten by a keeper (Burkhart 1991, p. 121; 158; Kayser 2007, p. 41). His staff described him as a strict, fair and well-meaning person, who sought to improve their material and social position (Kayser 2007, pp. 40 f.). In Hamburg, Meyer also conducted comparative pathological-anatomical research on different organ systems as well as pharmacological research (e.g., on opium; Tölle 2009; Kayser 2007, p. 41).

In 1866, Meyer was awarded a professorship in psychiatry at Göttingen University  and also became the director of Göttinger Irrenanstalt, the mental institution associated with the university. He held this position until his death in 1900, which made him the longest-serving professor of psychiatry in Germany. Among his many assistants was the later famed Swiss psychiatrist Robert Binswanger (1850-1910; in Göttingen from May to December 1876).

Impact

In the history of German psychiatry, Meyer is one of those who had considerable influence in the move to reform clinical care and treatment during the second half of the 19th century. His interest in and therapeutic attitude towards mentally ill patients make him a pioneer in his field and reveal an independently thinking scientist who always sought to combine systematic and analytical observation with a great sense of human dignity.

In 2017, the German writer Andreas Kollender published a novel about Ludwig Meyer titled Von allen guten Geistern (Out of Mind).

Awards

31 July 1867: Honorary Member, Royal College of Psychiatrists, London.

Literature

Burkhart, E. (1991): Ludwig Meyer (1827-1900) – Leben und Werk, ein Vertreter der deutschen Psychiatrie auf ihrem Weg zur medizinisch-naturwissenschaftlichen Fachdiziplin. Inaugural-Dissertation, Institut für Geschichte der Medizin der Freien Universität Berlin.

Kayser, H. (2007): Ludwig Meyer (1827-1900); Forscher, Lehrer und Begründer des “no restraint”. In: Schweizer Archiv für Neurologie und Psychiatrie 158, (1), pp. 39-42.

Kollender, A. (2017): Von allen guten Geistern. Bielefeld: Pendragon.

Lauter, H. (1999): Joachim-Ernst Meyer 2.7.1917–7.6.1998. In: Der Nervenarzt 70, (11), pp. 1034-1035.

Meyer, J. E. (1994): Meyer, Ludwig. In: Neue Deutsche Biographie 17, S. 364 f. URL: https://www.deutsche-biographie.de/gnd117565059.html#ndbcontent [last access: 12/10/2017].

Meyer, Hans-Hermann (1977): [without title; autobiography]. In: L. J. Pongratz (ed.): Psychiatrie in Selbstdarstellungen, Bern: Huber, pp. 283-325.

Meyer, L. (1897): Die Verbannung der Zwangsjacken aus der Irrenabteilung des alten allgemeinen Krankenhauses in Hamburg. In: Die Irrenpflege 1, pp.1-4.

Meyer, L. (1880): Aus der psychiatrischen Klinik zu Göttingen. Ueber die temporisirende Anwendung der Hypnotica. In: Berliner klinische Wochenschrift 17, pp. 521-523.

Meyer, L. (1877): Das ärztliche System der Marburger Irrenanstalt. In: Archiv für Psychiatrie und Nervenkrankheiten 7, pp. 224-230.

Meyer, L. (1874): Ueber circuläre Geisteskrankheiten. In: Archiv für Psychiatrie und Nervenkrankheiten 4, pp. 139-158.

Meyer, L. (1870): Studien zur forensischen Psychiatrie, speziell zur geminderten Zurechnungsfähigkeit. In: Archiv für Psychiatrie 2, pp. 425-445.

Meyer, L. (1864): Die Stimmung und ihre Beziehung zu den Hauptfunctionen des Nervensystems (der Sensibilität, Motilität, dem Denkvermögen). In: Annalen des Charité-Krankenhauses 5, pp. 26-99.

Meyer, L. (1863): Das No-Restraint und die deutsche Psychiatrie. Allgemeine Zeitschrift für Psychiatrie 20, pp. 542-581.

Meyer, L. (1861): Die Beziehungen der Geisteskranken zu den Besessenen und Hexen. In: Westermanns Monatshefte 57, pp. 258-264.

Meyer, L. (1857): Gerichtliches Gutachten über eine zwölfjährige Brandstifterin. In: Allgemeine Zeitschrift für Psychiatrie und psychisch-gerichtliche Medicin 14, pp. 227-257.

Meyer, L. (1854): Beitrag zur Pathologie des Choleratyphoids. In: Archiv für pathologische Anatomie und Physiologie und für klinische Medicin 6, pp. 471-509.

Meyer, L. (1854): Ist Hypochondrie Geisteskrankheit? Deutsche Klinik 6, pp. 354-356.

Meyer, L. (1854): Langdauernder Verfolgungs-Wahnsinn ohne Gehörstäuschungen. Hallucinationen des Gesichts, beim Bestehen des Wahnsinns nachlassend; statt ihrer lebhafte Träume. In: Allgemeine medizinische Zentral-Zeitung 23, pp. 570–571.

Meyer, L. (1852): Observationes quaedam in Tuberculosin. Medical Dissertation, Friedrich-Wilhelm University, Berlin.

Mönkmöller, O. (1924): Meyer, Ludwig (1827-1900). In: T. Kirchhoff (ed.): Deutsche Irrenärzte. Einzelbilder ihres Lebens und Wirkens. Vol. 2. Berlin: Springer, pp. 75-82.

N.N. (2016): Ludwig Meyer. In: Westfälische Biographien, hrsg. von Altertumsverein Paderborn und Verein für Geschichte Paderborn. Online edition: http://www.westfälische-biographien.de/biographien/person/1941 [last access: 12/10/2017].

Sammet, K. (2000). “Ueber Irrenanstalten und deren Weiterentwicklung in Deutschland” – Wilhelm Griesinger im Streit mit der konservativen Anstaltspsychiatrie 1865-1868. Hamburg, Münster, London: LIT-Verlag.

Tölle, R. (2009): Zwischen Griesinger und Kraepelin – Ludwig Meyer (1827-1900): Anatom und Psychiatriereformer. In: Fortschritte der Neurologie Psychiatrie 77, (9), pp. 513-522.

Ingrid Kampås

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