Michael Shepherd (psychiatrist)
Encyclopedia
Michael Shepherd, CBE
Order of the British Empire
The Most Excellent Order of the British Empire is an order of chivalry established on 4 June 1917 by George V of the United Kingdom. The Order comprises five classes in civil and military divisions...

, FRCP
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...

, FRCPsych (Hon)
Royal College of Psychiatrists
The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom responsible for representing psychiatrists, psychiatric research and providing public information about mental health problems...

, FAPA (Corr)
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...

, FAPHA
American Public Health Association
The American Public Health Association is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide...

 (30 July 1923–21 August 1995) was one of the most influential and internationally respected psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

s of his time, formerly Professor of Epidemiological Psychiatry, Institute of Psychiatry
Institute of Psychiatry
The Institute of Psychiatry is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place...

 and Consultant Psychiatrist, The Maudsley Hospital
Maudsley Hospital
The Maudsley Hospital is a British psychiatric hospital in South London. The Maudsley is the largest mental health training institution in the country...

, London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...

 and author of a number of influential publications in the field of psychiatry, including the seminal work Psychiatric Illness in General Practice.

Early life

Michael Shepherd was born on 30 July 1923 in Cardiff
Cardiff
Cardiff is the capital, largest city and most populous county of Wales and the 10th largest city in the United Kingdom. The city is Wales' chief commercial centre, the base for most national cultural and sporting institutions, the Welsh national media, and the seat of the National Assembly for...

 of a Jewish family with its roots in Odessa
Odessa
Odessa or Odesa is the administrative center of the Odessa Oblast located in southern Ukraine. The city is a major seaport located on the northwest shore of the Black Sea and the fourth largest city in Ukraine with a population of 1,029,000 .The predecessor of Odessa, a small Tatar settlement,...

 and Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...

. He attended Cardiff High School
Cardiff High School
Cardiff High School is a comprehensive school in the Cyncoed area of Cardiff, Wales. Cardiff High School is two miles from the city centre, serving a neighbourhood of privately-owned houses. According to the 2007 ESTYN Report, "Cardiff High School is a very good school with many outstanding...

 and pursued his medical studies at the Medical School of Oxford University and the Radcliffe Infirmary
Radcliffe Infirmary
The Radcliffe Infirmary was a hospital in central Oxford, England, located at the southern end of Woodstock Road on the western side, backing onto Walton Street. The Radcliffe Infirmary, named after physician John Radcliffe, opened in 1770 and was Oxford's first hospital...

. He was there influenced by the teaching of John Ryle, Professor of Social Medicine. Whilst under his tutorage, Shepherd was asked to visit a patient in her own home in Cowley
Cowley, Oxford
Cowley in Oxford, England, is a residential and industrial area that forms a small conurbation within greater Oxford. Cowley's neighbours are central Oxford to the northwest, Rose Hill and Blackbird Leys to the south, New Headington to the north and the villages of Horspath and Garsington across...

 in order to learn about the socio-medical significance of cardiac invalidism. Through such examples, Shepherd discerned the potential value to psychiatry of systematic research into the social causes of mental disorder. After qualifying he went on to complete his house appointments, and also his National Service
National service
National service is a common name for mandatory government service programmes . The term became common British usage during and for some years following the Second World War. Many young people spent one or more years in such programmes...

 in the Royal Air Force
Royal Air Force
The Royal Air Force is the aerial warfare service branch of the British Armed Forces. Formed on 1 April 1918, it is the oldest independent air force in the world...

.

Career

Shepherd began his psychiatric career at The Maudsley Hospital
Maudsley Hospital
The Maudsley Hospital is a British psychiatric hospital in South London. The Maudsley is the largest mental health training institution in the country...

 in 1947. In 1954 he obtained his Doctorate in Medicine from Oxford University, his thesis being a study of the pattern of major psychoses in the county of Buckinghamshire
Buckinghamshire
Buckinghamshire is a ceremonial and non-metropolitan home county in South East England. The county town is Aylesbury, the largest town in the ceremonial county is Milton Keynes and largest town in the non-metropolitan county is High Wycombe....

 during two periods, 1931–33 and 1945-47. In 1956 he joined the staff of the Institute of Psychiatry
Institute of Psychiatry
The Institute of Psychiatry is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place...

