Hughlings Jackson on Psychiatry

Kenneth Dewhurst

Oxford, Sanford Publications, 1982. pp. xi + 169

The clinical researches in neurology of John Hughlings Jackson (1834 –  1911) are well known, but his contributions to the field of psychiatry are not; nevertheless, they are considerable, as Kenneth Dewhurst notes in this fine small book. Jackson’s education at the medical school at York provided him with more experience in the field of psychiatry than most of his contemporary medical students. This was made possible by two exceptional professors on the faculty, Daniel Hack Tuke and Thomas Laycock, both of whom became leaders of British psychiatry during their era. Tuke probably had a greater impact on the clinical side while Laycock’s studies on brain reflexology and on the mind-brain problem had an enduring influence on neurophysiology.

Jackson also attended the St. Bartholomew Hospital Medical School in London for a year. He settled in London finally in 1859, where he spent the rest of his life in private practice and was associated with the London Hospital and the National Hospital for the Paralyzed and Epileptic. During his career, he wrote well over 300 articles using a careful observational and philosophical approach, but never put his findings and thoughts together in a coordinated whole in spite of the urgings of his professional friends. Nevertheless, he was “acclaimed as the greatest British scientific clinician of the 19th century.”

Jackson’s greatest contribution to the understanding of psychiatric issues arose from his careful studies of epilepsy and its phenomena. As he slowly collected material from 1866 on, he became interested in selected patients who experienced odors undetectable to others present (a form of olfactory hallucination). These subjects also revealed episodes of losses of consciousness, automatic movements and thoughts, and the appearance of certain dream-like states. Jackson also explored the amnesia that was associated with these states and finally named them “uncinate fits.” Over the years the terminology changed to epileptic equivalents, psychomotor epilepsy, and currently to temporal lobe epilepsy. Dewhurst also discusses a famous case of Jackson’s known as “Quaerens or Dr. Z.”, who has recently been identified by the studies of D. C. Taylor and S. M. Marsh as Dr. Arthur Thomas Myers, a distinguished sportsman and physician whose major contribution to medical history was his careful reportage of his own case, albeit anonymously. He became a patient of Jackson’s who published Myers’ case and included Myers’ autobiographical study. Both in his own right and through the efforts of his brother, Frederick W. H. Myers, Arthur contributed to the movement for the study of parapsychological phenomena and those of the subconscious. Arthur wrote articles on both hypnotism and telepathy. It was his brother Frederick, however, who helped to found the Society for Psychical Research and wrote extensively on subliminal matters. Both went to LeHavre, France, in 1886 to watch a then unknown professor of philosophy named Pierre Janet do experiments on hypnosis at a distance.

Arthur died in January 1894 from an overdose of chloral hydrate. His illness plus his medical focus thereup had made possible a greater clinical understanding of temporal lobe epilepsy. Exploration of the connections of the temporal lobes to psychiatry has experienced a resurgence during the past two decades. That religious and parapsychological behavior could be connected to this area of the brain was pointed out in a 1970 article by Drs. Dewhurst and Beard. They reported six cases of epilepsy with investigative evidence suggesting a temporal lobe focus. All of these patients reported experiences of religious conversion. Approaching the question from the other side, the authors also found support for their thesis from the history of conversions in a number of saints and religious figures who also had a history of convulsive-like episodes. A more recent study brought further confirmation to this view as well as demonstrating a high incident of dissociation and multiple personality in these patients.

Other topics explored by Dewhurst in Jackson’s writings are: the mind-body problem, consciousness, delirium, coma, psychosis, hysteria, dreams, Gilles de la Tourette Syndrome, obsessions, jokes, etc. Dewhurst concludes his book with a two-chapter review of Jackson’s impact on continental psychiatry as well as on British and North American psychiatry. Among the familiar names that emerge are: Freud, Pick, Charcot, Ribot, Henri Ey, S. Weir Mitchell, J. J. Putnam, Adolf Meyer, and Bernard Sachs.

We are highly indebted to Dr. Dewhurst for surveying John Hughlings Jackson’s voluminous writings and culling those comments of psychiatric import and placing them in their historical context. An excellent index makes the various topics easily accessible. Dewhurst has continued to make valuable contributions to the history of medicine. His range is impressive. He is famous for his 17th century book-length studies on Sydenham, Willis, and Locke. He recently wrote a book on Fredrich Schiller (19th century), and he now has an excellent book on Jackson.