psychiatry deals with the social organ of man , adolf meyer declared confidently in 1913 
 to his medical peers at the international congress of medicine in london . in the audience sat fellow physicians and researchers with 
 a special interest in abnormal mental states and their causes . many of his listeners were 
 eager to hear meyer s report as director of a new psychiatric clinic at johns hopkins 
 university in the united states . the henry phipps psychiatric clinic had opened a few months 
 earlier to become that country s first academic institute devoted to research and training 
 in psychiatry . meyer described his 
 well - appointed clinic in baltimore with beds for eighty - eight patients , laboratories for 
 histology and experimental psychology , and classrooms for clinical demonstrations and 
 instruction in brain anatomy and development . modern facilities also supported comprehensive 
 neurological and psychological assessments of patients , including continuous observation , 
 and a daily regimen that combined physical , occupational and talk therapies . built according 
 to meyer s general specifications , the clinic differed from the large custodial state 
 institutions where he had worked as pathologist and teacher for sixteen years before his 
 headline - making appointment to johns hopkins in 1908 . he staffed and organised the phipps 
 clinic to facilitate a clinical science of psychiatry that operated like the other medical 
 disciplines at the famous research university  producing scientific knowledge and 
 well - trained specialists . meyer emphasised to congress attendees , however , that clinical 
 psychiatry in the twentieth century must address an aspect of human biology that other 
 medical sciences could disregard . internal medicine cultivates the pathology and therapy of 
 special organs , he explained . psychiatry has to add to this the study of the broader 
 integrations , not only of individual organs , but also of the person as a whole in a system 
 of social adaptation. for meyer , that 
 meant mobilising programmes of scientific research , advanced training and therapeutics 
 derived not only from the material data of the sick or autopsied body , but also the 
 ephemeral data of social dysfunction . adolf meyer ( 18661950 ) possessed tremendous authority within anglo - american psychiatry 
 throughout the first half the twentieth century . he was a swiss migr with an elite german 
 medical education and advanced training with some of europe s most accomplished brain 
 researchers . he had a predilection for british evolutionary biology and american pragmatist 
 philosophy , and a lifelong aversion to reductionistic explanations of normal psychology or 
 psychiatric disorders  be they material , psychical , sexual or behavioural . based on his 
 reputation for introducing scientific methods into outdated american mental asylums , in 1908 he was appointed first chief of psychiatry at johns hopkins , at that time widely 
 acknowledged as the pre - eminent medical school and research university in the united states . the position placed him on par with other prominent johns hopkins chiefs such as william 
 osler and william welch , both of whom had campaigned for a psychiatric clinic at johns 
 hopkins and for meyer s appointment . 
 opened in 1913 , the clinic quickly became a leading centre for advanced training in 
 psychiatry and , until his retirement in 1941 , this powerful institutional position assured 
 meyer a leadership role within the discipline . in a period of rapid growth for psychiatry in 
 the 1930s and 1940s , they disseminated his concepts and methods to academic centres in 
 the united states , canada and britain , where multiple generations of clinicians were taught 
 to employ the meyerian approach to study and treat mental disorders . meyer utilised his 
 influence to shape psychiatry s accepted practices and training procedures according to his 
 own distinctive revision of longstanding notions of clinical skill in medical research , 
 teaching and practice . in the 1890s , meyer revised scientific medicine s traditional definition of clinical skill 
 to serve what he called the new psychiatry , a clinical discipline based on the principles 
 of biological adaptation , and that shared social ideals with other this 
 revision conformed to his biological theory of mind and mental illness , which he called 
  psychobiology , and accorded with his definition of scientific medicine as the unification 
 of  pathology and therapy. combining 
 insights derived from evolutionary biology , the new neuron theory and american pragmatist 
 philosophy , meyer concluded that subjective experience and social behaviour were 
 functions of human biology causal agents , not inert side - effects , in 
 the human organism s interaction with its environment . for him , it followed that some 
 pathological processes underlying mental disorders developed not organically , at the level 
 of tissues or cells , but functionally in experiences and social interactions . accordingly , 
 he redefined what clinical skill ought to mean for psychiatry : it could no longer be based 
 solely on correlating patients symptoms with evidence of disease , but must also comprise 
 techniques and aptitudes for discerning causal relationships between social dysfunction and 
 pathological experiences . in addition to the time - honoured techniques 
 devised to exploit the material data of the diseased body  observing and recording in the 
 clinic , dissecting in the morgue and conducting histological experiments in the laboratory  
 meyer insisted that the new clinical psychiatrist also be skilled in recognising and 
 exploiting the productive nature of interpersonal relationships in order to conceptualise , 
 collect , analyse and apply the ephemeral data of  social adaptation. for this analysis , i 
 rely on a prescriptive manual called outlines of examinations published by 
 meyer in 1918 , on his scientific papers and private correspondence , and on examples drawn 
 from medical records of patients admitted to the phipps clinic . i examine his clinical 
 practices and teaching at johns hopkins between 1913 and 1917 to illuminate the relationship 
 between meyer s conceptualisation of social behaviour as a biological function and his new 
 vision of clinical skill for twentieth - century psychiatry . elucidating adolf meyer s conception of clinical skill helps to reconcile an apparent 
 paradox within current scholarship on the meyerian project that so influenced american 
 psychiatry . scholarly consensus forms around his singular and lasting impact on the 
 discipline . psychobiology was merely a form of eclecticism that had little bearing on his success 
 as psychiatry s foremost professionaliser . other historians have gone further to say that his pronouncements about psychobiology were 
 devoid of substance and his research methods arbitrary . jack pressman , on the other hand , concludes that meyer s 
 psychobiological model became the master paradigm of american psychiatry after world war i 
 precisely because of its multi - disciplinary character , thereby consolidating authority in a 
 new medical specialist  the psychiatrist  who became responsible for all mental 
 abnormalities , from acute psychosis to depression to chronic worry . building on pressman s insights , i argue elsewhere that 
 the premise of psychobiology was that an action of the body s nervous apparatus ( at once 
 anatomical and physiological ) and its functional expression ( as mental 
 activity and social behaviour ) constituted a single adaptive response of 
 the human organism . this allowed meyer to advertise psychobiology as an interpretive 
 framework that integrated data and methodologies belonging to fundamentally different 
 phenomena ( anatomical , physiological and experiential ) . my analyses of investigative and 
 therapeutic practices he instituted at the phipps clinic , and of his interactions with 
 phipps patients and staff , showed how meyer s selective use of techniques derived from 
 clinical medicine , neurology , pathology , histology , natural history , experimental 
 psychology , moral therapy and psychoanalysis were united by the principles of psychobiology 
 to serve what he considered a single , scientific enterprise : a clinical science of 
 psychiatry . here , i identify his 
 conceptualisation of  social adaptation as a biological function with the new set of 
 clinical skills he taught at johns hopkins , and which he effectively implemented as a 
