I am currently the Chair and Head of the Department of Psychological Medicine at the Institute of Psychiatry, King’s College London. I am also a Consultant Liaison Psychiatrist at King’s and Maudsley Hospitals, which means that my main clinical work is in the general hospital or seeing patients with chronic fatigue syndrome. I am Vice Dean for Academic Psychiatry at the Institute of Psychiatry, with a wide range of responsibilities including medical education.
I was born and brought up in Sheffield in the north of England. I went to Trinity Hall, Cambridge to read medicine, but read Art for my Part 2, developing an abiding love for Vassily Kandinsky and dislike of the work of Marc Chagall. After that I moved to University College Oxford, where I qualified in medicine at Oxford University Medical School.
Following my “house jobs” I moved up to Newcastle to do two more years of general medicine which was where I passed my medical membership (MRCP). But I had already decided that I wanted to be a psychiatrist, and so I started training at the Maudsley Hospital in London in 1984. I haven’t really left Camberwell since, but I did spend time at the National Hospital for Neurology, and then studying epidemiology at the London School of Hygiene.
It was during my time at the Maudsley and then Queen Square that I decided that I wanted to pursue an academic career. My very first paper was called “Dementia and Mrs Thatcher”, but since then I have published over 600 papers on a variety of subjects.
First of all, I became very interested in the general area of medically unexplained symptoms and syndromes, and chronic fatigue syndrome in particular. For those who want to learn more, there is a lot more detail elsewhere on this site about the actual research that I and my colleagues did during this time. We looked at all aspects of the condition – biochemistry, epidemiology, genetics, history, immunology, psychology, psychiatry, sociology and virology. We studied the aetiology of CFS, the prognosis, the background, and perhaps most importantly of all, treatment.
I also had decided that my particular research expertise would be in epidemiology, the study of illness in populations. I did the Master’s course at the London School of Hygiene, one of the best in the world, and then returned to the Maudsley/Institute of Psychiatry, where I wrote my doctorate carrying out an epidemiological study of the relationship between crime and schizophrenia.
In 1991 I had to take a decision as to whether to concentrate on forensic psychiatry or liaison/general hospital psychiatry, and I chose the latter. I was appointed Senior Lecturer in the medical school at King’s College Hospital. There I set up the one of the first NHS only clinical service for patients with CFS, a service that flourished and continues to this day under the leadership of Professor Chalder, and where I have been seeing sufferers now for over 20 years.
In the mid 1990s, the media started to report on what was known as Gulf War Syndrome, which had some similarities with CFS. Using my epidemiological background, Tony David and I set up the first large scale studies of UK Gulf War veterans, comparing them with service personnel who had served elsewhere. These studies confirmed that there was indeed a problem, and over the next few years we carried out a series of studies with colleagues in immunology, neurology, and public health to take the research further. You can find a description of all of this in our 15 year report.
I developed a strong affinity for those who have or continue to serve in our Armed Forces, and little by little this became the focus of my main research endeavours. I established with Professor Dandeker of the KCL Department of War Studies.
King’s Centre for Military Health Research, a collaboration between psychiatry, medicine, history and war studies, and of the Academic Centre for Defence Mental Health (ACDMH), a partnership between the Ministry of Defence and King’s College London, in which serving military medics are seconded to the unit to carry out research and teaching in military mental health.
KCMHR’s main current research is around various aspects of military health, including psychological stressors of military life, PTSD, risk communication, risk and benefits of military service, screening and health surveillance within the Armed Forces, social and psychological outcomes of ex-service personnel, offending, and historical aspects of war and psychiatry.
In 2006 we published the first results of a study of the physical and psychological health of 12,000 UK military personnel, half of whom served in the Iraq conflict. The principal results were that there has been no repeat of the Gulf War Syndrome saga, that there is no overall increase in psychiatric disorders in Regular forces who served in Iraq, but there was an increase in those in combat roles and those in the Reserves. Other work showed the absence of long term health problems related to either the anthrax vaccination or exposure to depleted uranium. The unit confirmed the importance of shorter tour lengths in reducing the risk of mental health problems, and the ineffectiveness of pre deployment mental health screening. In 2010 we published a unique follow up of all those involved in the original study, which gave a first look at the longer term impact of Iraq/Afghanistan, including those who have now left the Services. As a result of that work I was honoured to be asked to become a trustee of Combat Stress, the principal charity helping ex service men and women with mental health problems.
Some of our current research looks at mental health on operations, “decompression”, risk taking behaviours, outcomes of primary and secondary health care, mild traumatic brain injury (mTBI)and the health and well being of service leavers, including issues such as violence, convictions and social exclusion.
KCMHR have completed a randomised trial of a new system of peer-led support (TRIM) intended to reduce stigma and encourage help-seeking, now being rolled out across the Services, and a randomised controlled trial of the new US system of “Battlemind”. A study of the impact of deployment on the mental health and adjustment of military children started in 2010, and the first ever controlled trial of post-deployment mental health screening in 2011.
I am also interested in how populations react to adversity, with a general theme that people tend to be more resilient that we sometimes credit. Starting with work suggesting that single session psychological debriefing is ineffective, my colleagues and I have looked at how civilian reacted to the London Blitz and how their modern counterparts reacted to the 2005 London bombings, the 2006 polonium incident and swine flu. We also study possible psychological and behavioural reactions to the threat of chemical and biological terrorism.
I have a great interest in public engagement activities. Years ago I used to write a column in the Times on medicine/science, and I still contribute articles, book and film reviews in the press from time to time. I do a lot of radio and TV – so far this year (2011) I have appeared on programmes as diverse as Today, Start the Week, Broadcasting House, Woman’s Hour, World Service and many news channels. I have been involved in documentaries ranging from the Nuremberg Trials, Hitler’s nervous breakdown, military medicine and history and regularly speak at science and arts festivals. I am particularly keen on engagement with schools, talking at our improving access to medicine events in local schools, and judging Debating Matters in both the UK and India, a schools debating programme that aims to increase scientific literacy.
As well as my professional publications I have also co-authored books on chronic fatigue syndrome, the randomised controlled trial in psychiatry, and a new history of shell shock, although sadly none are best sellers. I am more proud of the fact that I have now cycled six times to Paris to raise funds for the Royal British Legion to help ex-servicemen and women in need.
Outside work I am a keen but poor skier, and a keen and only slightly better cyclist. My dark secret is that together with my sons we are all Chelsea season ticket holders. Like most people I enjoy travel and family holidays, where, as friends and family will confirm, probably my favourite activity is arguing in foreign cafes.
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