In Memoriam of Hagop Souren Akiskal (1944-2021)

By Marcelo Cetkovich-Bakmas

       At the time of a pandemic that takes our breath away every day, we were seized by the sad news of the departure of Professor Hagop S. Akiskal. In recent times, his absence from academic events was a noisy silence for those of us who began to understand the world of bipolarity from the hand of his wisdom.

       Born in Lebanon to an Armenian family, he graduated as a medical doctor in the American university of Beirut. Shortly thereafter he moved to the USA, where he received his degree as Professor of Psychiatry and Pharmacology at the University of Tennessee in Memphis after which he was recruited as a Senior Scientific Advisor at NIMH. In 1994 he was appointed as Professor of Psychiatry at the University of California in San Diego, where he not only taught clinical psychiatry, but also History of Psychiatry, giving to the students the opportunity to glance at the roots of modern psychiatry outside the US. He was one of the few psychiatrists in the United States who was familiar with the contributions of French psychiatry and the German Wernicke-Kleist-Leonhard school, critical in the development of the concept of bipolarity. He was well aware of cycloid psychoses, which he considered part of the spectrum.

       It is difficult to decide what has been the most important contribution of Professor Akiskal in the field of bipolarity. We have no doubts that he was one of those who contributed the most to a whole generation of psychiatrists to understand that it was a little recognized and poorly treated condition. He designed pioneering research protocols that found that many people diagnosed with major depression actually suffered from attenuated forms of bipolar disorder. Thus was born the Soft Bipolar Spectrum approach that would open the doors of a new era in the clinic and management of affective disorders (Akiskal and Pinto 1999; Akiskal, Bourgeois, Angst et al. 2000). Years ahead of the movement of developmental psychopathology, he constructed a psychopathology of mood disorders based on affective temperaments. In order to be able to study temperaments with scientific rigor, he helped develop a structured tool, the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS) scale, already translated and validated in several languages and which has been useful to demonstrate the solidity of the construct (Vázquez, Kahn, Schiavo et al. 2008). In this conceptual framework, he developed a very attractive hypothesis about the adaptive role of affective temperaments in mankind's evolution where each trait implies an adaptive advantage. We always found it extraordinary that Akiskal claimed that the combination of depressive and anxious temperament traits gave the sensibility for others' suffering and concern that had been the motivating force of shamans, priests and doctors. On the other hand, he pulled the string of the links between bipolarity and creativity that he linked with the cyclothymic temperament (Akiskal and Akiskal 2005).

       A separate chapter to this story focuses on the enormous generosity Hagop Akiskal showed to those who approached him for guidance and advice. This was particularly true for a large number of Latin American psychiatrists. Every time we consulted him he responded promptly and kindly. He did us the honor of joining our group as co-author of the book Bipolar Disorders in 2006 (Akiskal, Cetkovich-Bakmas, García-Bonetto et al. 2006). Like the great Master that he was, he made numerous and uncomfortable trips to the region, only to give unforgettable lectures that marked a generation of psychiatrists. In 2000 he accepted an invitation from the Argentine Association of Biological Psychiatry, without any financial support, to give a complete course on bipolar disorder - an unforgettable day for all the members of our group and all those who attended. The notes from his four-hour lecture were published in a journal and remain reading material for young psychiatric residents (Akiskal 2001).  Professor Akiskal also encouraged the start of research careers of some colleagues.

       Hagop Akiskal was, above all, a militant humanist. He claimed that from temperaments to psychoses, bipolar disorder is both a fascinating and tragic human condition. He warned that we should not treat these people with mediocrity. While most psychotic bipolar patients are neither leaders nor creators, they constitute the reservoir of genes that, in a diluted form, could be the seeds of genius.

       Now, the certainty that we will never witness again his extraordinary image and nourish ourselves with his wisdom, grips our hearts. The academy has given us the opportunity to read and listen to great modern researchers in the field of psychiatry. Only Akiskal was able to deliver his wisdom in a poetic tone with just the right amount of drama, so that the concepts were captured by the audience. The tone and the mid-west accent of his voice were part of the hypnotic power of his lectures that, together with his wit and clever sense of humor, made each speech an unforgettable experience.

       By attending one of his master classes, one not only listened to his arguments, but was touched by his wisdom.

We will miss him.

References:

Akiskal HS. Actualización en Trastornos Bipolares. Curso Organizado por la Asociación Argentina de Psiquiatría Biológica. Vertex. Revista Argentina de Psiquiatría 2001; XII Supplemento Especial, pp. 1-48. 

Akiskal KK, Akiskal HS. The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature. J Affective Disord, 2005;85:231-9.

Akiskal HS, Bourgeois ML, Angst J, Post R, Möller HJ, Hirschfeld R. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affective Disord, 2000;59:S5-S30. 

Akiskal HS, Cetkovich-Bakmas M, García-Bonetto G, Strejilevich S, Vázquez G. Trastornos Bipolares. Conceptos Clínicos, neurobiológicos y terapéuticos. Buenos Aires: Médica Panamericana; 2006. 

Akiskal HS, Pinto O. The evolving bipolar spectrum. Prototypes I, II, III, and IV. Psychiatr Clin North Am, 1999; 22:517-34. 

Vázquez GH, Kahn C, Schiavo CE, Goldchluk A, Herbst L, Piccione M, Akiskal HS. Bipolar disorders and affective temperaments: a national family study testing the “endophenotype” and “subaffective” theses using the TEMPS-A Buenos Aires. J Affect Disord, 2008;108(1-2):25-32.

February 4, 2021