Julian Leff 1938-2021

In 1978, I joined Julian Leff's team at the Medical Research Council's Social Psychiatry Unit at the Institute of Psychiatry in south London in both a clinical and research role, working on a controlled trial, designed by Julian, based on his earlier work. In 1976, Julian and Christine Vaughan had published the results of research into the family atmosphere, or Expressed Emotion (EE), where one of the members suffered from schizophrenia. EE was measured using the Camberwell Family Interview, a highly reliable questionnaire. They had found that there were two groups, one Low EE, characterized by warmth as well as an absence of those qualities found in High EE families, such as criticism and over-involvement. In the former, there were far lower relapse rates in the patients than in the latter.

The aim of the trial was to assess whether it would be possible, using a variety of therapeutic interventions, to reduce the level of High EE in those families, and, thereby, reduce relapse rates. The programme lasting nine months was intensive. Julian worked his socks off and so did we. We travelled all over south London, running up and down staircases in council blocks, day and night, interviewing, educating families about schizophrenia, meeting fortnightly for family therapy sessions with the patient and the relative. And also holding group therapy sessions so a comparison could be made between these and the family therapy sessions.

This work was not about what had caused the illness but about what could be offered once it had been diagnosed. It was done in the wake of Fromm-Reichmann's notorious work on the schizophrenogenic mother, which heavily implicated mothers in the aetiology; and what in family therapy parlance came to be called parentectomy, that is, exclusion of the parents from any clinical contact. The interventions were not psychoanalytic. Family therapy, which was in its infancy, and cognitive behavioural therapy were used in our interventions. Julian was later gr