Hamilton, Max

   (1912–1988)

   Creator of widely used rating scales for depression and anxiety and a pioneer of British psychopharmacology, Hamilton was born in Offenburg (Hesse, Germany) and came with his parents to England at the beginning of the First World War. He graduated in medicine in 1934 at University College London and became interested in mental illness during the Second World War when assigned to an engineering unit, many of whose members had been placed there because of emotional problems. He started to read about psychology, then trained in psychiatry after the war, coming under the tutelage of psychologist Sir Cyril Burt (1883–1971) at University College Hospital, who began to teach him about statistics. "Within a couple of years," said Hamilton later, "I was probably the only psychiatrist in the country who knew psychometrics, rating scales and theories of measurement." In 1953, Hamilton went to the medical school at Leeds as senior lecturer, where he began intensive work on scales, of which few existed in psychiatry at that point. When chlorpromazine was introduced in England in 1953, the firm May & Baker asked him to conduct a clinical trial. Then in the mid-1950s, he organized another trial of the antianxiety drug meprobamate, which had just been introduced. He devised a scale to measure decreases in the levels of patients’ anxiety. When the trial was over, "We still had the patients," he said later. "We still had to see and treat them. Then something profoundly interesting happened: Two or three of these patients, carefully selected and diagnosed as anxiety states, became severely depressed and had to be given ECT, and responded very well. That set me thinking." So Hamilton devised a depression scale (later known as "HAM-D"). The anxiety scale was published in 1959 in the British Journal of Medical Psychology, the depression scale in 1960 in the Journal of Neurology, Neurosurgery and Psychiatry. In fact, the timing of these publications led to some confusion: In another article on clinical syndromes in depression, cowritten with Jack Morrison White (M.B. 1941) at Stanley Boyd Hospital in Wakefield, and published in 1959 in the Journal of Mental Science, Hamilton said he had devised a depression scale and cited its forthcoming appearance as "1959." Yet, as mentioned above, it was not published until 1960.

   Both scales are "household words," in a manner of speaking, in today’s psychiatry. Hamilton became chair of psychiatry at Leeds in 1963 and retired from that department in 1977. Because he was a member of the Communist Party, the psychiatric establishment in London never really warmed to him, and he remained in Leeds. (Others attribute it to Hamilton’s abrasive style.) His colleague, British psychopharmacologist Merton Sandler (1926–) later said, "Max should have been the successor of Aubrey Lewis at the Maudsley" (Healy, Psychopharmacologists, II, p. 389).