James Crichton-Browne

Sir James Crichton-Browne MD FRS (29 November 1840 – 31 January 1938) was a leading British psychiatrist famous for studies on the relationship of mental illness to neurological damage and for the development of public health policies in relation to mental health. Crichton-Browne was a celebrated author and orator, one of Charles Darwin's most significant correspondents and collaborators (from 1869 until 1875), editor of the West Riding Lunatic Asylum Medical Reports (1871 to 1876), Lord Chancellor's Visitor in Lunacy from 1875 until 1922, and - like Duchenne de Boulogne and Hugh Welch Diamond - a pioneer of clinical (neuropsychiatric) photography. Crichton-Browne - based in West Yorkshire from 1866 to 1875 - regarded himself as the "doyen of British medical psychology". He also made some remarkable predictions about the neurological changes associated with severe mental illness.

Family Background and Education

Crichton-Browne was born in Edinburgh at the family home of his mother, Magdalene Balfour, who had married William A. F. Browne in 1834. She belonged to one of Scotland's foremost scientific families, and the home (at St John's Hill near Salisbury Crags) had been built in 1770 for the unmarried geologist James Hutton (1726–1797) whose mother was Sarah Balfour. Hutton was a central figure in the Scottish Enlightenment and his geological theories, involving physical processes exerted over unimaginable periods of time ("...no vestige of a beginning, no prospect of an end...") laid much of the foundation for modern environmental science. Hutton's concepts were clarified and reiterated by Sir Charles Lyell (1797–1875) in his Principles of Geology (1830–1833). Crichton-Browne's uncle, John Hutton Balfour (1808–1884), was appointed Professor of Botany and Medicine at Edinburgh University in 1845 in preference to Charles Darwin's friend, Joseph Dalton Hooker (1817–1911).

Crichton-Browne's father, the asylum reformer William A.F. Browne (1805–1885), was a prominent phrenologist who had befriended Charles Darwin at the Plinian Society in Edinburgh in November 1826. Crichton-Browne's godmother was the childless widow Elizabeth Crichton (née Grierson) (1779–1862) who endowed the Crichton Royal hospital in Dumfries in memory of her husband, Dr James Crichton. Crichton-Browne's younger brother was the leader of the parliamentary bar, John Hutton Balfour-Browne K.C. (1845–1921) who wrote a classic work on the legal relations of insanity and his cousin was Sir Isaac Bayley Balfour (1853–1922), Sherardian Professor of Botany at Oxford and, later, Professor at Edinburgh.

Crichton-Browne spent much of his childhood at the Crichton Royal asylum in Dumfries where his father was the first medical superintendent from 1838 to 1857. William A.F. Browne was a pioneering Victorian psychiatrist, with an early interest in the psychological lives of his patients as evidenced by their group activities, symptoms, dreams, relationships and art-works. In his childhood, Crichton-Browne lost two siblings: William (aged 11 years) in 1846 and Jessie (aged 10 years) in 1852. He went to school at Dumfries Academy and then, in line with his mother's episcopalian outlook, to Trinity College, Glenalmond. Shortly before his death, Crichton-Browne wrote a valuable account of his Dumfries childhood, which was published as a Foreword to Charles Easterbrook's Chronicle of the Crichton Royal in 1940.

Darwin, Ferrier and the "Asylum Reports" 1866 - 1875

Crichton-Browne studied medicine at Edinburgh University where his uncle was Dean of the Faculty of Medicine; he qualified MRCS in 1861, and MD in 1862 with a thesis on hallucinations. Among his teachers was his father's friend Thomas Laycock (1812–1876), Professor of Medicine, whose "magnum opus" Mind and Brain^[11] is an extended speculative essay on neurology and psychological life.^[12] Like his father, Crichton-Browne had been elected one of the undergraduate Presidents of the Royal Medical Society^[13] and, in this capacity, he argued for the place of psychology in the medical curriculum. After working as assistant physician in asylums in Exeter (with John Charles Bucknill), Warwick and Derby, and a brief period in Newcastle, Crichton-Browne was appointed Physician-Superintendent of the West Riding Asylum at Wakefield in 1866; this was the year in which his father served as the first President of the Medico-Psychological Association (now the Royal College of Psychiatrists); and, in his Presidential address delivered at the Royal Society of Edinburgh, W.A.F. Browne gave a rather laborious account of the principles of medical psychology^[14] and recorded the deaths of John Conolly (1794–1866) and Sir Alexander Morison (1779–1866).

