In Conversation with Eliot Slater

Brian Barraclough interviews Eliot Slater (February 1981) 

 Psychiatric Bulletin 5, 158-161

 

BMB  I thought we might start with your editorship of the British Journal of Psychiatry.

ES  I was elected at the Annual General Meeting of the RMPA in 1961. Fleming, who was the existing Editor, was in bad health and wasn't able to carry on with the work. I don't quite know how my name came up. Somebody approached me and I was very pleased to do it because I felt it was something I would very greatly enjoy doing. I felt that it was something I could do.

BMB  Had you any previous experience as an editor?

ES  None. I remember discussing the job of an editor with Arnold Carmichael who was the Editor of the 'green rag', the Journal of Neurology and Psychiatry. It later changed its name to the Journal of Neurology, Neurosurgery and Psychiatry. I said my idea was to get a lot of helpers, let them do what they liked to do and just collate it and gather the threads. There should be many advisers so you could always have a paper vetted by somebody in whose field it lay. Carmichael said 'Oh no, that isn't the way to do it What you want to do is to have two good friends and the three of you decide everything.' But I thought that isn't the way I'd do it.

BMB  And what about the Journal's name?

ES  The Journal of Mental Science had already taken on a subtitle, The British Journal of Psychiatry, thereby pre-empting it from being gobbled up as a title for any new psychiatric journal by the Tavistock Square pub lishing house. When they published a psychiatric journal of their own, it couldn't take that name. In due course I went down to Fleming's house in Gloucester with a suitcase and took the papers that he hadn't been able to deal with. Then I got on with the job of going through the pile, and started to think of people who could be invited to come in as assessors.

BMB  What was the standing of the Journal of Mental Science then?

ES  Pretty low, but like the famous plum pudding, it did have the odd plum. Good papers got published now and again even if it published a lot of rubbish. By getting a lot of help we raised the standard. Assessors only got half a dozen or so papers in the course of a year, or if they were lucky up to a dozen, and this wasn't impossible for anybody. And people liked doing it. One or two said 'sorry' after a couple years, 'I have had enough' or 'I'm getting too busy'. But as a rule they like to go on for the term.

BMB  What journals published psychiatry then?

ES  Well, one didn't try to go to American journals, like the American Journal of Psychiatry. I don't think you would have got much chance of being accepted if you did, but the Lancet and BMJ took the odd paper, so did the Journal of Neurology and Psychiatry.

BMB  How do you explain the success of the British Journal of Psychiatry?

ES  I suppose it filled a vacuum. I think you are right in thinking there wasn't a lot of space to get your papers published. But also people weren't writing for publication much. The idea of writing papers for the young man who is building a career is modern, I think.

BMB  How often did the Journal come out?

ES  At first, two-monthly, six issues a year. It was a big adventure to go into monthly publication. That was possible because the readership went up so much, the subscriptions from overseas increased no end. And there was plenty of stuff coming in too.

BMB  For how long were you Editor?

ES  A bit over eleven years. I took it up in the middle of 1961 and I finished at the end of 1972. I went on as acting Editor when the College was formed because I was ineligible to be Editor. I was too old.

BMB  Would you like to say anything about your time as Editor?

ES  I enjoyed it no end. I loved the work, and it was never difficult for me. Edward Hare followed me and did it very conscientiously, but he never enjoyed it like I did. I regard myself as a bad organizer, but there was no trouble about organizing that show as far as I was concerned.

BMB  You concerned yourself with the papers published in the Journal rather than the general production?

ES  I paid attention to the production in the sense of what kind of printing we were getting, what kind of paper we should use, what our format should be. The wonderful new golden cover that was going to attract attention in all the scientific libraries, and how the advertisement income was organized and so forth. I wasn't as enthusiastic about that but I covered it more or less. I put any sticky things to the Journal Committee. But the thing that interested me was the stuff that came in and how it could be produced and how people could be encouraged and not squashed. I remember one young man sending a paper in. He got an awful brush off from the assessor who said 'no, this is unacceptable, he doesn't know how to write a paper'. I was all in favour of open editing. The style in those years was 'we regret we are unable to accept your paper for publication', no more, no explanation,  nothing. I thought 'this isn't the way to do things' and I nearly always sent a copy of the report of the assessor to the author. Sometimes a piece would be cut out if it was too painful or rude, but as a rule the author got an unvarnished opinion. Anyway, on this occasion I sent back the report from the assessor complete. It may not have been unkind, but it was quite annihilating. The wretched young man from a provincial hospital wrote back to say that he was greatly obliged to have this report because he realized now that writing papers was not for him and he would never try it again. And I said 'My God, that's not the way to do things!'

