Abstract
First president of the Royal College of Psychiatrists whose research broke new ground on Alzheimer's and anxiety
Sir Martin Roth contributed greatly to psychiatry and was one of only three psychiatrists to be elected to fellowship of the Royal Society. He was an intellectual giant and a fine orator and steered psychiatry towards an ethos that was research based, intellectually rigorous, and compassionate. He taught a generation of psychiatrists and was a source of inspiration for mental health research.
In the early 1950s, when he was director of clinical research at Graylingwell Hospital in Chichester, he showed that many elderly patients in long stay hospitals whose condition was attributed to senility and dementia and who were deemed incurable were suffering from treatable disorders such as depression, or from infection-induced delirium, and could recover. He spoke German, and by going back to Alzheimer's original description of the dementia that bears his name, and Kraepelin's equally superb descriptions of depression and anxiety, restored their view of these conditions, which had been largely forgotten during the age of Freud and psychoanalysis.
In Newcastle in the 1960s he showed, with Bernard Tomlinson, that the degree of cognitive impairment was related to the extent of brain damage found post mortem in stroke-induced dementia and Alzheimer's disease. These changes were absent or minimal in patients with functional disorders and delirium. This led to the establishment of psychogeriatrics and to singular improvements in patient care. In Cambridge he pursued these studies with the MRC Neurochemistry and Neuropharmacology Unit and with the Molecular Biology Laboratory and its Nobel laureate director Aaron Klug. He produced a series of papers on the abnormal protein, called tau, found in the brains of patients with Alzheimer's disease.
When Thomas Szasz published the Myth of Mental Illness Roth counter-argued, and published his arguments in a book called the Reality of Mental Illness. He cowrote the Textbook of Psychiatry, for 20 years the leader in its field, noted for its clarity, lucid clinical descriptions, scientific base, and humanity.
Roth, the son of a cantor in a synagogue, came to England with his parents when he was 8. He was educated at Davenent School in Whitechapel, where he acquired a love of poetry and literature. He was a fine musician and could have made music his career. He chose medicine and qualified at St Mary's Hospital Medical School in 1942, working as a physiology demonstrator while still a student, and rowing for the school team.
He did his house jobs at St Mary's and from 1943 to 1946 was neurology registrar and then senior registrar under Russell Brain and Wilfred Harris at the Maida Vale Hospital for Nervous Diseases. With Brain's approval he decided to enter psychiatry, and moved to the Maudsley as senior registrar to Sir Aubrey Lewis. Here he met Eliot Slater and Willy Mayer-Gross, who became lifelong friends. But Roth and Lewis clashed, and he moved after two years to become senior psychiatrist at Crichton Royal Hospital, Dumfries, under Mayer-Gross, who invited him to collaborate with him and Slater in writing the Textbook of Clinical Psychiatry (1954). This went into three editions over 23 years, the last of which was revised entirely by Roth, and was translated into five languages.
Two years later, in 1950, Roth embarked on his research career, as clinical research director at Graylingwell Hospital, Chichester. Here he expanded his research into quantifying the changes, including electroencephalographic phenomena, of electroconvulsive therapy. It was during this time that chlorpromazine, the first effective anxiolytic, was launched, and was rapidly followed by the first effective drugs for depression. Five years later Roth became professor and head of department at Newcastle University, where he built up one of Britain's main centres for clinical psychiatric research. As an honorary consultant he had administrative charge of psychological medicine at Newcastle General Hospital and the Royal Victoria Infirmary. He established units for child psychiatry, neurosis, and psychogeriatrics. He was director of the MRC Psychiatry Research Group, and he was awarded his KBE during his tenure there.
By this time he was on the MRC's clinical research board and was on the Ministry of Health mental health committee advising Sir Keith Joseph on replacing 1000-bed mental hospitals with smaller units in general hospitals and with care in the community. He had an international reputation and was consulted by the World Health Organization, contributing to its International Classification of Diseases. During this time he played a major part in transforming the Royal Medico-Psychological Association into the Royal College of Psychiatrists, and raising the money to buy its premises in Belgrave Square.
In 1977 he was appointed to the chair of psychiatry at Cambridge, building up a research department from scratch. He remained there until his “retirement” as emeritus professor in 1985. He continued to work, and published a further 150 papers—his total exceeded 400—mainly on affective disorders and Alzheimer's disease.
A fine orator and writer, Roth had some splendid intellectual battles, not only with Thomas Szasz on the realness of mental illness but also with Robert Kendall on the difference between anxiety disorder and depression. Kendall argued that they formed a continuum: Roth was convinced that they were different entities. He was good with the rapier, saying of Jacques Derrida: “The tide of his rhetoric is unimpeded by the outcrop of facts lying in its path.” On Ivan Illich: “a brooding presence in night, like a dysfunctional lighthouse emitting shafts of darkness to confuse unwary travellers.” The work on tau protein with his former PhD student Claude Wischik, now professor at Aberdeen, promises to lead to treatments, one of which is now in clinical trial.
His other books included Psychiatry, Society and the Law (with R Bluglass) (1986), CAMDEX—the Cambridge Examination for Mental Disorders of the Elderly (with three others) (1988, second edition 1999). This also has been translated into five languages. He edited the five volume Handbook of Anxiety (1988-92) and was a consultant editor and contributor to Richard Gregory's Oxford Companion to the Mind (2nd edition 2005).
He received honours and awards, too numerous to mention, around the world.
Roth developed Crohn's disease when young and realised this might shorten his life, which probably honed his desire to achieve. He underwent major surgery, which generated problems that dogged his life. In the event he lived to 88 and worked until, at 85, ill health forced him to retire. He died peacefully at home. His wife and three daughters survive him. There will be a memorial service at Trinity College, Cambridge, at 2.15 pm on 20 January 2007.