Arthur Hamilton Crisp
June 17, 1930 – October 13, 2006

Arthur Crisp, one of the most distinguished psychiatrists of his generation, died on Friday, 13 th October 2006. He was Professor Emeritus of the University of London. Until his retirement in 1995 he was Professor and Chairman of the Department of Psychiatry at St George’s Hospital Medical School and Vice-President of the Royal College of Psychiatrists.

It was in the field of anorexia nervosa that Arthur’s international reputation for clinical research was founded. He defined anorexia in its modern-day terms. He determined its psychopathology, its aetiology and pathogenesis. His statement that the core pathonomo-nic feature of anorexia is a phobic avoidance of normal body-weight has stood the test of time. His treatment programme for anorexia was considered, in its day, the international gold standard.

Arthur’s research was always unashamedly clinically focused and anchored in psychoso-matic medicine. He explored the relationship between sleep and nutrition, investigated migraine and the psychosomatic aspects of myocardial infarction, irritable bowel and even writer’s cramp. He conducted experimental studies of psychotherapeutic processes, overcoming the formidable difficulties of conducting a controlled evaluation of interpret-tative psychotherapy.

To Arthur, research was dominant. He claimed it was impossible for a good clinician not to be a researcher. He even researched his hobbies. One of these was a study of the River Wandle, a river that goes through the part of London in which St George’s is situated. On one occasion he wished to photograph the river at dawn as it flowed close to our psychiatric hospital.

The best view could be got from the roof above the locked ward which contained some of its more disturbed patients. Unfortunately, the door to the roof was blown shut by the wind and automatically locked, leaving Arthur stranded on the roof. No-one was around, save for the milkman delivering to the hospital. Arthur called out to him that he must be let out! The milkman nodded wisely. Arthur shouted he was the Professor of Psychiatry! The milkman nodded even more wisely ... .

Arthur Hamilton Crisp was born on the 17 th June 1930 in London. It is to psychiatry’s inestimable gain, that he was deflected from his first career choice of engineering when he was hospitalized following an accident whilst playing rugby for the English Schoolboys XV1. This early recognition that life-events can govern the expression of disease led to the study of medicine and subsequently psychiatry. Although offered a place at The Maudsley and Institute of Psychiatry, he chose instead to train at St George’s. I once asked him if he ever regretted his decision. He did not answer, his look said it all.

Arthur was a private person, but one who had a deep and well-thought out personal philosophy which drove his life at work and at play. He fought his corner without rancour and was a powerful advocate for psychiatry, as it has found its place in modern medical practice.

A doctor, Arthur once said, is primarily a teacher. Throughout most of his career, Arthur’s name was associated with undergraduate and postgraduate medical education in Britain and continental Europe. It was Arthur who integrated the examination of psychiatry into the Final Medical Examination of the University of London. This led to his election as Dean of the Faculty of Medicine at the University.

During his stewardship of the Education Committee of the General Medical Council, the medical curriculum acquired a broader base. There was a firmer recognition that medicine had its roots in sociology and psychology, as well as physiology and anatomy – concepts which now do not seem contentious, but were then. Arthur Crisp united his colleagues in a recognition that the modern doctor needed to draw deeply on a holistic understanding of the patient, encompassing mind, body and society; that in high-tech world, a doctor must retain core clinical skills and remain comfortable in an empathic relationship with the patient.

Arthur created an undergraduate psychiatric education programme at St George’s that was embarrassingly popular with students, reflected in the large percentage of St George’s students who went on to choose psychiatry as a career: a testament of his clinical example.

Arthur Crisp emphasised that psychiatry required the acquisition of a broad range of knowledge, skills and attitudes based on an eclectic mix of general and speciality experience. Not for Arthur the dogmatic, limited preoccupations of sectarian psychiatry.

For him behavioural, psychodynamic and pharmacological approaches were equally relevant when based on a diagnostic interview which attempts to answer the question “why?” as well as “how”. The week before he died he reprimanded me for curtailing my assessment interview to two hours, telling me firmly that three hours, if not four, was required to fully understand the anorectic patient within the concept of her family. How right he was!

The humanistic St. George’s approach, developed by Arthur Crisp, in which psychiatrists must carefully define the social, biological and psychological features of a patient and be able to harness them in treatment, using pharmacology and a broad spectrum of psycho-therapies, had a profound influence on a generation of psychiatrists.He took this work to the European Union when, as Chairman of the Committee of Medical Training, he laid down plans for Europe-wide medical postgraduate training which saw fruition in all the member countries.

Arthur Crisp was Editor of the British Journal of Medical Psychology; Chairman of the London Professors of Psychiatry; Chairman of the GMC’s Education Committee; and Dean of the Medical Faculty of London University. He was Visiting Professor in various universities including Harvard and Sydney; and external examiner in universities around the globe. He was WHO Advisor on Medical Education and advised the Governments of China and of Japan. During Arthur’s “retirement” he took on the massive brief for the Royal College of Psychiatrists, dealing with stigma as it pertains to psychiatric patients.

He also became an accomplished sculptor, exhibiting his work, together with other members of his family. His funeral last week -- in the exquisitely beautiful church of St Mary in the village of Friston, in Suffolk, in the heart of what was Saxon England, and from which his family derived -- was a warm, moving family affair. The service was also attended by his contemporaries and students, many of whom have gone on to distinction.

Professor Arthur Crisp achieved high office and rightly so. He was one of psychiatry’s great pioneer educationalists and certainly the one who brought psychiatry and psycho-logical ideas into the mainstream of medicine. He was an international authority in his research field and diagnostic criteria for anorexia originally proposed by him have been incorporated into the two main systems of classification.

Arthur was a family-man and was supported by his wife Irene and their three sons. His grandchildren were his special pleasure and to each on their fourteenth birthday he gave a framed copy of Polonius’s speech to Laertes in Hamlet. In this speech Shakespeare gives much good advice and ends with the injunction:

This above all: to thine ownself be true,
And it must follow, as the night the day,
Thou canst not then be false to any man.

Arthur, to your friends and colleagues, this is your epitaph.

Professor J Hubert Lacey
St George’s, University of London