Isaac Ray's Bibliography: Some Addenda and Ray's Evidence-Based Thinking

Isaac Ray (1807–1881), the founder of American forensic psychiatry, was a prolific writer, scholar, and tireless reformer. In conjunction with the 200th anniversary of his birth, I undertook a review of his published works after noticing a few small errors in Kirkbride's 1881 bibliography.¹ The bibliography, attached to a memorial piece read at the College of Physicians of Philadelphia, was handed by Ray to Kirkbride about a week before Ray's death.²

My search began with Kirkbride's list, which has been the gold standard. A carefully annotated 1982 doctoral dissertation by John Starrett Hughes on Ray's life and work included among its references most of Kirkbride's and some of Ray's letters from the Isaac Ray Library of the Butler Hospital in Providence, Rhode Island, and other sources.³ It appears that Hughes did not expand Kirkbride's list; nor did Stearns,⁴ Overholser⁵ and Quen,⁶ who also cited correspondence. An exception is the publication by Quen⁷ of Ray's 1827 medical school thesis. Otherwise, no other sources, to my knowledge, have expanded the list of publications.

Most of Ray's writings were easy to verify among journals such as the American Journal of Insanity. Others were reprints of lectures given to medical, legal, and civic groups. In the process of locating some of Ray's papers at the Historical Library of the College of Physicians of Philadelphia, for example, in the American Journal of the Medical Sciences, a Philadelphia-based magazine, I noticed that Ray and his son, Benjamin Lincoln Ray, were frequent contributors in the form of book reviews, especially in the 1870s (Ray, his wife, and son moved to Philadelphia in 1867). As was customary, reviews were not accompanied by the authors' full names, rather “I.R.” or “B.L.R.” Author indices confirmed their identities; and, indeed, in the case of Isaac Ray, the citations cross-referenced with Kirkbride's.

Because of the lack of bylines, I suspected that there were references unknown to Kirkbride and otherwise obscure to scholars. Next, I performed a search of 19th century periodicals using American Periodicals Series Online (APS Online), a product of ProQuest, which is accessible through subscribing libraries.⁸ This query, which included author search terms such as “Ray,” “Isaac Ray,” “I. Ray,” “I.R.” and “J.R.” (the latter because some of the known references were cited thus), produced several reviews and newspaper articles by Ray that do not appear in Kirkbride's list or elsewhere to date. I have listed these in the Appendix, along with evidence of authenticity. For readers who are interested, in a separate search of “B.L.R.” references, there were 95 book reviews published in the American Journal of the Medical Sciences between 1871 and 1880; B. Lincoln Ray died in 1879. Thus, we have a finding aid to Ray's additional writings as well as his son's. Of the Isaac Ray book reviews, I have selected one that illuminates his critical thinking.

The review in question is of The Pathology and Therapeutics of Mental Diseases by the Dutch physiologist van der Kolk, published in English posthumously in 1869.⁹ Ray begins by noting that little scholarly work had come out of The Netherlands since that of Leeuwenhoek, “who demonstrated many curious facts in the circulation of the blood” (Ref. 9, p 516). He disparages the author's originality and depth; then accuses him of a “spirit of speculation…calculated to mislead the inexperienced student” (Ref. 9, p 516). Not until the end of the review do we learn that, after the author died in 1862, the translation—from Dutch to German and then to English—was done by the author's protégés, whom Ray accuses of distortion. Especially critical of the English version, Ray says of the translator, “His language is often as destitute of idiomatic expression as the first exercise of a schoolboy in construing his Livy or Virgil” (Ref. 9, p 519). For readers unaccustomed to Ray's acerbic style, this is typical.

Ray's principal critique of van der Kolk's book resides in his objection to the author's separating mental disorders into idiopathic and sympathetic, which Ray attributes to: … some fancied analogy or plausible conjecture, rather than any positive evidence… . Our author's doctrine is, that idiopathic insanity is characterized by excitement, exaltation, turbulence, self-satisfaction, a quick pulse, and sparkling eyes, while the sympathetic is marked by more quiet, depression, unhappiness, seclusion, sadness, and despair [Ref. 9, p 516].

Ray was disturbed by the author's approach, because the dichotomy proposed was not identifiable in nature—that is, it was not evidence-based; rather, it was metaphysical. In a startlingly modern approach to the relationship between mind and brain, Ray comments: We have no reason to believe that insanity does not imply the same structural change, whether caused, in the ordinary use of the term, by a blow to the head, a disappointment in love, suppressed menstruation, or torpor of the liver [Ref. 9, p 517].

Irrespective of our views on the validity of the last two items, it is important to point out that Ray was a leading exponent of the concept that all mental disorders reside in the brain. As I have noted elsewhere in a discussion of Ray's interest in phrenology,¹⁰ he was a firm believer in the principle of locating the causes of illness within the offending organs, perhaps an obvious point today but not universally accepted in his time.

Ray then touches on a forensic topic—that it is difficult to explain mental illness in a legal setting. Van der Kolk appears bewildered by how it is possible that, in the prodromal phase of illness, the mind is excited and often more acute, whereas in the later phase the intellect is vitiated. Yet, mental disorders often run that course, as Ray notes: This is strikingly true very frequently in what is called circular insanity, much to the bewilderment of courts and juries, and all those worthy people who live and die in the belief that it is wrong and deserving of condign punishment to treat any person as insane who answers a question acutely and converses coherently and correctly [Ref. 9, p 517].

Van der Kolk is misguided, Ray says, in his overreliance on the physiology that imputes organ pathology as the cause of insanity. For example, whereas van der Kolk “observes” that in both idiopathic and sympathetic insanity there is often “a spasmodic contraction of the descending colon,” Ray considers the application of intestinal remedies to be “childlike.” Similarly, Ray is critical of the author's recommendations for somatic therapies in conditions such as mania, dementia, cachexia, paralysis and amenorrhea: We confess it almost took our breath away to witness the furious onslaught thus made on the whole tribe of mental disorders. It certainly was no rose-water affair [Ref. 9, p 518].

Finally, Ray discusses what might happen to a scientist, such as van der Kolk, who becomes so preoccupied with somatic therapies for conditions he assumes are linked to physical ailments that he loses sight of the patient's status. He speculates about his late Dutch colleague: Once a day perhaps he passed through the wards, his attention being given to those chiefly who seemed to require medication, and when the requisite amount of blood had been drawn, and a quantum sufficit of pills and powders and drafts were ordered, his work was done. Practically the mental condition was almost entirely ignored [Ref. 9, p 519].

Worst of all, Ray says, moral treatment is not even mentioned in the book.

Thus, we have Isaac Ray, late in his career, taking the time and energy to critique a work by a late author from a foreign country. His rhetoric had lost none of the fire we saw in his intellectual battles over care of the insane, moral insanity, civil commitment, and expert testimony.⁶ Standards of quality in clinical and forensic practice were equally important to Ray as the humane treatment of the mentally ill. For this reminder alone, we can be grateful that he took any opportunity to state his case—even in an obscure corner of the literature.

• American Academy of Psychiatry and the Law