Crichton-Browne spent ten years at the West Riding Asylum^[15]. He believed that the asylum should be an educational as well as a therapeutic institution and set about a major research programme, bringing biological insights to bear on the causes of insanity. He supervised hundreds of post-mortem examinations of the brain and took a special interest in the clinical features of neurosyphilis. In 1872, Crichton-Browne invited the Scottish neurologist David Ferrier (1843–1928) to direct the asylum laboratories and to conduct electrical studies on the cortical localization of cerebral functions, a research initiative which developed the phrenological theories of Crichton-Browne's father and echoed Duchenne de Boulogne's electrical experiments on the facial muscles^[16][17]. (In 1832-1834, William A.F. Browne had published a serial paper in the Phrenological Journal on the relationship of mental disorder to a disturbance of language, citing clinical cases of brain injury mainly in the frontal lobes)^[18]. On the more general confluence of Crichton-Browne's thinking with his father's phrenology, see Walmsley, 1993^[19]and 2003^[20]. Ferrier summarised his scientific work at Wakefield in his neurological classic The Functions of the Brain ^[21].

At the instigation of Henry Maudsley^[22] (1835–1918), Crichton-Browne corresponded with Charles Darwin (1809–1882) from May 1869 until December 1875.^{[23][24][25][26][27]} The bulk of the correspondence occurred during the preparation of Crichton-Browne's first Asylum Medical Reports and also of Darwin's The Expression of the Emotions in Man and Animals^[28]. On 8th June 1869, Darwin sent Crichton-Browne his copy of Duchenne's Mechanism of Human Facial Expression, asking for his comments. Crichton-Browne seems to have mislaid the book for about a year at the Wakefield asylum; but, on 6th June 1870, he returned it (with some embarrassment) to Darwin, along with an illustration of a woman with erected hair (from the Southern Counties Asylum at Dumfries). Darwin explored a huge range of subjects with Crichton-Browne, including references to Maudsley's Body and Mind^[29], the psychology of blushing, the functions of the platysma muscle (Darwin's "bete noire") and the clinical phenomena of bereavement and grief. Darwin's mysterious symptoms which included vomiting, sweating, sighing, and weeping, particularly troublesome in the early months of 1872, seem to have resolved around the time that he completed his work on the origins of the human emotions.

Building on the early psychiatric photography of Hugh Welch Diamond (1809 -1886)^[30] at Brookwood Hospital (Surrey's second County Asylum), Crichton-Browne sent about forty photographs of patients to Charles Darwin during the composition of his The Expression of the Emotions^[31]; however, Darwin used only one of these in the book and this (Darwin Correspondence Letter 7220) was of a patient (with erection of her hair "like wire") (photographer unknown) - under the care of Dr James Gilchrist at the Southern Counties Asylum (Crichton Royal) at Dumfries. The complete correspondence forms a remarkable contribution to the beginnings of behavioural science and Darwin remarked (of Ferrier's experiments) that "it seems that the physiology of the brain will soon be completely understood" . Nevertheless, Crichton-Browne attached greater importance to his six volumes of West Riding Lunatic Asylum Medical Reports (1871–1876) (Jellinek, 2005)^[32] - sending Darwin a copy of Volume One on 18th August 1871 - and to the neurological journal Brain which developed from them, in which he was assisted by John Hughlings Jackson (1835-1911)^[33][34], David Ferrier (1843-1928) and John Charles Bucknill (1817-1897) . It is notable, however, that Charles Darwin did not make a contribution to the Asylum Reports, nor did he visit the asylum when invited by Crichton-Browne in 1873.

