Elmer E. Southard, M.D. 1876–1920

Elmer E. Southard was a psychiatrist and leader of vision, empathy, charm, and brilliance. The Boston Psychopathic Hospital was jointly established in 1912 by the Harvard Medical School and the state of Massachusetts to serve as a center for research, education, and clinical services for the mentally ill. It was through the foresight of the state of Massachusetts and the Harvard Medical School that Dr. Southard was appointed as the first director of the hospital. In this role, he rose to prominence as a policy maker expounding the need for “parity”—care of the mentally ill equivalent to that given to the physically ill. At the Harvard Medical School in 1912, there was a profound discrepancy between the vigorous intelligence directed at the care of the physically ill and the lack of understanding that shrouded the view of psychiatric disorders. Also at that time in Massachusetts, persons suffering with mental illness were sorely neglected or poorly treated. Because of the lack of comprehension of the nature of mental illness, the mentally ill were often sent to “The Tombs” (the city prison), the police station, and the House of Correction, which left them classified as prisoners, not patients. The state’s and the Harvard Medical School’s establishment of this hospital (now called Massachusetts Mental Health Center), along with their appointing Southard to the helm as the Bullard Professor and Superintendent at the hospital, merged the state’s resources with the scientific advances of the Harvard community.

Dr. Southard was a remarkable clinician as well as a kind and devoted teacher. In 5- or 10-minute interviews, he was able to engender a feeling of hope in his patients by his keen insight into the nature of their struggles, so that they were better able to manage the seemingly intractable obstacles severe mental illness imposed on them and their families. Southard was well respected by his pupils (many of whom became great leaders in psychiatry) for his native ability to relate to each individual while achieving rapid, clear diagnostic formulations. Dr. Southard’s generous, open-minded spirit encouraged active inquiry and debate, although personally he eschewed any psychiatric treatments that he found to be too pessimistic. His role as a mentor set a precedent of attracting inspiring, distinguished teachers to the Massachusetts Mental Health Center, a tradition that continues today. Above all, Southard maintained that excellence in psychiatry must be rooted in empiricism. As a neuropathologist, his dream was to compile an authoritative anatomy of severe mental illness. Remarkably, on the basis of hundreds of rudimentary postmortem brain specimens viewed at the turn of the century, Southard presaged a “neurodevelopmental theory” of “dementia praecox” (schizophrenia). Noting that on autopsy there was a pattern of hypoplasia in the prefrontal regions of the brains of patients diagnosed with dementia praecox, Southard reasoned that such abnormalities may be examples of “aplasia or hypoplasia in the sense of a failure of the cells which have been quite properly laid down to progress in the normal direction” (1). He had the foresight also to be concerned lest these lesions be “dismissed in one of the senses of the term incidental.” At the First International Congress of Neuropathology in 1952, the evidence supporting schizophrenia as a biological brain disorder was dismissed as artifact by the prevailing consensus (2). For the next four decades following this conference, this view of schizophrenia was neglected. Now, in the wake of a host of findings stemming from the use of more advanced neuroscientific methods, Southard’s view of misaligned brain development is regaining attention (3). More important, Southard’s seminal work has paved the way for parity in policy making and hope generated by the promise of the future primary preventive interventions in the treatment of schizophrenia.

Looking back on the remarkable history of E.E. Southard and his clinic at the Massachusetts Mental Health Center, we can look forward to the future of academic psychiatry. The Southard Clinic remains committed to the provision of high-quality patient care as well as rich educational experiences for residents in psychiatry, informed by cutting-edge research.

Dr. Zornberg, Director, Southard Clinic, Harvard Medical School Department of Psychiatry at Massachusetts Mental Health Center, 74 Fenwood Rd., Boston, MA 02115. Photograph courtesy of Massachusetts Mental Health Center (Mr. Dan DeHainaut).