 disciplinary standard for american psychiatry . this analysis offers evidence , i suggest , 
 that  far from being incidental  the theoretical principles of psychobiology were at the 
 core of meyer s professional leadership and influence . meyer s new definition of clinical skill in psychiatry reflected his efforts in the years 
 before world war i to apply scientific methods already validated by physicians during the 
 previous century to emergent biological conceptions of mental illness as maladaptation . most 
 medical practitioners and investigators conceptualised disease as a material entity that 
 existed apart from the body it devastated , attributable to a distinctive anatomical lesion , 
 micro - organism or chemical reaction . this ontological view is often labelled the  disease 
 model , within which scientific medicine s primary objective was to locate disease in the 
 sick or autopsied body . its origins in early nineteenth - century paris , and its significance 
 to the development of medical science and specialisation , are both important for 
 understanding the relationship between meyer s theory of psychobiology and his conviction 
 that the skilled psychiatrist employed traditional methods of scientific medicine yet 
 dispensed with old assumptions about the materiality of all pathology . in post - revolutionary paris , the secularisation of the city s massive catholic hospitals 
 provided elite physicians with unrestricted access to patients bodies before and after 
 death . systematically , they examined living patients and , when they died , they performed 
 autopsies on those same bodies . no longer a christian hospice , the crowded ward was now a 
 source of research material and renamed la clinique after the greek word 
 for sickbed . clinicians meticulously 
 documented their observations at the bedside and pathological lesions in organic tissues 
 discovered during autopsy . using comparative and statistical methods to study thousands of 
 recorded cases , they were able to discern otherwise imperceptible patterns of pathology . the 
  clinical  pathological method elucidated for the first time the relatively predictable 
 courses of several common diseases . it placed diseased organs and their tissues at the 
 centre of medical discovery , and established record keeping , clinical observation and 
 dissection as essential techniques of investigation . the new term clinician 
 signified the hospital physician who used this novel method to derive knowledge about 
 disease  continually collecting and correlating data from both living and dead bodies . the clinical  pathological method endured as a guiding principle of scientific medicine 
 throughout the nineteenth century . pathology , the study of disease and diagnosis , emerged as 
 a distinct discipline . well - funded german universities opened institutes devoted to 
 specialised research , which became citadels of scientific work and advanced training in 
 medicine . improvements to the microscope enabled investigators to study disease at the 
 cellular level , fostering new laboratory disciplines such as bacteriology , histology and 
 neuro - pathology . in the 1880s , experimentalists across europe affirmed the principles of 
 germ theory and produced life - saving vaccines . by century s end , the material basis of all 
 sickness  whether at the anatomical or cellular level  appeared self - evident . case history that merged myriad data of clinical signs and pathological 
 processes into a single narrative of disease . elite training under prominent german , french and british 
 clinicians between 1887 and 1892 was rooted in this model of scientific medicine . at no time did it occur to him that the new psychiatry would proceed according to any other than this 
 established methodology . german scientific institutes devoted to psychiatry emerged in the 1870s with roots in 
 traditional mental asylums and hospital wards for neurological diseases . in general , the 
 term psychiatry in this period was associated with the study of abnormal mental states ( or 
 psychopathology ) in living patients , and the term neurology with 
 studying the normal mechanics and diseases of the nervous system . at institutes devoted to 
 clinical  pathological research , these enterprises tended to merge . in the 1880s , for 
 example , clinicians in vienna confirmed correlations between symptoms of aphasia , an 
 impairment involving speaking and writing , and lesions discovered in a particular area of 
 autopsied brains . these concrete but limited findings inspired widespread confidence that a 
 unique histological basis would be identified for every distinct form of 
 psychopathology . when meyer arrived in the united states in 1892 , however , no such lesion had materialised . not for another decade would investigators identify the spirochete responsible for 
 neuro - syphilis . theoretical and 
 methodological discord characterised the overlapping and ill - defined specialties of 
 neurology and psychiatry in europe and north america . experiments by clinicians such as 
 august forel , meyer s doctoral advisor , had confirmed distinctive and autonomous nerve cells 
 termed neurons , sparking the controversial suggestion that the nervous 
 system was not a connective network of nerves . new work in evolutionary biology , 
 particularly that of charles darwin , and the experimental results of physiologists such as 
 claude bernard , also challenged notions of a strictly anatomical basis of mental 
 illness . investigators began to study 
 other possible etiological factors including metabolism , infection and  subconscious mental 
 processes . in the united states , psychologists such as william james and john dewey 
 developed pragmatic epistemologies based on biological development as alternatives to 
 deterministic explanations based on the reflex arc . they viewed the interaction between 
 individual and environment as a dynamic , not determined , exchange  a premise meyer thought 
 was supported by the emerging science of neurons . by 1898 , he was determined to transform american psychiatry into a 
 branch of biology focused on the dynamic interaction between a maladjusted person and his or 
 her environment . his challenge was how to study maladjustment using established 
 clinical  pathological methods devised for studying the diseased body . in the united states , meyer found no academic discipline devoted to psychiatry and very few 
 neurologists conducting clinical  pathological research ; most neurologists were private 
 practitioners dealing with an epidemic of  nervousness associated with the diagnosis of 
 neurasthenia . he also discovered that the country s many mental asylums had not participated 
 in the transformation that had made the university hospital an essential part of medical 
 inquiry and teaching . a legal 
 declaration of insanity was typically a prerequisite for admission , and most asylums were 
 crowded with cases popularly perceived as hopeless . reports of mistreatment and false 
 confinement , as well as the common belief that insanity was inherited and incurable , tainted 
 public perceptions of asylums and the doctors inside them . for most americans in this 
 period , a mental hospital  like those in which meyer worked before his move to johns 
 hopkins  was a terrifying place of last resort . when the phipps clinic opened in 1913 it publicised a psychiatric reform movement already 
 underway in the united states . a small group of elite specialists , within which meyer was a 
 leading figure , tried to transcend the cynicism fostered by the deterioration of mental 
 asylums by abandoning the absolute distinction between health and disease , sanity and 
 insanity . this conceptual shift  
 from incurable insanity to potentially treatable maladjustment  resonated with the 
 progressivism and environmentalism that had emerged as governing views in the united states , 
 both of which posed serious challenges to pessimistic inferences of social and hereditary 
 determinism . meyer linked his 
 psychobiological psychiatry to other progressive reform movements , especially those 
 spearheaded by his close associates jane addams at hull house and john dewey through 
 pragmatism and the new psychology . he 
 spoke confidently about studying and treating severe mental disturbances and so - called 
 nervousness at the new phipps clinic . such optimism dovetailed with americans increasing 
