Interview with Scott Henderson - Emeritus Professor, psychiatrist and epidemiologist

Interview conducted June 2013 at ANU College of Law Library
Production – Jamie Kidston, Emily Duncan, and Peter Stewart
Engineer - Nik Fominas

Biographical introduction: Alexander Scott Henderson was born in Aberdeen, Scotland, in 1935. Following schooling at Mackie Academy in Stonehaven, Scott studied medicine at the University of Aberdeen, with specialist training at the Royal Infirmary and the Ross Clinic, also in Aberdeen. He moved to Sydney and married Priscilla in 1963, and was appointed registrar in psychiatry at Prince Henry Hospital, Sydney. In 1965 Scott returned to Scotland to obtain research experience in psychiatry and epidemiology, not available to him at that time in Australia.

In 1969, Scott was appointed Foundation Professor of Psychiatry at the University of Tasmania. In 1974 he inaugurated the Social Psychiatry Research Unit (SPRU), an elite NHMRC research unit which Scott elected to embed within ANU. This Unit, which became a WHO Collaborating Centre in Mental Disorders, developed elements of medical sciences (psychiatry, epidemiology and statistics), well suited to the new challenges confronting modern medicine.

Despite its non-tenured funding structure, SPRU thrived and became notably productive and internationally recognised. In later years, the Unit’s emphasis moved to mental disorders of the elderly – depression and dementia including Alzheimer’s disease.

In 2001, as Scott finished his formal appointment with ANU, SPRU was re-named the Centre for Mental Health Research, with one of Scott’s colleagues, Anthony Jorm, appointed its Director.

Scott Henderson was appointed Professor Emeritus at ANU in 2001, and AO by the Commonwealth Government in 2003. Since notional retirement in 2001, Scott has kept his hand in, with senior clinical and research appointments at Canberra Hospital, the Department of Defence, and as an editor of the ANZ Journal of Psychiatry.

Interview Synopsis:

Alexander Scott Henderson was born in Aberdeen, Scotland, in 1935. His father was a physician in the field of public health, and his mother had been Matron of teaching hospitals in Dundee and Glasgow. After completing schooling at Mackie Academy in Stonehaven in the North East of Scotland, he studied medicine at the University of Aberdeen, graduating MB, ChB in 1959. He then completed specialist training in general medicine at the Aberdeen Royal Infirmary. In 1961, he started training in Psychiatry at the Ross Clinic in Aberdeen, passing the Diploma in Psychological Medicine in London two years later. Scott then met Priscilla, his future wife, a young physiotherapist from Sydney, while on holiday in Norway. He had arranged to go to Rochester in the USA for overseas experience, but their friendship led to a change in plans. To obtain an appointment in Australia, he was interviewed by Professor Leslie Kiloh in Newcastle upon Tyne, who had just been appointed Foundation Professor of Psychiatry at the newly-established Medical School at UNSW. Scott sailed to Australia as a ship’s surgeon, marrying Priscilla in Sydney in 1963 and taking up the post of registrar in psychiatry at Prince Henry Hospital, Sydney, under Kiloh.

At Prince Henry Hospital, he worked in both the general medical wards and psychiatry, leading to his admission to Membership of the Royal Australasian College of Physicians in 1964. At that point, Scott felt he needed a concentrated period in psychiatric research. At that time, there was virtually no research in Australian in psychiatry, and few university departments had been established. So he returned to Scotland in 1965 to become a Member of the Scientific Staff in the MRC Unit for Research on the Epidemiology of Psychiatric Illness at the University of Edinburgh. His supervisors there were Professors Morris Carstairs and Norman Kreitman. Under them, he became immersed in the epidemiology of mental disorders. This is the study of the mass aspects of disease as it occurs in whole populations. That field became the basis for all of his subsequent scientific work. In 1966, he passed the Membership Examination of the Royal College of Physicians of London, and later Membership of the Royal College of Psychiatrists in London. Work for his MD from the University of Aberdeen was completed in the MRC Unit in Edinburgh, on the health of adolescents with mental disorders.

He returned to Australia in 1969 to become Foundation Professor of Psychiatry at the newly established Medical School at the University of Tasmania, where he remained until 1974, simultaneously serving as Clinical Commissioner with the Tasmanian Mental Health Services Commission and directing a 30-bed acute psychiatric unit at the Royal Hobart Hospital. The diversity of effort this required and the lack of time for research proved difficult to sustain.