BMB  Was the colour of the cover your idea?

ES  I can't say, but I fell for it. The idea was that if you went into a library, and instead of all the dull grey and brown you saw this golden yellow thing staring at you, you'd have to pick it up.

BMB  Do you think of any papers published during your editorship as being especially remarkable?

ES  I remember a long paper that came from America. It was about monozygotic twins who had been specially selected as discordant in respect of the American diagnose of schizophrenia and were taken in under observation in the National Institute of Mental Health. A huge amount of work was done on them. I thought the selection was illegitimate The twins were picked to be discordant. They weren't from any known or limited population. It was anybody the authors could find in the whole of America whose parents were willing for their offspring to come under observation in the research centre. But one couldn't suppress the data, I accepted this paper for publica­tion but I wrote to the authors and pointed out the defects in selection. Another thing I think of is the work by my colleagues at the National Hospital on the schizophrenia‑like psychoses of epilepsy. I was determined to publish the whole of this, however egoistic it looked, and take up 70 pages of the Journal to put it all out in grand array‑total lack of false modesty.

BMB  Well, you had a good time with the Journal.

ES  I did indeed.

BMB  And thought you achieved something?

ES  Well, the Journal improved in quality and status in my time; I think it was partly because of what I did, but very largely because of what all the other chaps did. A lot of people worked on it. It was a big co­operative effort of British psychiatrists.

BMB  Let's continue on publishing and talk about the two books you are so well known for.

ES  Those I wrote with With Mayer‑Gross and Martin Roth on the one hand and Will Sargant on the other hand.

BMB  Which would you like to start on?

ES  The one with Will Sargant was the one to get off the ground first in 1944. This was built upon his experi­ence of active treatment, and what some people would call an adventurous approach to treatment in psychiatry. I liked this approach. I liked his way of working with patients. He and I got to be very friendly. He would come to me with problems about how to make his points, or for criticism of points he wanted to make, and I col­laborated with him. But he was the leading spirit He was always thinking of new ways of treating people. When I first went to the Maudsley there was practic­ally speaking no treatment at all.

BMB You are talking now of before the war?

ES  Yes. I went to the Maudsley in 1931. The most appalling thing was the chronic melancholics, often people of most excellent personality, sunk deep in a depression which nothing could move. People have no idea now of what that illness could be. It never gets anywhere near that stage now. But then there was absolutely nothing.

BMB  It would be worthwhile if you could recall the features of the chronic melancholic before ECT.

