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Eating disorders and the legacy of Gerald Russell

During Eating Disorders International Conference last week, Beat was delighted to honour Professor Gerald Russell with a Lifetime Achievement Award for his groundbreaking work in the field of eating disorders. His friend and colleague, Professor Janet Treasure, kindly wrote this tribute to Professor Russell and to the work that has helped shape so much of what we understand about eating disorders today.

Professor Gerald Russell played important roles at the Institute of Psychiatry, first as Dean and later as Head of Psychiatry. At the same time, he was the director of the eating disorder unit at the Maudsley Hospital. These roles enabled Gerald to bring eating disorders into the domain of Psychiatry in the UK.

The most notable academic achievement during his lifetime was the publication of his seminal paper in 1979, in which he described a series of patients with an “ominous variant” of anorexia nervosa. He recognised this as a new form of illness, which he termed bulimia nervosa. This insight was derived from Gerald’s clinical skills as someone who carefully listened to patients’ stories. Bulimia, or bulimia nervosa, was quickly assimilated as new form of eating disorder and accepted into the American Diagnostic and Statistical Manual (DSM) and the World Health Organisation (WHO) classification of diseases.

The second important milestone was that Gerald designed and directed a randomised controlled trial funded by the MRC that compared two forms of relapse prevention following inpatient care. Family-based therapy (the Maudsley model) was compared with individual therapy. In designing that trial, Gerald recognised the importance of stratification of patients (precision psychiatry) decades before the term was invented! For example, he recognised that the duration of illness moderated the effect of treatment, and so he designed the study to ensure that this factor was matched after randomisation between the groups. What he found was that family-based therapy (the Maudsley model) reduced the relapse rate in patients below the age of 18 who had had the illness for less than three years. This finding (with variants forms of involving the family) has been replicated in many studies, and family-based therapy (the Maudsley model) remains the recommended treatment for adolescent anorexia nervosa and adolescent bulimia nervosa. Not only did Gerald’s work help define a treatment that worked, and for whom, but this study demonstrated that randomised trials of psychotherapy were possible, which was a step change in evidence-based treatment within psychiatry.

When I asked Professor Hubert Lacey to comment on Gerald’s achievements, he said, “The truly great thing about Gerald to me is the way he changed his view based on his own scientific enquiry. He is not scientifically bigoted or blinkered. He even recognised when he was wrong (or amiss might be a better phrase in the light of more recent research). So, as examples, he rejected his early hypothalamic theory, and the efficacy of family therapy was against the run of his original ideas.”

This quote brilliantly summarises the important legacy of Gerald Russell as a clinical scientist. His life’s work was a continued quest for further understanding of these puzzling diseases. He was not content to consider that he had found “the answer”; rather, he inspired those who learned from him to hold a strong spirit of scientific curiosity and humility.