Tom Ban’s Eulogy by Jose de Leon*
I apologize to the reader if he/she thinks this is about Tom Ban. Yes, it is about Tom Ban, but it is also about me. Tom was my friend. Not only my friend. The Germans have this unusual concept of doppelganger (literally "double-walker") which describes a biologically unrelated look-alike, or a double, of a living person. Tom is my doppelganger; his approach to psychiatry and psychopharmacology is extremely similar to mine. In 2015 I wrote commenting on one of his writings (de Leon, 2015a): “Like Ban, I am a European psychiatrist transplanted to North America; therefore, my views on the interaction between psychiatry and psychopharmacology are very similar to his, and I consider his approach of using clinical symptoms (Ban 1987, 2007, 2013) to be one of the main ways that psychiatry can move forward with the “fantasy” of personalizing psychiatric treatments” (de Leon 2014c). Then there is the problem of the unfairness of Time. Tom started living before me and his writings were written before mine. So, reluctantly, I need to acknowledge I may be Tom’s doppelganger. Tom arrived in North America from Europe in 1957. I arrived in the United States in 1987. Tom moved to Vanderbilt University in Tennessee in 1976. I started at the University of Kentucky in 1996 (Kentucky is just north of Tennessee). Tom was director of a state-funded research institute (Tennessee Neuropsychiatric Institute) from 1976-1983. When I first visited Vanderbilt in 2019, I was told that the state of Tennessee had stopped the funding many years before so I could not apply for Tom’s position. That is my story: 20-30 years behind Tom. He arrived at the right moment and was part of the Great Generation of immigrants and US-born psychiatrists who carried the baton of psychiatry from Europe to the US (de Leon 2021). I am a 62-year-old man who feels closer to Tom and his generation than to my own generation, so I was born 30 years too late.
There are two parts in the story of my encounter with Tom; the first one is about Tom Ban, the scientific writer, and the second about Tom, my friend.
My encounters with Tom Ban, the scientific writer
I was trained in the early 1980s during a strange time for European psychiatry (de Leon, 2014a). After decades of arguing, the Central European psychiatrists interested in descriptive psychopathology decided to forget their minor differences and never-ending arguments about “small little” things and agreed on a vocabulary called AMDP. Sorry, too late. The AMDP was killed by the DSM-III so when I arrived in the US in 1987, I found that US psychiatrists did not know that AMDP existed. After much effort, I found that there was an English translation (Guy and Ban 1982). It was not easy, but finally I bought it and then I thought, “Who is this Tom Ban? What a peculiar last name!” I did not realize that Ban was a Hungarian last name; that was the next step.
In 1996, I started managing the treatment-refractory unit of the state hospital in Lexington, KY. For three years beginning in 1998, I had to manage a catatonic patient with a familial form of catatonia whom I diagnosed with periodic catatonia (Zwiebel, Villasante-Tejanos and de Leon 2018). None of my residents had heard of periodic catatonia or of Leonhard’s nosological system, which included periodic catatonia as a familial disease. Thus, to explain Leonhard’s nosological system, I ordered through the librarian in my department a copy of the DCR Budapest-Nashville issue (Pethö and Ban 1988). The same Tom Ban who was interested in translating the AMDP into English was also interested in translating Leonhard’s nosological system into English (he was not copying my interest in Leonhard; his publication came out 10 years before I got interested). He was at Vanderbilt and appeared to be Hungarian. As with all Hungarians, Tom Ban appeared to manage multiple languages, a side effect of learning the complicated Hungarian language (I have concluded that after learning Hungarian any European language of Indo-European origin appears to be extremely simple). Then I forgot about Tom Ban, the scientific writer, despite only a three-hour driving distance between Vanderbilt and my hospital. At that time I did not realize that I was Tom’s doppelganger.
My encounters with Tom, my friend
Then my life took an unexpected twist; I developed colon cancer which destroyed my plan to systematically study the philosophy of science and write an article in 2013 about the centennial anniversary of Jaspers’ book General Psychiatry, the apex of German descriptive psychopathology (de Leon 2015b). Next, in April 2013, after doing the “right thing” (the worst thing that you can do in a bureaucratic system), I was asked to stop running the most difficult state mental health facility in Kentucky and I almost got fired. Suddenly, I had so much unexpected free time that I could write the first article about Jaspers, which I titled “Is psychiatry scientific?” and somehow it was published in a Korean journal for the centennial anniversary of Jaspers’ book (de Leon 2013). Then things got really weird; one year later, I do not understand how, I was able to publish an article focused on the 100-year anniversary in the American Journal of Psychiatry (de Leon 2014b), despite the editor confusing Jaspers with Kraepelin (they are both “dead Germans,” after all, and “everybody knows” Americans are not strong in history).