In 1973, soon after the Whitlam Government was first elected, the National Health and Medical Research Council (NHMRC) took the bold decision to establish specialist research units consisting of small groups of investigators focusing on selected national health priorities. The Council’s action was designed to complement their funding only research projects or programs in large medical research institutes in Melbourne and Sydney. The Council noted that while Australia had done well in some areas such as immunology and neuroscience, certain fields of medical research required strengthening. They chose three areas: psychiatry, cancer and cardiovascular epidemiology, and road accident research. With Eric Saint (Professor of Medicine at the University of Western Australia) as chair, Scott was invited to join the national committee which would oversee the necessary appointments and guide the setting up of a research unit.

The very nature of that committee’s remit, particularly in psychiatry and epidemiology, proved too tempting for Scott. He withdrew from the committee to become an applicant for one of the directorships. His submission was in social psychiatry, which is the study of factors in the social environment which contribute to the onset and development of mental disorders and their treatment. In August 1974, Scott resigned his tenured chair in Hobart. He was appointed Director of the NHMRC Social Psychiatry Research Unit by Dr Douglas Everingham, then Minister for Health in the new Labour Government. The NHMRC indicated he could take the unit to any medical school of his choice. Scott soon had attractive invitations to embed the new unit in the medical schools of Sydney, Melbourne or Adelaide. But he felt it important that the unit be sited in an environment with a strong research orientation, resourced with suitable infrastructure for the sort of endeavour he had in mind, along the lines of the MRC Unit he had experienced in Edinburgh. The Australian National University seemed to fulfil his needs, with the added bonus of allowing continued interaction with academic groups elsewhere in Australia, but with independence from them. ANU (then headed by Vice Chancellor Robert Williams [1973-75] and the then Registrar, David Hodgkin [1968 – 1974]) unhesitatingly agreed to host the new unit. The NHMRC Social Psychiatry Research Unit (SPRU) began in 3 Liversidge Street, near University House, in January 1975. In the first months of that year, he received a phone call from the Australian Medical Association seeking reassurance that the unit, in being called the Social Psychiatry Research Unit, was in no way concerned with socialism!

SPRU staff had no tenure. It was wholly funded by the NHMRC, secure for seven years in the first instance, with a formal review scheduled in the fifth year. Because of the nature of its work, and its dependence on external funding, the unit could not be part of the Institute of Advanced Studies, nor of the Faculties. It was said to be part of ANU’s ‘third world’. Administrative support in the form of a business manager and advisory committee were provided through the John Curtin School of Medical Research. Interestingly, the School saw Scott and his staff to be social scientists and therefore not appropriate to be part of its academic staff. The SPRU staff all welcomed the independence they thus gained.

From the outset, Scott and his colleagues knew they had to be both original and productive scientists, as their appointment at an elite national research Centre required, and as successive annual reports soon attested. For some years, Scott had thought about how the social environment might determine the prevalence of common mental disorders (including pathological anxiety, depression, and alcohol or substance abuse). At that time, there was a great deal of work going on in the UK, Scandinavia and the USA on the health consequences of adverse life events, such as bereavement, loss of property or status, unemployment, interpersonal friction, physical illness or trauma. There was also much interest in Attachment Theory, developed by John Bowlby. Scott came to wonder if the social environment was the source of certain as yet ill-defined elements that were essential for most people. While human beings could adversely affect each other in daily life, they were also the source of something important. In particular, they hypothesised that close personal relationships played a role in protecting mental health.

As the Unit began its life, wider scientific revolutions were underway, ranging across molecular biology and astrophysics and beyond. Humans had just set foot on the Moon. Yet the medical and social sciences had no method for measuring what it is that people give to each other in daily life – what is commonly known as social support. The SPRU therefore set about building the Interview Schedule for Social Interaction (the ISSI), and launched it as the basis for population surveys. Scott’s colleagues by this time included Don Byrne, Karen Ritchie and Helen Macaulay. Paul Duncan-Jones joined the team soon after, bringing much originality to the unit’s work, particularly in statistical methods such as latent trait theory and structural equation modeling. The unit was further strengthened by the appointment of Professor Patrick Moran FRS as a Visiting Fellow in 1982, following his retirement from the chair in Statistics at ANU’s Research School of Social Sciences. SPRU’s work on the psychiatric aspects of the social environment burgeoned and soon was acknowledged internationally. The book “Neurosis and the Social Environment” (Scott, Byrnes & Duncan-Jones, Academic Press, 1981) continues to be cited.

