Obituaries

Leon Eisenberg

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b4615 (Published 18 November 2009) Cite this as: BMJ 2009;339:b4615
  1. Ned Stafford

    Transformed child psychiatry by advocating research into developmental problems

    Early in his medical career, in the mid-1950s, Leon Eisenberg became fascinated with the childhood mind. Wanting to know more, he broke free from the shackles of the Freudian psychoanalytic dogma that dominated child psychiatry at the time to conduct groundbreaking biologically based research of childhood developmental problems. This research included the first randomised clinical drug trials in child psychiatry.

    “I think what Leon brought to the field was a different way of thinking—thinking out of the box,” said David DeMaso, chairman of psychiatry at Boston Children’s Hospital and professor of psychiatry and pediatrics at Harvard Medical School. “He was thinking in terms of biology, of evidence based treatment, way before anybody else. His was a bio-psycho-social model at a time when psychoanalytical thinking was the norm.”

    Eisenberg’s direct involvement as a child psychiatry researcher was over by 1967, when he moved to Harvard Medical School as chief of psychiatry at Massachusetts General Hospital. But in a dozen years he had helped transform the discipline.

    Beginning in 1952 at Johns Hopkins University in Baltimore, Eisenberg began a fellowship under Leo Kanner, the Austrian born child psychiatrist, who, in the early 1940s, first described autism. In a study of autistic adolescents published in 1956, Eisenberg recognised patterns of language use as the best predictor of prognosis. At the time, many patients who are now are diagnosed as having autism were thought to have mental retardation.

    He followed that paper with a barrage of papers on attention deficit disorder, learning delays, and other childhood problems. In a study of children otherwise developing normally, Eisenberg found that early reading difficulties increased the chances of later bad behaviour.

    His most revolutionary study came in 1962, when he launched the first randomised clinical drug trial in child psychiatry. In subsequent drug trials he showed that tranquillising drugs were inferior to placebo in the treatment of anxiety disorders and that stimulant drugs could be effective in controlling hyperactivity. Those studies were the first steps towards ever increasing use of drugs to treat child and adolescent disorders, a development that in recent years concerned Eisenberg.

    Drug companies

    DeMaso, who in the late 1970s became one of Eisenberg’s many protégés, said that Eisenberg thought that many psychiatrists were being influenced by drug companies, adding, “He thought children are now being overdiagnosed with bipolar illness and then overmedicated.”

    Leon Eisenberg was born in Philadelphia on 8 August 1922, the oldest child of Russian immigrants. His father steered him from the beginning towards medical school. But despite near straight As in college, he was turned down by several medical schools because of his Jewish background. Finally, with help from a Pennsylvania state legislator who his father knew, he was admitted to the University of Pennsylvania School of Medicine.

    After graduating in 1946 as valedictorian of his class, he took a rotating intern position at Mount Sinai Hospital in New York city, where he became interested in psychiatry. He served two years as a captain in the US Army Medical Corps and in 1952 moved to Johns Hopkins, becoming chief of child psychiatry in 1961. He held the position until becoming chief of psychiatry in 1967 at Harvard, where his focus shifted to training new generations of researchers.

    Although Eisenberg has been widely recognised for his childhood research, the Harvard psychiatrist and anthropologist Arthur Kleinman thinks that his contributions from the 1970s onward are as important. Kleinman, a psychiatry resident in the 1970s under Eisenberg, said that he converted the department from a small group of mostly psychoanalysts to a diverse and vibrant national powerhouse that helped shape modern psychiatry. “He made that department,” Kleinman says. “He set the intellectual tone to be highly academic.”

    In 1968 Eisenberg also became a leading proponent of affirmative action for African Americans and other minorities at Harvard Medical School, guided by his own experiences of discrimination as a Jew in the 1940s.

    Social sciences

    During the 1970s, Eisenberg advocated a closer relationship between medicine and the social sciences, which he thought would improve medical care by, as Kleinman put it, “bringing biology together with the social world.” In 1980 Eisenberg became founding chairman of Harvard’s department of social medicine, a position he held until 1991. Eisenberg was the ideal choice to guide the new department, said Kleinman, adding, “He had an omnivorous hunger for knowledge that went across the fields.”

    Eisenberg was honoured with numerous awards, including the distinguished service award and special presidential commendation from the American Psychiatric Association. He served from 1964 as mental health consultant to the World Health Organization in multiple capacities and was an honorary fellow of the UK Royal College of Psychiatrists.

    On 1 July this year, the Leon Eisenberg chair in child psychiatry at the Children’s Hospital Boston was officially launched, with DeMaso named as the first holder. Decades after his groundbreaking studies, he still yearned to better understand the childhood mind. “I was eating lunch with him about a year ago, and he told me that more child psychiatry research was needed,” said DeMaso. “He asked me, ‘What are you doing about encouraging your psychiatrists to do more research? They need to do more research. We need more research.’” And DeMaso dutifully followed the advice of his mentor. “We are going to do more research in child psychiatry,” he says. “We are planning to focus on training the next generation of child psychiatry researchers.”

    Eisenberg leaves his wife, Carola, former dean of students at Harvard Medical School and a cofounder of Physicians for Human Rights, two children from a previous marriage, and two stepsons.

    Notes

    Cite this as: BMJ 2009;339:b4615

    Footnotes

    • Leon Eisenberg, psychiatrist (b 1922, q 1946 Pennsylvania), died 15 September 2009 from prostate cancer.