|Year : 2021 | Volume
| Issue : 1 | Page : 74-76
Professor Julian Paul Leff
Department of Psychiatry, Institute of Mental Health, Osmania Medical College, Hyderabad, Telangana, India
|Date of Submission||07-Apr-2021|
|Date of Acceptance||19-Apr-2021|
|Date of Web Publication||18-Jul-2021|
Dr. Hamza Hussain
H. No. 11-5-90, Bazaar Ghat X Road, Nampally, Hyderabad - 500 004, Telangana
Source of Support: None, Conflict of Interest: None
Professor Julian Paul Leff was trained at University College Hospital and Maudsley hospital, he was emeritus professor at Institute of Psychiatry. He had 38 years of research experience with medical research council. He developed psychosocial interventions involving intensive group and individual work with families instead of treating patient alone. He was the pioneer in cultural psychiatry and conducted cross cultural studies demonstrating the association between high expressed emotions and relapse of psychosis in different cultures. With more than 150 researches, review articles, more than 10 books authored, co-authored and edited, he left treasury behind him and physically parted from us on February 23, 2021, surrounded by his family members.
Keywords: Camberwell family interview, expressed emotions, International Pilot Study of Schizophrenia, Julian Leff, Leff J
|How to cite this article:|
Hussain H. Professor Julian Paul Leff. Telangana J Psychiatry 2021;7:74-6
| Life History|| |
Professor Julian Paul Leff (July 4, 1938–February 23, 2021)
Professor Julian was born in Kentish Town, North London, to Vera (his mother) on 4th of July 1938. He left Haberdashers' Aske's school at the age of 16 and went to University College London medical school, where he qualified as a doctor. He worked as a house officer at University College hospital and the Whittington hospital before turning to psychiatry.
He started his career in 1973 as honorary consulting physician at Maudsley Hospital, London, England.
From 1974–1989, he worked as honorary senior lecturer at London School of Hygiene and as assistant director at MRC Social and Community Psychiatric Unit, London and as clinical sub-dean at Institute of Psychiatry, London.
In 1985, he became the director of Team for Assessment of Psychiatric Services, London.
In 1987, he became Professor of social and cultural psychiatry.
From 1989–1995, he was appointed as director at MRC Social and Community Psychiatric Unit, London.
It was during these years that he pioneered his group and individual sessions with schizophrenia patients. It was his family history of being committed to equality and equity and migration of his maternal great grandfather Marcus from Lithuania to UK which first influenced Julian's interest in social psychiatry. Indeed, he was sensitive to issues related to migration and the role family plays in the life of an individual whether they have mental illness or not. Julian continued to advocate for individuals with psychiatric disorders, their families and carers throughout his career. His research interests formed the cornerstone of practice of social psychiatry.
Julian loved playing piano and cooking, after retirement, he continued to study music and sing in choirs. He enjoyed swimming and playing squash with his sons. He also continued to study silk-screening, ceramics and sculpture, and became an ardent silver-smith, designing and making exceptional jewellery.
He is survived by his second wife, Joan, a psychoanalyst and his three children, Jessa, Jonty and Adriel, a son, Alex, from his first marriage and nine grandchildren.
He died at his home on Tuesday February 23, 2021.
| Contributions|| |
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 psychosis 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.
Martindale and Leff has played an important role in supporting the development of roles of community psychiatric nurses through psychosocial training programs now popular in the UK.
His paper described possibility of substantially reducing relapse and readmission rates in patients with schizophrenia by working with the families to reduce “Expressed Emotion” and excessive contact in 1982. The research work also demonstrated the synergic effect of combining psychosocial and pharmacological interventions.
From 1985 to 2005, he conducted a study of the emotional and social effects of the deinstitutionalisation on 1500 former patients who had lived in various hospitals.
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. Results showed psychological treatment was superior.
He directed epidemiological studies of schizophrenia in different ethnic groups and in the Caribbean countries, and on public attitudes to deinstitutionalisation among others.
He was the principal investigator for a transcultural psychiatric investigation of 1202 patients in 9 countries (Colombia, Czechoslovakia, Denmark, India, Nigeria, China, USSR, USA) called International Pilot Study of Schizophrenia in 1992; clinical and social outcomes were significantly better for patients in Agra and Ibadan (developing countries) than developed countries.
He recommended that the most cost-effective procedure to establish relatives' groups is family psychoeducation and one more initial family session in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the therapy sessions at the hospital.
