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 brain injury -  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, editor of the extremely influential West Riding Lunatic Asylum Medical Reports (six volumes, 1871 to 1876) - and - like Duchenne de Boulogne and Hugh Welch Diamond - a pioneer of neuropsychiatric photography. Crichton-Browne was based in Wakefield from 1866 to 1875, and there he set up a unique asylum laboratory, establishing instruction in psychiatry for students from the nearby Leeds School of Medicine. In 1895, Crichton-Browne delivered his Cavendish Lecture On Dreamy Mental States which attracted the disapproval of the American psychologist William James and - in 1907 - he summarised his neuropsychiatric research in his Royal Institution Lecture Dexterity and the Bend Sinister. In 1920, after forty-five years as Lord Chancellor's Medical Visitor, Crichton-Browne delivered the first Maudsley Lecture to the Medico-Psychological Association, in which he outlined his memories of Henry Maudsley. Throughout his career, Crichton-Browne warned of the dangers of subjecting children to emotional stress in the course of their education; emphasised the asymmetrical character of the human brain and behaviour; and also - like Emil Kraepelin and Alois Alzheimer - 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. She was the daughter of Dr Andrew Balfour and belonged to one of Scotland's foremost scientific families - 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 had been 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.

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 uncle, John Hutton Balfour (1808-1884), was appointed Professor of Botany at Edinburgh University in 1845 in preference to Joseph Dalton Hooker (1817-1911). Crichton-Browne's younger brother, John Hutton Balfour-Browne K.C. (1845–1921), wrote a classic work on the legal relations of insanity  and his first cousin, Sir Isaac Bayley Balfour (1853–1922), was Sherardian Professor at Oxford and, later, Professor of Botany 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 and an exponent of moral treatment, with an early interest in the psychological lives of his patients as evidenced by their group activities, symptoms, dreams, and art-works. During his twenty years at the Crichton Royal, W.A.F. Browne hoarded a huge collection of patient art, and this interest found a parallel in Crichton-Browne's later asylum photography. In his childhood, Crichton-Browne lost two siblings: his older brother, William (aged 11 years) in 1846 and his sister 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, including a description of the visit of the American asylum reformer Dorothea Lynde Dix, and this was published as a Foreword to Charles Easterbrook's Chronicle of the Crichton Royal in 1940.

Darwin, Ferrier and the Wakefield 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) whose "magnum opus" Mind and Brain is an extended speculative essay on neurology and psychological life. Crichton-Browne also drew on the writings of the physicians Sir Andrew Halliday and Sir Henry Holland. Like his father, Crichton-Browne had been elected one of the undergraduate Presidents of the Royal Medical Society 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 on Tyneside, 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 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. 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 echoed Duchenne de Boulogne's electrical experiments on the muscles supplied by the seventh (facial) cranial nerve and which developed the phrenological theories of Crichton-Browne's father, William A.F.Browne. (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). On the more general confluence of Crichton-Browne's thinking with his father's phrenology, see the papers by Walmsley, 1993 and 2003. Ferrier summarised his scientific work at the Wakefield asylum in his neurological classic The Functions of the Brain.

At the instigation of Henry Maudsley (1835–1918), Crichton-Browne corresponded with Charles Darwin (1809–1882) from May 1869 until December 1875. The bulk of the correspondence occurred during the preparation of Crichton-Browne's famous West Riding Lunatic Asylum Medical Reports and also of Darwin's The Expression of the Emotions in Man and Animals. 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 occasionally 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, the psychology of blushing, the functions of the platysma muscle (Darwin's "bête 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 largely 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) 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; however, Darwin used only one of these in the book (Figure 19) and this (Darwin Correspondence Project Letter 7220) was of the patient (with occasional erection of her hair "like wire") (photographer unknown) - under the care of Dr James Gilchrist at the Southern Counties Asylum, the public wing of (Crichton Royal) at Dumfries. The complete correspondence between Crichton-Browne and Charles Darwin forms a remarkable contribution to the beginnings of behavioural science. Nevertheless, Crichton-Browne attached greater importance to his six volumes of West Riding Lunatic Asylum Medical Reports (1871–1876) (Jellinek, 2005) - 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),  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 ridiculed the classification of mental disorders produced by the Edinburgh psychiatrist David Skae (1814–1873) which had been promoted by Skae's pupil Thomas Clouston (1840–1915); Skae had sought to associate specific forms of mental disorder with diseased states of various bodily organs. Crichton-Browne characterised it as "philosophically unsound, scientifically inaccurate and practically useless". In 1879, Crichton-Browne published his own considerations of the neuropathology of insanity making some exact 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) 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. Crichton-Browne summarised his own views on psychosis and cerebral asymmetry in his most important scientific paper: On The Weight of the Brain (1879); and the best appraisal is by Compston, 2007.

