Michael Llewellyn Rutter, KBE, MD, FRCP, FRCPsych (Hon), FRS

Formerly Professor of Child Psychiatry, King's College London, and Honorary Consultant Psychiatrist, Joint Bethlem and Maudsley Hospitals, London, UK

Michael (Mike) Rutter, who died on 23 October 2021 at the age of 88, was for nearly 50 years universally acknowledged as the world leader in the scientific study of child psychiatric disorders. Indeed, he can be regarded as the founder of modern child psychiatry based, as it became under his leadership, on scientific evidence. In the 1960s he realised that accurate measurement was the key to scientific advance in the subject and developed reliable and valid questionnaires and semi-structured interviews for use not only with parents and teachers but crucially, with children themselves, to identify ‘cases’. This made possible, for the first time, the use of epidemiological approaches to assess the prevalence of such disorders and the factors associated with them. An opportunity arose in the mid-1960s when he was invited by Jack Tizard to lead an epidemiological study of psychiatric disorders in 9- to 11-year-old children on the Isle of Wight. With Bill Yule taking responsibility for psychological investigations, this study, which served as a model for similar studies in many other countries, established the prevalence of emotional and behavioural problems in childhood and their important links to poor educational achievement and physical illness and disability.

Strongly resisting claims of reductionism, Mike went on to carry out epidemiological studies exploring differences between children reared in urban and semi-rural environments as well as rates of psychiatric disorders in minority ethnic groups. Over the next 30 years, findings from these epidemiological studies were quoted in virtually every British government report relating to children. At the same time, with the social psychologist George Brown, he developed methods to measure different aspects of family relationships, thus enabling them to study links between family disharmony and parental mental and physical illness and childhood disorders.

In 1977, with Susan Folstein, Mike published a twin study of childhood autism in Nature (this and other key papers by Michael Rutter brought together by Jim Stevenson are available from www.acamh.org/blog/a-digest-of-the-published-work-of-michel-rutter-1958-2020-2/). This showed very striking differences in the concordance rates in identical and non-identical twins, thus establishing scientifically, for the first time, the importance of genetic factors in the causation of this condition. Up to this point, it had been widely though not universally assumed that autism arose because of the child-rearing methods adopted by parents. The term ‘refrigerator’ mother was particularly stigmatising, adding to the stress experienced by the parents of children with autism. After the publication of the article in Nature, it became widely accepted that, although patterns of child-rearing might be implicated in some cases, genetic influences were of major significance. This led to a veritable industry of genetic investigations into autism achieving a much greater understanding of the complexity of the genetic origins of this condition. Later, with Catherine Lord, Mike was involved in the development of widely used scales to identify children with autism more accurately.

In the mid-1970s, in collaboration with Peter Mortimore and Barbara Maughan, Mike led a study examining the role of school organisation in the educational achievement, behaviour and emotional problems of students. He and his colleagues studied a dozen London secondary schools in an inner-city area and related these variables to various characteristics of the schools. They were able to show that both academic achievement and behaviour problems were linked to academic ethos and other school factors. This study, which was published in 1979 in the book Fifteen Thousand Hours, had a major impact on educational policy and was quoted in the party manifestos of both main British political parties.

While leading these studies, Mike published a series of magisterial reviews into a wide variety of topics related to child development. Subjects he reviewed in comprehensive fashion included classification and categorisation of child psychiatric disorders, psychosexual development, the interaction between genes and environmental factors in child development, and the origins of antisocial behaviour. With his close friend Norman Garmezy, an American psychologist, he wrote thoughtfully on childhood resilience and vulnerability in children exposed to stress. His most influential review was published in 1972 in the book Maternal Deprivation Reassessed, in which he critically reviewed the important work carried out by John Bowlby on the effects of parent–child separation on subsequent child development. Mike was able to modify Bowlby's findings by showing that, rather than separation, it was the material and emotional deprivation often accompanying separation that was the crucial factor. This review led to a reconsideration of childcare policy, with a reversal of policies discouraging mothers from working while their children were growing up. Such policies had been driven by the idea that it was always harmful for children to be separated from their parents even if they attended well-run preschool facilities. Later, in the 1990s, in a large study of Romanian children who had spent their early years in orphanages during the Ceaușescu regime before being adopted by families in the UK, Mike was able to use the findings to refine, and on occasions to change, his views on the impact of separation and deprivation.

