Frank Joseph Ayd
Authors: Jeanne Lenzer
Journal: BMJ (2008)

Frank J Ayd, a psychiatrist, is credited with ushering in the use of the first major tranquiliser, chlorpromazine (Thorazine), to treat schizophrenia in the early 1950s. Ayd became one of the pre-eminent advocates of biopsychiatry when most academic psychiatrists embraced a psychoanalytic model of mental illness.

When Ayd first studied the use of chlorpromazine the only treatments available for schizophrenia were extreme, including measures such as lobotomy, insulin shock therapy, electroconvulsive therapy, and permanent institutionalisation. The advent of the use of chlorpromazine triggered a “momentous sea change in the practice of psychiatry,” says Robert T Rubin, professor of psychiatry at the University of California, Los Angeles.

Ayd did not start out wanting to be a psychiatrist. As a young man he hoped to become a paediatrician like his father. He was exposed to the medical world early. His grandfather, a family physician who ran a pharmacy from his office, sent the young boy off on bicycle errands to deliver medicines to patients in their homes.

Ayd entered a paediatric residency at the University of Maryland Medical School after graduating from Loyola College in Baltimore in 1942. Just two years into his training, the US Navy called him to active duty. In a 1994 interview with Leo Hollister for the American College of Neuropsychopharmacology, Ayd relates what happened next: “In the incomprehensible way the navy does things I was assigned to surgery at Bethesda Naval Hospital.” But he had “no manual dexterity whatsoever and no interest in surgery.” After just three weeks of surgical training, he could bear it no longer. He told his commanding officer that there had been a terrible mistake. The officer told Ayd that the navy needed psychiatrists and reassigned him to the Veterans Administration hospital at Perry Point, Maryland.

Ayd was appalled by his new assignment, calling it a fate worse than death. “I had no real interest in psychiatry,” he said. Nonetheless, Ayd decided that he could at least take care of the “physical aspects of things.” But on arriving at Perry Point, he became fascinated by the veterans he saw, some of whom were violent or heard voices. One of the first things he noticed about schizophrenic patients was that they appeared to have a strange absence of sensitivity to temperature or pain.

Even though patients had to walk three quarters of a mile each way from their ward to the dining hall to eat—sometimes during freezing weather—the attendants “had to fight these guys to put on a coat,” he observed. One patient “stuffed himself with newspaper and ignited it, and when I got there he was pretty badly burnt, but he was still sitting there, hallucinating and answering to voices. We never gave him any morphine. He didn’t need it.”

Another experience dramatically affected Ayd’s views on psychiatry. His father, diagnosed with manic depression, was treated with electroconvulsive therapy. The effect, said Ayd, was “dramatic.” His father recovered soon after treatment and, according to Ayd, didn’t require hospitalisation again. Ayd did allow, however, that the shock treatment “was a rather crude thing [that produced] a lot of memory impairment.”

Ayd received the first permit from the Food and Drug Administration to treat schizophrenic patients with chlorpromazine. The drug, he said, could make a change in a matter of hours in quite disturbed individuals: “They were still hallucinating and they were still deluded, but by God they were changed.”

He tested other drugs on his patients with greater and lesser degrees of success, and his experience led him to become, in his own words, “St John the Baptist in the wilderness preaching the gospel of psychopharmaceuticals and their potential value for people.”

Although Ayd was known for his aggressive testing and interest in promoting psychotropic medicines for patients, he was said to be equally aggressive in studying the worrying side effects of the psychiatric medicines. “I was very interested in adverse effects . . . for every blessing there can be smite; you can help and you can smite people with these drugs,” he said.

Well before widespread concerns were raised about the deinstitutionalisation of psychotic patients, Ayd worried that too many patients taking major tranquilisers were being released into the community without adequate support systems in place. His concerns were prescient; several decades later, Professor Rubin says that “poor planning” led to a massive deinstitutionalisation movement in the 1960s that is still having detrimental effects for a number of schizophrenic patients who, lacking adequate support, are now homeless and filling up prisons. “There’s a belief that the Los Angeles jail is the biggest mental hospital in the country,” said Rubin, who says that although the major tranquilisers have helped many patients hold down jobs and have stable family lives, they are not effective in many others.

Ayd played a key part in establishing the American College of Neuropsychopharmacology. He served as chief of psychiatry at Franklin Square Hospital in Baltimore from 1955 until 1962 and lectured in Europe at the Pontifical Gregorian University in Rome between 1962 and 1965. In addition to his hallmark book, Lexicon of Psychiatry, Neurology and the Neurosciences, he wrote over 400 articles and contributed to over 50 books. He retired in 2003 at the age of 83.

He is survived by his wife of 64 years, the former Rita Anne Corasaniti, 12 children, and 32 grandchildren.