Things got even much weirder for me. Per Bech was a Danish psychiatrist with expertise in psychometrics whom I have always admired from a distance. In 2009, Bech wrote an excellent article on Pierre Pichot, a French psychiatrist whom I also admired (Bech 2009). Then on April 11, 2010, I got the courage to email Bech about his 2009 article. On October 21, 2013, using my 2010 email as a baseline, I sent Bech my article titled “Is psychiatry scientific?” which quotes one of his articles (Bech 2010). Bech not only said that he had learned new things and liked my article, he also sent it to his friend Tom. Then the person whom I knew as Tom Ban, the scientific writer, called me on November 16, 2013, and became my friend, Tom. Tom wanted me to get involved in his project call INHN and make a comment on the classic textbook that Bech wrote called Clinical Psychometrics (Bech 2012) that Bech had sent me. That was my first collaboration with INHN, which I sent on March 29, 2014. In it I started debating with some of the persons (Don Klein) whom I knew only through their writings. As I said, things had turned weird. I started calling Tom several times a year, and then in a phone conversation in November 2019, Tom realized that my comment on Bech’s book had not been posted; he apologized and posted the comment (de Leon 2019).
Tom, my friend, encouraged me to post my CV and my psychopharmacology lectures at INHN. It looked weird to have my name in the same place as those important psychiatric researchers who were famous and 20 or 30 years older than me and from another better generation. Tom helped me contact his friends, who had been only scientific names to me. Since the first call from Tom on November 16, 2013, I have interacted with Barry Blackwell, Max Fink, Sam Gershon, Martin M. Katz, Don Klein and Edward Shorter, among others. I knew their names from their articles and books but before then I would never have dreamed that I would be interacting with them or receiving their compliments or critiques. I was nobody. I am a Spanish psychiatrist in the middle of nowhere taking care of the most difficult patients of my state because the university system of my country did not let me return.
Since 2013 I have been trying to get invited to Toronto so I could give thanks to Tom in person and give him a hug. It did not happen. On April 21, 2019, I lost my opportunity of going to Toronto for a family occasion. Time is an enemy that does not forgive. I never met Tom in person, although we spent many hours on the phone. As he gave me access to his friends, I tried to reciprocate, although my friends are not important in the medical community as his friends. For many years, I was trying to leave my job and my state. Tom tried to help me and tried to enlist his friends to find jobs for me; I continued to call Tom two or three times per year. Time is an enemy that does not forgive, so I stayed in Kentucky and in 2019 started an extremely busy and productive time in my research career. I came up with this “fantasy” of changing the clozapine package insert, having forgotten that I am not a pharmaceutical company (de Leon, Ruan, Schoretsanitis and Kane 2020). Since 2019, then, I have only talked with Tom once a year. On November 2, 2020, I emailed to compliment Tom for his best piece on descriptive psychopathology at INHN and send him the list of 25 clozapine articles I had written thus far. Tom answered the next day, “In some way it is good that you stayed in Kentucky. By moving into an administrative position some of your excellent papers would not have been written.” So, I felt very reaffirmed; Time had defeated me and at that time I was willing to finish my career in Kentucky, but Tom gave me hope that maybe some of these clozapine articles would survive the unforgiving enemy, Time. Speaking of time and death, I asked him to call by phone a mutual friend whose wife had died.
Time flew by. In February 2021 I started writing an international clozapine guideline with 104 authors from 50 countries/regions (de Leon et al., 2021). That year I only sent Tom two emails to share articles by two different psychiatrists whom we mutually admire. My plan was to call Tom once the guideline was published and email it to him. The publication was in the hands of Time and got delayed and delayed. I had forgotten that Time is an unforgiving enemy. Finally, on December 27, 2021, I e-mailed Tom the clozapine guideline and asked him when would be a good time to call. He answered, “Thank you Jose. This is impressive. Congratulations. Please call any time. If busy, please leave message and I will return your call as soon as I can. Take care, Tom.” I received that message late at night. The next day I called his phone without remembering that Time is an unforgiving enemy. I did not hear Tom’s voice; his son Chris answered the phone and told me than Tom had had a stroke. In that moment I knew that Time is an unforgiving enemy and had defeated me. I will never get to hug Tom or discuss with him my most important article, the clozapine guideline. Then I exchanged emails with Barry Blackwell about Tom and another friend. I told Barry about my interest about writing a personal eulogy for Tom and on December 30, 2021, Barry told me to do it. I could not do it; it was too soon. I am not Time.