 as a Senior Lecturer, and then in 1961 he was appointed to the Institute's Readership in Psychiatry. In 1967 he had conferred on him a personal chair of epidemiological psychiatry, the first of its kind in the world. He became a Fellow of the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...

 in 1970 and a Foundation Fellow of the Royal College of Psychiatrists
Royal College of Psychiatrists
The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom responsible for representing psychiatrists, psychiatric research and providing public information about mental health problems...

 in 1971. He established the General Practice Research Unit at the Institute of Psychiatry
Institute of Psychiatry
The Institute of Psychiatry is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place...

 in the late 1950s and continued to direct its activities until his retirement in 1988. He was also the founder editor of the journal Psychological Medicine
Psychological Medicine
Psychological Medicine is a peer-reviewed medical journal in the field of psychiatry and related aspects of psychology and basic sciences. According to the Journal Citation Reports, the journal has a 2010 impact factor of 5.200, ranking 6th out of 73 journals in the category "Psychology", 11th out...

 and he was awarded the CBE
CBE
CBE and C.B.E. are abbreviations for "Commander of the Order of the British Empire", a grade in the Order of the British Empire.Other uses include:* Chemical and Biochemical Engineering...

 in 1989. During his career he also became a Fellow of both the American Public Health Association
American Public Health Association
The American Public Health Association is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide...

 and the American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...

.

Shepherd was heavily influenced during his early years at The Maudsley by Aubrey Lewis
Aubrey Lewis
Sir Aubrey Julian Lewis, FRCP, FRCPsych , was the first Professor of Psychiatry at the Institute of Psychiatry, London, and is credited with being a driving force behind the flowering of British psychiatry after World War II as well as raising the profile of the profession worldwide.-Early...

, who taught that the precise and well-organised collection of social data should become a new activity for the psychiatrist rather than limiting himself to the clinical study of the individual patient. Shepherd’s close working relationship with Lewis later resulted in a careful documentation of Lewis' legacies to psychiatry in his remarkable biographies. With the exception of one year's attachment to the School of Public Health at Johns Hopkins University
Johns Hopkins University
The Johns Hopkins University, commonly referred to as Johns Hopkins, JHU, or simply Hopkins, is a private research university based in Baltimore, Maryland, United States...

, Baltimore
Baltimore
Baltimore is the largest independent city in the United States and the largest city and cultural center of the US state of Maryland. The city is located in central Maryland along the tidal portion of the Patapsco River, an arm of the Chesapeake Bay. Baltimore is sometimes referred to as Baltimore...

, in 1955-56, Shepherd remained at The Maudsley for the entire duration of his professional career.

Role of GPs in the treatment of psychiatric illness

One of his outstanding contributions was to focus attention on the role of the NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 general practitioner in the treatment of patients with minor psychiatric illness. This was an important facet of the General Practice Research Unit which he established under the auspices of the Department of Health and Social Security
Department of Health and Social Security
The Department of Health and Social Security was a ministry of the British government in existence for twenty years from 1968 until 1988, and was headed by the Secretary of State for Social Services.-History:...

. In 1986 the Chief Medical Officer of the Department of Health and Social Security
Department of Health and Social Security
The Department of Health and Social Security was a ministry of the British government in existence for twenty years from 1968 until 1988, and was headed by the Secretary of State for Social Services.-History:...

 wrote:

"Within the structure of the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

, the medical responsibility for the care of (emotionally disturbed) patients falls principally on the general practitioner."

He went on to give credit to Shepherd for having carried out the work which clarified the nature and extent of these disorders. He further stated that the results of his enquiries had considerable implications for the organisation of medical services in Britain
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 and for medical education. This was in stark contrast to the opinion two decades earlier when the medical correspondent of The Times
The Times
The Times is a British daily national newspaper, first published in London in 1785 under the title The Daily Universal Register . The Times and its sister paper The Sunday Times are published by Times Newspapers Limited, a subsidiary since 1981 of News International...

 (summarising an article in The Practitioner) stated that "the optimal management of neurotic patients by their general practitioners is not possible under the National Health Service" due to the time it would take.

