Introduction

I am most pleased to have been asked to join the truly distinguished list of neuropsychologists to give tribute to Ralph M. Reitan. Realizing that these neuropsychologists will unquestionably cover a host of now well-established contributions of Dr. Reitan, I have chosen to make this more of a personal tribute to him, and to do it from the perspective of 50 years of influence upon my professional life. While it is not possible to write a personal tribute without reciting some stories of interactions with him, the intention is not to regale the reader with such stories but rather to convey specific areas of professional influence. I will focus upon those areas of professional influence which I believe have enduring value for neuropsychologists generally and especially for students of neuropsychology. To make these areas easy to see, I will present a summary statement of each of them in Bolded italics.

The Early Years (1965–1969)

In August 1965, I began my work as a Psychology Trainee at the Veterans Administration Hospital in Danville, Illinois. I actually started my work there before I attended my very first graduate class at Purdue University in West Lafayette, Indiana. Further, I met Dr. Reitan in my first days as a Psychology Trainee, and this was because Angela Folsom, PhD, supervising psychologist, had him come as a consultant to the psychology training program. While my first contact with him was 50 years ago, I still remember parts of it very well. I found him to be mild mannered and likeable, and he liked me. The major function of that contact was to connect me with him and him with me, connections which quickly became fruitful.

In 1966, I began to plan my master's thesis and with my interest in neuropsychology already well established, I consulted Dr. Reitan about a plan and a design. It was decided that I would do a lateralization study comparing groups of left hemisphere damaged, right hemisphere damaged, and bilaterally damaged adults on perceptual, cognitive, and motor measures from the Halstead–Reitan Neuropsychological Test Battery (HRB). It was, of course, impossible for me to collect data alone on any significant number of lateralized patients, much less with patient groups matched for age, sex, and type of neurological problem, so Dr. Reitan agreed to provide the data. My master's thesis committee agreed to this plan, and so I spent most of my time on my thesis not collecting data on the cases but on learning from the performance of detailed analyses on many HRB variables. The thesis into which Dr. Reitan had nudged me provided knowledge of neuropsychology of such depth and breadth that it was probably the equivalent of an entire postdoctoral year of study.

The generosity and time offered by Dr. Reitan to a wet-behind-the-ears graduate student provided the foundation for my entire professional career. While not all of our students will profit to this degree from the time and effort we expend upon them, we need to be aware that some of them will so profit and we need to spend extra time with students.

With my master's thesis done and the degree awarded in June 1967, I determined to get actual experience in an established neuropsychological laboratory with neurological patients. At the Psychology Clinic of Purdue University, I had been referred many of the students who had come in with neurological complaints, but I knew that I was doing too much fumbling with the partial HRB available to me, and I had no neuropsychologist from whom I could learn. Dr. Reitan agree to hire me as a Laboratory Assistant, and from March 1968 through August 1969, I spent as many days in his laboratory in Indianapolis as I could, and it was typically 3–4 days per week. This was incredibly influential for reasons I will now reveal.

First, just as I started my time in the laboratory, Dr. Reitan experienced a difficulty with a postdoctoral fellow. The fellow had made a bad error in test interpretation which he never would have made had he been more familiar with the tests (in those days, such fellows typically had a fairly brief exposure to the test battery and then they would begin interpretation soon in their tenures in the laboratory). Dr. Reitan was truly angry about this, and so at the start, he told me that I would be learning the tests inside and out, up and down, and back and forth until I knew them extremely well. That is just what happened. I was instructed in detail in testing by a highly skilled psychometrist, Susan Moore, and tested repeatedly by Jan Janesheski who took delight in stepping into the roles of incredibly difficult neurological patients. I began to administer the tests to neurological patients referred to Reitan's laboratory, and I did that on many occasions until Dr. Reitan (who was interpreting the tests I was administering) thought that I knew the tests extremely well. Only then did I begin to learn interpretive skills. I do not know of anyone else trained in Dr. Reitan's laboratory who had this huge emphasis upon testing.

One more comment about testing is necessary. I was in a challenging PhD program in Clinical Psychology which would certainly meet or exceed professional standards everywhere. This included training in the administration and scoring of a variety of tests such as the Wechsler scales, the Stanford-Binet, etc. However, when I got to Dr. Reitan's laboratory, I found that the standards were higher. Not only was there attention to giving every single test correctly, but every item had to be scored correctly as well because every item of every test was checked by someone else. I was brought up short when it was found that I had made errors here and there, and it presented an awkward situation for the psychometrists doing the checking who routinely had never been to graduate school. I soon learned to pay extremely close attention to what I was doing and the entire experience resulted in the practice of having every item of every test checked when I set up my own laboratory.