 fascination with self - improvement and spiritual  mind - cures. the clinic s association to johns hopkins advertised its 
 scientific credibility to physicians and their patients , and meyer used his authoritative 
 position to reshape negative attitudes about psychiatric illnesses and institutions , and to 
 influence the trajectory of american psychiatry . during its first five years of operation , 191317 , the clinic attracted and admitted a 
 socially diverse group of 1772 patients with a wide range of symptoms and motivations for 
 using the new psychiatric hospital . the vast majority of admissions were voluntary , the 
 average being fifty - six days and the longest that of a 39-year - old taxi driver from maryland 
 hospitalised for 1015 days . men and women were admitted in roughly even numbers and occupied 
 separate wings of the five - story clinic , each made up of communal wards with some private 
 rooms . as did its parent institution , 
 the clinic could waive or subsidise hospital fees for local poor and working - class patients 
 by catering to those willing to pay higher fees for private accommodations and consultations 
 with the university s eminent clinicians . meyer expected his unusually large staff of psychiatrists , 
 attendants and trained nurses and occupational therapists to convince every patient  
 including the very wealthy and the very sick  to participate in communal meals , occupations 
 and social activities , hydrotherapy and psychotherapy . his clinical staff and trainees 
 utilised state - of - the - art laboratory facilities for work in chemistry , histology , 
 neuropathology and experimental psychology . meyer and his senior staff of four 
 psychiatrists directed all clinical and therapeutic activities , and meyer hired and 
 supervised scientists to oversee the laboratories and pursue original research . like a general hospital , all admissions 
 were at the discretion of physicians , who were not obliged to accept individuals in the 
 custody of state authorities . meyer based admission and discharge decisions on his 
 evaluation of each case s usefulness to clinical work or teaching , and his perception of the 
 patient s capacity for collaboration . each and every patient , he was convinced , was a 
 remarkable source of data for the new psychiatry . meyer conceptualised the data of what he called  social adaptation in terms of his theory 
 of psychobiology , first formulated in 1898 . psychobiology combined the new theory of 
 autonomous neurons , john hughlings jackson s evolutionary model of a hierarchical nervous 
 system , and the epistemology of american pragmatist philosophy . the fundamental premise of 
 psychobiology was that an action of the body s nervous apparatus and its 
 expression as mental activity constituted a single adaptive response of the human organism . he described the brain as the  mechanism of sensory - motor 
 plasticity , a responsive , not fixed , anatomical and physiological apparatus . neural activity was expressed functionally 
 as the mind , which he identified as the  mechanism of adaptation and behavior. according to meyer , the result of this 
 biological integration was the person , an irreducible unit . a person adjusted constantly 
 not only to his or her physical surroundings , but also to a complex environment of symbolic 
 stimuli and tacit social codes social adaptation. he reasoned that 
 through an endless series of psychobiological reactions , a biological function called 
 mentation integrated and regulated a complex suite of adaptive resources accumulated during 
 human evolution , including physiological systems , instinctual urges , emotional responses , 
 learning , memory , perception of reality , imagination , abstract reasoning , social 
 co - operation and altruism . meyer s model of psychobiology framed mental disorders not as 
 distinct diseases , as did the majority of his peers in this era , but as types of 
 maladjustment . he deemed a patient s psychobiological reactions to his or her environment  
 manifest in thoughts and behaviour  to be observable natural phenomena , subject to 
 scientific inquiry and a promising site of medical intervention . greatest obstacle to establishing psychobiology as the basis of psychiatry was the 
 strong orientation toward material reductionism in medical science . he needed to assimilate 
 the ephemeral data of psychobiological reactions , or social adaptation , into the 
 clinical  pathological method premised on the disease model . in 1899 , he lamented that 
 medicine remained on a  pre - biological , materialistic standpoint. in 1908 , the year he was appointed to johns hopkins , 
 meyer declared that psychobiology would liberate psychiatry from the  narrowing 
 straight - jacket of traditional assumptions that had convinced many of his medical peers 
 that any scientific approach to mental illnesses involved correlating clinical observations 
 with pathological processes taking place inside the body . he was convinced that subjective 
 experience and social functioning were also sites of pathological processes . to validate the ephemeral data of social adaptation he appropriated william james s radical empiricism and , in 
 particular , james s instrumentalist revision of the philosophical principle of common 
 sense. james argued that the value of any voluntary act was dependent upon its usefulness 
 to the situation in which it emerged and was applied ; it was considered useful or knowledge and truth were not universal 
 but always dependent upon a specific interpretive context , he asserted , and human experience 
 was progressive and ever - expanding . according to james , he argued , however , that ( like 
 truth ) common sense was not universal since it had evolved according to its use by 
 individuals with subjective goals and beliefs . james redefined common sense as 
 effective judgment  always relative to a specific context , and always 
 formulated according to an individual s accumulated experience . adopting this instrumentalist view of common sense , meyer concluded that subjective 
 experience and social behaviours were integral biological functions in a person s total 
 adaptive performance . each person adjusted to a uniquely constituted environment comprising 
 two spheres : perceptions of external reality ( shared with others ) and the happenings of his 
 or her internal mental life . both objective reality and subjective experience were dominated 
 by symbols and social conventions that required interpretation using common sense . meyer 
 argued that abnormal thinking or social dysfunction , therefore , was as legitimate and 
 productive a source of pathological material as a brain lesion or syphilitic 
 spirochete . to assimilate this indispensable new source of data into the traditional 
 clinical  pathological method , clinicians required a standard of normal against which to 
 identify pathologies . james s concept of common sense as an instrument of individual 
 adaptation served this function in meyerian psychiatry . meyer advertised common sense as the 
 sensory modality that served mentation , supplying knowledge of those stimuli requiring 
 evaluation according to experience . he defined mental health as a natural state of 
 psychobiological balance between lower primal functions and higher abilities such as 
 cognition , abstract thought , delayed gratification , imagination and empathic reasoning . mentation regulated a person s psychobiological reactions to assure appropriately 
 differentiated responses to imminent danger , for example , and merely an abstract 
 idea of being in danger . when it comes to the mechanism of behavior 
 itself , to what we call our mind , he explained in 1912 ,  we find that behavior is regulated 
 by feelings , by fears and desires , by knowledge and wisdom , by personal desire or social 
 custom. common sense circumscribed 
 deeply internalised cultural norms that influenced the workability of myriad 
 psychobiological adjustments involving the co - ordination of physiological , instinctual , 
 emotional , intellectual and social responses . wearing clothes , using money or withholding urination 
 until socially acceptable , are good examples of what meyer considered normal and , more 
 importantly , useful psychobiological habits formed in accordance with 
 common sense . he proposed that psychiatrists could be trained to employ this principle 
 critically in the clinic . our comparative measure of the various disabilities , he wrote in 
 1908 ,  is the normal complete reaction. 
