| Stanley Cobb was a uniquely creative man. Possessing
the mind of a natural scientist, which in his youth
had been formed through exposure to wildlife and
by the study of ornithology, and with medical training
in human and comparative anatomy, neuropathology,
neurohistology, clinical neurology, and finally
psychiatry, he was able to cross back and forth
into all of these fields and piece together fragments
of these sciences into an understanding of the nervous
system that was imaginative and unique. In the doing,
he added several important building blocks to the
foundation structure of the modern neurosciences.
Believing that all bodily functions were interrelated
and that some somatic diseases had their origin
in mental and emotional processes, he drew no narrow
line between functional and organic illness. He
recognized that in varying degrees all disturbances
of the human brain demonstrated both tissue changes
and some forms of dysfunction. As a result, he attempted
to correlate the physical and the behavioral aspects
of the human condition in order to understand better
the underlying causes of disease and treat the patient
as a whole. |
On
December 10, 1887, Stanley Cobb was born at his parents'
home on Walnut Street in Brookline, Massachusetts. He
was only five years old when his family moved in 1893
from Brookline to Milton.
His relationship with his father was open and businesslike.
Mr. Cobb maintained a close interest in Stanley's activities
at Harvard College, during his years of medical school
and internship, and throughout the period of postgraduate
study in Baltimore. During Cobb's third year at medical
school he and Stanley conferred with Dr. David Edsall,
then Jackson Professor of Medicine at the Harvard Medical
School, about the most promising approach to an academic
career in the neurosciences. At that time Mr. Cobb was
doing well financially and was prepared to help Stanley
survive the inevitable lean years. Correspondence between
father and son was matter-of-fact, yet each appeared
to have a real feeling of concern for the position of
the other. When Mr. Cobb's real estate ventures bogged
down during World War I, Stanley sensed that his father
could no longer help materially and made every effort
to become self-sufficient as rapidly as possible.
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In
Milton Mrs. Cobb maintained a home in opulent good taste.
She kept up with the social amenities of the community
and attended the Unitarian Church. Stanley had a very
close relationship with his mother. He began to stammer
early, and stammering may have been one reason for her
keeping him out of school until the age of eight. In
any event, he got off to a slow start in reading and
writing. Later, Mrs. Cobb kept him out of school two
more years because both the school boys and faculty
members at Milton were teasing him about his stammer.
A severe
handicap, which creatively motivated Stanley Cobb's
entire life, was his stammering. There were in his family
tree a large number of ancestors and living persons
with speech disorders of one sort or another, so a genetic
factor is a possible explanation. Too, Stanley Cobb
was born left-handed and in infancy had his left arm
bound in a sort of sling to encourage the use of his
right. He was ambidextrous all his life; so mixed right-left
cerebral dominance may have been a factor in causing
the stammering. However, in his own mind the stammering
clearly dated from the birth of his sister Beatrice
on March 24, 1892, when he was four.
On
that day strange happenings were taking place at the
Cobb household on Walnut Street in Brookline. Stanley
had not seen his mother that morning. She had retired
to her bedroom, and an unfamiliar woman in a white uniform
came and went with pitchers of hot water and other paraphernalia.
A dignified older man with black bag had come and gone
more than once. There was an uneasy feeling of excitement
and expectancy from which Stanley felt that he was being
excluded. His curiosity was piqued because on several
occasions he thought he heard groans coming from his
mother's room. Later in the day the children were all
shooed out of the house to play. Stanley was on the
lawn with his older brothers and sisters when he heard
violent screams coming from his mother's room. His younger
sister, Beatrice, was being born. Not knowing what was
happening, Stanley stood transfixed with fear. His older
brothers and sisters ran away, and he chased after them
as hard as he could, but he could not catch up. At that
point he felt a great rush of wind into his chest and
was unable to catch his breath. From that day on he
had trouble talking. He was a stammerer.
