Ralph Reitan was introduced to neuropsychology as a recent college graduate in 1944, long before the term was commonly used. His first job, for which he received minimal training, involved working in an Armed Forces Induction Station, attempting to determine through interviews and tests whether illiterate inductees had the basic abilities to learn to read and write and thus be accepted into the army. We are not sure how accurate those predictions were, but one of the officers at the station was sufficiently impressed with Ralph that he recommended him for a job evaluating brain-injured soldiers at the Mayo Hospital in Galesburgh, Illinois. Ralph was fascinated by the difficulties and the recovery he observed in these patients, and struck by the lack of available publications in this area. He assembled a battery of measures that he hoped would capture the difficulties he was observing, and was able to enlist the help of his section chief, a neurologist named John Aita. Together, they published four articles in 1947–1948 on psychological consequences of brain injury.
It was Aita who encouraged Ralph to seek out Ward Halstead, a psychologist at the University of Chicago Medical School—Aita had chanced to hear a lecture by Halstead and thought he had unusual knowledge and insights concerning the effects of brain injury. Ralph did go to the University of Chicago, where he was fortunate to meet not only Ward Halstead, but also the eminent mathematical psychologist, Louis Thurstone. Both of these key figures were impressed with the young man, and encouraged and supported Ralph in entering graduate school in psychology. Through a combination of mishaps and serendipity, Ralph ended up taking an unusual course of study, split between the medical school and his “home” department of psychology, while he worked as an assistant in Halstead's laboratory. In that lab, he learned to test patients using the instruments Halstead had developed, expanding his knowledge of impairments in patients with brain lesions by observing their performances, deficiencies, and frustrations as they took the tests.
While he was still a graduate student, Ralph puzzled about how to use findings of group studies in individual cases, to draw valid conclusions about brain–behavior relationships. For this, he received important advice from Halstead that he kept throughout his research career: That advice was to be blinded regarding his criterion measures (medical/surgical/autopsy data regarding the condition of the brain) when initially interpreting his neuropsychological test results. He followed this approach with thousands of cases. His observations of individual cases led him to generate hypotheses that could then be tested by formal research with groups of patients, which in turn provided information regarding the generalizability of his observational findings. This process led also to his dropping and adding measures to the batteries that he developed, to make inferences not only about presence/absence, but also about the location, extent, and nature of the neurological condition of the brains of his subjects. He refined and standardized what most neuropsychologists now take for granted as they write their reports: the approach to inference in individual cases that takes into account such information as levels of performance, patterns of test results, right–left comparisons, and pathognomonic signs.
Ralph's approach has been characterized by some as atheoretical and descriptive. However, in truth most progress in medicine has resulted not from a top-down theory-driven approach [much as this sounds good in grant proposals], but in painstaking observations of phenomena, in finding relationships among observations, in building improved tools to make such observations, and ultimately in knitting these together into broader principles that can be subjected to further test. But without those validated and trustworthy instruments, no progress is possible. As a result, neuropsychological testing that has been built on his foundations can be performed reliably across many parts of the world, and data can be compared. And this has spurred enormous research internationally on causes and correlates of neurocognitive disorders.
While Reitan published extensively on the neuropsychology of neurologic and neurosurgical conditions, it should be noted that he also contributed pioneering work to our understanding that general medical conditions as well as addictions also can be associated with brain dysfunction. While often subtle in their manifestations, the CNS consequences of these conditions were shown to be appreciable through valid, reliable, and sensitive neuropsychological measurement. His early insights presaged development of neuropsychological understanding of alcohol abuse, substance abuse, hypertension, and elevated cholesterol.
There may not be any one father of neuropsychology, but certainly Ralph Reitan is among the founding fathers of the discipline as we know it. His distinguished academic career spanned six decades, and included professorships at the University of Indiana and University of Washington Schools of Medicine, and the University of Arizona Department of Psychology. He authored over 320 scientific publications, with an unusually high percentage of first authored works. Another major contribution to the field has been Ralph's enormous impact on the professional development and careers of a large number of other neuropsychology leaders, including Halgrim Klove, Charles Matthews, James Reed, Manfred Meier, Oscar Parsons, Byron Rourke, Paul Satz, Gerald Goldstein, Igor Grant, Sureyya Dikmen, Ken Adams, and Robert Heaton.
Of course, as in any evolving discipline, neuropsychology has not stood still. While many continue to find value in Reitan's original battery, others have modified it to address specific challenges, and to incorporate elements that were not strongly represented, e.g., more fine grained assessment of memory. However, Ralph's philosophy of empiricism, including standardization, cross-validation, and replication, has continued to guide such modifications, and in this way has produced logical successor batteries that remain true to his original concepts.
Perhaps the most fitting conclusion to this overview is a quote from Ralph himself:
From this, one can see Ralph's broad vision and commitment to linking neuroscientific understanding to measurements and measurement approaches; yet at the same time, the quote clearly reflects a humility that while much has been achieved, much remains to be done, and improved based upon new observations.
Our general purpose in developing … [a] … neuropsychological test battery was to reflect reliably, validly, and completely the behavioral correlates of brain function. Obviously, this aim extends beyond our current achievements … [but] … we have been able to make a reasonable start toward developing a fairly adequate neuropsychological test battery taking into consideration (1) major theoretical factors that involve nervous system functioning, (2) the range and type of measurements that must be included, and (3) the measurement strategies that are required … (p. 3, Reitan, 1986).