Lives of the fellows

Martin (Sir) Roth

b.6 November 1917 d.26 September 2006
Kt(1972) MRCS LRCP(1941) MB BS Lond(1943) MA(1943) MRCP(1944) MD(1946) DPM RCPSI(1949) FRCP(1958) FRCPsych(1971) Hon ScD Dublin(1972) Hon FRCPS Glasg(1973) Hon DSc Indiana(1993) FRS(1996)

From an inauspicious start as the second son of a refugee family, Sir Martin Roth rose to become an influential psychiatrist, the first professor of psychiatry at the University of Cambridge and the founder president of the Royal College of Psychiatrists.

Roth was born in Hungary, but was brought up in the East End of London. His father, Samuel Simon Roth, was a cantor in a synagogue. His mother was Regina Ann née Lieberman. At the Davenant Foundation Grammar School he acquired a lifelong love of literature and music, but chose medicine as a career “as he had to be sure of earning a living”. He entered St Mary’s Hospital, for which he rowed, and was taught among others by Sir George Pickering [Munk’s Roll, Vol.VII, p.464], whose exposition of the new discipline of ‘clinical science’ made a deep impression. He qualified in 1942, obtained the MRCP in 1944 and the London MD in 1945, and then trained in neurology at the Maida Vale hospital under Wilfred Harris [Munk’s Roll, Vol.V, p.175], once house physician to Hughlings Jackson [Munk’s Roll, IV, p.161], and Russell, later Lord, Brain [Munk’s Roll, Vol.VI, p.60], whom he found friendly and helpful. In his reflections, on his 80th birthday, he recalled working on the EEG with Grey Walter [Munk’s Roll, Vol.VI, p.60] at Bristol and being initiated into the preparation of brain sections by a skilled laboratory technician. He also recalled that in 1954, while visiting McGill University, Montreal, where Walter Penfield was a neurosurgeon, he had watched as a patient described feelings of unreality and detachment from self during stimulation of her temporal cortex.

During this period he wrote two papers, one on anosognosia (or lack of awareness of disability), both later published in Brain. A career in neurology seemed probable, but he became disenchanted when he realised that, with a few exceptions such as Lord Brain, the interest of British neurologists, in his own words, “stopped at the neck”, that anyone who dabbled above that level was virtually a charlatan, and that this ran counter to his own ideas that some abnormal mental states were associated with dysfunction at higher brain levels. However, he remained in touch with general medicine, becoming examiner in medicine for the Conjoint Board, a member of council of the Royal College of Physicians, and from 1968 to 1972 examiner for the MRCP.

Roth was impressed by Eliot Slater’s [Munk’s Roll, Vol.VII, p.541] scientific method in psychiatric research, and asked to be introduced. At Slater’s suggestion he went to the Maudsley Hospital to train in psychiatry, where he was senior registrar to Sir Aubrey Lewis [Munk’s Roll, Vol.VI, p.284]. But he found Lewis to be excessively critical and left after two years, while Slater became a lifelong friend and colleague. During the next two years Roth was senior psychiatrist at the Crichton Royal Hospital, Dumfries, where his relationship with W Mayer-Gross [Munk’s Roll, Vol.V, p.275], a distinguished German refugee who was director of research, had two very important results. The first was an invitation to join Slater and himself in a new textbook. The first edition of Clinical psychiatry (Cassell) was eventually published in 1954, and it became the leading textbook in psychiatry in English for 25 years and was translated into five languages. As a result, Roth’s name became well-known to British psychiatrists and abroad.

The second important result was to ignite Roth’s interest in the psychiatry of old age. This became his main field of enquiry when in 1950 he was appointed director of research at Graylingwell Hospital, a county mental hospital in Sussex. At that time patients over the age of 60 or 65 were generally regarded as suffering from ‘senility’ and aroused little medical interest. On the basis of their predominant symptoms, Roth defined five operational groups and showed that they differed markedly from each other in pattern of outcome: the dementias proper (subdivided into vascular and senile) had a high mortality, acute confusional states (often due to infections) and depressions often recovered with treatment, and paranoid psychoses (‘late paraphrenia’) persisted unchanged. At Newcastle, where he was appointed to the chair of psychological medicine in 1956, brains from each of these groups were studied and a quantitative relationship between the extent of degenerative change and degree of cognitive loss measured during life was clearly demonstrated. Bernard, later Sir Bernard, Tomlinson who was then pathologist at the Newcastle General Hospital, and Garry Blessed, consultant psychiatrist, collaborated in this work, which provided Roth’s classification with a pathological basis. A community-based survey of older people showed that prevalence of dementia increased regularly with age. A new specialty of geriatric psychiatry emerged, and treatment of older patients improved.