On February 4, 2022, Chris emailed me, saying that they were moving Tom to palliative care. I knew that it was time to write this eulogy. INHN takes some time to post things. I started asking for forgiveness from the reader and I am also finishing by asking for much more forgiveness; scientists are “serious” people; they do not write literature, much less poetry. English is my second language. I am pretty incompetent with languages, unlike Tom. So, I should be happy that I have been able to master enough English to write scientific articles and not try to write poetry in English. This time, I feel that trying to master poetry may have better enabled me to pay homage to Tom, my friend. I do not know much poetry in English but one poem by the 19th century poet Gerard Manley Hopkins is coming to me during this time when I am losing friends. It is called “Spring and Fall.” The poet describes a girl who is weeping because she sees the leaves falling from the trees, the passing of Time (the unforgiving enemy); the last line is, “It is Margaret you mourn for.” As far as I can tell, Hopkins says that maybe Margaret is really weeping for her own future death. So, please forgive me; I am afraid I am using the excuse of writing this to mourn for Tom, but maybe I am just mourning for myself, for the loss of my friend and soon for my own death. Please, reader, forgive me for acknowledging my poor human nature; let me use the words of Hopkins for my apology: “It is the blight man was born for.” To lose friends and close relatives to the hands of Time, the unforgiving enemy in this world.
References:
Ban TA. Prolegomenon to the clinical prerequisite: psychopharmacology and the classification of mental disorders. Prog Neuropsychopharmacol Biol Psychiatry 1987;11: 527-80.
Ban TA. Towards a clinical methodology for neuropsychopharmacological research. Neuropsychopharmacol Hung 2007;9: 81-90.
Ban TA. Neuropsychopharmacology and the forgotten language of psychiatry. International Network for the History of Neuropsychopharmacology. inhn.org.ebook. November 14, 2013.
Bech P. Applied psychometrics in clinical psychiatry: the pharmacopsychometric triangle. Acta Psychiatrica Scandinavica 2009;120:400-9.
Bech P. Is the antidepressive effect of second-generation antidepressants a myth? Psychol Med 2010;40:181-1
Bech P. Clinical Psychometrics. Wiley-Blackwell, A John Wiley & Sons Ltd. Publication, Oxford; 2012.
de Leon J. Is psychiatry scientific? A letter to a 21st century psychiatry resident. Psychiatry Investigation 2013;10:205-17.
de Leon J. Is it time to awaken Sleeping Beauty? European psychiatry has been sleeping since 1980. Revista de Psiquiatria y Salud Mental 2014a;7:186-94.
de Leon J. DSM-5 and the research domain criteria: 100 years after Jaspers' General psychopathology. Am J Psychiatry. 2014b;171:492-4.
de Leon J. Focusing on drug versus disease mechanisms and on clinical subgrouping to advance personal medicine in psychiatry. Acta Neuropsychiatrica 2014c;26:327-33.
de Leon J. Comments by Jose de Leon on Thomas A. Ban’s RDoC in Historical Perspective and on Following Comments by Bernard Carroll and Samuel Gershon. inhn.org.perspectives. April 30, 2015a.
de Leon J. Is psychiatry only neurology? Or only abnormal psychology? Déjà vu after 100 years. Acta Neuropsychiatrica 2015b;27:69-81.
de Leon J. Per Bech: Clinical Psychometrics. Jose de Leon' s comment on Donald F. Klein's response to Per Bech's and Martin Katz's reply to Klein's comment. inhn.org.books. November 28, 2019.
de Leon J, Ruan CJ, Schoretsanitis G, Kane JM. Dose and safety concerns of clozapine: worldwide package inserts need revisions. Schizophrenia Research 2020;216:2–4.
de Leon J. Reflections on US Psychiatry: How the baton was passed from European psychiatry and the contributions of US psychiatry. Journal of Nervous and Mental Diseases 2021;209:403-8.
de Leon J, Schoretsanitis G, Smith RL, et al. An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels. Pharmacopsychiatry 2021 Dec 15. Epub ahead of print.
Guy W, Ban TA. The AMDP-system. Heidelberg, Germany: Springer; 1982.
Hopkins, GH. Spring and Fall.https://www.poetryfoundation.org/poems/44400/spring-and-fall.
Pethö B, Ban TA. DCR Budapest-Nashville in the diagnosis and classification of functional psychoses. Psychopathology. 1988;21:149-240.
Zwiebel S, Villasante-Tejanos AG, de Leon J. Periodic catatonia marked by hypercortisolemia and exacerbated by the menses: a case report and literature review. Case Report in Psychiatry 2018;2018:4264763.
*The author is grateful to Lorraine Maw, M.A. for editing this obituary late on the night when Chris Ban, Tom’s son, e-mailed to let him know that Tom had died.
February 24, 2022