by Sir Martin Roth
Bethlem & Maudsley Gazette, Vol. 31 No 3, Summer 1983, p. 15-18
When the history of the psychiatry of this century comes to be written, the name of Eliot Slater, who died in London on 15th May in his seventy‑ninth year, will be found among those who are judged to have made a lasting imprint upon the subject.
He was best known for his genetical and clinical investigations into schizophrenia, manic‑depressive illness and the nature of the neurotic constitution. In virtue of his work in these areas and the methodological rigour, originality and intellectual distinction of his papers and text‑books, he must be regarded as one of the pioneers of contemporary biological psychiatr However, a glance at the titles of his main scientific contributions makes clear that he took a broad view of what was germane for a biological approach to the problems of mental disorder.
Eliot Travor Oakeshott Slater was born on August 28th, 1904. His father, Thomas Gilbert, had been Professor of Indian Economics at Madras, and his mothe Violet (nee Oakeshott), who was a Quaker, decided to send him to Leighton Park School. A minor exhibition took him to the University of Cambridge where his teachers included Frederick Gowland Hopkins and J. B. S. Haldane. His career at Cambridge was to prove undistinguished. He was lonely, reticent and rendered unsure of himself by the unresolved problems of a protracted adolescence. His was a uncompetitive spirit, and an obstinate independence of mind made him aver, to text‑book learning or class‑room teaching. But he was to achieve greater celebrity and leave a more lasting imprint than those of his year who gained firsts and carried off the prizes. The intellectual distinction which went undetected in the 1920s was to receive recognition more than h1f a century later by his election in 1981 to an Honorary Fellowship of St. John's, his old College in Cambridge, which gave him particular satisfaction.
From Cambridge, he proceeded to St. George's Hospital, and in an autobiographical introduction to "Man, Mind and Heredity", a collection of selected papers edited by James Shields and Irving Gottesman, he has described his early failures and ineptitudes as a houseman and general practitioner and his humiliations as a would‑be neurologist. His account of his failures strike an excessively self‑depreciatory note. Throughout his life he was a man of order and method, deft in handicrafts and calligraphy, and, as he was to show later in life, precise and creative with a paintbrush. Yet, it was wholly out of character for him to strike postures as victim or victor.
In 1931, he joined the staff of the Maudesley Hospital where, after his painful initiation into medicine, he "… revelled in the give and take, even in the cut and thrust of intellectual interchange". He felt entirely happy and fulfilled probably for the first time since he had left home to begin his education at Leighton Park School.
He was soon to be drawn to the work of a group of refugees from Nazi Germany including Willy Mayer‑Gross, Eric Cuttman and Alfred Meyer who brought with them the discipline of phenomenological psychiatry and with it an empirical approach towards the scientific investigation of mental disorder. He was influenced by Mayer‑Gross in particular and soon abandoned the Meyerian psychobiology which was the prevailing philosophy at the Maudsley in the early thirties. He came to regard it as humane in its influence and valuable in clinical practice as sterile as far as the scientific advancement of psychiatry was concerned.
His natural mathematical gifts were later to be expressed in a number of original papers and statistical methodology brought him at an early stage in his career under the influence of R.A. Fisher to whose generous help, support and tolerance, Slater has paid tribute. His early papers on the inheritance of manic‑depressive illness and his distinguished critical review of research in psychiatry, sets new standards of precision, rigour and objectivity in the handling of evidence. They appeared before the publication of Bradford Hill's "Principles of Medical Statistics" which familiarised a generation of medical scientists with the new mathematical tools for he analysis of quantified observations that stemmed from Fisher's discoveries. Slater was, thereforek a pioneer in the shaping of what was to become a distinctive features of medical and psychiatric research in Great Britain and which, for a number of decades, set them apart from the clinical science of most other countries.
It was natural for him to choose genetics as a discipline in which he should acquire special training during the Rockefeller Foundation scholarship which took him to Munich in 1934. In his autobiography he has given a full acount of his experiences there. The discipline of genetics gave him what he described as a combination of self‑esteem and humility, and his scientific contributions were to carry the imprint of these qualities for the rest of his life. But they were also to be marked by the dexterity, a ruthless objectivity in the handling of data and intellectual incisiveness and elegance in reasoning that have probably not been equalled by any other psychiatric investigator. The neurotic constitution, hysteria, schizophrenia, the inheritance of several forms of mental disorder, the methodology of genetic research, the pathography of musicians of genius, the judicial process from the standpoint of psychiatry, voluntary euthanasia and medical ethics were all to engage his restless curiosity.