In 1875, Crichton-Browne expressed dissatisfaction with the classification of mental disorders produced by the Edinburgh psychiatrist David Skae^[35] (1814–1873) which had been bravely championed by Skae's pupil Thomas Clouston^[36] (1840–1915); for Crichton-Browne it was "philosophically unsound, scientifically inaccurate and practically useless" ^[37]. In 1879, Crichton-Browne published his own considerations of the neuropathology of insanity^[38] making some very specific predictions about the morbid anatomy of the human brain in cases of severe psychiatric disorder: he proposed that in the insane the weight of the brain was reduced, that the lateral ventricles were enlarged and that the burden of damage fell on the left cerebral hemisphere. This involved an evolutionary view of cerebral localisation with an emphasis on the asymmetry of cerebral functions which he derived from the clinical research of the French neurologist Paul Broca (1824–1880)^[39][40] on language centres in the brain - originally published in 1861 - and presented by Broca to the British Association for the Advancement of Science at its 1868 meeting in Norwich (chaired by Joseph Dalton Hooker). The question of asymmetrical cerebral functions had been raised many years earlier by the Edinburgh phrenologist Hewett Cottrell Watson in the Phrenological Journal^[41][42]. Crichton-Browne summarised his own views on psychosis and cerebral asymmetry in his most important scientific paper: On The Weight of the Brain (1879)^[43]; the best appraisal is by Compston, 2007).^[44]

Lord Chancellor's Visitor in Lunacy 1875 - 1922

In 1875, Crichton-Browne was appointed as Lord Chancellor's Visitor in Lunacy, a position which involved the regular examination of Chancery patients throughout England and Wales. He held this post until his retirement in 1922 and used his public office to give influential addresses on medical matters of popular concern. He combined this with the development of an extensive private psychiatric practice in London and became a familiar figure on the metropolitan medical scene. He served for many years as Treasurer and Vice-President of the Royal Institution and, in 1878, he followed his father as President of the Medico-Psychological Association.

Crichton-Browne made friendships in the literary world with the idiosyncratic historian Thomas Carlyle (1795–1881) whose marital reputation he defended against the allegations of James Anthony Froude; and, less controversially, with his contemporary, the novelist Thomas Hardy (1840–1928) who consulted Crichton-Browne about the anatomical peculiarities of the female brain. Crichton-Browne informed Hardy that the brain/body ratio was much the same in women as in men; but it is not clear that he drew Hardy's attention to the greater symmetry of female nervous structure.

Crichton-Browne was a notable stylist and orator and he often combined this with a kind of couthy vernacular evocative of the Dumfries of his childhood. He was proud to have served as President of the Dumfriesshire and Galloway Natural History and Antiquarian Society from 1892 to 1896 and, on 24th January 1895, he delivered a remarkable Presidential lecture - in Dumfries - On Emotional Expression - in which he discussed some reservations about Darwin's views and touched on the role of the hands in expression, and on the relationship of language to the physical expression of the emotions. Five months later, on 30th June 1895 in London, Crichton-Browne gave his famous Cavendish Lecture on Dreamy Mental States, in which he explored the relationship of temporal lobe disease to deja vu, hallucinatory and supernatural experiences; this caught the attention of William James (1842-1910) who referred - rather negatively - to Crichton-Browne in his Gifford lectures on The Varieties of Religious Experience (delivered in Edinburgh in 1901-1902). In the early years of the twentieth century, Crichton-Browne delivered a number of lectures on the asymmetry of the human brain, publishing his conclusions in 1907.