 a psychiatrist had to learn to differentiate inefficient reactions by 
 employing social interaction and his or her own critical common sense . during his own medical training , meyer learned that the clinician s task was to scrutinise 
 all data in the case history , to identify what aspects of the case were clinically salient 
 and to mobilise the appropriate techniques to elucidate those factors . part of this process 
 was to differentiate contributing from incidental phenomena . by the time he became a medical 
 professor , he had concluded that a psychiatrist s clinical skill diverged from that of other 
 clinicians in that he or she was obligated to include the data of social adaptation . there 
 was no question for meyer that the psychiatrist must also master traditional clinical skills 
 devised to collect and analyse the data of the sick body , but he advised his trainees to 
 dispense with the disease model and the assumption that all pathological processes 
 originated in the body . he instructed them instead to view each case as a constellation of 
 causal factors with varying degrees of significance . in some cases , a disruption to the 
 regulatory function of mentation indeed originated with an organic pathology such as a brain 
 tumour or neuro - syphilis ; or , it could be the result of a metabolic imbalance or external 
 intoxicant such as alcohol or drugs . in another group of cases , however , meyer speculated 
 that the leading causal factors were mental , or psychobiological , in origin . he proposed that cases commonly diagnosed as hysteria , neurasthenia and psychasthenia 
 ( widely referred to as  functional disorders in this period )  as well as those typically 
 labelled dementia praecox or schizophrenia  could be categorised , more accurately , as a 
  habit disorder. like his contemporary 
 sigmund freud had suggested for hysteria , meyer theorised that the causal mechanism of habit 
 disorders was conflicting instinctual , emotional and intellectual impulses . when mentation no longer functioned 
 optimally as a regulator of adaptive resources , he suggested , uninhibited primitive nervous 
 mechanisms competed with higher mental functions ( such as common sense ) to respond to social 
 and symbolic stimuli . as a result , if the interpretation was not 
 corrected , the experience could become a recurring ( but false ) criterion for subsequent 
 adjustments to new situations structured by common sense . poorly planned and ill - adapted make - shifts. for example , a 30-year - old 
 artist from new york city who suffered from debilitating phobias was admitted to the phipps 
 clinic . what is it you want to retreat to? meyer asked her , to which she replied ,  to some 
 kind of safety , where i can at least be alone. he explained that  the impulse to hide is 
 like that of a wounded animal and the woman agreed that she was , indeed , just such a beast . yet she was not an animal , he assured her , merely a  bruised person .  a human being finds 
 reliance in social confidence , he informed her ,  you must find a way to get out of your 
 primitive reaction. despite the absence of any imminent danger , the artist could not be 
 re - assured that her fear was unwarranted . for meyer , this signalled a miscarriage of common 
 sense , a biological function that was integral to social adaptation . if generalised to other 
 stimuli and employed repeatedly , a substitute reaction could become progressively habitual 
 and harmful , leading to a failure of social functioning and what he termed a habit disorder . 
 often , he referred to a substitute reaction simply as a pathological habit . the design and organisation of the phipps clinic reflected meyer s goal to apply 
 clinical  pathological methods to what he called psychobiological phenomena ( experiencing , 
 thinking , behaving and socialising ) . for him , its physical and social 
 spaces functioned as quasi - experimental controls to study the conditions under which mental 
 disorders developed and might be modified . by instituting a regimented hospital routine , 
 meyer hoped to engineer optimal conditions  as did an experimentalist in a laboratory  for 
 detecting and better understanding abnormal psychobiological reactions . the daily routine 
 combined therapeutic strategies long used in mental asylums ( occupation , recreation and a 
 wholesome social , or the ideal of a modern psychiatric 
 hospital , he proposed , was to create an optimal environment for artificially enforcing 
 psychobiological balance and equanimity . according to meyer , the psychiatrist gained access to the ephemeral data of social 
 adaptation by utilising interpersonal skills and common sense as tools of clinical 
 investigation . he contended that , as the functional result of otherwise unobservable neural 
 mechanisms , maladaptive thinking and behaviour constituted legitimate material for 
 scientific work . he often expressed frustration that many of his peers in science and 
 medicine disagreed . common sense attitude , meyer 
 complained ,  with the conviction that this is the only admissible and scientific way. in 
 1907 , he deemed materialism , monism and solipsism embarrassments to scientific psychology 
 and psychiatry . i should quit being a physician and a teacher , he promised members of the 
 american medical association in 1915 ,  if i felt compelled to doubt the possibility of my 
 studying and knowing your minds and those of my patients well enough to draw practical 
 conclusions. critical observations of 
 one s own mental activity and that of others , he insisted , generated objective facts 
 admissible to the domain of science . the skilled psychiatrist recognised and utilised his or her own role as an object in the 
 patient s environment . during every interview and examination , meyer instructed , the 
 psychiatrist ascertained  the conduct , its inner consistency and its consistency with the 
 situation , showing the extent of adaptation and  the extent of rapport with the persons and 
 objects of the environment. the deft 
 use of social interaction and common sense facilitated the psychiatrist s assessment in this 
 regard . it is usually of little importance that a patient does or says any one thing , 
 meyer explained ,  but that he does or says it in a definite setting , gives the act or 
 utterance the value or adequacy or inadequacy , or normal or abnormal working. clinical skill also entailed acquiring the 
 facility for self - awareness and self - evaluation . sometimes it is wise to seek the aid of a 
 fellow physician who is more capable of meeting a particular situation , he advised readers 
 of his 1918 manual , outlines of examinations . a clinical psychiatrist not 
 only needed to regard the patient as a person in a system of social adaptation , but also 
 himself or herself in similar terms . collecting the data of social adaptation depended equally upon the psychiatrist s skill in 
 establishing  a safe foundation in the relation between physician and patient , in order to 
 make accurate observations on which to base clinical judgement . it was critical to obtain from the patient a statement 
 describing his or her illness and experiences . make sure that the patient realises the 
 attitude of cooperation and helpfulness , meyer told trainees ,  which alone will justify the 
 laying bare of the material. this was 
 not straightforward with actively symptomatic psychiatric patients exhibiting delusions , 
 hallucinations , paranoia , depression or mania . meyer felt strongly that the creative 
 psychiatrist could convince most patients that medical help from a doctor would prove 
 beneficial . i realise the difficulty , he wrote to one of his colleagues in 1914 , but i 
 rather think it is best that physicians should have to exert some efforts and exercise their 
 imagination and use their resources to the utmost. one way a psychiatrist accomplished this , meyer proposed , was to 
 develop the ability to engage with the patient s fantastic narrative conscientiously , whilst 
 never conceding the established values of common sense . he used a provocative comparison to 
 explain this principle in 1913 : i am as capable of listening calmly and politely to an account of a system of delusions 
 as i am inquir[ing ] into the religious and philosophical views of an oriental  with 
 equal fairness and equal suspense of criticism and argument  and to arrive at a working 
 agreement without any need of deception or sheer  humoring  . it is possible that such an 
 attitude becomes natural to one who looks upon any set of views as a legitimate outcome 
 of human mentation under certain conditions , and who sees the chief task [ of psychiatry ] 
 finding the conditions which led to such views . i am as capable of listening calmly and politely to an account of a system of delusions 
