The Alzheimer Photo

A professor recently brought my attention to this photo of Alois Alzheimer and his colleagues in Munich (source):

Alzheimer is the very-German-looking guy with the silly mustache third from the right on the top. Far right is Friedrich Lewy, discoverer of Lewy bodies and Lewy body dementia. Bottom, second from the left, looking kind of like Petyr Baelish, is Ugo Cerletti, inventor of electroconvulsive therapy.

Other members of Alzheimer’s team didn’t make it to the group photo. These include Alzheimer’s mentor, Emil Kraepelin, who discovered bipolar disorder, schizophrenia, etc, etc, etc (there’s a reason modern psychiatry calls itself “neo-Kraepelinian”). They include two of Alzheimer’s assistants, Hans Creutzfeldt and Alfons Jakob, who discovered Creutzfeldt-Jakob disease, the human version of mad cow. They include Alzheimer’s collaborator Franz Nissl, who discovered Nissl bodies and the Nissl stain at the same lab.

If you come across a neurological disease that sounds like a guy’s name, there’s a not insignificant chance that guy is either in this picture or else just barely missed it.

This made me think of a lot of the discussion around when fields of science prosper versus when they go stagnant. The last few decades haven’t really been great for neuropsychiatry. But one group of people in one lab came up with entire textbooks worth of advances. Why? Do we need to resurrect Alois Alzheimer and put him in charge of NIMH?

Part of it was that good histological staining had just been invented and Alzheimer’s lab was on the bleeding edge, so they were just sitting around picking off the low-hanging fruit that could be discovered by staining stuff. But Kraepelin’s and Cervetti’s discoveries didn’t have much to do with staining.

Part of it was that Alzheimer was in the right place at the right time. If he’d really wanted an impressive photo, he could have gotten together with his chief competitors, a group centered around Carl Westphal (cf. Westphal’s sign, Edinger-Westphal nucleus) which included his students Arnold Pick (cf. Pick’s dementia) and Karl Wernicke (cf. Wernicke’s area, Wernicke-Korsakoff syndrome). Heck, if he wanted to go further, the number of people within a day’s train journey staggers the imagination. Rudolph Virchow, Eugen Bleuler, Robert Koch, Sigmund Freud. Fin de siecle Central Europe was just a really good place for neurology and psychiatry.

Part of it was that the whole thing was arranged by Kraepelin, who besides being a scientific genius, was apparently an organizational genius as well. According to Wikipedia, “Kraepelin has been described as a ‘scientific manager’ and political operator, who developed a large-scale, clinically oriented, epidemiological research programme.” See also Psychiatric Governance And The German Institute Of Psychiatry In Munich. Kraepelin grabbed all these people, threw them at the most interesting problems, and made sure they always had all the funding they wanted – although the final form of all of this as the Institute for Psychiatric Research didn’t coalesce until after Alzheimer’s death.

And part of it is the natural tendency for some institution to gain a reputation for being the best, and then attract the best people. I’m sure you could find some pretty impressive conjunctions of people if you looked at photos of Harvard departments.

My theory of apparent scientific stagnation has always been that it’s easier to pick low-hanging fruit in one paradigm than to get entirely new ones – in other words, the problem is at least as much in the territory itself as in our engagement with it. I was interested to learn that one of the big hurdles to faster aircraft is a nonlinearity in fuel costs, which grow exponentially for physics reasons right when you start getting faster than modern planes. I think something similar might be going on here. Through painstaking trial-and-error, psychiatric hit upon a really fruitful paradigm of combining clinical observation, histopathology, and and random wacky ideas, right about when Alois Alzheimer opened his lab. Anybody who happened to be in the vicinity when the new paradigm was invented ended up getting a disease named after him. Eventually all the stuff that was easy to discover this way got discovered, and right now there just aren’t any equally fruitful paradigms coming to our attention.

This story has a sad ending. Alzheimer (ironically) died young. He was succeeded by his student Walther Spielmeyer (cf. Spielmeyer-Vogt-Sjögren-Batten Disease), and then Kurt Schneider (cf. Schneider’s first-rank symptoms). Schneider invented the modern concept of psychopathy, but unfortunately he was probably working from personal experience – this was in the middle of the rise of the Nazis. He was fired for political reasons and got replaced with Alzheimer’s fellow Kraepelin protege, Ernst Rudin, who re-centered the whole thing around the role of psychiatry in sterilizing the feeble-minded. The chain that started with Kraepelin and Alzheimer ended in Rudin’s own student, Josef Mengele.

After the war, Rudin was fined 500 deutschmarks, apparently the going penalty for leading a Nazi eugenics program at the time, and Kraepelin/Alzheimer’s institute was re-founded as the Max Planck Institute of Psychiatry. As far as I know they’re still around, but I haven’t heard of them discovering any interesting new diseases lately.