William B. Carey: TRIBUTE TO ALEXANDER THOMAS

I am Bill Carey, a pediatrician from Philadelphia. I had the pleasure of knowing Alexander Thomas for the last 35 years. I speak here today as a representative non-psychiatric colleague from outside of New York, called upon to present an independent view of the man and his works.

I join family, friends, and colleagues today in expressing our grief at the loss of our dear friend but at the same time our joy in having known him. I shall describe our admiration for his professional work, the strong positive influence it had on so many of us colleagues, and our affection for the man.

Alex was a New Yorker by birth and by persuasion. He graduated from high school at 14, college at 18, and NYU Medical School at 22. A major developmental milestone during this impressive set of educational achievements was meeting his fellow medical student, Stella Chess. She has revealed that what swept her off her feet was his ability to explain things. They were married soon after, when he was 24, thus beginning a most remarkable personal and professional alliance. As with Alex, her family was of eastern European origins. She brought with her a further infusion of diligence, self-reliance, independence, and dedication to human service.

After a few years in general medicine, he served as an Army medical officer from 1942-1946. During that period he discovered his interest and talents in psychiatry. Following discharge he pursued formal residency training in that field, and then entered practice. Subsequently his managerial and diplomatic skills resulted in his being appointed Director of Psychiatric Services at Bellevue Hospital from 1968-1978.

The zeitgeist or received wisdom of the 1940's and 1950's was that the environment, and in particular the child's mother, was responsible for all of children's behavioral and emotional problems. A major turning point in the careers of Alex and Stella came in 1952, when they began increasingly to recognize the inadequacy of that explanation. Their own clinical observations and their experience as parents informed them that their teaching had been incomplete. By 1956 they had shifted their main research focus to temperament differences in children, those largely innate behavioral style traits that influence how the individual experiences and responds to the particular environmental setting.

Thus began their New York Longitudinal Study, which defined the nature, clinical significance, and appropriate management of these temperament variations. Their extensive evaluation of 133 New York children over a period of 30 years has become one of the most important advances in the world's thinking about human development. Alex and Stella were not the first in the modern era to consider temperament but they did launch and complete the first, and still the most important, long-term study of it. They demonstrated the clinical significance of these differences for the development of normal and deviant behavior and how to manage them successfully. Their important concept of the "goodness of fit" explained that what matters most of all is not just the characteristics of the child or of the environment but the harmony or disharmony between them. Many of the adjustment problems in the child could be resolved simply by helping the parents to understand and tolerate better the temperament of the child and work with it rather than against it. As stated by the eminent psychologists, Patricia and Jacob Cohen, "It is hardly an exaggeration to say that empirically based modern American child psychiatry began with Stella Chess and Alexander Thomas."

The mental health establishment did not immediately embrace these brilliant insights. Some of them vigorously defended the prevailing environmentalist view, while others seem to have attacked for the sake of attacking. Nevertheless, acceptance has come gradually and by now has reached the point where many have forgotten the fierce opposition they faced 40 years ago. Unfortunately, as so often happens in the history of new ideas, some current theorists have taken their advance and carried it too far. Some current speculation now holds that the brain of the child is responsible for virtually all of his or her adjustment problems and the environment matters little or not at all. One must optimistically hope that soon the fallacies of this excessive emphasis on nature will become as evident as was the excessive emphasis on nurture of 50 years ago, and that all of psychology and medicine will before long reaffirm the interactionist view of Thomas and Chess. They got it right, and will increasingly be recognized for having done so.

When a team collaborates as did Stella and Alex, we wonder who contributed what. Several observers have offered the view that, although their work was a joint effort, Stella provided more of the detailed observations and descriptions of individuals while Alex was more the organizer, generalizer, and synthesizer. An astonished psychiatric colleague once commented to Alex, "I haven't found a psychiatrist like you who wasn't in competition with his wife." Alex's response was "What's the point?

The impact of their work on their colleagues has been enormous. Sir Michael Rutter, who spent a formative six months working with them in 1962 and is now the most eminent figure in child and adolescent psychiatry in the United Kingdom, offered this evaluation: "The mark of greatness in any new idea is to be found not in the extent to which it proves correct in all its details but rather in the extent to which it fosters new research that carries the field forward. It is obvious that the Chess/Thomas writings on temperament rate very high by that criterion, and deservedly so."

Here are some examples. A review of the contributors to the Festschrift for Stella and Alex assembled by Sean McDevitt and me in 1994 (and two other anthologies) demonstrates the diversity of topics, professions, and locations to which their influence has spread: developmental psychologists from Poland to Spain, Hawaii, Japan, and Australia; educational psychologists in Georgia, California, and South Africa; neurologists in New York; psychiatrists in Quebec, Finland, East Africa, and India; parent counselors in Minnesota, Oregon, California, and British Columbia, pediatricians in Italy and China, etc. Their influence has been extensive and has yet to reach its full potential.

But what of Alex, the man? Members of his family will have more to say on this matter. As a colleague, I saw in him: the brilliant insight to recognize that the received wisdom of 50 years ago was not in agreement with practical experience, the diligence to create and carry through a massive research project to get a more accurate view, the courage to present the unorthodox findings to his critical colleagues, the tolerance and good humor to meet patiently their contrary arguments, and always kindness toward all and commitment to the welfare of children. As with all truly great men, he was humble. He modestly attributed much of his success to good luck: to be living in America, to having had a good education, and to marrying Stella, with whom he shared so much in background and interests.

My personal relationship with Alex began in 1968, when I boldly ventured over to New York to see what he and Stella thought about my notion of a simplified questionnaire to facilitate parental reporting on the temperament traits of their infants. The long interview they had used in their research was not practical clinically. As always, they were friendly and supportive. Over the next 20 years, I published it, revised it, and developed four other scales for children of other ages with the collaboration of a group of psychologists, led by Sean McDevitt. These scales have been translated into many languages and used widely around the world. Stella and Alex aided us with their encouragement; we assisted them by demonstrating to skeptics that temperament can be fairly reliably assessed in minutes rather than hours. Also, among others we broadened further the areas of children's life beside behavior adjustment where their temperaments matter: in physical health care, development, school performance, and reactions to various stressors. This involvement allowed me to experience for myself the intellectual stimulation and sense of accomplishment from helping to clarify the true complexity of child development. With it came also the anguish of confronting the widespread indifference and often unreasonable criticism from colleagues that Stella and Alex had known.

In summary, Alexander Thomas was an authentic giant of modern medicine. His contributions to our understanding of human development are enormous. For many of us he was an inspiring role model, mentor, and friend. We colleagues who knew him are certain that his spirit lives on in us. He was also a great human being: wise, kind, and courageous. All of us will remember him fondly always.

William B. Carey, M.D. March 24, 2003