Ian Skottowe was in that classical mode of Scottish psychiatry which, stemming from Sir David Henderson [Munk’s Roll, Vol.V, p.188], inevitably embraced precise diagnostic formulation on the basis of detailed history and careful mental examination; yet this school has allowed for such diverse idiosyncracy of psychiatric personality as those of T A Munro, Arthur Spencer Paterson, Angus McNiven and Robin McInnes, as well as his own notable individuality; with Robin, who was by contrast far more of a dynamic psychotherapist and less of an exact nomothetist than Ian, long standing friendship and neighbourly collaboration during Ian’s Buckinghamshire days led to a remarkable balance of approach being offered to all who worked under them both, from the time Ian joined Robin as second consultant at Warneford Hospital, Oxford, in 1951, until his retirement to Winchester in 1964.
Born in Dumbartonshire, and educated at Sevenoaks School, Kent, and Morrison’s Academy, Crieff, he received his psychiatric education as an undergraduate at the Western Infirmary, Glasgow, becoming MD with commendation, and as a postgraduate at Boston, USA, which afforded him fascinating insights into American psychiatry.
His natural ability to put a point of view over clearly and firmly ensured that he would combine the roles of clinician and administrator: it was in 1927 that he crossed the border to become medical superintendent of Cefn Coed Hospital where he gained a knowledge of Welsh that, I suspect, about equalled that of his native Gaelic, but which he used for rapport with his Welsh patients - producing occasionally the first smile in depressive misery.
It is intriguing that his death was within a few weeks of that of his wife Phyllis, whom he married in 1927, and within a month of that of S R Tattersall, his deputy and most long standing colleague during the period when he was medical superintendent at Royal Bucks Mental Hospital, Stone, Aylesbury; to be renamed St John’s during his tenure. There he set about an extensive programme of modernization, less of its structure than of the clinical approach: his success led to, and was itself further fostered by the association of St John’s with the teaching of psychiatry at the Middlesex Hospital during the war time evacuation. This collaboration in teaching continues at St John’s till today, now mainly with the Oxford department of psychiatry. Michael Shepherd can be instanced among the top psychiatrists in whose formation Ian played a part. His postgraduate students, particularly his own junior staff on the road to consultantship, kept in loyal communication with him from all over the country: he once remarked that en route for a Scottish holiday he and Phyl could stay with former students at almost any point along either the eastern or western route.
During Warneford’s private hospital days he seemed to vie with Tattersall - referred by either, the patient was always interesting and could be helped - in the length of letter of referral, the detail of background and work-up and the exactitude of the problem which the Warneford needed to resolve. Since they both felt that Warneford was the most suitable for certain patients, even after it entered the NHS in 1948, referrals continued on the same meticulous basis until Ian himself moved over.
By this time, he was not only psychiatric member of the Oxford Regional Hospital Board, serving from 1948-55, but was also engaged in writing his short textbook of psychiatry. He would appear at clinical meetings apparently absorbed in his proof reading, only to produce a comment on the presentation so devastingly trenchant as to make it plain that he had not missed a relevant word. The book, which ran into two editions, can be considered the most felicitously succinct modern textbook of psychiatry in the English language - ultimately a collector’s piece. Take his initial description of the essential schizophrenic process, of the clinical elucidation of which he was a master:
‘Schizophrenic disorders, as the name implies, are characterized by a splitting of mental functions from one another, so that the mental activity of the individual no longer appears as an integrated whole function, but is fragmentary, inconsequential, freakishly aberrant and out of touch wih the immediate material environment, while the component sub-functions of the mind, for example, emotional functions and thinking functions, are liable to be grotesquely incongruous with one another. This produces a kind of bizarre caricature of the patient’s personality as it was before he became ill and, in many cases, in the end leaves nothing but a dilapidated fragmentary relic of the personality as it once was.’ Clinical Psychiatry for practitioners and students, London, Eyre & Spottiswoode, 1953; 2nd edition, London, Churchill, 1964.
It is tempting to suggest that the sophisticated diagnostician follows far more closely Ian’s diagnostic methods than relying on the presence or absence of ‘front-rank’ symptoms. Ian made his juniors connoisseurs of the earliest manifestation of thought disorder, to which he preferred the term ‘dyssymbole’, less clumsy and more suggestive of possible psycho-physiological aetiology.
In formulating delusional activity, Ian taught ‘Avoid being over categorical. "He believes that his sex is being changed by emanations from freemasons in Gravesend" conveys far more than "He harbours paranoid delusions."’.
His second clinical connoisseurship lay in the extraction of the essential depressive state from reactive and neurotic overlays. In the field of minor psychiatry: ‘Common sense and wise good will rather than depth analysis were his psychotherapeutic weapons. Sceptical of psychiatric over encroachment into the field of behaviour and personality disorders, he often talked of the need to ‘extend the boundaries of normality.’ [SS.Brit.med.J., 1984,288,866]. Tolerant of his dynamically-minded juniors, he would allow time for psychotherapy, recognizing the value of rapport while sceptical of the specific, as opposed to the general effects of the schools of dynamic psychotherapy: at the moment when therapeutic enthusiasm dwindles -‘Let us now see what we can do with some ECT.’, Ian would intersperse; and within a fortnight the patient was better.
Not that he was over enthusiastic for mechanical methods. If only means could be found for comparing the effect of his combination of an amphetamine and a carefully monitored mixture of tinct opii with that of today’s antidepressants and tranquillizers! Certainly many a depressant was maintained in the community, in the pre-antidepressant days, on this combination and without electroplexy. Resultant opiate addiction? Never.
He had no time for electronarcosis and was extremely reserved over cerebral surgery, though he rejoiced in the meticulous approach of Sir Hugh Cairns. For Ian, the really prolonged narcosis, using barbitone, provided curative respite for the agitated depressive and a few restless manics. To show how readily such narcosis once successfully constituted could be maintained, he would wheel narcotized patients from their wards into clinical demonstrations without disturbing their sleep which he might continue for up to a month.
Ian was much less of a researcher than clinician; but he collaborated enthusiastically with Richard Parnell (q.v.) in his studies correlating somatometry with psychiatry, joined with him in a number of articles and wrote, in collaboration with him, a mental health handbook.
When his move to Oxford, and his subsequent retirement from the Oxford Regional Hospital Board, allowed him respite from local administration he gave his wisdom and foresight increasingly to the Royal Medico-Psychological Association, to its parliamentary committee - of which he was chairman for years - and to its reformation into the Royal College of Psychiatrists. He was himself president of the RMPA, a well justified elevation which he encompassed with marked distinction from 1964-65.
Retirement to Winchester meant no cessation of work until he was about 80, as he became psychiatric adviser to both Wessex Regional Hospital Board (to become Wessex RHA) and Winchester College, as well as working in private consultancy.
Happily married to Phyl (their devoted daughter Gillian lives in Cornwall) he spent himself caring for her in her last illness and probably did not wish to survive her; his survival was in fact only five weeks.
‘She first deceased
He for a little tried
To live without her
Liked it not, and died.’
[Adapted from Sir Henry Wotton,
‘Upon the death of Sir Albert Morton’s wife.’]
Socially, he will be especially remembered at the piano, playing riotous improvised solos, or more measured duets with Robin Mclnnes. A natural extrovert and party man, he was delightful to have as a guest or to visit as a host. With his particular mixture of Scottish courtesy and impish humour - so that nothing, certainly not himself, was taken too seriously or too pompously - and with his wisdom as administrator, and his clinical expertise, Ian had a place among the illustrious psychiatrists of his day.
SJG Spencer
[Brit.med.J., 1984,288,866]