I have always thought that the emphasis upon learning the tests inside and out was the greatest professional impact that Dr. Reitan had on me. I knew the tools in my toolbox, and I knew them very, very well. This gave me the foundation for setting up my own neuropsychology laboratory and for training psychometrists decade after decade to give the tests precisely correctly. On this foundation I built my knowledge of interpretation and clinical work, my research, and my career.

During the months I worked in the laboratory, I learned other things. One was to think through the matter one was going to discuss with Dr. Reitan before starting a discussion with him. On more than one occasion he snapped at me when I made a comment which did not seem correct to him about a set of test results, a research paper, or the meaning of something in the realm of neuropsychology. The clear thrust of his remark was that what I had said was not very well thought out, and perhaps even somewhat stupid. I became afraid of him. However, even though I could never be described as impulsive or as a know-it-all, I started watching much more closely what I said. I made it a point to think through matters carefully before I spoke, and I did this throughout my career. When I did not know quite what to say, I learned to ask a question rather than make a comment. To Dr. Reitan, this was typically, “What do you believe …?” about the topic at hand.

Sharpening my thinking was a significant point I learned from Dr. Reitan. While my undergraduate and graduate professors were truly helpful, none were as helpful as was the direct and uncomfortable approach of Dr. Reitan.

With the administration and scoring of tests firmly under my belt, I spent much of the rest of my time in the laboratory on interpretation. Sometimes I got to sit in the office of Homer Reed while I studied cases, but most of the time I spent in the storeroom where I made for myself a small space to study. I used books of test results which were assembled in such a way that the data from the tests were provided in summary form with the responses on the Aphasia Screening Test and the Sensory-perceptual Examination. However, nothing else was provided, no referral question, no neurological information, and no report. After completing the analysis of the data and preparing at least the outline of a report, one could flip to the next page and find out what type of brain lesion was actually present, where it was, and other information.

One day, after spending significant time on a case and preparing, in writing, a brief report with a statement as to what type of lesion I believed was present and where it was, I flipped the page. However, the page had on it a single word: “Normal.” A normal control subject had been put in with the neurological cases. Flabbergasted, I turned back to examine the test data once again. I knew that the overall performance of this subject was quite good, but I had found a couple of lateralizing indicators (diminished motor performances with the left upper extremity, as I recall) which agreed with each other and I had drawn erroneous conclusions based upon those indicators.

The error I had made had a lasting impact upon me. I realized that in order to understand what was abnormal neurologically, I had to know what was normal. Consequently, when I developed my own neuropsychological battery in the 1970's, it was squarely based upon a sample of adults with completely negative neurological histories (Dodrill, 1978). It is almost impossible to convey to the reader the value of actually administering to persons with no neurological history whatsoever the battery of tests which one proposes to administer to persons with suspected cerebral problems. The reason is because of the fluctuation found in totally normal persons. At times, it is truly striking.

Insisting that one have a good understanding of what constitutes normal performance was a major contribution to my professional work with neurological patients.

The last item to be mentioned in the early years of contact with Dr. Reitan is my participating in the workshops that he ran during the last half of the 1960s. People came from far and wide to learn about this new area of neuropsychology, and not only did I attend these workshops, but I actually taught in one of them, introducing psychologists to the tests. Sitting through the workshops, I filled in gaps in my knowledge of the basics of Reitan's approach and I also came to understand where psychologists at that time were coming from, the concerns that they had, and the errors that they tended to make.

Dr. Reitan taught the basics of neuropsychology including the following: (1) that the objective of establishing the presence or absence of “organicity” was a grossly inadequate goal; (2) the use of a broad battery of tests was essential in order to sample the wide range of brain functions; (3) the battery must include a focus upon tests which have been empirically shown to discriminate between persons having normal histories and those with clearly established neurological disorders pertaining to the brain; (4) the tests needed to be selected in such a way that they provided complimentary methods of making inferences about the nervous system—level of performance alone was not adequate; and, (5) certain principles of interpretation formed the basis upon which the test results for individual patients were approached.

By August 1969, all foundational work in neuropsychology was done, and I headed off to my clinical internship year.