The
stammering was such a source of embarrassment that not
only was Cobb's schooling interrupted but his social
life was limited as well. On the other hand his loneliness
and free time in the country made it possible for him
to develop his interest in nature. Moreover, it was
his curiosity about the origin of his stammering that
later led him into the medical neurosciences and particularly
into analytic psychiatry. So, the entire course of his
productive life may well have originated in this handicap.
Cobb's classroom work in college was better than respectable
but not outstanding. In his senior year Cobb was in
the cast of the Hasty Pudding Club play. He was in a
chorus of males, while other members of the cast were
decked out to look like Indian maidens.
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Admission to
the Harvard Medical School was not highly competitive
at that time. There were seventy-six men in the class
of 1914, with a capacity for one hundred and twenty-five.
In 1901 Charles W. Eliot, then president of Harvard University,
in his effort to improve the academic standards of the
graduate schools, had recommended to the medical faculty
that all candidates for admission must have obtained the
degree of Bachelor of Arts and also show evidence of knowledge
of physics and chemistry. This academic restriction had
grossly limited the number of qualified applicants.
Although
Cobb's undergraduate grades were not outstanding, in
medical school things were different. He took his work
seriously from the beginning; yet he found time for
horsemanship and other interests.
He
first met Elizabeth Mason Almy, whom he later married,
on the railroad platform in Lake Placid. The marriage
took place at Cotuit, on Cape Cod, July 10, 1915, and
the couple departed for a nautical honeymoon, cruising
in a leaky catboat. After his marriage, Cobb's stammering
showed considerable improvement. It was an exciting
time when, after their four-month wedding trip, the
Cobbs moved to Baltimore, where for the next three years
Stanley was to work in physiology and psychiatry. Baltimore
was exciting, too, because of the brilliant men in many
departments of the Johns Hopkins Hospital and in the
medical school laboratories.
The years of training at Harvard and Johns Hopkins had
come to an end, and the war had given Cobb an opportunity
to see some of the problems that faced practitioners
of medicine.
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When
he arrived on the Boston scene in the late spring of
1919 Cobb had worked out with Dean Edsall a program
of activities designed to support him financially. He
had also developed a milieu that would allow for his
own professional growth and at the same time permit
him to make a contribution to neurology and psychiatry
at the Harvard Medical School. Cobb's base of operations
was to be at the Massachusetts General Hospital, where
he would have an office in which to see his private
patients and would be available as a psychiatric consultant
in the hospital. In addition, he was to carry out investigations
with Alexander Forbes and Walter B. Cannon in the physiology
laboratories in the quadrangle of the Harvard Medical
School.
By the time that he and his family sailed for England
in October 1923, Cobb had already demonstrated his ability
as an investigator, clinician, teacher, and laboratory
director. He had learned to seize the opportunities
that came within his grasp and to pursue his objectives
with an appropriate degree of flexibility.
He thought that Carl Jung was indeed a most remarkable
man, a bit too interested in dreams and world interpretation
of neurotic phenomena, but very helpful to people in
treatment and provocative of creative thinking.
Cobb's
domestic life during the latter half of the twenties
had many delightful aspects. The parents and the growing
children continued to live in the old Cherry Hill Tavern
in Ponkapoag until 1929, when they moved to Milton.
A particularly joyous feature of the Cotuit vacations
was sailing on Pamaho, the yawl that Cobb and
his father bought in 1925 after the European trip. Prior
to 1930, the Pamaho was used primarily for day
sailing and for brief cruises to nearby islands such
as Martha's Vineyard, Tuckernuck, Muskeget, and Naushon,
where Cobb's sister Hildegarde and her husband, Harry
Forbes, spent their summers.
A
neurological unit that Cobb built at Boston City Hospital
was a remarkable achievement. It had grown out of his
own deep interest in the neurosciences, his imagination
in seeing the creative possibilities of various situations
as they arose, his unselfish dedication to the interests
of students, house staff, and colleagues, and his manifold
administrative talents. The neurological unit had become
in all probability the leading center where scholars
of varying disciplines could cooperate closely in studies
of the nervous system. Nineteen hundred and thirty-four
was the year of Cobb's departure for the Massachusetts
General Hospital. It was in 1937 that a symposium on
electrical activity in the nervous system was held by
the Congress of Psychology in Paris. Nineteen thirty-nine
was an eventful year at the neurological unit. On Cobb's
retirement from the Massachusetts General Hospital in
1954 the Harvard Medical School class yearbook, the
Aesculapiad, was dedicated to him.