ES  The involutional melancholic would be a thin, elderly man or woman, inert, with the head lifted up off the pillow. There were some sort of Parkinsonian‑like qualities, mask‑like face sunk deep in misery, and speaking in a retarded way. If you could get them to say anything it would be something about how hopeless things were, how they were wicked, doomed to disease, death and a terrible afterlife, if there was one. And there wasn't anything you could do except to try to make them sleep, try to get them to take some food, tube‑feed them if they were refusing food, which happened frequently. If they were very retarded and inert then they were reasonably safe from a suicide attempt. If they began to improve, or were at an early stage of the illness, you had the risk of a desperate suicidal attempt A lot of the patients who came into the hospital were in that condition, and quickly went on to suicidal caution. Even then we had suicides. I remember a man in the male acute ward, with its own enclosed garden, who was found to be dying. His stomach at postmortem was full of yew leaves. The beds were wheeled out into the garden, and his bed had come under a yew tree. He had assiduously chewed up these leaves and swallowed them. None of us knew the yew is poisonous. I don't know what its alkaloid is, but it killed him all right. Poor Edward Mapother, our Medical Superintendent, went into a panic about this getting into the news­papers, and getting to County Hall. Staff were sent next thing to cut that tree down. It was a very handsome yew tree, which shouldn't have been there, admittedly. The pleasanter sort of case, of course, was the manic or hypomanic, where you could get some rapport. The schizophrenics would go into any kind of state. We might give them some form of sedation. We tried out the Swiss treatment of continuous narcosis for a week or fortnight. This is a dangerous treatment if it's done really properly, with sixteen hours of deep sleep a day. We didn't have any short-acting barbiturates then. We had phenobarbitone and medinal; but they were long-acting and in a heavy dosage, as for continuous narcosis, they were dangerous. Bromides, paraldehyde and, by injection, morphine and hyoscine –  we had to do our best with them, and with physical measures such as the continuous bath. Sulfosin was tried out on schizophrenics, but with no good results. Then, before the war, along came first convulsive therapy with cardiazol and then insulin treatment. Both of them, of course, have achieved a bad name. But there was absolutely no question in my mind that insulin coma therapy would produce a remarkable remission in acute schizophrenics who, in the ordinary way, one couldn't expect to do anything but go bad. Will Sargant was an enthusiast, and he and Russell Fraser, who went off into general medicine, managed the Villa as an acute treatment centre. What happened there was most encouraging; it was really quite wonderful. Then came Cerletti and Bini and eletroshock; and then electroshock under sedation; then under anaesthesia with an antispasmodic, and the modern form of treatment. There was absolutely no question about the revolution in treatment. A few cardiazol epileptic fits are horrible to witness, but for the involutional melancholies the response was almost miraculous. So I arrived in psychiatry at a time when one was quite hopeless and helpless practically speaking. Before these advances the only treatment where you could really do something was the malarial treatment of general paresis. A breed of mosquitoes was kept at Horton Hospital and they were brought around if you got a GPI. I saw quite a few GPIs in my early days but you don't see them now; penicillin has done its work. With the neurotics one did the sort of psychotherapy that suited one's personality. Quite a few people, of course, went and got some sort of analytic training, but there wasn't much of a move towards psychoanalysis at that stage. The big surge towards psychoanalysis came after the war.

BMB  What kind of psychotherapy suited you?

ES  Perhaps what you might call commonsense psychotherapy, trying to find out what was hurting this individual and how it could be influenced by persuasion, by making some intervention or suggesting some intervention. I was never a depth explorer.

BMB  Shall we get back to how Sargant and Slater got written.

ES  Sargant said 'Come on you, you must write the introductory chapter and the section on psychotherapy in conjunction with physical treatment.' He would write everything else, and I would have to take it and see what his line of thought was and improve it in logical progression and coherence. When he first started to write, his English was not good. He went on writing, and got to be a good writer in the end. His paperback books are very good.

BMB  When did it first come out?

ES  Before the end of the war, in 1944. Will was very keen that it should be on the market soon. He wanted it priced low so that his big message should get to the world. As he saw it, this was a very big message. He is the son of a Methodist minister and he is an evan gelist for the good way of doing things. He would sacrifice himself to help his patients. He is one of the few people who really would do almost anything to help the patients he thought could be helped. I once talked to him about this and I asked him if there were any limits to this. He said 'Oh yes, indeed, if I come to the conclusion that I can't help somebody, then that's that. I have to go on to someone else whom I can help.' So he keeps things within a reasonable measure. But he is a great enthusiast. He got this book published quickly and it was of course very influential. I always feel it was because of the popularization of physical methods of treatment in psychiatry that Britain was saved from following America down the psychoanalyticpath. An Introduction to Physical Methods we called it. It contained every item of know ledge that we had. But an introduction' it was, gone on a very long way since then. When physical treat ments started, it was purely a guess. Somebody tried it, malaria, cardiazol, insulin. The convulsive treat ment of mental illness was started because Meduna thought that epileptics didn't get schizophrenia. Sakel was allowed to try insulin coma at the Vienna clinic. I saw insulin coma there before it was being done anywhere else. I thought to myself this is a lot of poppycock. Because they discovered that malaria cured GPI, they think they can do another miracle cure. I regarded the whole issue with contempt. But I changed my mind when Will Sargant and Russell Fraser took it up.

BMB  Do you still believe insulin is a useful treatment in schizophrenia?

ES  There is no point in giving it because there are other treatments.

BMB  I was thinking of the controlled trial of barbiturates and insulin.

ES  I could never quite believe that trial because deep sleep therapy had not proved successful in schizophrenia. But insulin therapy was replaced by phenothiazines. They proved to be the effective treatment.