 as i am inquir[ing ] into the religious and philosophical views of an oriental  with 
 equal fairness and equal suspense of criticism and argument  and to arrive at a working 
 agreement without any need of deception or sheer  humoring  . it is possible that such an 
 attitude becomes natural to one who looks upon any set of views as a legitimate outcome 
 of human mentation under certain conditions , and who sees the chief task [ of psychiatry ] 
 finding the conditions which led to such views . using a representation of otherness that was common in european discourses at the beginning 
 of the twentieth century , the  oriental , meyer advised psychiatrists to respond to bizarre 
 manifestations of psychopathology  like steffi s claim , below , that her thoughts were 
 controlled by electricity  with a kind of cultural relativism appropriate to meeting a 
 person who practised buddhism or islam as a result of being raised in asia where those 
 systems of belief were commonly revered . indeed , as he suggests above , for the psychiatrist 
 it should become natural to view personal beliefs and experiences as products of specific 
 environmental conditions , including delusions and pathological experiences . the clinical psychiatrist also learned to utilise the hospital environment as a tool for 
 collecting the data of social adaptation .  in the hospital the patient is reduced to a 
 common level with all the others , meyer explained , and  put upon a strange experimental 
 field. against the backdrop of the hospital routine , he observed , peculiar reactions and 
 behaviours were brought into relief . he instructed trainees to pay close attention to a 
 patient s responses to encounters with fellow patients , and to visits or letters from family 
 and friends . the skilled observer will see the advantage in utilising such incidents, he 
 explained , and benefit from  the decided boon in being able to limit his observations on the 
 patient and his description to the great experimental plane of ordinary hospital life. he 
 surmised that a patient s attempt to adjust to the relatively predictable hospital routine 
 brought into relief abnormal patterns of social adaptation that would be far less 
 conspicuous if observed within the everyday contexts in which they arose . on the day of a patient s admission to the phipps clinic , a clinician conducted an initial 
 interview with the patient and , like colleagues in other specialities , documented the 
 individual s medical history including details about previous periods of ill health , 
 diseases of family members and his or her medical complaints . personal history during which he or 
 she questioned the patient about the circumstances that preceded hospitalisation , childhood 
 experiences , schooling , family , friendships , religious views , romantic attachments , 
 emotional responses to various aspects of life , vocation and hobbies . the psychiatrist also 
 inquired about personal habits involving diet , tobacco , alcohol , drugs , masturbation , 
 hygiene , sleep , leisure , birth control and sexual intercourse . throughout this comprehensive interview , the skilled 
 clinician was to simultaneously observe and document the patient s conduct and statements . meyer utilised shorthand to describe noteworthy expressions and behaviour , and to record 
 statements verbatim ; he expected his trainees at the phipps clinic to do 
 the same . steffi was 29 years old and lived a few blocks from the phipps clinic . in the outpatient 
 dispensary , psychiatrist esther my 
 thoughts are in electricity all the time , and people read them as i go along the streets , 
 steffi reported .  in any electric streetcars or other machinery run by electricity they cast 
 this spell on me i find myself saying and thinking things that i do not want to say. when 
 richards asked her patient to elaborate , steffi assured her that her thoughts were too 
 immodest , i wo nt tell you. she used to be a good catholic , steffi explained , but was 
 forced to stop going to church . priests can not say mass when i am in the room because this 
 spell that is on me interferes with their thoughts. steffi had attracted attention a few 
 months earlier when she experienced sudden attacks of pain at the underwear factory where 
 she worked . she complained that the noisy electric machinery from another factory was 
 casting a spell on her . electricity compelled her to do things and she feared she might 
 commit some dreadful act . a family member reported that she worried over trifles , sat 
 wringing her hands , and brooded or laughed foolishly without reason . once the psychiatrist elicited initial biographical details from the patient , he or she 
 interviewed family members , friends and employers . these so - called  informants were asked 
 to provide a picture of  the make - up of the patient at his or her best in order to help 
 establish a comparative measure of normal . in steffi s case history , meyer recorded that 
  the patient is described as cheerful , and for the most part 
 easy - going. she got along well with associates at school and in the factory , 
 steffi s mother reported , but she had  always been very modest , being unwilling to 
 undress before her sisters. the emphases meyer added to his clinical notes in 
 this example stressed steffi s usual cheerful disposition and her abnormal pre - occupation 
 with modesty . when interviewing informants , meyer advised the clinician to push the 
 questions carefully in directions that elucidated the onset of illness and facts that could 
 rule out possible diagnoses . the clinician then returned to the patient to conduct a comprehensive , standardised 
 neurological examination . he or she employed well - established clinical techniques to 
 evaluate normal functions of the nervous system : for example , reflexes , motility ( symmetry 
 of gait or ability to balance ) , subjective sensations ( pain or dizziness ) , sight , touch , 
 hearing , taste and smell . for example , if the examiner asked the patient to stand with eyes closed and the 
 individual repeatedly swayed ( romberg s sign ) , it indicated a problem of the sensory nerves , 
 rather than the brain or mental functioning . an asymmetrical smile signalled that a 
 patient s paralysis was due to nerve damage , rather than a psychobiological impairment . difficulties repeating test words such as third artillery brigade or 
 hippopotamus also pointed to the likelihood that causal factors were 
 organic and mental factors incidental . nurses collected and measured the quantity of each patient s 
 urine , after which it was analysed chemically to test for other known disease processes . blood and spinal fluid were drawn from every patient and tested for a wasserman reaction , a 
 new serological test for syphilis . clinicians in the department of neurology at johns 
 hopkins hospital employed these same physical and laboratory tests to evaluate their 
 patients . in the phipps clinic , psychiatrists also performed a comprehensive psychiatric assessment 
 of each patient . still in use today , meyer lobbied to establish the  mental status exam as 
 a standard clinical procedure in american psychiatry . he provided detailed and cinematic 
 instructions for administering and interpreting its many tests in outlines of 
 examinations . like a neurological examination , it involved a 
 lengthy series of questions and tasks that enabled the skilled clinician to gauge abilities 
 such as abstract thought , reasoning , learning , judgment , planning , problem solving , social 
 awareness , symbol recognition and the comprehension and expression of language . meyer 
 emphasised that a patient s responses to the mental status exam were relative , not absolute . when the phipps psychiatrist edward kempf examined a young man who could not name the 
 largest river in africa , he suggested to his patient that perhaps it was the mississippi 
 river . no , the mississippi is in the united states , the patient responded sceptically , 
  you know that as well as i do. this established for kempf at least one marker of normal 
 judgment . perhaps it is the river nice? kempf then asked , and immediately the patient 
 remembered that the largest river in africa was the nile . as kempf did here , in order to 
 discriminate between ignorance ( a normal phenomenon , relative to a patient s life 
 experiences ) and psychobiological impairment , meyer expected psychiatrists to modify the 
 procedure using common sense as an additional tool of evaluating results and collecting 
 data . psychiatrists not only had to exploit , but appraise and protect their interpersonal 
 relationships with patients . interviews and examinations should remain fluid , and meyer 