He could be controversial and provocative. But hardly ever did he fail to illuminate and cause his readers to reconsider well‑entrenched opinions. A number of his papers and books have been widely influential in the updating of psychiatric practice and the development of scientific research. "Physical Methods of Treatment", the fruit of his war‑time collaboration with William Sargant and "Clinical Psychiatry" with W. MayerGross and Martin Roth (first published in 1954 and soon to appear in its fourth edition) were, between them, to be translated into ten languages. "The Genetics of Mental Disorders" with Valerie Cowie (1971) remains the standard book on the subject.
Many tributes have been paid to the role played by the Clinical Textbook in the initiation of the burgeoning movement of biological psychiatry in the United States in particular. A pirated Japanese translation of the introductory chapter of the 1954 edition was used as a manifesto by a group of young psychiatrists who distributed some 800 copies in centres throughout Japan in an attempt to spread the influence of a more powerful scientific spirit in their subject.
In 1946, Slater was appointed as Physician in Psychological Medicine at the National Hospital, Queen's Square. He asembled around him a group of neuropsychologists headed by Oliver Zangwill from Cambridge. It included Elithorn, Piercy, Ettlinger and McFie, all of them destined to make notable scinetific contributions later. He was bitterly disappointed at the failure of the National Hospital to establish the Academic Unit in Psychiatry he had spent some years in planning, and resigned from the staff in 1959 to devote his entire energies to his work as Director of the Medical Research Council Psychiatric Genetics Unit at the Maudsley until his retirement in 1965. But he continued to make regular visits to what remained of his team of genetical workers, and, until the very last week of his life, was engaged in painting, scientific work and writing with a passionate intensity.
In the eleven years from 1961 in which he served as the Editor of the British Journal of Psychiatry, he transformed it into one of the world's most influential psychiatric journals. There can have been few Editors who took such pains with the scientific and scholarly papers submitted to them. The letters from his pen during this period to contributors at every level, served as a kind of sustained Master Class in psychiatric reasoning and methodology. Towards the end of his period of office, I read through much of this unique correspondence and hoped that it might prove possible to publish a selection of the Editorial letters at some time. However, when I made enquiries a few weeks ago in an attempt to gain access, I learned that, owing to reasons of space, the Journal had been compelled to dispose of the relevant material some years ago. The following is an extract from an Editorial commentary of four to five pages:
"The last paragraph on Page 9 of your original manuscript relating to the regression analysis is not comprehensible as it stands. The results of the analysis appear to be embodied in Table 8 and the only thing not clearly stated there is the last column, "estimated cc efficient" which I suppose is more or less a loading factor which went into the multiple correlation co‑efficinet. The exact means by which the figures in this column were calculated do not need to be explicitl stated, and you could refer the reader to X.Y., 1970. However, you dc need to say just what this last column signifies. Furthermore, in thi paragraph you refer to a Table 10 which does not exist, and I would suppose that what is meant is Table 8. Perhaps you could let me have a very short statement, the equivalent of the paragraph 1 mentioned, which could be entered in the new manuscript at the bottom of Page 11."
An Editorial letter about a genetical paper began as follows:‑
"I hope you will not take me amiss if I liken your work to a magnifice ruin; one could not stand on it without risk of breaking an ankle. But it was a splendid enterprise and has many lessons for clinicians. psychologists and geneticists. Its weaknesses are nearly all due to t difficulties of the terrain on which you are building. Let us now come to practicalities. The work clearly must be published; but I should like you to reconsider…”
The model with which he approached his work as a clinical psychiatrist differed radically from that which he applied in scientific enquiry. Everything that might have contributed to make the patient ill or might promote his recovery had to be taken into account in the clinical situation. The case conferences at which he presided were memorable for the wealth of observation, phenomenological analysis and when appropriate, psychodynamic insight brought together in the formulation at the end. It w in his pathographic writings, as in his study of the Sonnets of Shakespeare and the identity of William of Stratford that his gift for looking before and after in the lives of people, his compassion and his disciplined clinic imagination are most clearly displayed in his writings.
It was not the uses but the scientific status of psychoanalysis that he called in question. In his view, as it was concerned entirely with an endopsychic world and lacked rules of correspondence with an external world in which findings could be put to the test of empirical observation, it belonged to a realm of understanding other than the scientific one. As his sympathetic review of a recent book by Anthony Stevens showed, he had, in recent years, become increasingly interested in Jungian depth psychology as a source of psychological insight into the structure and development of human personality rather than as a means of investigating psychiatric illness. He conceived of the archetype as a construct in which either matter or non‑matter, as for example the flow of energies, may be arranged. It was accessible both to introspective apprehension from within and an objective study from without. In its external manifestations, he found a kinship between the archetype and the innate releasing mechanisms of Tinbergen which provided man with a repertoire of predispositions that preceded learning and experience. Such a view was incompatible both with the behaviourist psychologies which conceived man as a tabula rasa, and with those determinist forms of sociology which regarded human consciousness as wholly or largely shaped by social and economic forces. What remains of the individuality and integrity of human personality if man is malleable without limit, a helpless victim of the environment into which he happens to be born? Assuming concepts were scientifically interesting and valid for Slater only so far as they were accessible both to objective study and publicly verifiable prediction from without as well as introspective apprehension from within.