The Middle Years (1969–1976)

My predoctoral internship (September 1969–August 1970) in Medical Psychology was at what was then the University of Oregon Medical School in Portland, Oregon. It was under the direction of Joseph Matarazzo, who along with his staff had been significantly influenced by Dr. Reitan. The HRB was in use, and my internship had a sprinkling of neuropsychological cases among the general clinical patients I saw. I will not comment upon this extremely strong internship farther except to say that I was in touch with Dr. Reitan during this year. He was not able to provide a position for me upon completion of my doctoral work as it was in 1970 that he moved from Indiana to the University of Washington School of Medicine in Seattle. Consequently, I taught undergraduate psychology at Westmont College from the fall of 1970 through the spring of 1973, obtaining the full HRB testing materials and doing what neuropsychology I could.

Early in 1973, I was contacted by Ralph (I now felt comfortable in calling him by his first name) who informed me that there was a faculty position available in epilepsy in his Department of Neurological Surgery at the University of Washington. He paved the way for an interview visit after which I was hired, and I began work in June 1973. Ralph's bringing me to Seattle unquestionably formed the basis for my entire career in neuropsychology. I never left UW and at the time of writing the present paper, I am Professor Emeritus.

Serving as a faculty member alongside Ralph was interesting. Even before I was hired, he advised me of limitations in the position and personnel and of things to watch for. Once on site, I had a single supervision session with him in which he outlined the principal things in our department of which I needed to be aware, the unquestioned publish-or-perish situation, and some specific thoughts about where I might direct my publications. That was our first and last supervision session, and he expected me to make it on my own from there. At the same time, when I had questions, he offered sage advice, and he always informed me of important happenings in our department of which I needed to be aware. I had other contacts with him from time to time, but he was very busy during this period writing grants. Unfortunately, most of them were not funded, and he left his position in mid-1976 and went to Tucson while I remained at the University of Washington for the rest of my career.

While he was still at the University of Washington, I launched a very serious effort to develop a neuropsychological battery to evaluate adults with epilepsy. It was not enough to merely use a generally good battery of tests. Rather, the assignment I was handed as a young Research Assistant Professor by the Department Chairman Arthur Ward, MD, was to come up with a battery of tests specifically directed to the deficits found in persons with seizure disorders. That meant that the battery had to be sensitive to deficits associated with repeated seizures, cognitive effects of medications, and EEG abnormalities associated with epilepsy. By 1976, I had published in each of these areas and I had also seen several hundred adults with epilepsy. I had begun with the standard HRB, but almost immediately I began to add additional tests including the Wechsler Memory Scale, the Seashore Tonal Memory Test, and my version of the Stroop Test. I furthermore found it useful to handle some of the HRB variables in different ways including quantifying all performances on the Aphasia Screening Test, quantifying name writing speed in terms of letters/second (with a right–left comparison) from the Lateral Dominance Examination, quantifying errors on the Sensory–perceptual Examination, and evaluating results on Finger Tapping based upon gender because of the substantial differences between men and women on this test. All of these variables held up through both a rigorous validational study (Dodrill, 1978) and were used effectively through the rest of my career.

Ralph definitely did not like the changes I had made in the battery for various reasons. For example, he thought that the language-related errors on the Aphasia Screening Test should not be quantified since this test provided data for a “sign” approach to neuropsychological inference. He recognized that men tapped a little faster than women related to hand size, but he did not consider the difference worthy of attention and of the different norms I developed. He could see why I selected the Logical Memory and Visual Reproduction portions of the Wechsler Memory Scale—Form I, but he thought he could get the same information from the rest of the battery. And, he was not happy that I had dropped the Speech-sounds Perception Test when it failed to demonstrate value with my epilepsy cases. He would discuss these changes with me bringing to my attention points I already knew, but in the end, when I did not change, he did not make it a “do or die” situation, and on a somewhat reluctant level, he let me proceed.

Supporting young colleagues, guiding them, and giving them the freedom to pursue their own avenues of thinking are some of the best things that senior neuropsychologists can do. By doing this for me (probably despite some reservations due to the independent thinking I had shown in Indiana), Ralph got me into the job setting of my lifetime and into a truly rewarding career. When I went down different lines of thinking from his, he did not break off the relationship.

