Joel ElkesBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6675 (Published 08 December 2015) Cite this as: BMJ 2015;351:h6675
- Ned Stafford, Hamburg
Towards the end of 1952, or maybe it was early 1953, Joel Elkes received a visitor in his office at Birmingham University in the UK. Nearly a half century later, Elkes recalled that the man was “very properly dressed and very proper generally,” and he said: “Professor Elkes, this is not a routine visit, do you mind if I shut the door?”1
The man, W R Thrower, medical director of the pharmaceutical firm May & Baker, unlocked his briefcase and pulled out a manuscript written by researchers in Paris who had been studying the potential of using the antihistamine chlorpromazine to treat psychotic patients.2 “We have just got this from France,” Thrower told Elkes. “Would you please read it?”
Elkes, founding chair of Birmingham’s Department of Experimental Psychiatry, the first experimental psychiatry department in the world, read the paper with “slight disbelief.” He found the results outlined in the French paper “too good to be true.”3 Elkes, in the late 1940s, had studied the potential of using amobarbital, amphetamine, and mephenesin as possible treatments for catatonic schizophrenic stupor. But his work had yielded only “paradoxical results.”4
Thrower told Elkes that May & Baker had acquired UK rights for chlorpromazine, had 500 g in the company safe, and would be glad to supply Elkes with tablets and placebos if he were to conduct a controlled trial with psychotic patients. Elkes eagerly agreed.
The result of the study of 27 chronically agitated patients with psychosis—seen by many as a pioneering effort in the use of double blind controlled drug trials—was published in The BMJ in 1954 in a paper whose authors were Elkes and his wife, Charmian Elkes.5 Seven patients showed definite improvement and 11 slight improvement, they wrote, concluding that “this drug may have its place in the management of the chronically overactive psychotic patient.”
Chlorpromazine, also sold under the brand name Thorazine, would go on to become a widely used treatment for psychotic disorders, including schizophrenia. And Elkes would go on to become a towering figure in the emerging specialism of neuropsychopharmacology.
Barry Blackwell, a former chair of psychiatry at the Milwaukee campus of the University of Wisconsin, who studied medicine in London and is a chronicler of the history of neuropsychopharmacology, describes Elkes as “a worthy successor to [German born and later London based physician and biochemist John Louis William] Thudichum, the acknowledged founder of neuroscience and first ‘chemist of the brain.’”4
Joel Elkes was born into a German speaking family on 12 November 1913 in Königsberg, then part of East Prussia and now the city of Kaliningrad in Russia. His father, Elkhanan Elkes, was a prominent physician who served as a medical officer in the Russian Army during the first world war and the Russian revolution. When Joel was 5 years old the family settled in Kovno (now Kaunas) in Lithuania.
Joel attended a Jewish secondary school, with lessons taught in Hebrew. He loved physics and was attracted to biology and chemistry. His three “heroes” were Albert Einstein, Johann Wolfgang von Goethe, and Paul Ehrlich (for his work on receptors). He returned to Königsberg for his last year of secondary school, followed by four months at the University of Lausanne in Switzerland to prepare for medical school.
In October 1931, shortly before his 18th birthday, he arrived in London with a letter of recommendation from the British ambassador to Lithuania, a patient of his father. He studied at St Mary’s Hospital Medical School. While still a student he worked with Alastair Frazer, and in 1939 he was coauthor of his first research paper.6
In 1937 his younger sister, Sara, joined him in London. At the start of the second world war, Elkes lost the financial support of his father. After Germany invaded Lithuania in 1941, Jews in Kovno forced into a ghetto elected Elkhanan Elkes as their leader. The ghetto was destroyed and in 1944 survivors, including Elkes’s mother and father, were sent to concentration camps. His father and other family members died. His mother survived. More than a half a century later, Elkes wrote a memoir about his father: Values, Belief, and Survival: Dr Elkhanan Elkes and the Kovno Ghetto.
After qualifying in medicine in 1941, Elkes trained in orthopaedic surgery, ophthalmology, and internal medicine, enjoying the clinical work. In 1942 his chief and friend Frazer moved to Birmingham University as chair of the Department of Pharmacology, and Elkes joined him as a research assistant.
In 1950, Elkes spent a year in the US on a travelling fellowship, learning psychiatry. His travels included time at Fritz Redlich’s institute at Yale University, and learning from John Nemiah, then at Tufts University. He spent five months at Norwich State Hospital in Connecticut.
In 1951 he returned to Birmingham as chair of the new Department of Experimental Psychiatry and became “a leading exponent of the view that neurochemical transmission was important in the central nervous system,” a view that was greeted at the time with “scepticism and disbelief from some of the most eminent neuroscientists.”7 Elkes and his colleague Phillip Bradley developed the concept during the 1950s.8 They also studied LSD, which Elkes at one time ingested. He described LSD as “extraordinarily powerful stuff” and was strongly opposed to its use in a non-clinical setting.1
In 1957 he accepted an offer to be founding chief of the US National Institute of Mental Health’s new clinical neuropharmacology research centre at St Elizabeth’s Hospital in Washington.9 Around this time he convened the first World Health Organization study group on psychopharmacological agents. In 1954 he had already initiated the first international neurochemical symposium at Oxford. He also founded the International Brain Research Organization and was founding president of the American College of Neuropsychopharmacology.
In 1963 Elkes moved to Johns Hopkins University in Baltimore as chair of the psychiatry department, renaming it the Department of Psychiatry and Behavioural Sciences. Wanting to strengthen ties between psychiatry and the rest of medicine, he invited chairs of other departments to give lectures in the introductory psychiatry course. He also founded the MD-PhD programme in medicine and behavioural sciences. His innovations helped attract top psychiatric residents who went on to become leaders in the neurosciences, including Solomon Snyder, Joseph Coyle, Ross Baldessarini, and Joseph Brady.
David Healy, a psychiatrist at the University of Bangor in the UK, has said of Elkes that “the names of those who worked or trained with him read like a Who’s Who of modern American neuropsychopharmacology.”7 Healy told The BMJ that Elkes “had charisma. He enthused people.”
Elkes left Johns Hopkins in 1974 for positions at McMaster University in Canada, and the University of Louisville in Kentucky. He wrote extensively throughout his career,10 served on the editorial boards of six journals, and was the first president of the American Institute of Stress. He was a fellow of the Royal College of Psychiatrists and was widely acknowledged as an outstanding speaker at conferences and universities around the world. He was founder and leader of the National Institute for Psychobiology in Israel. He also was a committed artist (http://joelelkesartist.com), painting throughout his life to express his emotions, and had been planning an exhibition to celebrate his 102nd birthday.
Elkes and his first wife, Charmian, divorced in the 1970s. His second wife, Josephine Rhodes, died in the late 1990s. He leaves his wife, Sally Lucke Elkes; a daughter; and a granddaughter.
Cite this as: BMJ 2015;351:h6675
Joel Elkes (b 1913, q St Mary’s Hospital Medical School, London, 1941), died from kidney failure on 30 October 2015.)