Shepherd’s research and influence led to a much closer scrutiny of the needs of the numerous patients encountered in general practice with psychological disorders, and also resulted in an increase in the personnel composing the professional team in primary care. Shepherd’s seminal work Psychiatric Illness in General Practice (published in 1966) was the catalyst for this whole area of mental health research and policy for the best part of 30 years. It has been suggested that the resources available to the psychiatrists themselves remained stagnant and yet it is to them that virtually all the acute and serious cases of mental illness are referred straight away Also, Shepherd's insistence that the mental health services could only be enhanced by better training and better support for GPs rather than a proliferation of psychiatrists did not endear him to many of his psychiatric colleagues. However, not only has it been praised by the Chief Medical Officer, it has also been endorsed by a succession of World Health Organisation declarations and is enshrined in a variety of Government strategy documents, including the 1992 publication, "The Health of the Nation".

Clinician

Shepherd’s noted clinical study on the symptom of morbid jealousy early in his career led him to the conclusion that a medical opinion is of most value when the inter-personal and social aspects of a case are as closely understood as the narrower issue of diagnosis. He went on to apply these precepts to the full range of psychiatric disorders. Despite the value he gained from this study, Shepherd immediately became less concerned with the minutiae of clinical or experimental research and left the spadework to his team of research workers. As a clinician, Shepherd's style has been described as "unusual". He continued to be involved in clinical work until his retirement, although day-to-day management of his patients was delegated. His detachment was described as "Olympian" and was captured by a former patient in the lines of her book thus:

"a tall dark pale man, with a chillingly superior glance and quellingly English voice made another appointment to see me. I knew that if anyone could discover the 'truth' it would be he alone or with his colleagues."

Tackling conceptual issues in psychiatry

One of Shepherd’s legacies is the progress he made in helping the profession define and clarify difficult conceptual issues. He wrote extensively on the thorny problems of psychiatric classifications, psychopathology and the causation of mental illness. He was renowned for his "adroit dissection of poorly defined concepts" and for his success in clarifying them in his writings. In his 1987 article on the Formulation of New Research Strategies on Schizophrenia he concluded that the most persistent obstacle remained that of the reliable identification of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

. He went on to instigate the move towards obtaining international agreement for the definition of schizophrenia in communicable form He also wrote extensively on the general psychopathology of Karl Jaspers
Karl Jaspers
Karl Theodor Jaspers was a German psychiatrist and philosopher who had a strong influence on modern theology, psychiatry and philosophy. After being trained in and practicing psychiatry, Jaspers turned to philosophical inquiry and attempted to discover an innovative philosophical system...

 illuminating his belief that the main appeal of Jaspers' book as its breadth in extending the field of general psychopathology
Psychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...

 from the natural sciences, via phenomenology
Phenomenology (science)
The term phenomenology in science is used to describe a body of knowledge that relates empirical observations of phenomena to each other, in a way that is consistent with fundamental theory, but is not directly derived from theory. For example, we find the following definition in the Concise...

, to existentialist philosophy. In other words, the complex field of psychopathology had to be explored not only through biological science but through an analysis of what essentially belongs to Man and not man as a species of animal. Despite the seminal nature of Jasper’s book, it is also recognized that it contains no clear definition of psychopathology, a weakness addressed by Shepherd who went about successfully converting English speaking psychiatrists to this work both through his essays and by instituting in the late 1950s a course of seminars on psychopathology for the benefit of doctors training in psychiatry at the Maudsley Hospital.

Biographical essays

Shepherd used biographical essays as a vehicle to reveal his own personal philosophy and his leanings in psychiatry. Most notable are those centred on the achievements of people he admired including John Ryle, Aubrey Lewis
Aubrey Lewis
Sir Aubrey Julian Lewis, FRCP, FRCPsych , was the first Professor of Psychiatry at the Institute of Psychiatry, London, and is credited with being a driving force behind the flowering of British psychiatry after World War II as well as raising the profile of the profession worldwide.-Early...

 and Jean Starobinski
Jean Starobinski
Jean Starobinski is a Swiss literary critic.-Biography:Jean Starobinski studied classical literature, and then medicine at the University of Geneva, and graduated from that school with a doctorate in letters and in medicine...