 expected his clinicians to adapt themselves to the specific contexts and interpersonal 
 dynamics of each new situation .  wherever the patients do not speak freely it is natural 
 that we should first make sure that they have all they need for their comfort , he 
 counselled . special caution was needed when inquiring about pre - occupations , dominant ideas , 
 delusions , hallucinations , obsessions or odd experiences . take up some of the least 
 irritating topics , such as will most likely elicit a pleasant answer and create a congenial 
 starting point. when a particular issue threatened to  adulterate the account , he advised 
 the clinician to pre - emptively employ  ordinary human tact to change the subject . clinical skill also involved policing 
 social contexts of interviews to obtain a complete and clear statement . whether or not to 
 interview a patient in the presence of family members or fellow patients , for example , 
 depended upon the psychiatrist s judgment regarding potential gains or liabilities . evil results follow inevitably any false 
 relation between patient and physician , meyer stated emphatically . the patient must be 
 treated absolutely as a person on equal footing with the physician. above all , it was 
 essential to  get the patient s confidence as soon as possible. meyer highlighted this special aspect of psychiatry 
 compared to other medical disciplines , encouraging trainees to collect valuable data by 
 combining their own experience with  imagination and memory to guide you in the examination 
 for symptoms which others might overlook. both collecting and analysing the data of 
 psychobiological reactions depended upon utilising social skills in every encounter with a 
 patient . using a revised set of clinical skills based on the instrumentalist principles of 
 psychobiology , meyer maintained that psychiatrists could use the clinical pathological 
 method to achieve what clinicians and pathologists had already accomplished for many 
 pulmonary , infectious and neurological diseases : to identify distinctive pathological 
 patterns particular to the development of various habit disorders . it will be our duty , he 
 proclaimed to his peers in 1912 ,  to define in actual cases what habits we find interwoven 
 and with what effect. he held that the 
 objective of any scientist was to discern relationships between cause and effect , stimulus 
 and response , pathology and symptom . reduction of the essential facts to terms of an 
 experiment in nature , he decreed ,  and study of the modifiability of the experiment is the 
 fundamental law and aim of medical science , and this holds clearly enough for the 
 psychobiologic assets as well as for any other type of reaction. nineteenth - century clinicians mobilised the idea of the 
 clinical case as an  experiment in nature to emphasise that their cases had the same 
 epistemic status as laboratory experiments , and that clinical knowledge depended upon the 
 ability to scrutinise cases in a systematic way . meyer deemed this an essential technique 
 for collecting the data of social adaptation . approaching the case as an  experiment in 
 nature helped the clinician to see each patient s unique form of psychopathology as the end 
 result of multiple causal chains , not unlike the experimentalist s results in a 
 laboratory . steffi was able to recall 
 recent and distant events , perform calculations , recognise people she knew and correctly 
 analyse images . nevertheless , as meyer explained in a clinical lecture based on this case , a 
 segment of steffi s mental activity was bound up in  a realm of unrealities  a sort of 
 parasitic growth of pathological experience. here , meyer used bodily disease as metaphor in 
 order to emphasise to his students that , like an anatomical lesion or infection , a 
 pathological experience also had a natural development . he maintained that the new clinical psychiatrist must be skilled at analysing the data of 
 social adaptation in order to formulate intermediate conclusions about the development of 
 the patient s condition  a process he referred to as  reconstructing the experiment in 
 nature . it was the german clinician emil kraepelin who demonstrated a legitimate method for 
 transforming clinical observations of psychiatric patients into useable data that led to 
 definitive results . in germany during the 1880s and 1890s , kraepelin compiled and compared 
 thousands of medical histories from patients observed for months , years and decades . his 
 quantitative analyses of these clinical data revealed two distinctive forms of insanity 
 based on the periodicity of psychotic symptoms : episodic manic - depressive 
 insanity versus deteriorative dementia praecox . this diagnostic 
 distinction , established by taking a comprehensive and exhaustive medical history , was of 
 immediate practical use to physicians as it enabled them to rule on the individual s 
 prognosis . kraepelin s work revolutionised attitudes about the utility of clinical work with 
 psychiatric patients by showing that observable manifestations of their diseases  not just 
 the brain lesions thought to cause them  could be studied scientifically and produce 
 knowledge . meyer spent the summer of 
 1896 apprenticing in kraepelin s clinic and was inspired by these results . he concluded 
 that , similarly , he might discern distinctive causal patterns in the 
 development of mental disorders , including at the level of social functioning , by amassing 
 and analysing large numbers of case histories . if the traditional case history merged observations of clinical signs and pathological 
 lesions to create a single narrative of disease , the meyerian case history was to represent 
 a coherent narrative of individual maladjustment and serve as a common disciplinary object 
 for psychiatrists . in contrast to 
 kraepelin s focus on periodicity and prognosis , meyer explained , his aim was  to put the 
 emphasis on the living patient and the problems of the determination of his condition , the 
 causes , and remedial measures. in the 
 phipps clinic , the case history became a dossier comprising all potentially relevant data : 
 the patient s medical history and life experiences , results of neurological and mental 
 status exams , the clinician s ongoing observations of both social and bodily phenomena , 
 laboratory findings and transcripts of interviews with the patient . its purpose was to 
 highlight causal relationships in the development of the individual s illness and to 
 objectify the ephemeral data of social adaptation so that  every step is like an experiment 
 telling us the story. a conscientiously 
 crafted case history became a permanent demonstration of the data. their notations , he advised , must convey the highly 
 contextualised settings in which psychobiological reactions emerged . this was another way in 
 which the meyerian case history diverged from conventional practices that aimed to depict an 
 acontextual and objective snapshot of disease . whereas chemical reactions or physiological 
 reflexes observed in traditional experiments remained contingent upon proximate stimuli 
 ( temporally and spatially ) , a psychobiological reaction involved a  more extensive scope of 
 potential links and interrelations among stimuli spanning past , present and imagined 
 experiences .  to do justice to the 
 principles of an experiment , which is the fundamental requirement of pathology , and of 
 science in general , he explained ,  we must give each fact its true value in the chain of 
 cause and effect. experience and social behaviour , the pragmatist meyer repeatedly 
 emphasised , were inseparable from their interpretive contexts .  a reaction , he told 
 students in 1918 ,  can not be judged without a knowledge of the stimulus. he explained that the psychiatric case history must  read 
 like a continuous , consistent story that depicted the patient s dynamic interaction with 
 his or her environment . the patient s life experiences constituted the psychiatrist s primary material for 
 reconstructing the experiment in nature . during daily interviews , psychiatrists asked 
 patients to respond to questions and describe their experiences , past and present . not so well - managed , meyer 
 told one of his patients ,  [ and ] they are sorted out in terms of events of the past and the 
 way they were handled. by systematising 
 these data , the clinician aimed to identify discrepancies between the patient s adaptive 
 resources and the demands he or she faced . steffi recalled that a  habit of hers had 
 generated heated discussion between her mother and her public school teacher . she herself 
 could only recall that the habit was  a nervousness that would go through her whole body. 
