Random but Controlled Thoughts on Mental Health Epidemiology and Services Research.

Abstract

It is indeed humbling to be a recipient of an award carrying the name of Dr Alex Leighton. While undertaking studies in epidemiology many years ago, I was deeply impressed and inspired when studying Dr Leighton's well-known works, and I consider them remarkable accomplishments in research and epidemiology. Professor Leighton (1908-2007) was an American psychiatrist and social anthropologist trained at Princeton, Cambridge, and Johns Hopkins universities who held leadership positions at Cornell and Harvard. He maintained a special relationship with Canada- particularly Atlantic Canada-where he often spent summers during his childhood and adolescence. It was in Nova Scotia where he worked on the groundbreaking Stirling County Study,1,2 a multi-faceted, longitudinal study of mental health and illness in a set of communities and individuals during a continuous period for more than 50 years. Comprising 3 waves of data collection, in 1952, 1970, and 1992, this was a layered study that applied and examined an integrated and holistic theoretical framework. Its design and approach were prescient and visionary. Although rigorous and scientific, the Stirling County Study was also humanistic in its approach. Its findings and discussion presaged conceptualization of the social determinants of health, and viewed mental health through a population health lens.When I first read Dr Leighton's reports of the Stirling County Study as a young psychiatrist, I found them to provide a welcome antidote to the biological reductionism that constricted the field of psychiatry toward the end of the 20th century and beyond. Many years after reading Dr Leighton's works, when my colleagues and I wrote a textbook to introduce students to mental health in Canada,3 we sought to emphasize an interdisciplinary view of mental health, integrating contributions from fields that include neuroscience, sociology, psychology, anthropology, cultural studies, gender studies, criminology, and ethology. This follows closely the interdisciplinary and antireductionist standpoint so well espoused and championed by Dr Leighton.Dr Leighton, together with his wife and research partner, Professor Jane Murphy, a highly accomplished social anthropologist, formed a dynamic team (Figure 1). Among his lengthy list of accomplishments, Dr Leighton was instrumental in establishing the CAPE following his retirement from Harvard University and during his tenure as a distinguished professor at Dalhousie University. Both Dr Leighton and Dr Murphy were regular participants in the annual CAPE scientific meetings up until Dr Leighton's death, and, subsequently, Dr Murphy has continued to attend and is a cherished contributor to those events. First-rate discussions on the contributions of Dr Leighton and Dr Murphy can be found in a chapter written by Dr Cairney and Dr Streiner in the book they edited on the epidemiology of mental disorders in Canada4 and in a tribute paper written by Dr Tremblay,5 who was mentored by Dr Leighton and worked on the Stirling County Study from 1950 to 1956.In reflecting on my own career to date, I am thankful for the inspiring and illuminating work of Dr Leighton and Dr Murphy. As a clinician-scientist who began my career striving to help individuals and families with anorexia nervosa and other eating disorders, I found the holistic vision they articulated to be invaluable when addressing such complex and multi-faceted disorders, which so clearly have prominent social, psychological, cultural, and biological antecedents and consequences. An epidemiologic vantage point was helpful when considering the well-known sex and (or) gender differences in the distribution of eating disorders among the general population. A firm footing in the sophisticated biopsychosocial framework that is so prominent in Dr Leighton and Dr Murphy's work helped to maintain a balanced and nuanced perspective when seeking to understand why girls and women are much more prone to develop eating disorders than are boys and men. …