PROFESSOR SIR MARTIN ROTH ; Erudite Psychiatrist Who Guided His Discipline from Post-Freudian Thinking to the Age of Prozac

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Martin Roth, from modest origins, became the leading figure in British psychiatry of his day, one of only three psychiatrists ever awarded a Fellowship of the Royal Society, along with Sigmund Freud. He was the first President of the Royal College of Psychiatrists, 1971-75, and played a critical role in the foundation of the college. But he will be remembered best as the teacher of a generation of psychiatrists and as an inspiration for research in mental illness.

Roth was born in 1917 in Budapest and moved with his family to the East End of London as a young boy. He studied Medicine at St Mary's Hospital and first trained in neurology under Lord Brain. Brain communicated not only an interest in neurology, but also in the psychological aspects of illness, psychoanalysis and philosophy, which stimulated Roth to enter psychiatry. He went on to train in psychiatry at the Maudsley Hospital, with influences particularly from Aubrey Lewis, Eliot Slater and Erich Guttman. He then moved to the Crichton Royal Hospital in Dumfries, where he worked with Willy Mayer-Gross.

It was from the triad of Mayer-Gross, Slater and Roth that emerged the classic textbook Clinical Psychiatry, which became the bedrock of Roth's influence on British psychiatry. The first edition appeared in 1954 and it continued with new editions and revisions until 1977. This textbook set a stamp on British psychiatry well into the 1980s in defining what it is to be a psychiatrist, and what the business of psychiatry is as a medical discipline. It was written with immense erudition and humanity, with lucid clinical descriptions directly linked to the rich phenomenology of the German literature, and an underlying hunger to achieve a coherent scientific understanding of the nature of mental illness. His textbook was a sure, humane and safe pilot for the discipline of psychiatry in ideologically stormy times: the transition from the post-Freudian thinking to the age of Prozac. These were times that Roth and his co-authors inspired with a unique blend of clarity, critical thought, breadth of scholarship, charm, and humanity. It was in the German tradition of Emile Kraepelin, who in his daytransformedpsychiatrywithhisclear descriptions of the major psychiatric syndromes, only to be swept aside in late life by the rise of the Freudians.

Freud, as Roth liked to say, was not a psychiatrist, but a neurologist. Freud has come to be loved more in departments of literature and the history of ideas than in departments of psychiatry. This is because he never really came to grips professionally with the stuff of mental illness. The times of vast psychiatric institutions housing populations in excess of 1,000 souls in varying degrees of torment and hopelessness are still etched in the collective social consciousness, and their residue lives on in the stigma which is still too often attached to mental illness.

The transition came in 1952 with Jean Delay and Pierre Deniker's first description in Paris of the remarkable calming influence of chlorpromazine, a drug developed originally as a preoperative sedative, in a series of 38 psychotic patients. This was the time of the first introduction of anti-depressants that worked, initially the monoamine oxidase inhibitors, and then the tricyclics, dangerous drugs in overdose, but highly effective clinically.

Although newer drugs with safer profiles have been developed since, the therapeutic landscape has not altered in its fundamentals now for 50 years. It fell to Roth to teach his generation what these developments meant for understanding the discipline of psychiatry.

The recognition came that mental illness cannot be, of its essence, a moral disorder of the psyche that originates from adverse formative experiences, but consists in highly stereotyped expressions of characteristic states of the brain. These can be identified diagnostically and can be modified chemically. …