The Later Years (1976 and Beyond)

These were middle and latter career years for me, and Ralph was gone. Nevertheless, we still saw each other at meetings. I went to his workshops periodically, and when Deborah Wolfson came on board, the contacts increased somewhat. In 1992, I was Program Chair for Division 40, and that year APA had its 100th year anniversary with a convention in Washington, DC. I got Ralph to come and give a 1 h address right in the middle of the meeting. It was in fact on August 16, 1992. He spoke very well, hundreds of people came, and it was a huge success. I felt that this was one of the best ways in which I could honor the most influential person in my professional life.

Contacts continued at intervals, and I even contributed to his workshops periodically, the most recent of which was in 2004 when I gave a paper on “effort” and its effects on neuropsychological variables. Perhaps it was because he and I agreed so closely or perhaps it was because I had generated new data on this variable which he did not have that he was enthusiastic about this paper. At any rate, it was one of the last things we did together, before his health failed too badly, and it was a fitting end to these types of contacts.

The final area of huge professional influence that simply must be covered in the later years is that of his influence upon my research productivity. There are three aspects of his influence here which deserve special comment.

First, I was greatly influenced by his research productivity. Everyone knew that he was very productive, of course, but I know of no one else other than myself who went through his Vita and figured out that approximately every 60 days, he had published a research report for many years. I took this as a direct challenge to do the same thing. To monitor my own progress, for decades, I posted a yellow sheet of paper on the wall directly in front of where I sat at my desk. I glanced at it frequently and noted how long it had been since I had sent off the last research article to a journal. I also kept a running tally of average number of days per publication since I assumed the University of Washington job in June 1973. The goal was to get the number down to 60, and at one point, I actually had the number down to 63—every 63 days on average I had a research-based publication out since I had been hired. While I never reached 60, this goal was ever before me through my career, and it lead to my publishing 170 data-based research papers as well as a number of papers and chapters that did not report new data.

Second, it was Ralph who pointed out to me the possibility of doing the writing of a complete research report in a single day. This is viewed incredibly by almost all neuropsychologists today who see a research paper as an effort which will certainly require weeks to months and a large number of hours. But, I learned that this is a perceptual set which routinely leads to getting very little research ever published. The problem in getting the paper out is routinely the writing of the paper, not the data collection nor the analyses. Often, data are collected and analyzed and maybe even presented at meetings, but the paper never gets written and therefore never published. And, as Dr. Ward used to say, “Unpublished research is no research at all.”

Here is how I learned that one can put into practice Ralph's idea of writing up a study in a single day: (1) record test data in a uniform way for each patient by putting all summary test scores on one side of a single sheet of paper and on the other side of the sheet putting the neurological criterion information about the patient (I noticed that the use of 4 × 6 cards for data in Ralph's laboratory did not allow enough room for the data and also that these data were separated from the critical criterion medical information—it is much better to keep them together); (2) have the data entered into the computer on a regular basis; (3) analyze the data in various ways as you get ideas and as you hear talks and read papers by others, focusing on the occasional idea where the data show that the results will make a contribution to the literature and discarding all other analyses; (4) type the data analyses up in tables which will be part of the manuscript you send to the journal and have them in front of you in hardcopy as you type the text; and (5) get all the background articles you wish to cite in front of you.

Having done the above, you can write a draft of most short and medium scientific papers in 1 day. The Abstract is one paragraph, the Background is two to four paragraphs, Methods are two to five paragraphs, Results are two to four paragraphs, and Discussion need be no longer than six paragraphs. Say 15–18 paragraphs altogether for a medium-length article, and for a short one 6–10 paragraphs. Sure, you will then have to polish it the next day and hopefully get it to a colleague before sending it out, but Ralph taught me that it just is not that difficult to write these papers. A perfect example is a medium-length paper I wrote with one of my psychometrists in a single day, and this was a complicated project with a test–retest data on control and experimental groups (Dodrill & Thoreson, 1993).

Thirdly, Ralph taught me to always be eager to do the next project, answer the next question, and explore interesting matters farther. I was not with him near the end of his life, but I will bet that he still had areas of inquiry in the back of his mind and studies that he would like to do. That is exactly how he reported it was for Ward Halstead near the end of his life, and so it is for me even though I am now retired. A continuing curiosity is what he conveyed.