. In particular, Shepherd revered Lewis, whom he called a "Representative Psychiatrist". Kenneth Rawnsley suggested that he identified in his mentor the very qualities that he aspired to himself: intellectual integrity, scholarship, a vast range of knowledge and a cultivated capacity for juridical thought.

Hammer of Psychoanalysis

Shepherd was described by colleagues as the "Hammer of Psychoanalysis", although he was not totally antipathetic towards its use. The conclusion he drew in his essay entitled "Sherlock Holmes and the case of Dr Freud", where he compared the Sherlock Holmes
Sherlock Holmes
Sherlock Holmes is a fictional detective created by Scottish author and physician Sir Arthur Conan Doyle. The fantastic London-based "consulting detective", Holmes is famous for his astute logical reasoning, his ability to take almost any disguise, and his use of forensic science skills to solve...

 method of drawing sweeping inferences from trivial clues with Freud's analytic method for examining the human mind, was that in both cases the method is viewed as essentially intuitive and devoid of logic. He coined the term neologism "mythod" to describe their method embedded in a myth, devoid of scientific value. Although he conceded reluctantly that psychoanalysis might still have some value as an arching metaphor, he demolished psychoanalysis as a scientific discipline.

Founding editor of Psychological Medicine

During Shepherd’s career, he wrote and co-authored over 30 books and around 200 original articles including the five volumes of the Handbook of Psychiatry. However, perhaps his finest literary legacy was the establishment of what has been described as "arguably the finest psychiatric journal in the English-speaking world", the journal Psychological Medicine. He was the founding editor of Psychological Medicine from 1969 until 1993. It is interesting to note that he favoured the term "Psychological Medicine" over "Psychiatry" and he attached great importance to the title which he resurrected from the Journal of Psychological Medicine, first conceived by Forbes Winslow. He defined psychological medicine as including not only psychiatry but also the study of abnormal behaviour from the medical point of view. He aimed to concentrate on original high-quality work across the wide spectrum of both psychiatry and its allied disciplines and contributed extensively himself investing much time and care towards its success. According to his successor, Psychological Medicine was to become perhaps his greatest and most enduring creation set in an academic and research career which was already highly distinguished.

Teacher

As a teacher he has been described as being without peer. He was an incorrigible opponent of the growing mass-production trends in contemporary university teaching with their emphasis on multiple-choice examination and impersonal teaching methods. He shunned didactic teaching but used the Socratic method
Socratic method
The Socratic method , named after the classical Greek philosopher Socrates, is a form of inquiry and debate between individuals with opposing viewpoints based on asking and answering questions to stimulate critical thinking and to illuminate ideas...

 of teaching by cross-questioning and challenging remaining devoted to the tutorial approach of which he was a "consummate practitioner". He jealously guarded his own opinions on controversial issues and remained enigmatic, provoking powerful exchanges of views. Former students of Shepherd have stated that he was a "challenging, provocative and inspiring teacher". He was renowned for his single-minded dedication to the scientific method and his incisive analytical skills, and hostility to vague speculation. His scepticism was not ideologically based and he was as likely to turn his critical gaze upon the contemporary enthusiasm for more detailed psychiatric classification as he was of the more established Freudian movement.

It is important to note that he was served by generations of young research workers whose assistance helped him achieve the epidemiological studies for which he is renowned. Conversely, he was the inspiration behind their efforts and psychiatric careers that followed. A former student, Anthony Clare
Anthony Clare
Anthony Ward Clare was an Irish psychiatrist well known in the UK and Ireland as a presenter of radio and TV programmes.-Career:...

, has said that he was without equal in his record of selecting, nurturing and encouraging young men and women who would go on to fill senior academic posts in Britain and throughout the world. He was noted for identifying able and committed doctors in Africa, Asia, South America and Eastern Europe on his travels there. He often raised funds for their salaries, and took a great personal involvement in their research topics and apprenticeships securing them "a foot on the ladder of academic achievement" whilst helping to maintain The Maudsley’s position as one of the world's great postgraduate centres for psychiatric teaching and research.

A former researcher of Michael Shepherd wrote:

"His students will always remember the spidery red ink which took apart their best efforts, and the equally spidery black ink with a small message attached to an article he thought relevant to the current problem, always signed MS."

