DR. AUGUST FOREL
PRO HUMANITATE

J. DAVID MCNEELY, MD

 

     {This paper is a shortened version of a considerably larger essay delivered before the Innominate Society of Louisville on January 12, 1993.)

 

     Dr. August Forel (1848-1931) is one of the most unappreciated figures in modern world psychiatry.  He is virtually unknown to American psychiatrists, even though cited briefly in the works of Sigmund Freud who is commonly considered the Father of Modern Psychiatry.  After reading this article the reader may have cause to reflect that perhaps Dr. Forel may lay just claim to that appellation.  Only two sentences are listed in Zilgoorg’s The History of Medical Psychology and he is not even listed in the Encyclopedia Britannica.  In the American Literature there was only one small reference to his life and work by Kyle and Shampo in JAMA, January, 1978 submitted on the occasion of the issuing of the Swiss stamp in his honor.

     August Henri Forel (Fig.1) was a world-renowned psychiatrist, entomologist, neurologist, neuroanatomist, medical administrator, social reformer and worker toward world peace.  Late in his extremely productive life he became a major religious and spiritual figure as a member of the Bahai Faith and was a founding influence for the National Spiritual Assembly of Bahais of Switzerland.  Forel has been described as “one of the last representatives of a generation of encyclopaedists, of open and curious minds, who took interest in almost all human activities.”  He is so revered in his native Switzerland that his visage appears on a postage stamp and on the one-thousand franc Swiss bank note.  He is considered a great patriot and father figure among the Swiss.

     Forel was born September 1, 1848, in the small town of Morges on the shores of Lake Geneva in French speaking Switzerland.  He was the eldest of four children born to an upper middle class family.  As a youth he was shy, rather frail and only a mediocre student.  He describes himself as a bit of a loner.  As a child he developed a passion for observing insects, particularly ants, and he continued this interest the rest of his life.  While a medical student, he wrote a classic work on “The Ants of Switzerland” which earned him the Schlafi Foundation Prize and was recognized as an international leader in the field of entomology.  Forel studied the internal anatomy of ants and proposed a new taxonomy for these insects.  He was first to describe the phenomenon of ant farming (cultivation of fungi) and ant cattle (the raising of aphids).  Forel made many wonderful observations in regard to the social organization and instinctive behaviors of ants which he used to illuminate his subsequent writings about human society and world peace.  In 1914, when he donated his ant collection to the Zoological Museum there were two entire truckloads of specimens.  He had personally collected six thousand species of ants, thirty-five hundred of which, he had personally discovered and named in his worldwide travels.

     In his autobiography entitled Out of My Life and Work, he describes how he, while a student in Lausanne, became fascinated with the works of Charles Darwin which ultimately influenced him toward his studies in medicine, neurology, and psychiatry.  He had been introduced to Darwin’s works by his fellow student and future brother-in-law, Edouard Bugnion.  Together they matriculated in the University of Zurich where he completed his studies in 1872.  Forel received his doctorate for his work on the anatomy of the Optic Thalamus under the guidance of Theodor Meynert of Vienna who was considered the leading expert on brain structure of that day.

     Dr. Forel, after completing medical school took a position as an assistant to Dr. B.A. Von Gudden in Munich where he continued his studies in Neurology.  He invented the microtome which allowed for the first time thin microscopic sections of the human brain.  This event alone should ensure his place in medical history.  Forel expanded and corrected many previous misconceptions about brain structure and described in great detail the trigemnal, pneumogstric, and hypoglossal nerves.  His studies included the hypothalamus where one of the structures was named “Ventral Tegmental Decussation of Forel” in his honor.

     It is interesting to note that his successor at Munich was not less than Emil Kraepelin who eventually became known as “the great classifier” of mental illness.

     In 1879, while only 31 years of age, Forel assumed the Directorship of the Burgholzli Asylum and also was appointed Professor of Psychiatry at the University of Zurich.  He held this post until his early retirement in 1898.  When Forel assumed the directorship of the Burgholzli, he inherited a government run institution which was in disarray.  There were various abuses of the patients by the staff, financial and political corruption, with even a tavern and brothel on the hospital grounds.  He and his young assistant Dr. Laufer had to literally fight with and drive off intruders who were disappointed in the closing of these local institutions.  It is to Forel and his medical administrative abilities, often willing to struggle publicly and in the press with local politicians, that the Burgholzli became one of the preeminent institutions for the mentally ill in Europe.

     In August of 1883, he married Emma Steinheil.  Forel was 35, Emma was only 18 years old.  She was the daughter of one of his best friends and fellow entomologist, Edouard Steinheil who tragically died on one of their bug gathering trips to Central and South America.  Steinheil died of tropical heat stroke, misdiagnosed as Yellow Fever.  Forel never forgave himself for not being able to save his friend.  Emma became a wonderful helpmate for him in running the Burgholzli asylum; in that, she provided a mother figure for the institution and organized entertainments for the patients in the form of concerts and other cultural events.  She was quite talented musically while Forel was not.  The Forel’s had six children, two of whom became physicians, Edouard and Oscar.  Martha, his oldest daughter married a physician, Dr. Brauns.

     Forel introduced modern advanced treatment techniques at the Burgholzli Asylum and those that could not be adapted from elsewhere were invented by him.  Parallel to S. Weir Mitchell’s work, he introduced the “rest cure” which involved humane care, proper food and recreations, as well as educational pursuits for the patients.  Forel is credited with having invented occupational therapy, consisting of arts and crafts activities, as well as meaningful work around the institution.  He became interested in hypnotism long before Freud and culminated this interest by studying with Dr. Bernheim at Nancy.  In 1894, Forel published Hypnotism or Suggestion and Psychotherapy.  This book went through many translations and revisions and was widely used as a textbook in Europe.  Forel was a gifted hypnotist and trained many psychiatrists in the skill, including Eugen Bleuler who became his assistant at the Burgholzli in 1885.  Bleuler became best known for inventing the term schizophrenia.  In the book he described dreams, the unconscious mind, the levels of sleep, hypnotic techniques, a fascinating case of “double consciousness” which was one of the earliest descriptions of multiple personality disorder.  There is a most fascinating chapter where a hypn