Ralph M. Reitan: Evidenced Based Before Evidence Based Was Cool

Archives of Clinical Neuropsychology 30 (2015) 740–747 Special Article Ralph M. Reitan: Evidenced Based Before Evidence Based Was Cool Arthur MacNeill Horton, Jr1,*, Cecil R. Reynolds 2 1 Neuropsychology Section, Psych Associates of Maryland, LLC, Towson and Columbia, MD, USA 2 Texas A&M University, College Station, TX, USA *E-mail address: . Accepted 5 October 2015 Ralph M. Reitan’s passing on August 24, 2014 washed as a tsunami of great sadness over the many clinical neuropsychologists who knew Reitan, and for the field generally. Ralph was the anchor of empiricism and evidence-based practice in clinical neuropsychology, who developed and vigorously promoted neuropsychology as an evidence-based specialty long before the term was so popular. Reitan is best known for his development of the various age levels of the Halstead-Reitan Neuropsychological Test Battery (HRNTB) for clinical applications to the assessment and treatment of brain-damaged individuals. As is well known, the core tests of the HRNTB were initially developed by Reitan’s primary mentor, Ward Halstead, as part of a research program on biological intelligence, but Reitan, over many decades, adapted, and augmented the original core battery for clinical application in the assessment and treatment of brain-damaged individuals. Reitan’s initial research approach was to compare control subjects to previously diagnosed persons known to have heterogeneous types of lesions in various locations and identify the procedures that were sensitive to the general condition of the brain. Essentially, the HRNTB was developed to be sensitive to neurological as opposed to behavioral variables as a critical concern for clinical neuropsychologists was the biological condition of the human brain. Reitan used empirical methods to determine and demonstrate that performances on specific psychological tests (HRNTB) were brain related rather than behavior related. In a research career of over 60 years, Reitan published numerous scientific peer-reviewed articles, book chapters, and books demonstrating the validity of the interpretations he proffered for the various score patterns on the HRNTB in the clinical assessment of brain-damaged individuals while working at major research universities including Indiana University, University of Washington, and the University of Arizona. Reitan published numerous peer-reviewed papers from 1948 (Aita & Reitan, 1948) to 2008 (Reitan & Wolfson, 2008), a 60-year span of impressive scholarship. Numerous other research studies have since cross-validated Reitan’s research findings in the USA and in other countries around the world (Hevern, 1980; Horton, 1997, 2008). Perhaps less understood and less appreciated was the impact of Reitan’s research and innovative clinical procedures in establishing the role of the clinical neuropsychologist in the healthcare system, particularly in hospital and medical school practice and curriculum. When Reitan began his research program at Indiana University, psychologists were not typically included as clinicians in departments of neurology. Reitan’s research was of such a high level that neurologists and other physicians had to accept the fact that clinical neuropsychologists had important contributions to make in terms of the assessment and treatment of brain-damaged individuals. Clinical neuropsychologists who entered the field in this century, many times are unaware that in the last century, the clinical role of the neuropsychologist had to be carved out of an initially unwelcoming healthcare system. Reitan through his research and clinical work with brain-damaged individuals clearly demonstrated the important contributions that clinical neuropsychologists make to the assessment and treatment of brain-damaged individuals. In a time where X-ray was nearly the only imaging procedure available and localization of brain functions was crude at best, Reitan travelled the lecture circuit demonstrating the value of neuropsychological test data in localization and diagnosis of central nervous system issues and often contributed to the surgical interventions required by providing surgeons with information on brain functions in the individual patient not otherwise available. Reitan’s impact is difficult to overstate as his research was the major reason that departments of neurology decided to include neuropsychologists as clinical staff members. Every clinical neuropsychologist working today owes a debt to Reitan’s contributions. It might also be noted that in addition to these outstanding clinical neuropsychology research contributions, Reitan was an extremely erudite and kind individual who spent numerous hours teaching and supervising graduate students, interns, and # The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: . doi:10.1093/arclin/acv070 A.M. Horton, C.R. Reynolds / Archives of Clinical Neuropsychology 30 (2015); 740–747 741 postdoctoral students. He was extremely generous in sharing his research findings and clinical wisdom, and the majority of leaders in clinical neuropsychology in the last century had been either students of Reitan or students of his students. Reitan was truly the Father of American Clinical Neuropsychology, and the great importance of his many contributions will always be remembered. Early Life Reitan was born in the place that translated from Norwegian as “Sweet Meadow” in South Dakota. He was a son of a Lutheran minister and spent much of his early life traveling from one parsonage to another in the Midwest. Unfortunately, Reitan’s family was quite poor, and he had to go to school with newspapers stuffed in his shoes because the shoes had holes in them, and his family was too poor to buy new shoes. Interestingly, Reitan did not speak English until he went to elementary school because his first language was Norwegian as many of the Lutheran communities in the Midwest where his father served as a minister only spoke Norwegian. So the father of American neuropsychology was a speaker of English as a second language. Elementary school was not a pleasant experience for Reitan as he rather famously punched his fifth grade teacher because the teacher tried to make him go to the blackboard to do fractions. Reitan noted no teachers bothered him after that. He did retain his feistiness throughout his career, and it served him well in the early days of establishing clinical neuropsychology as a contributing field to patient care. Also in high school, Reitan could not run for the Presidency of the Senior Class because of his parents’ religious beliefs. His minister father forbade dancing, singing, drinking alcohol, or going to movies. In Reitan’s high school, the tradition was the senior class president danced the first dance at the senior prom. As Reitan could not dance, he could not run to be the senior class president and instead served as the vice-president of the high school senior (...truncated)