Honours and awards

Michael Shepherd received professional recognition with the presentation of:
  • Donald Reid Medal
    Donald Reid Medal
    The Donald Reid Medal is awarded triennially by the London School of Hygiene and Tropical Medicine in recognition of distinguished contributions to epidemiology.-Institution:...

     for Epidemiology
    Epidemiology
    Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

     in 1982.
  • Rema Lapouse Award
    Rema Lapouse Award
    This award is granted to an outstanding scientist in the area of psychiatric epidemiology in recognition of "significant contributions to the scientific understanding of the epidemiology and control of mental disorders. It is sponsored by the Mental Health, Epidemiology, and Statistics Sections of...

     of the American Public Health Association
    American Public Health Association
    The American Public Health Association is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide...

     in 1983.


He was honoured with:
  • CBE
    CBE
    CBE and C.B.E. are abbreviations for "Commander of the Order of the British Empire", a grade in the Order of the British Empire.Other uses include:* Chemical and Biochemical Engineering...

     in 1989.
  • Honorary Fellowship of the Royal College of Psychiatrists
    Royal College of Psychiatrists
    The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom responsible for representing psychiatrists, psychiatric research and providing public information about mental health problems...

     in 1990.
  • Honorary Fellowship of the Royal Society of Medicine
    Royal Society of Medicine
    The Royal Society of Medicine is a British charitable organisation whose main purpose is as a provider of medical education, running over 350 meetings and conferences each year.- History and overview :...

     in 1995 shortly before his death.

Family and personal life

Shepherd was described as an entertaining companion whose breadth of knowledge was dazzling. He had a multitude of interests from ballet
Ballet
Ballet is a type of performance dance, that originated in the Italian Renaissance courts of the 15th century, and which was further developed in France and Russia as a concert dance form. The early portions preceded the invention of the proscenium stage and were presented in large chambers with...

 to rugby football
Rugby football
Rugby football is a style of football named after Rugby School in the United Kingdom. It is seen most prominently in two current sports, rugby league and rugby union.-History:...

, and took a great personal interest in the personal lives and backgrounds of those with whom he worked. He was a truly cultured man, well versed in literature and fluent in several languages. He was also a modest man, despite his pre-eminence in his field. Although described as being usually reticent in any exchange of personal emotion, he was also at heart a private and family man. He married Margaret Rock in 1947, a school teacher and together they had four children, two daughters, Catherine and Lucy, and two sons, Simon and Daniel, whom they raised in a large house on Alleyn Park Road in West Dulwich
West Dulwich
West Dulwich is an area in southeast London, England, that straddles the London Borough of Lambeth and the London Borough of Southwark. Croxted Road and South Croxted Road mark the boundary between London Borough of Southwark on the east and London Borough of Lambeth to the west...

, south London, a relatively short distance from Maudsley Hospital
Maudsley Hospital
The Maudsley Hospital is a British psychiatric hospital in South London. The Maudsley is the largest mental health training institution in the country...

. He was devastated by the death of his wife after a long illness in 1992 and withdrew for a period from public appearances. At the time of Michael Shepherd’s death on 21 August 1995, he had two grandsons, his first granddaughter being born a few days after his death.

Selected publications

  • A Study of the Major Psychoses in an English County, 1957;
  • Psychiatric Illness in General Practice, 1966, London: Oxford University Press;
  • (et al.) An experimental approach to psychiatric diagnosis, Acta Psychiatrica Scandinavica, 210. Suppl, 1968;
  • Psychotropic Drugs in Psychiatry, 1981;
  • Handbook of Psychiatry', 1982;
  • Psychiatrists on Psychiatry, 1983;
  • The Anatomy of Madness, 1985 (co-editor with William Bynum and Roy Porter);
  • Sherlock Holmes and the Case of Dr Freud, 1985;
  • A representative psychiatrist: the career, contributions and legacies of Sir Aubrey Lewis, Psychological Medicine Supplement 10. Cambridge:Cambridge University Press, 1988;
  • Primary care of patients with mental disorder In the community, British Medical Journal, 299. 666-669, 1989
  • Conceptual Issues in Psychological Medicine, 1990, London: Tavistock
  • Two faces of Kraepelin, British Journal of Psychiatry. 167, 174-183, 1995
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