Leonardo Tondo: interview with Michael Shepherd On Epidemiology in Psychiatry
Comment by Malcolm Lader
I am honoured to have been asked to comment upon this interview of Michael Shepherd with Leonardo Tondo in 1987.
I first met Michael Shepherd in January 1960 when I was interviewed by him for a junior research post. He was co-holder of an NIMH grant with Heinz Schild and Hannah Steinberg. I last met Michael in December 1994 when we were members of an advisory panel invited to Taiwan to discuss mental health facilities with the Taiwanese president. In the 35 intervening years, I was treated by him with exceptional kindness, consideration and help with my career.
The interview is mainly related to Michael Shepherd’s epidemiological interests and expertise. But his psychopharmacology interests were also a major part of his activities. Perhaps the best example is his lead authorship of one of the first textbooks of clinical psychopharmacology. I was still a junior doctor when he asked me to collaborate with him on this, together with a biochemist, Richard Rodnight. Michael provided the overall strategy and the philosophy, Richard the technical aspects of biochemical pharmacology, and I worked assiduously writing the clinical aspects. The book was quite successful.
Later, Michael became involved in 2 aspects of psychopharmacology and therapeutics, both concerning long-term therapy. He fuelled the lithium controversy and cast doubt on the superior efficacy of depot neuroleptics. The latter were very extensively used in the UK because of the structural organisation of the National Health Service. I recall numerous discussions with Michael about both topics. We agreed that the model for a prophylactic therapy differed greatly from that of the treatment of an acute illness. The main complication was spontaneous natural remission which would promote the discontinuation in due course of an acute treatment but could lead to indefinite prolongation of a prophylactic treatment with long-term dangers. Michael therefore thought that the burden of proof for long-term treatments had to be greater than for short-term interventions.
After my three years’ research training with Schild, Shepherd and Steinberg, I decided to undergo the formal three years’ of psychiatric training at the Maudsley Hospital. My first year was with Michael. He was a brilliant diagnostician but less proficient in treatment. He was concerned to establish the diagnosis in unequivocal terms and to that end he would carry out lengthy searching interviews that often bewildered the patients. His senior assistant, James Birley, was a sympathetic and humane clinician, who later became president of the Royal College of Psychiatrists. After each ward round we would go round and reassure the disconcerted patients that we would arrange the most appropriate and hopefully up-to-date treatments.
Michael’s greatest and most enduring lesson for me was the broadening of the concept of normality. I would suspect some subtle psychopathology but he would show me that this was within the bounds of normality and was really British eccentricity. He was an expert on all sorts of obscure and esoteric cults.
Michael was at great pains to emphasize that hospital psychiatry was only a small and unrepresentative part of wider psychiatry as practised by General Practitioners in the UK National Health Service. He had many contacts and friendships with academic and practising GPs. This led to resentment on the part of his fellow hospital consultants who conspired to oppose him as the successor to Aubrey Lewis in 1966. Instead, the following year he was given a personal Professorship in Epidemiological Psychiatry as a consolation prize. He never forgave his colleagues.
Michael was a shy man who often became quite anxious in company. His main attribute was not to suffer fools gladly but he made this quite obvious instead of trying to hide his exasperation.
He was spoke and read several languages fluently. He was a true polymath and his knowledge of philosophies and and literature was unparalleled. Although critical of American psychiatry (Shepherd 1957), he often spoke fondly of his time in the United States where he made friends who remained close throughout his life.
His anathema was Emil Kraepelin (Shepherd, 1995), whom he regarded as not just a proto-fascist but a proto-Nazi in that his racial prejudices and rigidity provided a pseudoscientific rationale for the World War II atrocities in which mentally ill people were exterminated, as were the Jews and the Roma.
I quickly realised and accepted that I was neither intelligent enough nor eclectic enough to fully appreciate the towering intellect of Michael Shepherd. The only time that I felt any superiority was in Taiwan when it was apparent that he was unable to use chopsticks while I was quite adept.
Shepherd, M. An English view of American psychiatry. Am J Psychiat 1957; 114: 417- 20.
Shepherd, M. The two faces of Emil Kraepelin. Br J Psychiat 1995: 167: 174-83.
Shepherd, M, Lader, M, Rodnight R. Clinical Psychopharmacology. London: English Universities Press; 1967.
May 19, 2016