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For
a number of years Cobb took an active interest in the
Boston Psychoanalytic Society. Psychoanalysis, as such,
was not one of Cobb's major problems when he opened
the doors of the Massachusetts General Hospital psychiatric
service in 1934. A much greater challenge was the monumental
task of organizing a psychiatric service at that conservative
institution where he encountered doubts and some overt
hostility about the place of psychiatry in a general
hospital setting. Some colleagues resented the number
of Jews on the psychiatric service, and the neurologists,
most of whom looked upon themselves as neuropsychiatrists,
felt threatened by the competition from a new department
of psychiatry.
Cobb
was receptive to opportunities to welcome other psychoanalysts
on his staff. Chronologically, the very first was a
young man named Erik Homburger, who had worked with
children in Freud's home in Vienna. Homburger, who later
became internationally known as Erik H. Erikson, arrived
in Cambridge during October, 1933. Although Erikson
had known Anna Freud and had been exposed to child analysis
when living at Freud's home, he presented a problem
for both Cobb and the Boston Psychoanalytic Society
because he had no academic degree whatever. However,
in 1934 Cobb was successful in obtaining for him an
academic appointment at Harvard. Erikson reported that
he was a research assistant in psychiatry at the medical
school.
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Available
only on a part-time basis because of her busy analytic
practice was Helene Deutsch, who came from Vienna in
October, 1935. As a recognized European training analyst
in Boston, she soon took on a number of the staff members
for analysis. Moreover, as a physician, she was able
to do hospital work and in later years made ward rounds
on a regular basis. When Helene Deutsch completed her
volumes on The Psychology of Women, Cobb wrote
a sympathetic and warm foreword. She died in 1982 at
the age of ninety-seven.
Psychoanalysis was an exciting field that gave promise
of adding a powerful new dimension to psychiatry, and
the aspiring young men returning from World War II were
anxious for experience at this growing edge of knowledge.
Cobb, too, saw psychoanalysis as important. He had been
helped with his own speech defect by analytic therapy.
He knew that it could be effective, and he wanted his
resident staff to be analyzed and to plan their future
lives in the light of what they learned.
One of the most significant things Cobb did for psychoanalysis
was to view it as important. He gave psychoanalysis
respectability at a time when it was almost an underground
cult in Vienna. He saw psychoanalysis as one approach
to the incredibly complex relations of mind, body, and
environment. He was effective in establishing psychoanalysis
as an academically recognized empirical science. With
his impeccably proper Bostonian background he was able
to introduce a number of talented foreign analysts into
the conventional and ultraconservative Massachusetts
General Hospital. He promoted psychoanalysis as an important
new therapeutic and investigative method and looked
upon it objectively. He never became entrapped in the
quasi-religious fervor which, possibly because of their
emotional rebirth experiences during analysis, took
over many of his colleagues. He was not one to honor
orthodoxy, whether in a conventional religious setting
or in psychoanalysis.
Although Cobb and his co-workers were interested in
psychosomatic problems, the chiefs of other services
such as gynecology, orthopedics, pediatrics, and even
neurology were either blind or did not want to see.
At one conference in about 1936 a patient with anorexia
nervosa was presented, and Cobb in his summary concluded
that anorexia nervosa was a disease entity in its own
right, not a manifestation of schizophrenia.
The conference was presided over by Cobb, then forty-seven
years of age. He was strikingly handsome in his long
white clinical coat with a Queen Square reflex hammer
protruding from one of the pockets, yet the arthritic
deformity of his hands could not be overlooked.
In addition to influencing the nonpsychiatric members
of the medical profession through psychiatric consultations,
emergency care, joint research projects, clinical teaching,
and work on the curriculum committee at Harvard, Cobb
from 1935 through 1959 published each year a review
of neuropsychiatry in the Archives of Internal Medicine.
