Leonardo Tondo: Michael Shepherd – On Epidemiology in Psychiatry

Leonardo Tondo’s reply to Malcolm Lader’s comment

I deeply appreciate the comments of Malcolm H. Lader, currently Emeritus Professor at the King’s College in London.  His reflectons on Shepherd, with whom he worked for a long time, reveal information on Shepherd’s personality.  From Lader we learn that Shepherd was strongly attached to his opinions and obsessed with the diagnostic process to the point of forgetting that diagnosing is not just an aimless philosophical exercise that provides little help for patients but is needed for delivering treatment.

From his comments I understand that his mentor dealt with psychopathology somewhat in the realm of British eccentricity and we, continental Europeans, may agree with him although sometimes with a bit of admiration for the overseas lifestyles.  Lader confirmed also my impression that Shepherd favored the involvement of general practitioners in the treatment of psychiatric patients, envisioning an attitude more and more common today that is probably also efficient and cost-saving.  In fact, minor psychiatric problems may not need a specialist’s consultation.  I am sorry to know that his view was opposed by the psychiatric establishment that was defending its privileges.  

Shepherd criticised American psychiatry because it adopted psychoanalytical theories he considered unsubstantiated and applicable only to some privileged people.   On the other hand, Shepherd’s criticism of Emil Kraepelin (1856–1926) is uncalled for.  The German psychiatrist died years before Hitler became Chancellor in 1933 and Kraepelin’s theories on mental illnesses, which may be seen as proto-fascist today or even thirty years ago, represented the prevalent view of a positivistic perspective on psychiatric disorders. 

From Lader’s comment the portrait of an erudite, multilingual, curious (to the point of leaning to esoteric), humane, democratic man emerges, as well as that of a gentleman very fond of his Britishness, and therefore somewhat anti-American. 

Leonardo Tondo

August 4, 2016