Michael Rutter, the eldest of four children, was born in the Lebanon on 15 August 1933 to Llewellyn and Winifred (née Barber) Rutter. His father was a doctor in a Quaker hospital. The family returned to Wolverhampton, England, in 1937, where his father worked as a general practitioner. In 1940, Mike and his sister Priscilla were evacuated to the USA. He returned to England in 1944, subsequently remaining in close and affectionate contact for many years with the American family which had fostered him. He attended the local grammar school and then went as a boarder to Bootham, a Quaker school in York. From here he gained admission to the University of Birmingham Medical School, from which he graduated with honours in 1955. As a medical student, he spent time working with Willie Mayer-Gross, an experience that turned him towards psychiatry. After house jobs in the Midlands and in London, he started psychiatric training at the Maudsley Hospital and the Institute of Psychiatry, London, in 1958, the same year that he married Marjorie (née Heys), a nurse.

With the strong support of Aubrey Lewis, the senior professor of psychiatry at the Institute of Psychiatry, who directed him into child psychiatry, Mike joined the Institute in 1963 as a member of the scientific staff of the Medical Research Council's Social Psychiatry Unit. Apart from a year (1962–1963) spent in New York at the Albert Einstein College of Medicine working with Herb Birch and Stella Chess and another year (1979–1980) as a Fellow of the Stanford Centre for Advanced Studies in Behavioral Sciences, his entire career was spent at the Institute of Psychiatry. In 1973, he was appointed to the first Chair of Child Psychiatry in the UK, a position that was created for him at the Institute. In 1984, he was made Director of a new Medical Research Council Unit in Child Psychiatry. Then, in 1994, he and David Goldberg established the Social, Genetic and Developmental Psychiatry (SGDP) Research Centre, of which he was Director until 1998. This Centre attracted stellar scientists from abroad, including two husband and wife couples, Judy Dunn and Robert Plomin, and Terrie Moffitt and Avshalom Caspi, who, with several other leaders in the field, made it the foremost academic centre in the world for the study of the interaction between genetic and environmental factors in human development.

After the establishment of the SGDP, although Mike collaborated with researchers in quantitative genetics (twin studies) and molecular genetics (DNA studies), he did not conduct his own empirical research. His contribution was conceptual: he saw himself as a referee between ‘evangelical’ geneticists and extreme environmentalists. His focus continued to be on the complex interactions between genes and environment. His thoughtful contributions on this subject continued to demonstrate his unique capacity for analytical thought, taking into account in a quite remarkable way all the relevant evidence to come to conclusions that could guide future research. Overall, he published over 500 scientific papers, some 300 chapters and over 40 books. His multi-authored textbook Child and Adolescent Psychiatry: Modern Approaches, initially co-edited with Lionel Hersov, is now in its sixth edition and remains the classic text on the subject.

Throughout his active research career, Mike practised as a clinical child and adolescent psychiatrist. His interviewing style, demonstrating a relentlessly probing but always respectful approach to children and parents, became a model for many others. He was an inspiring teacher in the field, attracting many trainee psychiatrists, psychologists and other academic clinicians and human scientists, who themselves later became leaders in the field both in the UK and abroad. His very high standards and absolute integrity made him a demanding collaborator and there were sometimes tensions in his working relationships, but the great majority of those who worked with him regarded their time with him as the most rewarding learning experience of their careers.

Mike's contributions to the fields of psychiatry, developmental psychology and education were widely recognised. He was appointed CBE in 1985 and KBE in 1992. He received honorary doctorates from 20 universities both in the UK and abroad. But the honour that meant most to him was his election to the Fellowship of the Royal Society (FRS) in 1987. He was the first psychiatrist to be awarded this honour since Sigmund Freud had been elected a foreign member of the Royal Society in 1936.

Despite the fact that he worked phenomenally long hours, Michael found time for his beloved family, as well as playing tennis, going to the theatre, cinema, concerts (both classical and jazz) and art galleries. He brought the same systematic approach to his leisure pursuits as he did to his work. When an American guest asked what to go and see at the theatre, Michael responded by giving him a lecture going from firstly to seventhly about what was on. Having seen all the plays himself, he was able to add his own thoughtful and penetrating comments. He was a good judge of fine wine, once winning a wine-tasting competition, the prize being a tour of French vineyards. Most of all, he and Marjorie loved hill-walking, both in the Lake District, where they owned a house for many years, and in the American national park Yosemite, after which they named their house in Dulwich, south London.

Mike is survived by Marjorie, who gave him the most wonderful emotional support throughout his demanding career and during his final distressing illness, his children Sheila, Stephen and Christine, and seven grandchildren.