BMB  But I thought that controlled trial of insulin coma and barbiturate coma which was published by Brian Ackner put a finish to the use of insulin.

ES  I don't know. I wouldn't say that's all wrong but I'm doubtful about it. Nobody's gone on to give barbiturate coma to schizophrenic patients as a systematic treatment, so in a way he was comparing insulin coma therapy with non-therapy and I am firmly convinced that insulin coma therapy was quite remarkably successful in cases which would have been utterly hopeless in the pre-treatment era. Good clinical judges thought so. Mayer-Gross was a superb clinician. He had absolutely no doubt about what he was seeing. When you see things happen under your eyes, it is very difficult to say it's all chance.

BMB  Well I suppose that applies particularly now with ECT being under such heavy criticism as being a useless treatment and investigations to find out whether it is the anaesthetic or the convulsion which causes the improvement. What you are saying is that people were so ill in the '30s and were not going to get better.

ES  The involutional melancholies I was talking about might take six months and then start getting better, twelve months or fifteen months. If they went on much longer than that they went into a chronic depressive state which was immovable. But I think that in the mental hospitals they did take electroshock into the wards for people who had been certified as suffering from chronic melancholia for years and still got results. I think the anti-ECT campaign is ideologically directed in the main, that is to say it is by people who believe that psychic illness is the product of psychic causes and to intervene along a physical line is a form of assault and they are not going to believe it does any good. But there have recently been controlled trials on ECT which show it does have an effect. [1] Anyway the way it is done now is pretty harmless.

BMB You mention William Mayer-Gross.

ES Willi Mayer-Gross was one of three German Jewish refugees who came to us about 1934 when things were getting impossible for the Jews in Germany. Mapother organized it with Rockefeller help. It was one of the most far-sighted things he ever did; and it has made a historic difference to British psychiatry. The other two were Eric Guttmann and Alfred Meyer, who was (and still is) a world-famous neuropathologist. Mayer-Gross was rather short, powerfully built, very extraverted, a ball of energy. Eric was long and thin, elegant, aquiline. Freddie Meyer was the most slightly built. He was sensitive and retiring, one of the kindest and gentlest souls I ever met. Freddie went upstairs to work in Golla's laboratory; the other two were with us in the wards. All three would come to lunch with us. They were an immense addition to our society, which was a warm intimate one in the years before the war. Mayer-Gross was greatly respected as a clinician of the German phenomenological school. The idea was that if one couldn't do anything to cure schizophrenia, at least let us study it. What is the form of thought disorder, what kind of ways does a delusional idea appear in the mind of a schizophrenic, and so on. And that was one way to save one's soul, because it was soul-destroying not to be able to do anything for patients. Mayer-Gross came with a whole world of subtle clinical observations to instruct us in, and taught us above all to talk to our patients in an attempt at getting an understanding of the way their minds were working. I got on very well with him, and with the other two as well. Eric Guttmann gave me endless help in my own work. But Willi Mayer-Gross said 'Come on, let's write a textbook of psychiatry for England, for the British'.

BMB  That was before the war was it?

ES  It can't have been before the war. During the war Mayer-Gross went to the Crichton at Dumfries.

BMB  Why did he do that—an extraordinary thing to leave London?

ES  As I was saying, there weren't a tremendous number of jobs going around. Why, for instance, didn't I become a professor?

BMB  Yes, I have wondered that.

ES  Because there weren't any professorships worth having. There was one in Edinburgh and one in London. When other professorships did come along eventually, I found they were terrible jobs organizing psychiatry in new towns so to speak, where nobody cared about psychiatry and you would have to fight tooth and nail for everything. You would have to be an empire builder. It wasn't my line at all. No, there weren't jobs available. Freddie Meyer had to go for a time to Barnwood House in Gloucester with Fleming. Eric Guttmann was actually interned for a time. The Maudsley closed down. It just became Mill Hill and Sutton. Anyway, after the war Mayer-Gross and I proceeded to write this book. He wrote most of it I had to turn his Germanic English into English. I wrote chapters of my own, some of which were an awful sweat; the chapter on law, for instance, was a frightful toil. We both began to get stale and thought we really must have more help and we asked Martin Roth to come in and write the organic stuff. It worked very well indeed and the book came out in 1954.

BMB  Were there any competitors for it at the time?

