Dr. Ralph M. Reitan was a very young, already full Professor of Neurological Surgery when I was hired as a technician (psychometrist) in the Neuropsychology Laboratory, Indiana University Medical center. The Lab was actively engaged in examining adults and children drawn from neurosurgical, neurological, and pediatric services. His associates initially were Hallgrim Klove and Homer Reed and later James Reed, who became a long-time friend. The Lab occupied a good portion of the third floor of Riley hospital at IUMC. If I recall correctly, there were 15 desks for technicians and visitors, and 8 offices.
Technician training, generally over a 6-week period, included strict memorization of test instructions for adults and children, and training in administration of IQ measures. Ralph was insistent about full memorization of his batteries to ensure standardization and collaboration of data. The verbiage and content of instructions had been researched by himself and Dr. Halstead, his mentor, who Ralph highly respected and admired. Prior to testing actual patients, new technicians were required to test Ralph, which in itself could prove a daunting experience. Once through such an exercise, a technician was considered well trained and prepared. Neuropsychologists were always available to technicians should problems arise. Ralph was incredibly understanding and tolerant of a mistake, but not its repetition.
Testing room doors were always ajar, and one could hear the same script when walking through the hallway. Four to five patients were examined daily, and depending on the patient's health and stamina, usually involved two or three 3 h sessions. Only technicians administered tests, not a neuropsychologist. Instead, the Lab maintained separation of the patient data and diagnoses from the test data until after the neuropsychologists had completed and submitted their analyses and conclusions in the patient's medical chart. Subsequently, information could be made available relative to the correlation and correctness of test findings and underlying etiology. I can attest to the fact that these reports were written blindly, as patient information was skillfully, and intentionally withheld. Ralph's intent was to identify the behavioral consequences of specific brain lesions on cognitive and adaptive behavior, without previous knowledge of independent neurological findings. Over time and with research, these interpretations became more extensive in terms of clinical applications for the individual adult and child. Critics have opined that the testing “took too long,” but Ralph viewed brain–behavior relationships as complex and far-reaching, not identifiable by a single test or a battery that explored only a predetermined diagnosis.
Ralph was prolific in terms of written production, which drew the attention of many psychologists who came to train as postdoctoral fellows. With supporting research and expanding interest in his methods, he also began conducting 3-day workshops, first at IUMC, with psychologists (some of impressive repute) from the United States, Canada, and abroad. His program always stressed the importance of standardized testing methods. He once asked, “Why don't people give these researched instructions the same respect as they do Wechsler's?” Voluminous hand-out materials were always provided to attendees. One of Ralph's most innovative handouts he referred to as the “Black Books” (referring to the color of their binders). He compiled cases that represented classic neuropsychological test results for specific neurological lesions and disorders. Information included only summary scores, aphasia and MMPI results, age, sex, and education. Patient protocols included right and left cerebral lesions with various diagnoses (i.e., intrinsic and extrinsic tumors, cerebrovascular disease, head injury, demyelinating diseases, alcoholism, dementias, etc.). Many psychologists expressed gratitude for the invaluable contribution of this learning exercise.
Ralph's research methods and findings resulted in active interest from NIH, NIDA, NASA, and the Armed Forces. Over the years at IUMC and the Universities of Washington and Arizona, numerous investigations were conducted including the impact on cognitive functioning of Agent Orange, PTSD, polydrug abuse, space travel, lead poisoning, head injury, aging, and minimal brain dysfunction, to cite a few. Ralph provided me with an opportunity to participate in many of these projects, as well as to train psychologists in private practice.
Ralph was consistently concerned about interpretation of the HRB on the basis of level of performance alone. His publications stressed the importance of the four methods of inference to be used in concert to interpret data. With the onset of brain scans, some critics felt that there was little use for the HRB, believing it was only diagnosis bound. This was discouraging to Ralph, as he believed in the importance of understanding the cognitive and behavioral effects of brain impairment. I believe he provided all the information he could to encourage and allow professionals to successfully use his methods to infer and predict behavioral performance, not just diagnostic status. He was remarkably generous in providing professionals access to all his data and files, as well as his ideas for future research. The important and most relevant issue to him was the individual person, and how any condition would affect adjustment.
The man was intense, generous, and honest, with an “unusual” sense of humor. He told me that Dr. Halstead once commented “Ralph, you tend to center, but don't you think you swing in rather wide arcs!?” Ralph was once asked: “How do you pronounce your name? Is it Reetan or Ryetan?” “Rithmetic,” he responded with some glee. He afforded his technicians with respect and loyalty, trusted their observations, and valued their contributions. Once when angry with him, I threatened to leave the University of Washington and return to Indiana University. He commented, “Well, that would raise the mean IQ of both institutions.” I stayed anyway.
He had a tremendous impact on my career, and that of many others. I could not begin to cite the many impressive neuropsychologists I have had the privilege to work with and meet. I recently received a note from William Burkhart, PhD, who underwent his first training with Ralph as an Air Force Officer at Wilford Hall. Upon hearing about Ralph's death, Bill commented, “I owe my career success to Ralph Reitan, ….with his legacy of innovative research and collaborative efforts. I would have thanked him many times over.” As do I.
Rest in peace, my friend. Your contributions were legion. I know you are up there with Ward Halstead, Byron Rourke, and Harry Harlow, and have not lost your hellish sense of humor!
With utmost respect,