Obituary

map. “He was the most significant person in these disorders

in the 20th century”, he says.
Although it was in psychiatry that Russell forged a
reputation, this was not his initial choice of specialty. His
father worked at the British Embassy in Belgium, and Russell
began his school education in Brussels before the onset
of World War 2 brought the family to the UK. He studied
medicine at the University of Edinburgh, qualifying in 1950
and deciding to specialise in neurology. Having been advised
that working for 6 months in psychiatry would make him
a better neurologist, he duly found a temporary post at
London’s Maudsley Hospital where he met the eminent
and hugely influential psychiatrist Aubrey Lewis. “He was
completely won over by the way that Lewis thought about
and practised psychiatry”, says Szmukler. Instead of becoming
a better neurologist, Russell too became a psychiatrist.
It was during the 1970s, while working at London’s Royal
Free Hospital, that Russell began to notice how some
patients with eating disorders seemed not to fit the classic
description of anorexia. He began to keep a record of those
who showed two particular characteristics: a powerful
Gerald Francis Morris Russell and irresistible urge to overeat followed by self-induced
vomiting or large doses of purgatives or both; and a morbid
Psychiatrist who first described bulimia fear of becoming fat. It was these patients who led him to
nervosa. He was born in Brussels, Belgium, on develop the diagnostic category of bulimia nervosa. More
Jan 12, 1928, and died of cancer in London, UK, generally, Russell’s career coincided with the emergence of
family therapy as a treatment for eating disorders. Besides
on July 26, 2018, aged 90 years. developing and refining this approach, he also evaluated
it using a controlled trial—one of the earliest and most
“The patient was much preoccupied with food and derived influential demonstrations that psychotherapy could
great pleasure from eating. During a bout of eating she be subjected to the form of critical assessment that had
might consume 7 pounds of food, including half a loaf, become routine in many other branches of medicine. “The
cakes and yoghurt, until she could hardly stand. She trial was extremely well executed and had a big influence
would then make herself sick by pushing the handle of a on the treatment of anorexia nervosa”, says Treasure.
toothbrush down her throat. After vomiting she would Much of this work was done between 1979 and 1993 at
induce 35–40 retchings, which would be followed by a sense the Institute of Psychiatry, where Russell was Professor of
of relief at having got rid of all the food eaten.” In 1979, Psychiatry and founder of the then Eating Disorders Unit
when psychiatrist Gerald Russell reported the case of that at the associated Maudsley Hospital. “During his career he
patient and 29 others like her in the journal Psychological moved from taking a primarily biological view of eating
Medicine, he introduced both a new diagnostic label and a disorders to one more broadly based and psychological”,
new sub-group, bulimia nervosa, into the classification of says Szmukler, who adds that Russell was a master of clinical
eating disorders. Vomiting had already been noted among observation. “He was an extraordinarily gifted clinician,
some patients diagnosed with anorexia, but it was Russell’s extremely attentive to what patients were saying and
close and careful clinical observations that led him to see observing how other people reacted to what they were
these individuals as a group apart. The impact of the paper saying.” He also describes Russell as a skilled interpreter of
was immediate, says Janet Treasure, Professor of Psychiatry what he witnessed. “He could put his observations together
in the Eating Disorders Research Group of the Institute in ways that had clear clinical meaning, either diagnostic or,
of Psychiatry, Psychology and Neuroscience at King’s more importantly, for therapy.” Treasure remembers Russell
College London. “It really was like lighting a touchpaper. as a man who was “very meticulous with high standards…
[Bulimia] very quickly got accepted into the Diagnostic and and also prepared to change his views depending on what
Statistical Manual of the time.” George Szmukler, Professor he saw. He was very open minded.” Russell leaves three
of Psychiatry and Society at the Institute of Psychiatry, who sons, Graham, Malcolm, and Nigel.
first met Russell while working as a junior doctor, sees him as
the man who put eating disorders firmly on the psychiatric Geoff Watts

1620 www.thelancet.com Vol 392 November 3, 2018