As a closing tribute to Ralph, I would now like to present very briefly some summary data on a variable which he was interested in but could never collect. The variable is footedness. At times, he spoke about Hal Klove's Foot Tapping Test, but when I asked him why he did not give the test, he said it was because the battery was too long as it was. But, he wondered how foot dexterity and foot preference might relate to brain functions. Unfortunately, his employment situations never allowed him to give even one intracarotid amobarbital or Wada Test to positively determine the cerebral hemisphere associated with speech, and thus he was never able to connect either handedness or footedness with this variable.

I had given 956 of these amobarbital procedures over nearly 30 years using a standard technique (Dodrill, 2004), and in 2003, I assembled the data on these cases and presented them in Grand Rounds to the Department of Neurological Surgery. At that point, I had 886 cases on which speech lateralization could confidently be determined as Left, Right, or Bilateral as based upon unequivocal speech blockage and/or object naming errors. These patients averaged 30.35 years of age (SD = 11.47; range 7–70 years) with 51.3% female and 48.7% male. On every case, I had hand preference (hand used to write) and in 845 cases I also had foot preference (foot used to illustrate how one would punt a football—shown to be very reliable in Dodrill & Thoreson, 1993). As these data have never been published, and as Ralph would have had an interest, I present them here in summary form as a kind of tribute to him in his quest for continuing knowledge.

Table 1 summarizes the data. As the Fisher's exact statistics show, side of speech is very strongly related to handedness. This is a surprise to no one, but that footedness is also strongly related to side of speech is a surprise. Furthermore, when the two variables are put together, one gets slightly better discrimination than when either variable is considered alone. For example, among people who are both left handed and left footed, there is only a 35.2% chance that there is typical (left) speech lateralization. I do not believe that Ralph ever saw these data, but he would have been interested in them, and he would have had a host of questions to investigate next. That would be typical for him. It is this continual curiosity of his that grabbed me and left an enduring impact.

Table 1.

Lateralization of speech in relationship to handedness and footedness

Lateral preference Speech lateralization
 
Fisher's exact 
Left Right Bilateral 
Handedness (n = 886) 
 Right (n = 716) 663 (92.6%) 17 (2.5%) 35 (4.9%) 0.4−32 
 Left (n = 170) 91 (53.5%) 53 (31.2%) 26 (15.3%)  
Footedness (n = 845) 
 Right (n = 727) 664 (91.3%) 23 (3.2%) 40 (5.5%) 0.1−28 
 Left (n = 118) 57 (48.3%) 45 (38.1%) 16 (13.6%)  
Handedness + footedness (n = 845) 
 RH/RF (n = 658) 612 (93.0%) 15 (2.3%) 31 (4.7%) 0.4−36 
 RH/LF or LH/RF (n = 99) 78 (78.8%) 11 (11.1%) 10 (10.1%)  
 LH/LF (n = 88) 31 (35.2%) 42 (47.7%) 15 (17.1%)  
Lateral preference Speech lateralization
 
Fisher's exact 
Left Right Bilateral 
Handedness (n = 886) 
 Right (n = 716) 663 (92.6%) 17 (2.5%) 35 (4.9%) 0.4−32 
 Left (n = 170) 91 (53.5%) 53 (31.2%) 26 (15.3%)  
Footedness (n = 845) 
 Right (n = 727) 664 (91.3%) 23 (3.2%) 40 (5.5%) 0.1−28 
 Left (n = 118) 57 (48.3%) 45 (38.1%) 16 (13.6%)  
Handedness + footedness (n = 845) 
 RH/RF (n = 658) 612 (93.0%) 15 (2.3%) 31 (4.7%) 0.4−36 
 RH/LF or LH/RF (n = 99) 78 (78.8%) 11 (11.1%) 10 (10.1%)  
 LH/LF (n = 88) 31 (35.2%) 42 (47.7%) 15 (17.1%)  

Note: Handedness is determined by the hand used to write. Footedness is determined by the foot used to illustrate how one would punt a football.

Encouragement of research productivity, making it easier to write up research findings, and promoting continual curiosity in the pursuit of neuropsychological knowledge is something that Ralph did very well. I hope that we can do equally well with our colleagues and students.

Conclusions

As I indicated at the beginning of this paper, my intention here has been to convey the professional influences which Ralph Reitan made to me and which I believe have enduring value to neuropsychologists generally and in particular to students of neuropsychology. It is my hope that I have done so faithfully and in a way that others can profit from his influence for the indefinite future. Clearly, I am in huge debt to him, and I believe that all of us are as well.

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