In Celebration of Per Bech by Thomas A. Ban
On May 9, 2018, Per Bech, a leading psychopharmacologist over four decades and an active contributing member of our International Network for the History of Neuropsychopharmacology, passed away. Born in Svendborg, Denmark, on January 12, 1942, at the time of his death, Bech was 76 years old, but still fully active as Professor of Clinical Psychiatry and Head of the Psychiatric Research Unit at the New Zealand Mental Health Center, University of Copenhagen.
A 1969 graduate of the medical school of Copenhagen University, Per Bech became involved in psychopharmacology and psychometrics during his training in psychiatry at Aarhus University in Aarhus, Denmark. Following the footsteps of Emil Kraepelin (1856 – 1926), who studied dose-effect relationships with alcohol by measuring reaction time in Wilhelm Wundt’s (1832 -1920) laboratories, Bech studied dose-effect relationships with tetrahydrocannabinol with the employment of various psychological measurements (Ban 2016). Then, in the 1970s while working in Ole Rafaelsen’s (1930 -1987) Psychochemical Institute in Copenhagen, Bech became involved in the evaluation of validity of rating scales for measuring changes in the course of treatment of depression and mania, as well as in developing new scales. His dissertation on the “clinical and psychometric validity of rating scales in depression and mania” earned him the degree of Doctor of Medical Science in 1981. In the same year, following the publication of his first book, Rating Scales for Affective Disorders: Their Validity and Consistency, he received the prestigious Anna-Monika Prize for his contributions in the field of depression. (Bech 1981).
During the 1980s pharmacotherapy with psychotropic drugs became the primary form of treatment for mental disorders and with the introduction of Third Edition of the Diagnostic and Statistical Manual of the America Psychiatric Association, in 1980, psychiatric patients were classified by diagnoses, accessible to “psychometrics” and treated with drugs developed by a methodology based on “psychometrics.” An active participant of this development, Bech broadened the scope of his research to study scales employed in a wide variety of mental disorders and in 1986 he presented his findings in a “Mini-compendium of rating scales for states of anxiety depression, mania, schizophrenia with corresponding DSM-III syndromes” written in collaboration with Marianne . Kastrup and Ole Rafaelsen. By the 1990s, Bech’s research embraced mental health, and not only its pathology; he was developing instruments suitable for measuring also the effects of treatment on enjoyment of life and adaptation to society, as reflected in his book, Rating Scales for Psychopathology, Health Status and Quality of Life, published in 1993.
Actively involved in clinical investigations with psychotropic drugs and psychometrics throughout the years, in 2008 Bech was appointed professor of applied clinical psychometrics at Copenhagen University. Four years later, in 2012 he published Clinical Psychometrics, a tour de force, in which he defined the field, outlined its development, summarized its progress between 1993 and 2012 and conceptualized his own contributions to it over four decades. The two major models for testing the measurement aspect of rating scales, Hotelling’s Principal Component Analysis for identifying the structure of items included in a scale, and Rasch’s and Mokken’s Item Response Theory models for examining the “scalability” of rating scales, are given special attention. Yet, at the heart of the monograph is Bech’s “pharmacopsychometric triangle” of which one of the angles “covers” measurements relevant to therapeutic (desired) effects, another angle covers measurements relevant to side or adverse (unwanted) effects and the third, measurements relevant to patients’ quality of life. The “psychometric triangle” is a conceptual construct for translating the therapeutic ratio of psychotropic drugs into measurable benefits of treatment in patients’ well-being, based on patients’ “subjective” experience.
While in Clinical Psychometrics Bech provides a conceptual framework for “measurement – based care of mental disorders,” in his Measurement-Based Care of Mental Disorder, published in 2016, just two years before his untimely death, he translates theory into practice by selecting easy to use, short and valid rating scales and questionnaires for use in both: clinical research throughout the clinical development of psychotropic drugs and in daily practice in evaluating their effect in clinical practice. Adoption of the scales he selected in clinical routine would open up the possibility of an accountable clinical practice in psychiatry. It would also generate information that would allow for rational decisions whether adoption of a particular new drug would offer any advantages in treatment. With publication of his last book Bech has opened a new horizon in which evidence-based care will be replaced by measurement-based care in psychiatry.
Per Bech’s contributions were crowned in 2010 with the “pioneer award” of the International College of Neuropsychopharmacology (CINP).
American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders. DSM-III. Washington: American Psychiatric Association; 1980.
Ban TA. Foreword. In Bech P. Measurement Based Care in Mental Disorders. New York: Springer; 2016.
Bech P. Rating scales for affective disorders: their validity and consistency. Acta Psychiatr Scand Suppl. 1981;295:1-101.
Bech P. Clinical Psychometrics. Oxford: Wiley – Blackwell; 2012.
Bech P. Measurement Based Care in Mental Disorders. New York: Springer; 2016.
Bech P. Rating Scales for Psychopathology, Health Status and Quality of Life. New York: Springer; 1993.
Bech P, Kastrup M, Rafaelsen O. Mini rating scales for states of anxiety, depression, mania, schizophrenia with corresponding DSM-III syndromes. Acta Psychiatrica Scandinavica 1986; 326: 1-37.
February 20, 2020