Correspondence Address:
Prof. Tom K J Craig
Emeritus Professor Social Psychiatry, Box 33, HSPRD, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF
UK

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Prof. Julian Paul Leff (1938–2021) passed away peacefully after a long illness on February 23, 2021, surrounded by the family he loved.

Julian was a leading light in Social Psychiatry who made a hugely important contribution to the care and treatment of people suffering from schizophrenia and other severe mental disorders. He qualified in medicine at London University in 1961, worked in a variety of London hospitals for 3 years becoming a Member of the Royal College of Physicians before entering the field of psychiatry at the Maudsley Hospital in 1965. His gift for research was apparent in his early study of the effects of sensory deprivation in healthy volunteers, which rapidly brought on hallucinations. His excellence was quickly spotted, and he entered the prestigious MRC Social Psychiatry Unit at the Institute of Psychiatry under the direction of John Wing, carrying out one of the first UK studies of the benefit of antipsychotic medication in reducing relapse in schizophrenia and working with colleagues on the WHO international studies of the incidence of schizophrenia around the world. These two studies were to prompt much later research: expanding understanding of the contribution of social conditions to varying incidence rates in schizophrenia and developing novel treatments for auditory verbal hallucinations. However, in the meantime, he became interested in apparently puzzling findings that showed an association between “expressed emotion” in family carers and relapse in patients with schizophrenia. He developed a family intervention aimed at helping families to better manage the demands of care and showed this approach to be highly successful in a series of clinical trials, reducing relapse in people suffering from schizophrenia from over 50% to <10% on average. He went on to teach the intervention to other mental health professionals including on the Thorn Nurse Training initiative. The findings of his research were replicated in some 34 controlled trials worldwide, became citation classics, and are arguably among the most important developments in our field.

Julian left the Maudsley in 1981 to establish the Team for the Assessment of Psychiatric Services (TAPS) that evaluated the closure of two hospital asylums and the reprovision of the care they provided in new community settings. This research, spanning more than 10 years, remains the most comprehensive study of this important change in how long-term care was provided in England. When the TAPS research came to an end, Julian returned to the Institute of Psychiatry as Deputy Director of the MRC Unit and turned his attention to another puzzle. Research from several centers in the UK had found higher incidence rates of schizophrenia and other psychoses among black Caribbean migrants and their children compared to the indigenous White British population. Julian et al. quickly established that the incidence in Trinidad and Barbados was no different than those in the white British population, suggesting that some features of the migration or subsequent life in the UK were responsible. In the subsequent AESOP study with colleagues in three UK cities, he showed that the higher rates might be explained by social conditions, notably those resulting in relative social isolation.

That, one might think, was a very good set of achievements for a career but more was to come even after retirement. In 2008, he became intrigued by reports that some patients who had been plagued by hostile verbal hallucinations, might be helped by a therapy that tried to develop a dialog with these voices. He took this forward by inventing an approach, in which patients could create and converse with a computerized avatar in a dialog controlled by the therapist so that the patient gradually felt empowered and more in control. He showed in a pilot study that this approach was hugely successful in reducing both the frequency and distress associated with hearing voices. These findings were replicated in a later controlled trial and are currently being taken forward in a large multicenter study preparatory to dissemination in routine care.

As this brief resume of his career attests, Julian was an inspired original thinker whose ideas and research made a clinically and theoretically significant contribution to social psychiatry. His contributions are widely applauded internationally. His many awards include the inaugural Burgholzli Award from the University of Zurich in 1999, the Marsh Award for Mental Health Work in 2010, lifetime membership of the International Society for Psychological and Social approaches to psychosis, and the Yves Pelicier Lifetime Achievement Award from the World Association of Social Psychiatry in 2017. In 2015, he was awarded honorary Fellowship of the Royal College of Psychiatrists – the highest honor given by that institution.

Despite these stellar achievements, Julian remained a modest, warm-hearted colleague, a brilliant teacher, and communicator with a lively sense of humor that brought him admirers and friends around the world. His talents extended beyond psychiatry though skills as a silver smith, playing the piano in a chamber group, and singing in a local choir. Julian is survived by his wife, Joan Raphael-Leff, his four children (Alex, Jessa, Jonty, and Adriel), and nine grandchildren.