 deducing masturbation , a few days later meyer asked her explicitly about sexual feelings or 
 curiosity . she vehemently denied having had any sexual thoughts , ever , and instead returned 
 to  vague and disguised references to the remarks about a habit at school. in 
 outlines of examination , he advised trainees that  any suggestion that 
 something is concealed requires special investigation. since she spoke chronically of being whipped for  knowing too much 
 about grown up things , he reasoned that she had been severely reproached , perhaps 
 violently , as a child for masturbating in school . as a result of this traumatic experience , 
 he speculated further , steffi had misinterpreted similar sexual sensations in young 
 adulthood as abhorrent . with mentation no longer functioning adequately to regulate 
 conflicting impulses of fear and pleasure , his patient had substituted a primal response of 
 hiding ( in an abstract internal world ) , and this substitute had become progressively 
 habitual and pathological . just as the traditional clinician and pathologist worked 
 collaboratively and methodically to identify organic disease processes , meyer believed that 
 the psychiatrist skilled in combining common sense and the methodological rigour of the 
 clinical  pathological method could establish useful intermediate conclusions about the 
 origins of substitute reactions and the factors that perpetuated their development . those 
 conclusions , he urged , ought to be applied without delay to therapeutic efforts with the 
 patient , even as the collection and analysis of data continued throughout the 
 hospitalisation . applying the data of social adaptation meant intervening in the experiment in nature , in 
 order to modify a patient s psychobiological reactions . a psychiatrist exploited the 
 hospital s contrived social milieu resourcefully . in cases of habit disorders , he or she 
 focused therapeutic efforts on producing a healthy adjustment through the inculcation of 
 more efficient adaptive habits in place of harmful ones . in a clinical lecture based on the case of steffi , meyer told 
 students that  where the patient is as open as this one we may get on a footing of common 
 interests which may crowd out much of the abnormal substitutions. derived from the 
 principles of psychobiology and his concept of habit disorders , meyer called this approach 
 habit training .  social influences, he had declared in another lecture before his move to johns hopkins , 
  must be brought to bear to rescue the sound instincts that are left. indeed , every member of the hospital staff , according to 
 meyer , was obliged to interact with patients in a genuine manner , both to collect data and 
 to serve the exercise of habit training . twenty - seven - year - old lottie was one of the first 
 patients admitted to the phipps clinic in 1913 . nine years earlier , while at boarding school 
 in europe , lottie had suffered fits after hearing ghost stories and being teased by her 
 classmates about her sexual ignorance . during the sea voyage home , she had accused the 
 ship s doctor of improprieties and had become convinced that she was pregnant and disgraced . she had wept for a baby she threw into the sea , and had attempted to jump overboard four 
 times . once ashore she had promptly informed her parents she was married and had delivered 
 two children ( she had been gone only a few months ) . throughout her hospitalisation at 
 phipps , lottie experienced psychotic episodes and , alternately , long periods of stupor in 
 which she was unresponsive to physical or social stimuli . one afternoon , however , she 
 enjoyed an organ recital in the auditorium of the clinic . i wore my violet chiffon dress , 
 she wrote her mother ,  and one of the young doctors sat beside me. psychiatrists observed 
 and recorded her comment , considering it an encouraging sign of healthy participation in the 
 social environment . meyer also perceived the hospital environment as a stage for rehearsing scenarios drawn 
 from the script of common sense that governed everyday life . each friday afternoon , for 
 example , the female patients helped to plan and then attended a party in the auditorium 
 where they served tea , played cards and danced with each other . a billiards room nearby 
 provided a space where the male patients could socialise without female nurses or doctors . nurses and attendants devised these special activities to recreate social spaces and 
 interactions of everyday activities ( in this period , of course , highly gendered and 
 classed ) . during these exercises , theoretically , staff modelled and patients practised 
 utilising normative social behaviours that meyer considered essential adaptive assets . in the contrived social milieu of the hospital , the clinical psychiatrist had to be attuned 
 to utterances or behaviours that were significant , and while attending one of the weekly tea parties , however , nurses noted that 
 she  would talk quite sensibly at intervals. two days later , psychiatrist tedrow keyser 
 pulled up a chair in the communal women s ward to speak with another patient , placing a 
 cushion on it as he did so . this drew lottie s immediate attention :  why do you have that on 
 there ? did you get spanked behind the barn? keyser slowly turned from the patient he had 
 intended to interview and calmly asked lottie if the cushion had reminded her of something , 
 to which she replied ,  when my brother got spanked behind the barn. sensing a valuable 
 opportunity , he immediately questioned her further . lottie related disconnected remarks 
 about being in the barn with her brother who afterward received a spanking from her father . when keyser pressed her about what they were doing in the barn ,  the patient became very 
 quiet and then sat unresponsive for hours . social interaction , deftly combined with 
 clinical acuity and opportunism , led keyser to elicit significant data about possible causal 
 factors  even from a patient as inaccessible as lottie . the skilled clinician was adept not only at establishing and exploiting productive social 
 interactions , but also at patrolling those developing around the patient . the first page of 
 the official nursing manual for the phipps clinic in this period warned the all - female 
 nursing staff that , while it was important to be always gracious , a nurse must remember that 
 patients were not ordinary social contacts. lottie s mother repeatedly wrote to meyer asking for his permission 
 to visit her daughter . taking his patient s social abilities as his gauge , he gently but 
 consistently put her off for over six months :  please accept my emphatic assurance that as 
 soon as i see that miss lottie is capable again of a reasonable amount of what we call 
 rapport  in other words [ the ] ability to team with anyone or to have at least some mental 
 relationship and profit from being together i shall call on your help. in this explanation to lottie s mother , he touched upon 
 the productive nature of social relations : if lottie herself was not able to profit from 
 the interaction , its effect was either benign or potentially detrimental . for meyer , 
 preserving the integrity of the therapeutic social milieu was yet another important 
 component of clinical skill for the new psychiatry . occupational therapy , employed widely as medical treatment in this period , played a central 
 role in the regime meyer imposed on phipps patients . eleanor clark slagle , a dominant force 
 within this emerging profession , was the inaugural occupational therapist at the phipps 
 clinic . meyer and slagle shared a pragmatic orientation that shaped how occupational therapy 
 developed in the twentieth century . for them , patients did not just make baskets or play 
 games  every activity was imbued with socialisation that could be exploited for therapeutic 
 gain . the hold it is possible to get 
 upon the patients as the result of these recreational and occupational methods is very 
 remarkable , meyer reported to the superintendent of johns hopkins hospital in 1914 . underwriting his use of occupation was 
 william james s instrumentalist notion that mentation merely activated instinctive drives 
 for satisfying self - interested goals . talk and feeling and thinking , he stated in 1916 , 
  are but a way to action. if a person reacted to his or her thoughts and feelings with more 
 thoughts and feelings , rather than with productive activity , it could instigate a 
 potentially harmful process . this mental feedback loop , as it were , could lead to a 
  troubling fermentation of thought and fancy culminating in irrational phobias , delusions , 
 debilitating anxiety or emotional extremes . manual occupation and social activities interrupted rumination , 
 meyer theorised , directing the patient s attention away from attractions alluring to his 
 morbid appetite , longings , and fancies. 