Roth was one of the first to describe fully the clinical and EEG differences between acute confusion and dementia. He also studied the effects of electroconvulsive therapy (ECT) on the EEG and his essay on the mode of action of ECT won the Burlingame prize of the Royal Medico-Psychological Association.

During his 21 years at Newcastle he established units for child psychiatry, neurosis and geriatric psychiatry, and took the discipline of clinical psychology into his department, which became the main centre of psychiatric research in Britain, in which many of his colleagues were involved. A major topic was the classification of depressive disorders. In a series of papers Roth and colleagues produced evidence for the distinctness of endogenous (psychotic, melancholic) depression from other forms. And, like Freud, Roth was fascinated by anxiety and its manifestations. In his studies on depersonalisation, panic attacks, and agoraphobia, and their demarcation from each other and from depression, with the collaboration of the psychologist Roger Garside, he made early use of computers and multivariate statistical programs to establish categories of illness and their treatment, and argued against the dimensional approach with, as he put it, its ‘seamless continuities’. Later he edited jointly the Handbook of anxiety (Amsterdam, Elsvier, 1988-1992) in five volumes. He also involved himself in many current issues, defended psychiatry against its critics in The reality of mental illness (Cambridge, Cambridge University Press, 1986) with Jerome Kroll, and wrote on human violence, pornography and society, transsexualism and sex change, Soviet dissidents, and psychiatry and the law.

Roth soon achieved a national and international reputation. From 1958 to 1959 and again from 1966 to 1984 he was a consultant for the World Health Organization (WHO) and a member of scientific groups on geriatric care. During 1984 to 1987 he was a consultant adviser to WHO on the mental health section of the International Classification of Diseases. In 1964 he became a member of the clinical research board of the Medical Research Council (MRC) and director of an MRC research group in psychiatry in Newcastle. From 1965 to 1975 he was on the Ministry of Health’s advisory committees on the health service, and was involved in the government’s plans to replace mental hospitals by units in district general hospitals and community care. He expressed qualms about the quality and scope of care, which went unheeded. During 1977 to 1982 he was a member, then vice president, of the Medical Defence Union.

In 1971, Roth was elected by ballot as the first president of the newly-formed Royal College of Psychiatrists, which superseded the Royal Medico-Psychological Association. At this time a group of psychiatric trainees were seriously concerned about having to sit a membership examination (required by the charter), which they threatened to boycott. In his induction address, delayed until 1972, Roth undertook to introduce new training programmes, including accreditation of hospitals for teaching, and succeeded in establishing unity. Later, with the help of the philanthropist Lord Goodman, he acquired permanent headquarters for the College in Belgravia.

In 1977 he was appointed the first professor of psychiatry at Cambridge University and, while organising a new department, continued research. CAMDEX: the Cambridge examination for mental disorders of the elderly (Cambridge, Cambridge University Press) was published in 1988 and translated into five languages. He collaborated with the MRC’s neurochemical pharmacology unit under Leslie Iversen, and later with Sir Aaron Klug and the laboratory for molecular biology to investigate the filaments that make up the neurofibrillary tangles characteristic of Alzheimer’s disease. His talented team, in which Claude Wischik, now professor of mental health at Aberdeen University, was a prominent member, produced a stream of papers on the protein known as tau, which was found to be present in the tangles in an abnormal insoluble form, raising hopes of a remedy in the not too distant future.

Roth was an erudite, cultured and gentle man, and a talented pianist. He had a prodigious capacity for work and devoted himself to it without reserve. He was an outstanding speaker and teacher, with a love of paradox and a strong sense of the absurd, which could reduce his listeners to helpless laughter. He never lost sight of the individual and was supremely skilful at interviewing patients and exploring their mental lives with empathy and understanding. He is survived by Constance Heller, whom he married in 1945, and who supported him at all times, and by their three daughters.

David Kay

[The Daily Telegraph 13 October 2006; The Independent 19 October 2006; The Times 24 October 2006; The Guardian 27 October 2006; Psychiatric Bulletin 2007 31:195; Brit.med.J., 2006 333 1175]

(Volume XII, page web)

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