He was to receive many distinctions and honours. He was a member of the Royal Commission on Capital Punishment in 1949, President of the Psychiatric Section of the Royal Society of Medicine 1958 to 1959 and Maudsley Lecturer in 1960. The Honorary Fellowships of the Royal Society of Medicine, Royal College of Psychiatrists and the American Psychiatric Association were conferred upon him. He gave the Lichfield Lecture at Oxford University in 1959 and was Galton Lecturer in 1960. He received an honorary doctorate from the University of St. Andrews and in 1966 he was made Commander of the British Empire. A selectioc of his writings together with an autobiographical sketch was published in 1971 and a Festschrift for his 75th birthday entitled Psychiatry Genetics and Pathography in 1979 which contains two new contributions by Slater including "What Happened at Elsinore", a playful phantasy derived from an intricate, scholarly analysis of Shakespeare's text.
He would doubtless have achieved even greater eminence had he been more concerned with personal advancement, possessed more of the conquistador spirit that could have made him a celebrity in a single field of research all his own and had he been less generous in devoting his time to helping pupils, colleagues and friends. He spent several weeks translating a number of papers from German into English to encourage and boost the morale of one of my registrars who had gone to work with him for a period and was later to publish an important monograph on the organic schizophrenias.
In the years after retirement, his interests in Art, Philosophy and wider human concerns were to claim more and more of his time, interest and energy. His paintings bore the unmistakable imprint of his personality; the same combination of humility and self‑esteem, the same passionate quest for the order behind the appearances. A few months before his death he wrote to me
"I am just back from a visit to my Polish art master at St. Christopher's Hospice. I took along a flower painting of which I was rather proud. It was laid flat on the floor, and he looked at it. What was it I heard? I couldn't believe my ears. "Very bad! Dilettantish!" He asked permission to paint on it himself. He laid out colours on a palatte, and started altering it very radically. It was fascinating to watch. I have seldom been so excited. But after a bit he was tired and could not go on. He will do some more, at leisure. I hope again in a fortnight, to see the completed transformation. I hope I shall have a better understanding of what was bad. But what a master!”
The humility and intellectual passion were manifestuntil the end.
After a period of struggle, he managed to get his papers published regularly in journals devoted to Shakespearean studies. In his 76th year, he was awarded a Ph.D in the University of London for a thesis devoted to a statistical word study of the authorship of the play "Edward III" in which he had applied his own version of mathematical techniques originally introduced by an erstwhile Fellow of his old College, St. John's, Udney Yule. It would have delighted him to know that the Cambridge University Press had deciced to publish the greater part of his thesis as a book. But he had learned the week before his death that publication was probable.
He had prepared himself with intensive reading in philosophy for the Mapother Lectures, and they have provided perhaps the must lucid and comprehensive analysis on record, of the philosophical foundations of knowledge in psychiatry. He did not manage to complete the fourth and final article because the final synthesis which was to have provided a common, conceptual framework for clinical practice and scientific enquiry in psychiatry, failed to satisfy him and he abandoned the work, intending to take up the threads at a later date. In the last few years, much of his writing was devoted to medical ethics, euthanasia and nature conservation. He challenged the arrogant presumption that man was lord and master rather than merely an integral part of nature, and his gentle, compassionate spirit had been deeply stirred by the threats of pollution, overpopulation and the destruction of mankind Which he saw looming increasingly larger.
Eliot Slater had four children by his marriage to Lydia Pasternak, sister of the poet and novelist whom he met while working in Rüdin's Institute in Munich. They appear to have inherited and acquired equal, but overlapping portions of his creative gifts and many‑sided personality. His older daughter, Catherine, is a psychiatrist and the younger, Anne, a Shakespearean scholar of distinction. One son, Nicholas, is a Medical Scientist and the other, Michael, a University Lecturer in Mathemantics. He is survived by his devoted second wife, Jean, also a gifted painter.
British psychiatry has lost its most renowned representative and the influence of a mind vigorous, bold and imaginative and a spirit generous, disinterested and noble to an exceptional degree.