Gerald Russell
Psychiatrist who first described the eating disorder bulimia
GERALD RUSSELL, who has died aged 90, was a psychiatrist who identified the eating disorder bulimia, which drives sufferers to binge-eat before “purging” themselves by vomiting or taking laxatives.
Russell first encountered the condition in 1972, when a patient checked into the Royal Free Hospital in London, where he was a professor of psychiatry. The diagnosis was anorexia nervosa, but Russell’s patient did not fit the diagnostic criteria. While anorexic patients typically had sallow complexions and emaciated frames, this woman was of a normal weight for her height, with healthy-looking skin.
Over the next seven years some 30 other patients were admitted, all looking well but with disordered eating habits. They were often depressed, and could be suicidal. Many admitted abusing laxatives and making themselves vomit, as anorexics frequently do; but it took testimony from another patient, herself a doctor, before Russell began to understand why established methods were not working. “[This patient said]: ‘The reason I vomit is simply to get rid of all this food I eat’,” he recalled.
Russell was convinced that he was not dealing with classic anorexia, but with some “ominous variant”. A 1979 paper in the journal Psychological Medicine presented a description of “bulimia nervosa” – from the Greek words bous (ox) and limos (hunger): “hunger of an ox”. Russell explained: “My mother tongue is French, and when I used to have a good meal, my mother would accuse me of having ‘boulimie’ … eating too much,” he recalled.
Russell gave his name to a condition observed in bulimic patients. “Russell’s sign” refers to calluses on the knuckles caused by putting fingers down the throat to induce vomiting.
Psychiatrists expected to be treating a handful of patients a year. By the early 1990s, however, estimates suggested that three in every 100 women would suffer from bulimia at some stage. In a 1992 report for the European Eating Disorders Review Russell trawled through records dating back to the 1930s. He showed that the disorder was more prevalent among those born in more recent decades. “Bulimia belongs to a family of neurotic illnesses which come and go according to fashion,” he said. “The current increase is almost certainly due to the cult of thinness.”
The youngest of three children, Gerald Francis Morris Russell was born in Belgium on January 12 1928, to Major Daniel Russell MC, and his wife Berthe (née De Boe). Gerald attended St John Berchmans College in Brussels, where his father worked at the British Embassy. When Belgium came under attack in 1940, Gerald’s father stayed in position until staff were evacuated via Dunkirk.
The family settled in Ventnor, Isle of Wight, where Gerald attended grammar school in Newport, and then George Watson’s College, Edinburgh. He qualified as a doctor at the University of Edinburgh in 1950.
From 1979 to 1993 he was a professor at the Institute of Psychiatry, University of London. The eating disorders unit which he founded at the Maudsley specialised in therapy involving family members.
He outlined the advantages of this strategy in a 1987 study of 80 participants allocated either to family or individual therapy. Family therapy improved the outcome for young anorexic patients whose disorder had begun in their early teens but who were not yet chronically ill. The “Maudsley Approach” was adopted internationally.
As Russell neared retirement in 1993, the eating disorders unit came under threat of closure. In his last months in post he battled to keep the doors open for his successor, Professor Janet Treasure. He went on to work as a consultant at the Priory Hospital, Bromley.
He married Margaret Taylor in 1950. They had three sons, and she predeceased him last year.
Professor Gerald Russell, born January 12 1928, died July 26 2018