ES  Because he had to find a job. And he was offered a job there. The hospital was keen and progressive, and he would have his own house and a reasonable income to live on. I don't think he was at all keen to leave London itself, but he adjusted himself to it very well. The fact is there weren't a tremendous number of jobs going around.

ES The textbooks available at that time were either not very comprehensive or not all that good. The American ones were mainly full of Freud, or Adolf Meyer's psychobiology. Henderson and Gillespie was rather an old-stager. Curran and Guttmann had come out in 1949 but was meant principally for beginners. The best textbooks available were in German, especially Bleuler and Bumke. I believe there were excellent textbooks in French, for instance by Henri

Ey; but I could never read French psychiatry.

BMB  Do you think they were an influence for the good?

ES  The Mayer-Gross – Guttmann – Meyer influence was as far as I am concerned profoundly to the good. I think it enlarged the vision of British psychiatry tremendously. It gave a lot of people a lot more to think about. It taught them to pay close attention to their patients, to sift, to discriminate.

BMB  Was it only the subject matter of research or a new approach?

ES  I think the effect of these Germans upon me and some others was to promote enthusiasm. You really became enthusiastic about the subject in which you spent your every day. In point of fact, that degree of acute interest antedated their arrival. I can remember first arriving at the Maudsley Hospital and being completely overwhelmed with curiosity by a young nurse from one of the mental hospitals who was possessed with the Devil. The Devil compelled her to write screeds of stuff and then God would stop the Devil and there was a sort of colloquy between God, the Devil and her going on. It was, of course, a lot of hysteria, but some of the ideas coming out were very strange. I was completely fascinated by it, I was staying there up on the ward, writing it all down, up to 10 o'clock at night before going home. That kind of thing. I remember we had a very high level Jesuit priest, tormented by obsessions. This was in Aubrey Lewis's ward. Aubrey spent hours and hours and hours talking to this Jesuit priest. They shared a common fund of arcane knowledge because Aubrey himself had been brought up in a Jesuit school you know, and he knew all the Jesuitical ways of looking at things, and he could talk to this Jesuit fine. The Jesuit eventually left the hospital just as obsessional as ever. It was a big change from the absolute apathy in the county mental hospital I had come from to the enthusiasm I found at the Maudsley. I must not put it all down to the Germans, but they provided a whole lot of new outlooks.

BMB  How did the Maudsley become so lively a place, was it a German influence at secondhand, because people had been there?

ES  No, it was Edward Mapother looking around for the brightest young people he could find in British medicine, and inviting and persuading them to come there. He made a great effort to get Desmond Curran to come. When Aubrey Lewis turned up from Australia on an anthropological study year, Mapother was very struck, as of course one would be, by his intellectual abilities. Mapother got him to go over to America and spend a time with Adolf Meyer and then come back to the Maudsley. He was later made its Clinical Director. Before I ever came near the Maudsley I was told there was this place, that in psychiatry the Maudsley was a place where one wouldn't be ashamed to go. I originally wanted to be a neurologist. I had seen wonderful demonstrations by James Collier at St George's Hospital, and I was fascinated by the crossword-like accuracy with which one could pinpoint lesions. So I tried to train myself into neurology and to get to Queen Square, but Queen Square wouldn't have me. They looked at me the first time I applied for a house physician job, but said 'Come again another day'. Then I thought I will go and get some psychiatry; I went to see Mapother, who said 'Sorry, we haven't got anything at this time, but keep in touch'. So I took a job in a provincial mental hospital and got a princely salarty of £350 a year and keep, which was very worth having. From there I tried for a second time at Queen Square; but now, of course, I was tarred with a dirty brush, and they would not look at me. After six months I could not stand it any longer and felt 1 must leave, for the sake of my soul. I wrote to Mapother and he took me on as a Locum. That is how I came to the Maudsley and that is how he picked up people. He collected people who had a good record in medicine. He loved to have people who had the MRCP. He wanted to make his staff respectable in the eyes of medical teaching in London. And he succeeded.

BMB  Did you go there to do research?

