Ralph M. Reitan: The Pioneer of Clinical Neuropsychology

Archives of Clinical Neuropsychology 30 (2015) 724–732 Special Article Ralph M. Reitan: The Pioneer of Clinical Neuropsychology Jim Hom*, Janice Nici The Neuropsychology Center, Plano, TX, USA *E-mail address: . Accepted 5 October 2015 On August 24, 2014, Ralph M. Reitan, PhD, passed away in his home in Mesa, Arizona. He is survived by his wife, Deborah Wolfson, and his five children, Ellen, Jon, Richard, Ann, and Erik. Ralph was born in Beresford, South Dakota, on August 29, 1922. He was the third of five children; his father was a clergyman, and his mother was trained as a teacher. His parents were of Norwegian descent, and the family spoke Norwegian at home. In fact, Ralph did not learn English until after starting school. He would often relate stories about his upbringing and the very strong influence of his family and, especially, of his father’s moral teachings. These influences had a significant impact on his outlook, his interpersonal interactions, and his career. The Early Years Ralph grew up during the Depression and had to work during his school years to help out the family. He worked full time while attending college. After 2 years of college, during World War II, he attempted to become an officer in the U.S. Marine Corps. He was deemed medically ineligible because of a pre-existing condition. With his original plan thwarted, he enlisted in the U.S. Army in 1942. While waiting to be called up, he was able to complete his third year of college. When he entered basic training, his shoulder was repeatedly dislocated (from an earlier injury), and so, fortunately for neuropsychology, he had to be discharged from the service. At that point, he returned to college, earning his Bachelor of Arts degree in Psychology in 1944 from Central YMCA College in Chicago. Because of financial circumstances, he was unable to immediately attend graduate school but was qualified to work as a psychometrist in the Armed Forces Induction Station in Chicago, assessing the basic abilities of inductees. He was recommended for a job as a psychologist, and in 1945, he started work at the Mayo General Hospital in Galesburg, Illinois. It was in this position that he was first exposed to soldiers with brain injuries. He considered this experience to be his introduction into the area of neuropsychology. Through this experience, he came to appreciate the effects of brain injury on adaptive behavior. In addition, he quickly realized the inadequacy of the scientific literature and assessment procedures available at the time. For example, Ralph often recounted his experience testing an injured physician who scored within normal limits on the tests he was using. Yet the physician clearly understood that he could not return to his former practice of medicine. In recounting this episode, Ralph described his feeling of helplessness in being unable to address the doctor’s impairments. It is likely that this experience, in concert with his upbringing and natural intellectual drive, led him to challenge the current techniques and try to find a better solution to the understanding of the psychological effects of brain injury. Along with Dr. John Aita, a neurologist and section head, and other colleagues, Ralph developed a battery of available tests that were routinely administered to patients. Ralph and these colleagues published three papers concerning brain injury in 1947 and 1948 (Aita, Armitage, Reitan, & Rabinovitz, 1947; Aita & Reitan, 1948; Aita, Reitan, & Ruth, 1947). Interestingly, they reported that, using the Rorschach, they found that some of Piotrowski’s 10 signs and several additional signs were helpful in diagnosing posttraumatic brain-injured patients (Aita, Reitan, & Ruth, 1947). In contrast, they found that the Shipley– Hartford Retreat Scale for Intellectual Impairment and the Hunt Minnesota Test for Organic Brain Damage were of little value in differentiating braindamaged from control patients. On the other hand, the Wechsler Mental Abilities Scale, an Army analog of the Wechsler– Bellevue Scale, was shown to have “definite diagnostic value” (p. 34) in determining brain injury (Aita, Armitage, et al., 1947). # The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: . doi:10.1093/arclin/acv067 J. Hom, J. Nici / Archives of Clinical Neuropsychology 30 (2015); 724–732 725 It is clear that, even at this early stage of Ralph’s career, he was already searching for clinical methods to measure brain function. If a test was purported to measure “organic brain damage,” he tested it out on real patients. This is the touchstone of his approach, exemplified by his attitude—“unless you’ve ‘been there,’ you don’t know what you’re talking about.” This attitude sometimes offended experts and colleagues—in fact, he came close to being kicked out of graduate school after he offended a professor by pointing out—in front of the class—the limitations of the professor’s knowledge of brain injury and disease. Ralph began graduate work at the University of Chicago in 1945. Ralph often related that he felt his admission to the graduate program was heavily dependent on his positive interaction with Louis Thurstone, PhD, in a pre-admission interview, and the strong influence of Ward Halstead, PhD. These benefactors also later rescued him from dismissal from the program. In addition to taking psychology courses within the department, Ralph also completed the equivalent of 2 years of medical school courses. He was trained as a physiological psychologist and completed his PhD in 1950. His dissertation was titled, “Relationships of Certain Rorschach Test Indicators to the Abstraction and Power Factors of Biological Intelligence.” His dissertation director was Ward C. Halstead, PhD. Ralph met Ward Halstead while working as a psychologist at the Mayo General Hospital prior to his admission to graduate school. At that point, Ralph had been testing brain-injured soldiers from World War II, and he realized the limitations of the available procedures in identifying the effects of brain injury. Halstead had by then established his pioneering laboratory dedicated to the experimental study of brain function. He had developed a series of tests to evaluate the behavioral effects of brain injury in humans. These tests were initially based on many hours of personal observations of and interactions with brain-damaged individuals while they were engaging in real-life behaviors. Halstead’s 1947 monograph, Brain and Intelligence: A Quantitative Study of the Frontal Lobes, summarizes the results of more than a decade of his visionary research program. Reitan (1994) details Halstead’s commitment to understanding the behaviors of brain-damaged individuals; this paper also explicates Halstead’s contribution to neuropsychology. It is clear that Halstead had little regard for the techniques available at the time for understanding brain function. Given Ralph’s hands-on experienc (...truncated)