(Biography written at time of nomination.)
Julian Leff has researched in many areas during his thirty eight years with the Medical Research Council, during which time he has always held clinical appointments. He is surely best known for his now widely replicated research demonstrating the possibility of substantially reducing relapse and readmission rates in patients with schizophrenia by working with the families to reduce ‘Expressed Emotion’ and excessive contact. Indeed, his 1982 paper describing this work has become a classic, with over 500 citations in the world literature. The research work also demonstrated the synergic effect of combining psychosocial and pharmacological interventions.
In a psychological therapies field often beset by theoretical partisanship, Julian Leff has staunchly maintained his role as a social scientist and much of his work is rigorously empirical. He has gone on to demonstrate that expressed emotion is not a particular characteristic of families with psychosis and through research refuted the specificity of communication deviance in families that was gaining hold in the 1970s and 1980s, a matter that remains a source of scientific controversy. He has therefore played an invaluable part in retaining the focus on the importance of aspects of the family in psychosis. He has done this without re-evoking the complex problem of family attribution which has led to many professionals abandoning involvement with families who have considerable needs for help both in their own right and in the specific professional assistance they often need to provide domestic environments that will be maximally facilitating to the recovery of their relative.
It remains a matter of international concern that, in spite of the long acceptance of the concepts and the research evidence, few psychiatrists learn how to engage families to the latter’s satisfaction when they have a member prone to psychosis, let alone apply the specific interventions that Leff and his colleagues demonstrated to be effective more than three decades ago now. This is strong evidence that psychiatrists are quite selective in the evidence they choose to implement.
Julian Leff has played an important role in supporting the development of the roles of community psychiatric nurses through the many psycho-social training programmes now present in many parts of the UK.
OTHER AREAS OF RESEARCH
It may be interesting for ISPS members to know of some of his wider contributions in social psychiatry. Some of Leff’s early research was on the effect of sensory deprivation in the production of hallucinations in normal persons. The role of culture in psychiatric disorders has always been prominent in his research interests. One expression of this was his contribution to the work clarifying different diagnostic practices towards the psychoses on the two sides of the Atlantic. His work with Professor John Wing and others in standardising assessment interviews and rating scales has made international research work much more possible and relevant. He also conducted cross-cultural studies of expressed emotion, demonstrating the general reliability of his key findings of the association between high expressed emotion and psychosis relapse rates in the different cultures. There were also important studies highlighting the important fact that mental health settings can contain professionals who themselves create a deleteriously high expressed emotion atmosphere.
His research work on cultural commonalities and differences has involved him in projects in countries far and wide in the world of which a few are Barbados and Trinidad (in the West Indies), Aarhus (Denmark) Chandigarh, (N. India), Chengdu, (China). It goes without saying that the importance and interest in his expressed emotion work has led to invitations to speak all around the world.
In more recent years, the research focus has been on the well being of long stay patients when discharged thoughtfully into the community following the closure of the hospitals that had been their homes for decades, demonstrating the possibility of successful rehabilitation and relocation.
Another interesting and important research was into severe depression in one partner in a couple relationship, comparing psychological treatments with the best of medication management and showing the superiority of the former.
One could almost write a book just reviewing Julian Leff’s published life work as this amounts to more than ten books authored, co-authored or edited, some hundred or more chapters and more than 150 research or review articles, nearly all in the world’s prominent journals.
Julian Leff’s family background included medical members of which his father was one. Because of the war, his grandfather was an especially important figure at home in a small Buckinghamshire village. Buckinghamshire is of course well known for another pioneering schizophrenia study by Ian Falloon and others. Julian’s empirical approach has withstood the fact that he is married to a prominent UK psychoanalyst!
When Murray Jackson (another ISPS Life Member) retired from the Maudsley in 1987, Julian Leff took over the in patient unit that Murray had been the consultant to.
Professor Leff has now substantially retired and spends a considerable amount of time developing his longstanding skills with the piano where - to quote “I delight in playing with other instrumentalists and singers, and feel that achieving unison in a small chamber group is akin to working skilfully with a family. As his tutor says, 'the most important thing is to listen, listen, listen!' “.
Those of us who have encountered Julian at ISPS conferences and elsewhere will probably have similar images of him as a quiet, friendly modest man in social settings, but an eloquent and powerful communicator and teacher when lecturing. His international contribution to the social and psychological well being of those vulnerable to psychosis and their families has been immense and we have little doubt that this influence will continue for the decades to come as the scientific, profession and lay public are increasingly convinced of the relevance of the importance of the interplay of the psychological and social with biology in psychosis. We are delighted that Professor Julian Leff has accepted Honorary Life Membership of ISPS.