ES  The Maudsley? No. Yes. I don't know, I must have had some sort of idea about doing research because when I wrote to Mapother I said 'there's no research going on here'. And he thought this was super, I suppose. Here was a young man who wanted to do research, and at the Maudsley he had this fellow Lewis, who was telling everybody 'Come on now, you have got to do a bit of research'. Everybody had to do something. We had Tuesday evening meetings after the day's work was over, and you would stay and have an evening meal and then you'd go and sit in Lewis's room, It was Lewis who said I must provide something interesting for one of these meetings, and suggested hypnagogic hallucinations as a subject: How many people have them? What are they like? And I proceeded to make an enquiry among the patients about whether they had any hypnagogic hallucinations. And after this the morel did of delving and researching, the morel liked that kind of activity.

BMB  So Lewis was the main influence, at least to begin with, in directing your attention to research?

ES  Yes, he was emphatically. We must give him that credit very much.

BMB  And he did it with other people as well?

ES  Yes.

BMB  And be continued to do it I suppose until retirement?

ES  Eventually he had a devastating effect on enquiring minds. At one time, in the early years of his pro­fessorship at the Maudsley, he was found quite crushing by some of the registrars when they presented cases at his conference. I don't think that considering what they had in the way of bright people the Maudsley research record is very good, at any rate in the early years. I wouldn't like to say what it is like now. But in Lewis's early years, the post‑war years, there wasn't a lot of new thought going on. It was not that Lewis was not stimulating but he was so sceptical. If you thought up any idea he would find reasons for debunking it. You can't go on researching if you are just debunked.

BMB  What about other influences in the '30s on your developing interest in research?

ES  Well, I suppose the critical thing for me was finding I liked playing with numbers. And then going and getting myself a statistical training.

BMB Where did you get that?

ES  At the School of Hygiene and Tropical Medicine. I only had about six weeks of it, but I learned a lot of stuff. There was a lot of work on incidences and pre­valences, on birth rates, death rates, national statistics. But they also gave you a training in small sample statistics. It was that, of course, that was invaluable in psychiatry. They used to give us lectures and then set exercises and we would sit at a desk, about a dozen or fifteen of us, with a little mechanical calculator in front of us, and work out tables and come to results and they would be checked. My great teacher was K. A. Fisher. I absorbed his book Statistical Methods for Research Workers, and when problems came up which I didn't know how to handle I would write to him at his journal office‑he was Editor of the Annals of Eugenics. He was always helpful. He was a great saint in my mind.

BMB  I once remember reading a paper you had written, about admission rates or discharge rates in British mental hospitals that you had got from the Board of Control, and you ended up...

ES  'These statistics are not absolutely useless.' The journal was the Annals of Eugenics. When Lionel Penrose took over the editorship he disliked the term 'eugenics'‑Galton's idea‑so much that he got it changed to Annals of Human Genetics. The article was published there. It was great fun. Lewis said to me, 'Why not try to duplicate the work that has been done in Germany': finding out what the risks are for members of the general population to get this, that and the other psychiatric disorder. I got permission to go into the medical and surgical wards at King's and obtained information from people having their appendix out or having a hernia done. But this was a biased population too. Lots of these people were neurotics and only in hospital because of neurosis. The incidence of psychiatric disorder in their relatives was much too high. Then it occurred to me that one could make use of the Board of Control data, the central statistics, and I got permission to see them. But, of course, the official diagnoses were out of date: primary dementia, systematised and non‑systematised delusion insanity, etc. But I suppose it was the first big thing I wrote. It started off with an idea of Lewis's, not of mine.

BMB  What happened next in your research career?

ES  I went to Germany on a Rockefeller fellowship. After that I went up to the Medical Research Council and said what about doing research on twins. They said 'Yes'. They gave me a grant and I spent a couple of years or so going around the London County Council mental hospitals, collecting twin cases. If a patient was reported to be one of twins, I had to go into the case in depth, which meant going off and doing the fieldwork myself. Very laborious and taxing. When the war came, this work hadn't been completed, but after the war the MRC agreed that I finish it off and polish it up. I got James Shields to come and do it. It was such a relief that he could visit the relatives instead of me, and knock on their doors and get them to answer questions, rather like being a politician, worming your way into people's homes.

BMB  Where did the idea for the twin method come from?