Other writings for the general medical public which
appeared during the thirties included an article on
shock therapy in the New England Journal of Medicine
and a paper on the psychiatric approach to the treatment
of epilepsy.
While Cobb was carrying on the multitudinous tasks inherent
in the building of his psychiatric service, he also
had other interests that were important to him and broadened
the scope of his knowledge and effectiveness. One of
these interests had to do with the physicians, mostly
Jewish, who were fleeing from European dictatorships,
especially in Germany and Spain. Walter
B. Cannon, professor of physiology at Harvard,
was active in submitting names of appropriate émigrés.
A review of Cobb's activities during the late thirties
would be incomplete without mention of the honorary
degree awarded to Jung by Harvard at the time of its
tercentenary in 1936. To the department of psychology
was delegated the authority to make one nomination for
an honorary degree candidate. They would have liked
to nominate Freud, but they feared he would decline,
and they had no authority to make a substitute nomination.
So they settled on Jung, who promptly accepted and visited
the Cobbs when he came to this country for the presentation.
The
demands upon Cobb during the late thirties when he was
establishing the new psychiatric service were taking
their toll from his physical and emotional reserves.
The rheumatoid arthritis, from which he had suffered
for many years, gradually became more crippling, yet
he continued to need the change of pace that he found
in such activities as sailing, skiing, watercolor painting,
and the study of nature.
Although
Cobb had suffered from rheumatoid arthritis all his
adult life—it was demonstrable on the group photograph
taken during his internship —there was marked progression
in its severity during the thirties. Still, Cobb remained
active physically. He used his fingers deftly in the
watercolor painting that he so greatly enjoyed and in
other activities requiring manual dexterity.
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The
full impact of Cobb's work was to be developed in the
future, which was to see psychiatric wards in general
hospitals throughout the country, widespread acceptance
of psychiatry as a respected specialty of medicine,
effective new forms of therapy, a marked decrease in
the number of patients occupying state hospital beds,
and vital new knowledge of neurotransmitters, which
became important in psychiatric brain research. Cobb's
work during the forties was destined to include a number
of classified studies of direct importance to the war
effort and, in spite of a limited staff, the expansion
of cooperative studies with other hospital departments.
In the late forties and fifties psychoanalysis assumed
an increasingly important role and, with various forms
of funding available, there was a vast increase in the
number of residents and fellows in training. The psychiatric
service was destined to become one of the largest and
most important in the entire hospital.
Cobb wrote a number of other papers on psychosomatic
medicine and on psychiatry in a general hospital, as
well as the decennial report of the psychiatric service
at the Massachusetts General Hospital. This report contains
a wealth of information about the work done there from
1934 to 1944. In addition Cobb brought out a new edition
of his classic volume, Foundations of Neuropsychiatry
and wrote a new book entitled Borderlands of Psychiatry
.
Cobb was making preparations in his mind for the transition
to postwar psychiatry and the demands that it would
make upon him and his service. So a new interest in
psychiatry was growing up among the doctors on military
duty. Along with this greater awareness of the importance
of psychiatry came the G.I. Bill of Rights which insured
financial aid for students during the early peacetime
years.
The postwar years constituted for Cobb a period of rapid
adjustment. Of course, during these later years he continued
to teach the neuropathology course at the Harvard Medical
School, and through their clinical work the members
of his attending staff were constantly teaching the
residents, fellows, and medical students.
When
Cobb retired in mid-1954 after twenty years as psychiatrist-in-chief
at the Massachusetts General Hospital, he was faced
with quandaries about the future. Cobb made up his mind
to remain in Boston. He established himself in a number
of settings that would keep alive his interests in ornithology
and in the human mind. He recalled his former pathology
teacher, William Councilman, as having said in his old
age, "When you have to retire, find a narrow field
you love and till it extensively." Having been
an ornithologist and having spent most of his professional
life trying to learn how the brain worked, it was natural
that he chose avian neurology as his niche. However,
he also felt a need to carry on some work in human psychiatry.