Elder Statesman of British Psychiatry 1922 - 1938

In 1920, Crichton-Browne delivered the first Maudsley Lecture to the Royal Medico-Psychological Association,giving an affecting tribute to Henry Maudsley whose enthusiasm and energy in the 1860s had been a source of inspiration and encouragement to him. He spoke with some feeling of Maudsley the man, and of the divergence of their pathways in the later development of British psychiatry. Crichton-Browne, rather in awe of Maudsley's intellectual powers, seems to have chilled at the unforgiving character of Maudsley's emotional landscape. Four years later, on 29th February 1924, Crichton-Browne gave the Ramsay Henderson Bequest Lecture in Edinburgh. His title was The Story of the Brain. In this, he gave a remarkable tribute to members of the Edinburgh Phrenological Society - to George Combe (1788–1858), Andrew Combe (1797–1847) and to Robert Chambers (1802–1871) who had sought to combine phrenology with evolutionary Lamarckism in his Vestiges of the Natural History of Creation - written in St Andrews, published in 1844 and inverting Hutton's aphorism "no vestige of a beginning". However, Crichton-Browne did not mention that the lecture was delivered a century (almost to the day) after his father had joined the Edinburgh Phrenological Society. With increasing age, and perhaps with his personal losses in the First World War, Sir James' rhetoric had taken on a more authoritarian tone and this caused his reputation to tarnish in the last two decades of his life.

Crichton-Browne's Legacy

Crichton-Browne's unusual longevity, taken together with his father's lengthy psychiatric career, brought the early world of the Edinburgh phrenologists - George and Andrew Combe, Hewett Cottrell Watson, Robert Chambers and William A.F. Browne - into contact with scientific psychiatry at the dawn of the twentieth century. Crichton-Browne's psychiatric thinking showed a remarkable balance of sociological and neurological interests and his considerations of the cerebral basis of psychotic disorder were well ahead of their time. Within the medical world, he held out the promise of a continuum of neurological and psychiatric illness and, in the narrower world of psychiatry, he demonstrated a public role for the specialist in mental disorders.

Very early in his career, Crichton-Browne emphasised the importance of psychiatric disorders in childhood and, much later, he was to emphasise the distinction between organic and functional illness in the elderly. He was considered an expert in many aspects of psychological medicine, public health and social reform. He supported a campaign for the open-air treatment of tuberculosis, housing reform for the working-classes, and a practical approach to sexually transmitted diseases. He condemned the corporal punishment of children. He stressed the importance of the asymmetric lateralization of brain function in the development of language and deplored the fads relating to ambidexterity advocated by (among others) Robert Baden-Powell. He was critical of public education systems for their repetitive and fact-bound character, warning of mental exhaustion in otherwise happy and healthy children. He was openly - even offensively - sceptical concerning the claims of psychic investigators and spiritualists (see The Times articles of 1897/1899 concerning the Ballechin House controversy) and of dietary faddists and vegetarians. He argued that the benefits of Freudian psychotherapy had been assessed with insufficient rigour. He advocated the fluoridation of human dietary intake (in 1892) and he worried about the consequences of mass transportation by motor vehicles.

In the last years of his life, from retirement at his home "Crindau" by the River Nith in Dumfries, Sir James published six volumes of memoirs selected from his commonplace books, consisting of fragmentary essays ranging widely over medical, psychological, biographical, literary and Scottish themes. In 1925, he published a notable study of Robert Burns' medical problems and physical decline - but he revealed little of himself. Crichton-Browne was twice married and cherished a lifelong affection for the traditions of the Anglican liturgy; he was a loyal member of the congregation at the Church of St John the Evangelist, Dumfries. Through family connections he became friendly with the painter Hannah Gluckstein ("Gluck") (1895–1978) who executed an arresting portrait of Sir James in 1928, now in the National Portrait Gallery. Crichton-Browne was elected a Fellow of The Royal Society in 1883 (supported by Charles Darwin) and he was knighted in 1886. He was a vigorous opponent of teetotalism, stating that "no writer has done much without alcohol". When he died on 31 January 1938, at the age of 97, Crichton-Browne - like Robert Burns, Thomas Carlyle and James Clerk Maxwell - was acclaimed as one of the greatest sons of Dumfries and Galloway in South-West Scotland; and as one of the last Victorians.

See also

• council housing
• female brain
• Gustav Fritsch
• Eduard Hitzig
• teleology

External links

• American Journal of Public Health Sir James Crichton-Browne: Victorian Psychiatrist and Public Health Reformer (biography)