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 wealthy Chancery patients throughout England and Wales. He held this post until his retirement in 1922 and he combined it with the development of an extensive London consulting practice, becoming a familiar figure on the metropolitan medical scene. . In 1878, he followed his father as President of the Medico-Psychological Association; in 1883, he was elected a Fellow of the Royal Society; and he served as Treasurer and Vice-President of the Royal Institution from 1889 till 1926. Crichton-Browne also 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 gave a remarkable and light-hearted Presidential lecture - in Dumfries - On Emotional Expression - in which he discussed some reservations about Darwin's views and touched on the role of the motor cortex in expression, on the relations of gender to expressive asymmetry, and on the relationship of language to the physical expression of the emotions. A few months later, on 30th June 1895 in London, Crichton-Browne delivered his famous Cavendish Lecture on Dreamy Mental States, in which he explored the relationship of trauma in the uniquely vulnerable temporal lobes to déjà vu, hallucinatory and supernatural experiences; this caught the attention of William James (1842-1910) who referred - rather dismissively - 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 the Summer of 1920, Crichton-Browne delivered the first Maudsley Lecture to the Royal Medico-Psychological Association, at the Royal Society of Medicine in London, 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, regretting Maudsley's social and professional withdrawal in the last thirty years of his life. 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 and this lecture formed a kind of peroration to his public career. 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), the author of The Constitution of Man (1828), to Andrew Combe (1797–1847), author of Observations on Mental Derangement (1831) -  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 as Chambers recuperated from a complex psychiatric disorder, published  in 1844, and inverting Hutton's aphorism "no vestige of a beginning". However, Crichton-Browne did not mention that his lecture was delivered a century (almost to the day) after his father had joined the Edinburgh Phrenological Society.With increasing age, with the death of his first wife, and perhaps with his personal losses in the first world war, Crichton-Browne's rhetoric took on a more authoritarian tone, and this compromised his reputation in the last two decades of his life.

Crichton-Browne's Legacy
In spite of the pervasive influence of his medical psychology, Crichton-Browne remains a strangely neglected figure in the history of British psychiatry. His reputation as a raffish medical expert, his latterly reactionary political views, and his elegant but convoluted Victorian prose did little to attract twentieth century interest or opinion. Crichton-Browne's unusual longevity, taken together with his father's unique psychiatric career, brought the world of the early Edinburgh phrenologists - George Combe, Hewett Cottrell Watson and Robert Chambers - into contact with developing neuroscience in the course of the twentieth century - and he did not ignore the intervening influences of Duchenne de Boulogne, Pierre Paul Broca and Charles Scott Sherrington. The phrenologists' concept of the brain was of a genetically determined, dynamic system vulnerable to environmental stress. Crichton-Browne's psychiatric thinking showed a remarkable blend of social and neurological concerns and his considerations of the cerebral basis of psychotic disorder were well ahead of their time. Beyond this, Crichton-Browne's medical psychology embodied the accommodation of evolutionary theory within the framework of clinical observation. 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 - a week after the publication of On the Origin of Species - 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 and sanitary 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 (in 1892) the fluoridation of human dietary intake 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" (37 Nunholm Road) by the River Nith in the Nunholm district of Dumfries, Sir James published a notable study of Robert Burns' medical problems and physical decline, based on some articles he had contributed to the Glasgow Herald, and seven volumes of memoirs selected from his commonplace books, consisting of fragmentary essays ranging widely over medical, psychological, biographical and Scottish themes. 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 (with posthumous support from 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; one of the last men in Britain to sport Dundreary whiskers - and as one of the last Victorians.