Retired, retiring – oh … and tireless

Which leading thinker on child development was born in Beirut, spoke Arabic as much as English in his early years, was fostered in the US – and claims to have no home town?

The pub-quiz prize will go to the team who know at least as much as this about the child and adolescent psychiatrist Sir Michael Rutter.

A number of other questions would produce the same answer. Who has done most to transform child and adolescent mental health services in the UK during the last half century? Who has made ground-breaking contributions to our understanding of autism, the effects of early deprivation on maternal care and the classification of disorders? Whose work is as well known in the fields of adoption, residential care and mainstream education?

For insight into Rutter's versatility consider his mentors. It was another polymath, the psychiatrist Wilhelm Mayer-Gross whose achievements alerted him to the potential for making adventurous connections between diagnostic information on patients. Paul Wood, at the National Heart Hospital, taught him the value of ruthless self-examination and the virtue of learning from mistakes – on the principle that uncovering faults in the logic of an experiment or the data it generates can be as instructive as a carefully assembled and proven hypothesis.

Arguably the greatest influence on his career was Aubrey Lewis at the Maudsley Hospital who encouraged him to cultivate a distrust of theory-driven answers. Concepts and ideas are critical for making sense of facts and establishing hypotheses, but lapsing into all-encompassing theoretical explanation is as lazy as it is dangerous.

And then there was Jack Tizard, who encouraged him in his epidemiological studies in the London neighborhood of Camberwell and on the Isle of Wight. Those alone would have made Rutter’s reputation. They helped conceptualize and measure conduct and emotional disorders among deprived and less deprived communities. Follow-up work led by Barbara Maughan at the Institute of Psychiatry has deepened understanding of developmental pathways, the long-term sequelae of developmental impairment, patterns of service use and the cost of non-intervention – but all builds on Rutter’s foundations.

It was Tizard who also excited his interest in the turbulent relationship between science and social policy. Child psychiatry was relatively unconcerned about data when he entered the ring. It was preoccupied with psycho-dynamic explanations of disturbance, not much interested in prevention and, some would say, over-concerned about its middle-class client base.

With his colleagues at the Institute of Psychiatry, he transformed the field of children's mental health and gradually made a mark on other UK children's services. Ordinary schools, adoption and fostering services, east European orphanages and the youth justice provision have all felt the benefit.

In the last decade he has made significant contributions to the expansion of prevention and early intervention services. As an adviser to UK Government, he has been a stimulating thorn in its side. His article on the failings of the Sure Start evaluation – and the salutary lessons to be learned from those mistakes [See, for example Learning the moral of the Sure Start story [1] and Isn't it time to start finding out if Sure Start children centers work? [2]] – should be hugely embarrassing for the Government, if only it knew how to be embarrassed.

Interviewed by Issy Kolvin for an article in the British Journal of Psychiatry in 1998 Michael Rutter highlighted some features of his approach to research.

He values innovation in concept and research strategies – for example championing methods that identify the mediating and moderating mechanisms by which risk “gets into the body”.

His work and the convictions that drive it are characterized by plain statements that can be proved wrong, as opposed to vague ones that are difficult to test. (Compare, for example, Rutter's concept of resilience to the woolen variations of other analysts.)

Kolvin's article was published to mark Rutter's retirement. But a decade later his work rate is unchanged.

His 2001 Presidential address to the Society for Research on Child Development is a brilliant exposition of the huge advances made and lacunae remaining in our understanding of the interaction between genes and environment.

And in that same fascinating territory he continues to make productive connections between the evidence burgeoning from molecular genetics and the conceptual and empirical findings.

At the same time retiring and imposing, he has supported and continues to nurture the talents of many researchers and practitioners across the disciplines. There is also a patriarchal streak: he is suspicious of those who agree with him too readily, and appreciative of those who dispute and challenge.

Still to be mentioned is his contribution on the effects of early deprivation. His study Maternal Deprivation Re-assessed is one of the seminal texts, combining diverse ideas and evidence in a single narrative. Tomorrow, when he gives his second Emanuel Miller Lecture, he will draw together what is known and not known alongside what can be done to support children, and reflect afresh on what we need to find out.

References
Issy Kolvin, “Talking with Michael Rutter”, British Journal of Psychiatry, 1999, 174, pp494-499
Michael Rutter, Maternal Deprivation Re-assessed, Penguin, 1999