Max Hamilton

Biography

• Born on April 12, 1912 as Max Himmelschein in Offenbach am Main, Germany
• 1914 – Himmelschein family migrated to the UK
• Educated at the Central Foundation school, Cowper Street, London
• 1934 – Graduated LRCP, MRCS from the University College Hospital, London
• 1937 – MB BS, University of London
• 1939-1945 Medical officer in the Royal Air Force during World War II; Completed DPM Part 1
• 1945 – Diploma in Psychological Medicine (DPM); demobilised and commenced training in psychiatry at the Maudsley Hospital, London
• 1950 – MD, University of London. MD thesis on the personality of patients with dyspepsia.
• 1953-1957 Senior lecturer in the Department of Psychiatry, University of Leeds. Funded by the Medical Research Council for the testing of pharmacological drugs in psychiatry
• 1957 – Resigned from his lectureship to concentrate on designing scales for anxiety and depression. Breaking away from the psychoanalytical approach Hamilton focussed on behaviours and feelings with an interview based (rather than patient recorded) approach. Initially intended to be used for enrolment into randomised clinical drug trials.
• 1959 – Published the Hamilton Anxiety Rating Scale (HAM-A)
• 1960 – Hamilton Depression Rating Scale (HAM-D) originally included 21 diverse symptoms
• 1961 – Published 12 lectures on the methodology of randomised clinical trials in psychiatry
• 1963 – Professor of Psychiatry, University of Leeds
• 1967 – Published a revised version as the HAM-D₁₇ including only the first 17 items of the scale
• 1969 – Published a 14-item revised version of the HAM-A
• 1972-1973 President of the the British Psychological Society
• 1977 – Retired
• 1978 – Assisted in the development of the Bech-Rafaelsen Mania Scale
• Died on August 6, 1988

Medical Eponyms

Hamilton Anxiety Rating Scale (HAM-A)

Hamilton Depression Rating Scale (HAM-D)(HDRS)

One of the most widely used clinician-administered depression assessment scales. Hamilton’s original publication in 1960 contains 21 items pertaining to symptoms of depression experienced over the preceding week.

In 1967, Hamilton published a revised version as the HAM-D₁₇ including only the first 17 items of the scale; to be used for measuring the global impression of the severity of the burden which the depressive symptoms place on the patient.

1970 – Three further items: Helplessness, Hopelessness and Worthlessness were added to create HAM-D₂₄ to cover the cognitive triad of depression within Beck’s depression model

1975 – Bech et al reviewed the summed scores of two raters and defined depressed mood, guilt, work and interests, psychomotor retardation, psychic anxiety and general somatics as the HAM-D₆ which corresponded to the experienced psychiatrists’ global ratings

1987 – Alvan R. Feinstein defined the term Clinimetrics to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena.

Feinstein considered the HAM-D to be a scale in which total score gives a global impression of depressive states but where factor scores should only be used to measure outcome of antidepressant treatment.

Key Medical Contributions

Major Publications

• Hamilton M. The personality of dyspeptics; with special reference to gastric and duodenal ulcer. British Journal of Medical Psychology. 1951 Jan;23(3-4):182-198. [paper based on MD thesis 1950]
• Hamilton M. Treatment of anxiety states. III. Components of anxiety and their response to benactyzine. J Ment Sci. 1958 Oct;104(437):1062-8.
• Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5. [HAM-A]
• Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960 Feb;23(1):56-62 [HAM-D]
• Hamilton M. Lectures on the Methodology of Clinical Research. 1961
• Hamilton M. Assessment of change in psychiatric state by means of rating scales. Proc R Soc Med. 1966;59 Suppl(Suppl 1):10-3.
• Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967 Dec;6(4):278-96
• Hamilton M. Abnormal Psychology. Harmondsworth, Eng. Penguin Books. 1967
• Hamilton M. Diagnosis and Ratings of Anxiety. British Journal of Psychiatry, 1969; 3: 76-79.
• Hamilton M. Standardised assessment and recording of depressive symptoms. Psychiatr Neurol Neurochir. 1969 Mar-Apr;72(2):201-5.
• Hamilton M. Rating depressive patients. J Clin Psychiatry. 1980 Dec;41(12 Pt 2):21-4.
• Hamilton M. Frequency of symptoms in melancholia (depressive illness). Br J Psychiatry. 1989 Feb;154:201-6.

Controversies

Date of death varies from August 6th, 16th to September 9th

References

Biography

• Obituary: M Hamilton. BMJ. 1988 Oct 8; 297(6653): 914
• Obituary: Max Hamilton. Lancet 1988; 332(8610): 582
• Roth M. Max Hamilton: A life devoted to psychiatric science, In: Bech P, Coppen A (eds): The Hamilton Scales. Berlin, Springer 1990: 1–9
• Wilkinson G. Max Hamilton with Brian Barraclough (1982 interview). In: Talking about psychiatry. 1993: 13-27
• Max Hamilton Biography. University of Leeds School of Medicine
• Biography: Max Hamilton. Lives of the Fellows of the Royal College of Physicians of London. Munk’s Roll: Volume VIII: 205.
• Bibliography. Hamilton, Max. WorldCat Identities

Eponymous terms: HAM-A

• Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord. 1988 Jan-Feb;14(1):61-8.
• Hamilton Anxiety Rating Scale – Online

Eponymous terms: HAM-D

• Feinstein AR. Clinimetrics. New Haven, Yale University Press, 1987.
• Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988 Aug;45(8):742-7.
• Bech P. Fifty years with the Hamilton scales for anxiety and depression. A tribute to Max Hamilton. Psychother Psychosom. 2009;78(4):202-11.