Around 1982, Scott and his colleagues came to see a need to better understand the epidemiology of mental disorders in later life, such as the dementias, Alzheimer’s disease, and depression. Because people were increasingly living to a later age, the numbers of the elderly were recognised to be increasing all over the world. The scientific opportunities for understanding these conditions seemed manifold. The group saw a need for new methods for assessing early dementia or mild cognitive impairment and depressive disorders in the elderly. They chose to investigate these conditions as they occur in the general population, not just in people who have reached general practice or hospitals. The objective was to estimate the prevalence of these disorders, the course that they take, and then identify risk factors.

An important benefit of working on the health of the elderly was its appeal to funding agencies. This was important for a Unit competing in the highly competitive NHMRC environment, with regular formal reviews, including assessment by overseas experts. Scott sometimes wondered what would happen to his family and himself if the NHMRC decided to end its funding of the Unit. Pat Moran reassured Scott with his wonderful wit, saying “You can always put your plate up in Queanbeyan!” A succession of Vice Chancellors had made it clear that no financial support would be forthcoming from ANU in the event of NHMRC withdrawing funding.

A strikingly successful collaboration for Scott was with Professor GA (Tony) Broe in the Department of Geriatric Medicine at Concord Hospital in Sydney. With their two teams, they conducted a large case control study of patients with Alzheimer’s disease, comparing them with an equal number of older persons who had no dementia, matched for age and even recruited from the same general practices in Sydney. This study was able to make a significant contribution to the then-known risk factors for Alzheimer’s disease.

In 1989, Scott was made a Professor for the term of his appointment in the NHMRC unit. The work on mental health in older persons prospered, continuing for some twenty years with strong international recognition. Hundreds of refereed journal papers, reports, and books provide a quantitative measure of SPRU’s scientific success, among which more than 300 have Professor Henderson’s name on them. The Unit’s work was further strengthened by the appointment of Anthony Jorm in 1984, who succeeded Scott Henderson as Director in 2001. The Unit was renamed the Centre for Mental Health Research in 1995. Scott was appointed Emeritus Professor by ANU in 2001.

Scott served as chair or member of many advisory and research funding committees in mental health, and of important professional bodies guiding research in mental health. More recently, he has been active in a number of high level federal government committees advising the Department of Defence in their intensive program of health surveillance of serving personnel, including the long-term effects of deployment to Iraq and Afghanistan.

In 2003, Scott was appointed Officer of the Order of Australia (AO) “for service to medicine in the field of mental health as a leading clinician, researcher and scientist, and to the development of national and international policy in regard to greater awareness, education and improved treatments.” Although formally retired since 2001, Scott actively maintains his practice as a clinician through appointments as Visiting Senior Specialist in the Psychiatry Unit at The Canberra Hospital (since 1994), and as Visiting Fellow at both the Centre for Mental Health Research (CMHR) and the Centre for Research on Ageing, Health and Wellbeing (CRAHW).

Throughout his years at ANU, Scott has continued to see patients and to attend clinical meetings at The Canberra Hospital and Sydney. In doing so, he followed the precept he had experienced with the Medical Research Council in his Edinburgh years. The Council believed it was important for its clinical staff to retain some engagement with patients for a few hours a week.

Among those who have been important mentors and collaborators during Professor Henderson’s ANU years, he counts as prominent: Professors Patrick Moran, FRS, Jack Smart and Simon Easteal; Dr Bryan Furnass (formerly Director, University Health Service) and Professor Ralph Elliott, together with the collegial ambience of University House members and visitors.

Scott’s wife, Priscilla, did not continue as a physiotherapist after they married. Instead, she and Scott had five children. After they had all started school, she studied Art History at ANU under Professor Sasha Grishin, obtaining First Class Honours, then continued, as Art History’s first postgraduate student, to complete a PhD entitled “The Christian Mosaics of Byzantine Palestine”. They now have nine grandchildren dispersed across Canberra, Sydney and Melbourne. In February 2013, they celebrated 50 years of marriage. As an epidemiologist, Scott is aware that such continuity is an increasing demographic rarity. He is very conscious of the rapid advancement of knowledge in the neurosciences, making him wish he were again only 25 years old.

Scott’s outside interests include bird-watching, fly fishing when he can find ready access to water, and travel. He is a long-standing member of St Andrew’s Church, Canberra.