Cobb's next most important work area was the Museum
of Comparative Zoology at Harvard, where the atmosphere
and aromas brought back nostalgic memories of college
days. Making a collection of brains adequate for studies
in comparative anatomy took several years.
Cobb’s
third work area was the department of student health
at the Massachusetts Institute of Technology. He was
a psychiatrist to students three days a week for several
years.
During retirement Cobb published more than sixty papers
from his office and laboratory in the Warren Building.
During the second trimester of Cobb's retirement years,
from 1959 through 1963, enough specimens of bird brains
had been accumulated so that he could make some meaningful
studies of comparative anatomy. During the final trimester
of retirement, from 1964 until his death in 1968, Cobb
continued to write primarily on ornithological topics.
The
most widely read article Cobb ever wrote was "Death
of a Salt Pond," which appeared in Audubon Magazine
in May, 1963. It was one of his writings on social issues
and more particularly on protection of the environment.
He was concerned with the use of insecticides, especially
DDT. In I962, as a mosquito control measure, ponds and
marshlands on Cape Cod were sprayed with this insecticide,
which proved fatal to crustacea such as fiddler crabs
as well as to insect arthropods.
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When
his own salt pond was sprayed Cobb was furious. His
wife wrote the story of his anger and how he transformed
it into the most widely read publication of his life:
"Nineteen sixty-two was the summer that Stanley
lost his eyesight. We had a great Scandinavian doctor
who kept saying, "You will get your vision back.
I have seen many cases like this at home in Scandinavia."
Stanley did not believe him and was very depressed.
"Then came the day at Cotuit when an airplane flew
over and sprayed us and the salt pond in front of our
cottage with DDT. Stanley was furious. He asked me to
call various governmental agencies until we located
the person responsible for the spraying. We then left
word for him to call back. The call came as evening
approached. Sparks flew, and we had our dinner. After
dinner, two men arrived and asked to see Stanley. I
told them he was not seeing anyone now because of his
bad eyes. They told me who they were. Immediately I
let Stanley know and he came in. I did not hear the
conversation that followed, but I am sure that Stanley
did not mince words. When the men departed an hour later
all they could say was that they had agreed to disagree
about the wisdom of the spray.
"Next
day Stanley took pen and paper in hand and began to
write in letters one-half inch high, carefully keeping
the sheets of paper in sequence. I remember Aunt Helen
came in, and because I was busy, she undertook to write
for him, just what I don't recall. Gradually, during
the next few days Stanley discovered that he could write
his thoughts in large letters and see what he had written.
Then he decided that he needed someone to whom he could
talk or even dictate. Finally, I found a Cotuit woman
who had previously done secretarial work for Erik Erikson.
She was just right, silent when she needed to be, but
very attentive, having taken in at one swallow—
as it were—my few words about the situation—Stanley's
eyes, his strong feelings, and his need to write about
the spraying situation. I drove Stanley to the lady's
house on several different days. She took much of what
Stanley dictated directly on the typewriter. Stanley
then took her rough drafts home and edited them. I had
no function in this. Stanley and his amanuensis understood
each other perfectly.
"And so, to make a long story short, Stanley decided
to publish what he had written in the Barnstable Patriot.
"I was in the local grocery in Marston's Mills
the night the article came out. When I asked for a copy
of the paper the girl who sold it said, "Read that
first article. It is very good." She had no notion
of why I wanted the paper.
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"The
article was reprinted or quoted all over the Cape and
later in Audubon Society publications across the country
as far away as Texas. There were more requests for reprints
than for anything else Stanley had ever written."
The Death of a Salt Pond was not the last thing
Stanley wrote, but it was something of vital importance
into which he put his whole self.
Because of Cobb's long-standing interest in nature and
in conservation of natural resources, he had deep admiration
for the pioneer environmentalist, Rachel Carson, whose
Silent Spring aroused widespread interest and
concern. When Rachel Carson died in 1964 Cobb wrote
a tribute to her:
To Rachel Carson, who died April 14, 1964