 he counselled one phipps patient to  build up a foundation of habits and interests of 
 activity in order to  crowd out the feelings which have become morbidly habitual. playing 
 billiards and participating in other activities , he later told the patient s family ,  quite 
 obviously roused some natural and helpful instincts of self - activation. according to the principles of psychobiology , a 
 psychiatrist could exploit occupational therapy and everyday activities as ( artificially 
 produced ) opportunities for the patient to set productive goals and derive satisfaction from 
 achieving them . finally , meyer taught psychiatrists how to employ various psychotherapeutic techniques to 
 continue the search for causal factors and , ideally , to modify subsequent developments in 
 the direction of recovery . his particular brand of psychotherapy was just one of numerous 
 forms of medical talk therapies to emerge in the united states in the decade before world 
 war i. meyerian psychotherapy incorporated ideas and methods developed by other theorists 
 such as pierre janet , carl jung and sigmund freud , which meyer often modified to conform to 
 psychobiological principles . for example , he framed the psychotherapeutic encounter as a 
 dynamic interaction between an organism ( the psychiatric patient ) and its environment ( of 
 which the therapist was a part ) . in stark contrast to freud , then , meyer deemed 
 psychotherapy a collaboration between psychiatrist and patient . the assistant director of 
 the phipps clinic , macfie campbell , described psychotherapy to one patient as  a thorough 
 study of subconscious adaptation in which they would combine the patient s  introspective 
 insights with his medical analysis . meyer encouraged the same patient  to review the facts 
 of his life and to reconstruct the situation from which his symptoms arose. conducting multiple interviews each day 
 ( according to a patient s capacity to collaborate ) , the psychiatrist utilised psychotherapy 
 to generate insights into the origin of pathological habits , and to help the patient 
 identify and correct misinterpreted experiences . the 
 material that you ought to be able to reconstruct into a sufficiently successful 
 adaptation. the skilled psychiatrist stimulated and fostered healthy social instincts . the 
 physician puts something in , meyer mused in his private notes about psychotherapy ,  not 
 content  but as a catalyzer which will enable the patient to rearrange the components of 
 his own life , to become more and more focused and capable of performance. requiring patients to talk endlessly about 
 thoughts and feelings was , for meyer , worthless without also insisting that they set and 
 achieve concrete goals . understanding and influencing  actions and attitude and their 
 adaptation , he declared , were essential clinical skills for psychiatrists in the twentieth 
 century . while clinicians in other specialities evaluated the effectiveness of treatment in terms of 
 the restoration of bodily functions , meyer proposed that the psychiatrist did so using the 
 measure of common sense to assess changes in individual social functioning . when lottie s 
 awareness of her social environment increased , for example , it indicated improvement . they 
 do nt give me any medicine or tonics here , so i would be just as well at home and the food 
 would be better , she wrote to her mother after many months in the clinic . i am knitting 
 you a shawl but do nt know whether you will like it. she went on to ask about the welfare 
 of relatives and friends , and to comment on the weather in baltimore . her parents were 
 delighted with her note , the most coherent utterance they had heard from her in years . a 
 week i am up and dressed every day there is a sun parlour where we sit in 
 most of the time and a gymnasium where we have exercises , not at all violent principally 
 deep breathing. her mother forwarded the letters to meyer with her immense gratitude , 
 describing them as quite wonderful. the more connected to the social environment lottie 
 became , the more lucid her dispatches and the more scathing her criticisms : we are housed in all together and some of the patients are completely off their 
 heads. when lottie had arrived at the phipps clinic six months earlier , she had not known 
 where she was and had not recognised meyer , who had treated her for many years before her 
 admission . now , she was acutely aware of her surroundings , which she reasonably perceived as 
 miserable . she not only recognised meyer but harboured definite opinions about the 
 interrelationships between him , herself and her parents . s perspective , collecting , analysing and applying the 
 data of social adaptation had enabled him and his staff to elucidate and intervene in the 
 experiment in nature . familiarity with the various conditions of life , adolf meyer assured trainees in 1918 , 
  and ways of succeeding and failing in psychobiological adaptation is necessary. experience and social interaction were 
 biological functions that enabled a person to adapt successfully to a complex environment , 
 he maintained , and they were nothing more and nothing less than natural phenomena to be 
 subjected to scientific study . his determination to apply the logic and techniques of the 
 clinical  pathological method to the ephemeral data of social adaptation produced a new 
 definition of clinical skill for the progressive new psychiatry of the twentieth century . opportunities to advance scientific inquiry or therapeutic efforts , he taught his specialist 
 trainees , emerged from both the patient s sick body and his or her adaptive behaviour . in 
 addition to honing the traditional skills of the clinic , autopsy and laboratory , a 
 psychiatrist also had to be able to employ social interaction and interpersonal 
 relationships as investigative and therapeutic tools . as such , the meyerian psychiatrist 
 never allowed his or her view of the patient to crystallise . it has to organise and grow , 
 to expand or shrink itself , the pragmatist meyer explained ,  according to demands and 
 opportunities. meyer s psychobiological revision of psychiatric knowledge and skill had a significant and 
 lasting impact on anglo - american psychiatry in the twentieth century . psychobiology widened 
 clinical inquiry and psychiatric treatment to include the data of emotions , instincts , 
 personal experience , behaviour and individual social functioning . from his powerful 
 institutional position at johns hopkins , he campaigned for new affiliations between clinical 
 psychiatry and state mental hospitals , neurology , social work , experimental psychology , 
 sociology , education , public health and the law . between 1913 and 1941 , he trained 
 generations of elite specialists who transported his concepts and practices to new centres 
 of academic psychiatry in the united states , canada and britain . many psychiatrists who trained and worked at the phipps 
 clinic , such as trigant burrow , jerome frank , alexander leighton , paul lemkau and paul 
 schilder , developed new investigative and therapeutic methods in psychotherapy , psychiatric 
 epidemiology and community psychiatry
adolf meyer ( 18661950 ) exercised considerable influence over the development of 
 anglo - american psychiatry during the first half of the twentieth century . 
 the concepts and 
 techniques he implemented at his prominent phipps psychiatric clinic at johns hopkins 
 remain important to psychiatric practice and neuro - scientific research today . in the 
 1890s , meyer revised scientific medicine s traditional notion of clinical skill to serve 
 what he called the 
 new psychiatry , a clinical discipline that embodied social and 
 scientific ideals shared with other 
 new progressive reform movements in the united 
 states . 
 this revision conformed to his concept of psychobiology  his 
 biological theory of mind and mental disorders  and accorded with his definition of 
 scientific medicine as a unity of clinical  pathological methods and therapeutics . 
 combining insights from evolutionary biology , neuron theory and american pragmatist 
 philosophy , 
 meyer concluded that subjective experience and social behaviour were functions 
 of human biology . 
 in addition to the time - honoured techniques devised to exploit the 
 material data of the diseased body  observing and recording in the clinic , dissecting in 
 the morgue and conducting histological experiments in the laboratory  he insisted that 
 psychiatrists must also be skilled at wielding social interaction and interpersonal 
 relationships as investigative and therapeutic tools in order to conceptualise , collect , 
 analyse and apply the ephemeral data of  social adaptation. an examination of his 
 clinical practices and teaching at johns hopkins between 1913 and 1917 shows how 
 particular historical and intellectual contexts shaped meyer s conceptualisation of social 
 behaviour as a biological function and , subsequently , his new vision of clinical skill for 
 twentieth - century psychiatry .