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  • Psychology and Its Contributions to Neurosurgery at the Barrow Neurological Institute: 1962 to 1984

    Authors

    George P. Prigatano, PhD
    Arthur S. Schwartz, PhD*
    Herbert L. Collier, PhD**

    Division of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
    *Retired Psychologist, Phoenix, Arizona
    **Retired Psychologist, Scottsdale, Arizona

    Abstract

    The contributions of physiological psychology and clinical psychology to the Barrow Neurological Institute between 1962 to 1984 are reviewed in the historical context of the contributions of psychology to the practice of neurosurgery.

    Key Words: history, neurosurgery, psychology

    The history of neurosurgery at the Barrow Neurological Institute (BNI), the founding efforts of John Raymond Green, MD, and the role of various consultants in planning the BNI are well documented.[1] From the inception of the BNI, psychologists have been active members of the institute working with neurosurgeons. During the last 15 years, the contributions of clinical neuropsychologists at the BNI have been highlighted in a series of papers published in the BNI Quarterly.  Then in 2000 a special issue of the BNI Quarterly celebrated the contributions of clinical neuropsychologists since that section was founded in 1985.

    The joint contributions of physiological psychology and clinical psychology form the basis of the current practice of clinical neuropsychology at the BNI.  To capture the legacy of these two traditions at the BNI, Arthur S. Schwartz, PhD, physiological psychologist, and Herbert Collier, PhD, clinical psychologist, provided historical perspectives that have been integrated into the following account, which documents the history of psychology at the BNI and its supportive role to neurosurgery between 1962 and 1984.

    Physiological Psychology at the BNI

    Historically, psychology evolved from the combined influence of philosophy and physiology.  Traditionally, experimental psychologists used the methods of physiology to study basic psychological processes.  One such psychologist was Donald Lindsley.  “Donald Lindsley, of the University of California Los Angeles (UCLA), laid the foundation for the concept of arousal.  Together with Magoun and others, Lindsley emphasized that low voltage fast-EEG characteristics of the alert waking state… was a brain index of arousal.”[2]

    Donald Lindsley and Horace Magoun worked with the neurosurgeon John D. French, MD, at the Brain Research Institute at UCLA.  Dr. French served as a consultant to Dr. Green and had suggested that Dr. Eduardo Eidelberg be invited to serve as the first Chair of the Division of Neurobiology.[1]

    Arthur S. Schwartz, PhD, was a postdoctoral fellow with Donald Lindsley at the Veteran’s Administration Hospital in Long Beach, California in 1956.  In 1958 he left Long Beach and his work with Dr. Lindsley to join the Clinical Pharmacological Research Center in Washington, DC.  A year after Dr. French had recommended Dr. Eduardo Eidelberg to head the Division of Neurobiology, Dr. Eidelberg invited Dr. Schwartz to establish a Laboratory of Physiological Psychology at the BNI.  This laboratory was the precursor of contemporary clinical neuropsychology.

    Between 1963 and 1986, the main lines of research occupying the Laboratory of Physiological Psychology at the BNI were sensory mechanisms (visual, somatosensory) and psychopharmacology.  Much of the research was performed and published jointly with Dr. Eidelberg.  The laboratory made several significant contributions: (1) the identification of dopamine as the primary, critical neurotransmitter for the reinforcement effects of morphine, (2) clarification of the role of the sensory spinal tracts and somatosensory functions, and (3) mechanisms of sensory extinction in brain-damaged humans.

    In addition to these contributions, the Laboratory of Physiological Psychology established a formal relationship with the Psychology Department at Arizona State University in Tempe. Dr. Schwartz provided an opportunity for several doctoral and master’s candidates to complete their dissertations and theses in the physiological psychology laboratory at BNI.

    These early contributions show that psychologists primarily worked in a research capacity with neurosurgeons at the BNI. Their focus was to evaluate basic mechanisms underlying brain-behavior relationships. These early efforts in physiological psychology at the BNI were the precursors for contemporary studies of neuropsychology and functional magnetic resonance imaging now being conducted by Sterling C. Johnson, PhD.

    Clinical Psychology at the BNI

    The first salaried position of a psychologist at the BNI was in physiological psychology and geared toward research. Nonetheless, quite early Dr. Green recognized the role of clinical psychology in the care of patients. In the late 1950s and early 1960s neurosurgeon George Austin, MD, at the University of Oregon Medical School [now Oregon Health and Sciences University], was collaborating with Joseph Matarazzo, PhD, a clinical psychologist who was head of medical psychology. Richard Thompson, PhD, physiological psychologist, also was in that department. Their work and training included the psychometric assessment of patients with brain tumors and injuries.

    One of Dr. Matarazzo’s students was Herbert Collier. After Dr. Collier finished his doctoral training at the University of Oregon Medical Center, he came to Phoenix in 1962 and began working at the Child Evaluation Center. Soon thereafter he met Dr. John Green. Dr. Collier was a member of the new Mental Health Center, created by psychiatrist Ray Huger, MD, and Sister Mary Francesca.

