Obituary: Martin Roth
Excerpts from lengthy obit by Claude M. Wischik in The Independent (UK) for Hungarian-born psychiatrist Martin Roth:
His textbook was a sure, humane and safe pilot for the discipline of psychiatry in ideologically stormy times: the transition from the post-Freudian thinking to the age of Prozac. These were times that Roth and his co-authors inspired with a unique blend of clarity, critical thought, breadth of scholarship, charm, and humanity. It was in the German tradition of Emile Kraepelin, who in his day transformed psychiatry with his clear descriptions of the major psychiatric syndromes, only to be swept aside in late life by the rise of the Freudians.
Freud, as Roth liked to say, was not a psychiatrist, but a neurologist. Freud has come to be loved more in departments of literature and the history of ideas than in departments of psychiatry. This is because he never really came to grips professionally with the stuff of mental illness. The times of vast psychiatric institutions housing populations in excess of 1,000 souls in varying degrees of torment and hopelessness are still etched in the collective social consciousness, and their residue lives on in the stigma which is still too often attached to mental illness...
He emerged from these battles with his characteristic intellectual fearlessness, tenacity and honesty. These qualities were particularly needed when it came to dealing with the anti-psychiatry movement. He eventually published as The Reality of Mental Illness (1986) the debate between himself and Thomas Szasz dealing with the question whether mental illness is merely a social construct. The proposition here was that there is no such thing as mental illness. Psychiatry merely provides a police and custodial service on behalf of the socio-political establishment to deal with deviancy.
According to Szasz and Scientology, the whole psychiatric enterprise is bogus. According to Ivan Illich, we have no business medicalising the rich brocade of human diversity. Roth's response to this came from his long experiences in the psychiatric hospitals, where one cannot escape from the reality and torment of mental illness, and where the post-modernist rhetoric becomes inaudible against the cries that echo along the corridors in the night. Mental illness is real illness: the problem is how to help.
Roth had a fine turn of phrase in these battles. I remember his advice when dealing with an opponent: "The rapier is better than the broadsword." Or when dealing with Jacques Derrida: "The tide of his rhetoric is unimpeded by the outcrops of fact lying in its path." Or on Illich: "a brooding presence in night, like a dysfunctional lighthouse, emitting shafts of darkness to confuse unwary travellers".
He had fierce battles also within psychiatry, the most renowned being with Robert Kendell on the difference between anxiety disorder and depression. Kendell argued that they form an undifferentiated spectrum of emotional disorder, too often seen together to be able to distinguish the two. Roth argued that they were distinct biological entities, with different clinical features, different genetics and different natural history. Who was right in the end? From the diagnostic point of view, and also now from the molecular genetics, Roth's concept has been enshrined in DSM and ICD. From a therapeutic point of view, there remains a large overlap in terms of treatment.,,
The enduring sadness of the biological revolution in psychiatry that Roth helped to inspire is that its early promise has not been fulfilled through new treatments. Kraepelin delineated the major disorders, schizophrenia and manic depressive disorder, in the 1890s. Although there are newer drugs that do much the same as the originals of the 1960s, no fundamentally new approaches have emerged. This is not for want of effort, as neuroscience research is now a vast worldwide enterprise. The problem is that these disorders have proved to be difficult to unravel, and the mechanism of these diseases, unlike that of Alzheimer's disease, leaves no discernible trace in the brain. Unravelling them may take several more generations of research...