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By Lucy D. Ozarin, M.D.
John C. Whitehorn (1894-1973) was selected in 1943 to succeed Adolf Meyer as the Henry Phipps Professor of Psychiatry at the Johns Hopkins School of Medicine, where he remained until his retirement in 1960. Whitehorn had a special approach to mental disorders, sharing with Meyers a belief that the psychiatrist should direct his efforts primarily to the person who was the patient rather than to the patient's evident symptoms.
The clinical interests of Whitehorn, who lacked formal psychiatric training, were sparked by his contacts with patients at McLean Hospital, where he was director of laboratories. While collecting blood for his studies on hormonal changes and emotion, Whitehorn talked with the patients, and over time it became apparent that the patients with whom he had developed a relationship improved clinically. His clinical interests extended to an appointment at Massachusetts General Hospital.
The APA Archives contain 25 boxes of Whitehorn's correspondence, speeches, publications, and other materials dating from 1930 to 1970. In 1944 he published the "Guide to Interviewing and Clinical Personality Study" (Archives of Psychiatry and Neurology 52:177-216). In this article, which had a distribution of 180,000 reprints, he set forth his ideas about mental health and illness, which he termed a psychobiologic approach.
In an undated letter probably written in the 1960's, he notes that the way in which he spoke with patients was different from that of other psychiatrists and had demonstrable effectiveness. Basic to his approach was the premise that individuals react to other people and to situations in a learned manner that depends on their "attitudes and sentiments" by which they establish relationships and negotiate in interpersonal transactions. He thus defined personality. He writes in the interviewing guide that "all persons in the process of developing personality have found and acquired certain attitudes for dealing with anxiety-provoking situations and people. When the aptitudes to deal with these anxiety-provoking situations are not available or adequate, symptoms or maladaptive behavioral patterns emerge. Sentiments serve as an emotional response to expectations of others as developed or fixed through interpersonal experiences."
Whitehorn was especially interested in the therapist's leadership role in treating patients. He and fellow researcher Barbara Betz found that patients with schizophrenia showed far more improvement when the therapist, in his day-by-day tactics, makes use of active personal participation. He advocated a therapy that reaches out, promotes learning, and builds up a patient's expectations about his or her ability to cope with anxiety-provoking situations.
He thought leadership was important in everyday life as well. In his 1961 Shattuck lecture, titled "The Doctor's Image of Man (New England Journal of Medicine 265:7,301-309), he said that "the origin and development of human beings involved domestication, socialization, and language, which are. . .instrumentalities of leadership." Each person must learn to accept and exert leadership. Consultative leadership generates greater wisdom in leaders and more acceptance and understanding in those led. Evocative leadership is the style of consultative leadership expressed through language that seeks to evoke initiative and spontaneity. It encourages the leadership potential in others. In therapy, the evocative leader/therapist actively guides the patient in a collaborative process to correct misperceptions, assume more realistic attitudes, and seek solutions to dealing with disturbing people and situations.
Whitehorn's attitude toward psychoanalysis was chiefly negative, although he credits Freud with introducing a talking-listening therapy and playing a revolutionary role in liberalizing psychiatry. Two letters addressed to Helena Deutsch in 1938-39 indicate Whitehorn's interest in becoming her analysand, but there is no information to show that this happened. In a 1963 letter he writes, "I think psychoanalytic theories will in the future be seen to have played a historical role in the development of dynamic psychiatry." He maintained that psychoanalysis was rigid and deterministic, and occasionally he used the word "cultish."
In a 1965 letter, Whitehorn recalls talking with Dr. Franz Alexander about Freud and his central ideas, and quotes Dr. Alexander, who claimed that Freud had told him that he "had radically changed his mind. . .and would like to reformulate the whole approach but. . .it might disrupt the psychoanalytic movement." Whitehorn commented that the innovator became the captive of his disciples. In a review of Percival Bailey's 1965 book Sigmund The Unserene, Whitehorn ends by observing, "Perhaps psychiatry will fare better without an all-embracing theory, presuming to explain all" (Archives of General Psychiatry 14:108-109).
The underlying role of anxiety was central to Whitehorn's thinking. He did not like the use of anxiety as a diagnosis but thought it was more useful in its original meaning, "sort of all choked up."
He wrote to a friend in 1965 that the human experience of anxiety is not pathological but a "spur. . .to changing one's mind, a necessary process for sensible living and constructive personality growth."
Anxiety plays an important part in motivating change. Attitudes change only with emotional experiences. It would appear that Whitehorn's approach bore resemblance to current cognitive therapy techniques.
(Psychiatric News, June 6, 1997)