    Dr. Green was aware of the potential role of psychometric studies and psychological interventions with patients with neurological disorders. He invited Dr. Collier to perform psychometric studies on a number of neurological patients at the BNI, particularly candidates for neurosurgical procedures intended to control their epilepsy. Dr. Atkinson recognized the role of clinical psychological evaluations and psychotherapy in helping neurosurgeons confronted with the long-term problems associated with caring for patients with neurological disease and disorders.

    James Atkinson, MD, was recruited to the BNI to serve as Dr. Green’s successor, but a small plane crash resulted in Dr. Atkinson’s untimely death.  Before his death, however, Dr. Atkinson had worked closely with Dr. Collier on a number of projects.  They were particularly interested in the problem of pain and the potential role of cingulotomies in its treatment.  In 1964 a bilateral procedure was introduced for cingulotomy, and 21 patients at the BNI were studied with psychometric measures before and after surgery.  Dr. Collier was the psychologist who performed those early psychological evaluations.  Dr. Atkinson concluded that pre- and postoperative psychometric evaluation was of considerable clinical utility.

    This collaboration set the stage for both clinical and physiological psychologists to aid neurosurgeons in their clinical work at the BNI.  Dr. Atkinson recognized the role of psychotherapy in helping patients deal with long-term problems of pain. In 1967 Dr. Collier, along with Dr. Ray Huger, Chief of the Mental Health Unit; Alan Sidell, MD, neurologist; and William Helme, MD, neurosurgeon, among others, joined Dr. Atkinson to form the first outpatient interdisciplinary pain unit at BNI.  A few years later it was converted to a combined psychiatric-pain inpatient service at the Convalescent Unit, where the interdisciplinary team continued its work until insurance companies eliminated reimbursement for these services.

    Neuropsychology at the BNI

    From the inception of the BNI, physiological and clinical psychologists worked closely with neurosurgeons on a wide variety of clinical and research projects.  It became clear that psychologists needed a strong background in biology to appreciate the complexity of brain-behavior relationships. Psychologists also needed to be sensitive to the clinical problems that brain dysfunctional patients experience while undergoing evaluation, treatment, and rehabilitation.  Furthermore, they needed to help patients’ families understand the effects of brain injury on behavior.  As these exigencies emerged, Dr. Green and Dr. Joseph White, Chair of Neurology, recognized the importance of incorporating clinical neuropsychology at the BNI.

    In 1984 Dr. White treated a brain-injured patient who had gone through rehabilitation but who was still unable to return to gainful employment.  At the suggestion of Yehuda Ben-Yishay, PhD, of New York University, Dr. White sent the patient to a new program of brain injury rehabilitation at the Presbyterian Hospital in Oklahoma City, under the direction of George P. Prigatano, PhD.

    As a result of participating in that rehabilitation, the patient was able to return to work. Dr. White then approached Dr. Prigatano about relocating to Phoenix to establish a rehabilitation program at the BNI.  The initial intention was to limit the scope of the work to rehabilitation.  Further discussion with Drs. White, Green, and Spetzler, however, led to an appreciation that clinical neuropsychology could provide many different services to the Institute.  Clinical neuropsychologists not only could help with patients’ acute and postacute rehabilitation, they also could actively participate in the assessment of patients before and after surgery and of those with inoperable brain disorders. The Adult Day Hospital for Neurological Rehabilitation was established just before Dr. Prigatano’s arrival on May 1, 1985.  In January 1986, Dr. Prigatano became Director of that clinical program, which underwent numerous changes based on the previous program that he had developed in Oklahoma City with the help of Dr. Ben-Yishay.

    At the same time, the Section of Clinical Neuropsychology also was established.  Besides helping with patients undergoing postacute rehabilitation, the Section accepted referrals from inpatient neurorehabilitation, neurosurgery, neurology, and psychiatry. Patients with cerebrovascular accidents, arteriovenous malformations, aneurysms, malignant and nonmalignant neoplasms, dementia, Parkinson’s disease, and other neurological conditions were evaluated. The Section of Clinical Neuropsychology now serves almost every patient group treated at the BNI.  Concomitantly, the Section has expanded and its members collaborate not only with neurosurgeons but with neurologists and neuroradiologists.  The confluence of the two traditions, physiological psychology and clinical psychology, underlies the contemporary practice of clinical neuropsychology and established a strong legacy of collaboration between clinical neuropsychologists and other neuroscience professionals involved in many aspects of patient care and research at the BNI.

    Conclusion

    Institutions, as well as individuals, need to be aware of their history.  Understanding the past clarifies the present by allowing us to reflect not only on what we have accomplished but on what we need to accomplish.  The reader is referred to the special issue of the BNI Quarterly (volume 16, number 3, 2000) devoted to the activities of the Section of Clinical Neuropsychology; that celebration would be incomplete without recognizing the individuals who preceded the establishment of that section.

    References

    1. Kick SA, Sonntag VKH, Spetzler RF: Neurosurgery at the Barrow Neurological Institute. Neurosurgery 41:930-937, 1997
    2. Thompson RF: Introduction to Physiological Psychology. Harper & Row: New York, 1975

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