Leff J et al. developed a scale Camberwell family interview for measuring expressed emotions status of family members of patients. It has ratings on 5 scales (criticism, hostility, emotional overinvolvement, warmth, positive remarks).
He invented avatar therapy, in which patients create computer avatars of the voices they hear and thus find a way to talk back to their hallucinations.
| Publications|| |
He authored more than 10 books some of which are:
- Social inclusion of people with mental illness, 2006
- Abnormalities in Parents of Schizophrenics: A Review of the Literature and an Investigation of Communication Defects and Deviances, Oxford University Press (New York, NY), 1975
- Psychiatric Examination in Clinical Practice, Blackwell Scientific Publications (Oxford, England), 1978
- Expressed Emotion in Families, Guilford Press (New York, NY), 1985
- Psychiatry around the Globe: A Transcultural View, Dekker (New York), 1988
- Family Work for Schizophrenia, 1992
- The Unbalanced Mind, Columbia University Press (New York, NY), 2001.
He was the editor for many books some of which are:
- Principles of Social Psychiatry, Blackwell Publishing (Oxford, England), 1993
- Care in the Community: Illusion or Reality? Wiley (Chichester, England), 1997.
He has done more than 150 research or review articles, nearly all in the world's prominent journals some of which include:
- Leff JP. Psychiatry around The Globe: A Transcultural View Marcel Dekker Inc.; 1982.
- Leff JP, Brown GW. Family and social factors in the course of schizophrenia (letter), Br J Psychiatry 1977;130:417-20.
- Leff JP, Hirsch SR, Gaind R, Rohde PD, Stevens BC. Life events and maintenance therapy in schizophrenia relapse. Br J Psychiatry 1973;123:659-60.
- Leff J P, Kuipers L, Berkowitz R, Eherlein-Vries R, Sturgeon D, A controlled trial of social intervention of schizophrenic patients. Br J Psychiatry 1982;141:121-34.
- Leff JP. Kuipers L, Berkowitz R. Vaughn C, Sturgeon DA. Life events, relatives 'expressed emotion' and maintenance neuroleptics in schizophrenic relapse. Psychol Med 1983;93:799-806.
- Leff JP, Vaughn C, The interaction of life events and relative expressed emotion in schizophrenia and depressive neurosis. Br J Psychiatry 1980;9.36:146-53.
- Leff JP, Vaughn C. The role of maintenance therapy and relatives expressed emotion in relapse of schizophrenia: A 2 year follow-up. Br J Psychiatry 1981;139:102-4.
- Leff JP, Wing. Trial of maintenance therapy in schizophrenia Br Med J 1971;999:559-6114.
| Awards and Honours|| |
- He won the Royal College of Health's Starkey prize in 1976
- The Burgholzli award from the University of Zurich in 1999
- The Marsh award for mental health work in 2010
- He was awarded honorary Fellowship-the highest honour given by the Royal College of Psychiatrists-in 2015
- The Pelicier lifetime achievement award from the World Association of Psychiatry in 2017.
| Conclusion|| |
Julian P Leff has spent 38 years of his career in the field of psychiatry. He is highly respected internationally for his research, with his decades of research experience he concluded that cultural, environmental, socioeconomic, early separation from parents, political factors can influence psychiatric disorders. He tried translating this research into practice of management of depression, anxiety and schizophrenia. He argued that severity of disorder can be lessened by supportive and uncritical relationship with family and friends. His close associates recall him as quiet, friendly, modest man in social settings but a powerful communicator and teacher while lecturing. His contributions towards interplay of psychological, social and cultural factors in psychosis has left immense influence on professional and lay public and will continue in decades to come.
I would like to thank Dr.S.Sireesha madam, Professor of Psychiatry, Institute of Mental Health, Hyderabad, for giving me this opportunity and providing me with her constant support and guidance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Leff J, Santorius N, Jablensky A, Korten A, Eomberg G. The IPSS: 5 years follow up findings. Psychol Med 1992;22:131-45.
Leff J, Berkowitz R, Shavit N, Strachan A, Glass I, Vaughn C. A trial of family therapy versus a relatives' group for schizophrenia. Two-year follow-up. Br J Psychiatry 1990;157:571-7.0
Leff J, Varighn C. Expressed Emotion in Families. New York: Guilford Press; 1985.