St. Louis School of Psychiatry

   (at Washington University in St. Louis)

   (from 1942). The St. Louis school of psychiatry is significant because it introduced biological thinking into American psychiatry at a time when the prestigious teaching institutions were all dominated by psychoanalysis.

   Founded by psychiatrist David Rioch (1900–1985) in 1938, the department of psychiatry at "Wash U" started to resound as the main voice for biological psychiatry in the United States in 1942 when Edwin Gildea (pronounced GIL-day) (1898–1977) became head of the department. (Rioch was a psychoanalyst.) The university was already a national center of innovative medical research, and it is said to have been the Washington University biochemist Carl Cori (1896–1984) who plumped for the appointment of Gildea. Gildea, born in Colorado Springs, had received his M.D. from Harvard in 1924, trained in psychiatry at the Boston Psychopathic Hospital between 1926 and 1928, and taught neuropathology at Harvard before going to Yale in 1929 as a member of the department of psychiatry. In 1942, he was called to Wash U as professor of psychiatry and head of neuropsychiatry. His wife, Margaret Crane-Lillie Gildea (1903–?), was also a psychiatrist. Gildea set out to give the department, at that point full of psychoanalysts, a biological spin.

   In 1949, Gildea brought Eli Robins (1921–1994) to Washington University as an instructor in neuropsychiatry. Robins became head of the department of psychiatry in 1963 when Gildea retired, retiring in 1975 himself as a result of his advancing illness. (Robins’s wife, Lee Nelken Robins [1922–] was a distinguished medical sociologist * Lewis, a noted child psychiatrist, later became head of the New York State Psychiatric Institute, which is affiliated with the department of psychiatry of Columbia University’s College of Physicians and Surgeons. who, together with Darrel A. Regier (1944–), led the first major epidemiological study in U.S. psychiatry, the Epidemiological Catchment Area Study, funded by the National Institute of Mental Health and published in 1991 as Psychiatric Disorders in America.) Between 1975 and 1989, Samuel Guze succeeded Robins as chair of psychiatry. A third member of the triumvirate was George Winokur, who came to Wash U in 1951 as an instructor in the psychiatry department and remained there until becoming chair of psychiatry at the University of Iowa in 1971.

   The "St. Louis school," under Robins, Guze, and Winokur, began to take on a collective existence as the three of them presented a plan for future resident training to a somewhat taken aback Gildea. During the years, they established their distinctive imprint of conducting long-term follow-up studies and doing genetic research. They trained many influential American figures in biological psychiatry after the Second World War, including C. Robert Cloninger (1944–), Paula J. Clayton (see Women in Psychiatry), Robert A. Woodruff, Jr. (1934–), and Rodrigo Muñoz (1939–). Known as the "neo-Kraepelinians," they replaced the previous insider group in American psychiatry, the Group for the Advancement of Psychiatry based at the Menninger Clinic, as the intellectual leadership in American psychiatry.

   Much later, American psychiatrist David Sheehan (1947–), at the Institute for Research in Psychiatry of the University of South Florida in Tampa, Florida, reflected about the significance of the St. Louis school: "It’s an invisible network. Those involved know it. They never comment on it. It is understood, like they are all wearing the same college tie. . . . It’s the equivalent of the Maudsley or the Salpêtrière in Paris or Kraepelin’s group in Munich" (Healy Psychopharmacologists, III, p. 503).