ES  It was around. When 1 went to Germany, I spent a year at Munich and met Klaus Conrad. He did a wonderful piece of research into the monozygotic and dizygotic twins of epileptics. It was a model of perfection technically. You could say I took the twin idea from the Forschungsanstalt für Psychiatrie in Munich. I made a very good friend there, Bruno Schulz, who taught me a lot on genetica! methods in psychiatry. When I came back, I got the MRC grant and did the twin job, and then came the war. I went to Sutton and started doing things on the soldier population there: patterns of marriage with Moya Woodside, and fascinating things like that. And then picking and delving became something that had to be part of my life wherever I went. When I went to Queen Square as psychiatrist to the National Hospital, I was keen to pursue research there, which wasn't so easy. They didn't like it there. They wanted good clinical work and top level teaching. I started off at Queen Square with every sort of encouragement from people like Carmichael. But gradually things went wrong. I got at cross purposes with my colleagues. Looking back, I can't blame them. For instance, I refused the job of Dean. Of course that was very bad. If you are on board a ship and the captain says you will be the officer who will receive the guests when we have our great gala day, you are then the officer who receives the guests, there is no help for it. I wasn't playing fair by the chaps. There were certain things I wasn't at all keen on that they wanted me to do. Lectures on psychiatry, for instance, struck me as a ghastly thing to have to do. What I really enjoyed was having teaching rounds or conferences on my own patients. The young housemen (not all that young, some of them were getting old) were wonderful people to teach, and to be taught by. The interesting thing was that the really bright, brightest of the bright, were the young house physicians who were going to be accomplished general physicians. These young people told me about everything that was going on in medicine, and were constantly keeping me up to the mark. What happened eventually was a sad storm. The Mental Health Research Fund had some money with which they wanted to endow an academic unit at one of the hospitals. I put in an application which they agreed. It was going to be an appointment for a senior lecturer, working in my department. It would have been the top of my ambition to make a small academic psychiatric unit at the National Hospital. This was battled in the hospital's Medical Committee for about a year, and they turned it down. I felt that was too much for me and I sent in my resignation. But 1 think if I hadn't blotted my copybook, neurologically speaking, I might have got their support.

BMB  Do you think their refusal was a personal matter?

ES  I think in a way, we were such different sorts of people, the more senior physicians and I. Another thing which must have irritated them very much was when 1 did a follow-up on National Hospital cases diagnosed as hysteria and found a big loading of organic disease had been missed. It was not a good thing.

BMB  I don't suppose it could have been entirely personal or there would now be a larger psychiatric component at Queen Square.

ES  When I left the National, I asked the MRC to give me another couple of sessions in the Genetics Unit, and they kindly agreed. Jerry Shields was very active, though he was confined to a wheel-chair after an attack of polio. I was collaborating with him, and with Valerie Cowie on mental subnormality. We had guest workers from America, Australia and the Far East. Ming-Tso Tsuang took a PhD with us. Our biggest acquisition was Irving Gottesman, who brought out standing ability, new ideas, technical aids and finance into a most productive collaboration with Jerry Shields. They took up twin work where I had left it off. When I was approaching retirement, the MRC had to consider what to do with the Unit. They decided it must be closed down, but also that the twin work under Shields should go on. So Jerry was transferred to the Institute with MRC support, and Irving Gottesman came over regularly from the USA to continue work with him.

BMB  Do you think that psychiatry will disappear as a specialty, one part being taken up by the neurologists or physicians and the other being done by psychologists and social workers?

ES  No, I don't. Perhaps it is because I have always thought of myself as a psychiatrist, I haven't thought of myself as being a geneticist or an MRC man or this and that, and it seems to me such a fascinating field. You can approach it from physical medicine with human and humane interest and find such an enormous lot to do. I can't think that the psychologists are as well placed, and certainly not the sociologists. A lot of them are totally misled by bogus ideas. The psychologists are better than the sociologists, who get their ideas from social know ledge which is knowledge about societies and groups, not about individuals. And I think they go completely adrift when they come up against ndividuals. Theyhave these dogmas, that a child's best place is with his mother, for instance. Even when the child is running away at every possible opportunity they still send him back. As for the neurologists, I have no hope for them at all. I think the neurologists could only advance if they really became neuropsychiatrists. If you are interested in brain function you must pay attention, a great interest, to the top level functions of the brain, that is the speech, emotional reaction, communication with other people at the highest level.

 

[1] See WEST. ERIC D. (1981) Electric convulsion therapy in depression: a double-blind controlled trial. British Medical Journal, 31 January, 355-57.