Dr.Iconoclast Psychiatrist Paul McHugh has waged a ceaseless campaign to restore sanity to his own profession. He wants psychiatrists to pay less attention to intellectual fads and more to the hard realities of science.

February 02, 1997|By Richard O'Mara | Richard O'Mara,SUN STAFF

The ancient folk had a name for him. They called him Momus. He was the licensed critic who sprayed the gods with ridicule.

Is Paul Rodney McHugh a modern, flesh-and-blood Momus? A persistent faultfinder of the wannabe gods in psychiatry?

He hardly seems the type: He's not cranky; he doesn't go around preoccupied all the time. For someone who spends so much time among the depressed and insane, he's suspiciously happy.

Probably his reputation has less to do with the way he is than with his annihilating opinions on everything from doctor-assisted suicide (utterly wrong) to multiple personality disorder (it doesn't exist).

McHugh speak outs about the dubious practices -- and practitioners -- in the medical profession. People like Dr. Jack Kevorkian, whom McHugh regards as "insane" and "dangerous to others." Or Dr. Bruno Bettelheim, a renowned expert on children, who was "a habitual liar, thankless friend, vicious bully and brazen plagiarist. He died in 1990. Why not just forget him?"

But McHugh is always toughest on his own specialty, psychiatry, which he believes enjoys entirely too much credibility with the public and in the official world of courts and the law.

"Psychiatry," he writes, "is a rudimentary medical art." It is full of people who say things they can't prove about why human beings do what they do. Though all psychiatrists are medical doctors, psychiatry is largely bereft of the certainties that general medicine or chemistry or biology can claim. This is where it is most vulnerable to attack.

McHugh does not say most psychiatrists are irresponsible. He would admit many are.

He mentions an incident that occurred during the 1964 presidential campaign. It involved Barry Goldwater, the Republican nominee, considered by some to be reckless on the issue of nuclear war, and a gambit by an obscure magazine titled Fact.

The editors of this journal sent questionnaires to psychiatrists all across the country asking them to assess Goldwater's mental state. Many, having never even met the senator, declared him unfit to be president.

"Scandalous and wrong," McHugh calls it.

This is the sort of thing that has always upset Paul McHugh, Henry Phipps Professor and director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins' School of Medicine.

This is an Olympian position in the world of psychiatry, one which McHugh seems to occupy without taking himself too seriously. He is an amiable man, with many interests, prepared ++ to talk knowledgeably on subjects as diverse as Evelyn Waugh's novels and Japan's post-war drug-abuse crisis. His recreations are almost entirely intellectual.

"I engage in conversation with friends. I read a lot of books [fiction, biographies and philosophy, mainly]. I travel with my dear wife [Jean, from Shropshire, England, whom he met in Boston and married 38 years ago]."

McHugh reveals his New England origins (Lawrence, Mass.) the moment he opens his mouth and launches those flat, large-tongued aaa's into the conversation. He is the son of a high-school teacher, father of three grown children: a journalist, an athletic director at a private school, a banker.

He earned his medical degree from Harvard in 1956 and completed residencies in psychiatry in Maudsley Hospital, London, and in neurology in Massachusetts General Hospital in Boston. He taught at Cornell and the University of Oregon before coming to Hopkins more than 20 years ago.

McHugh has an expressive, slightly cherubic, pale-pinkish face, a large forehead beneath not too much gray hair. He is 65, a man of many words and few gestures. Usually, when lecturing he just holds his hands before him, palms up, and raises and lowers them like somebody weighing a baby.

Over the years, he has trained hundreds of psychiatrists. Many remember their time with him as one of the high points in their professional lives.

"Paul teaches you how to think. How to take a stand in a world filled with ambiguity. He teaches you to think scientifically," says Michael A. Schwartz, professor of psychiatry at Case Western Reserve University who studied under McHugh 30 years ago and has followed his career ever since.

Patient interview

On Friday rounds at Hopkins, McHugh gathers 20 psychiatric residents in a room to interview a patient, a young man suffering from schizophrenia. The doctor is wearing a blue-striped Oxford shirt, black trousers and blazer. His students are in white lab coats.

First McHugh interviews the resident who has selected the young man. "Are you sufficiently interested in this patient?" he asks. "Or are you doing this pro forma?"

When McHugh has satisfied himself about the doctor's intentions, the patient is brought in. He hears voices, finds the world about him "unreal."

"How do you feel?" McHugh asks gently. "How's your mood?"

"Not good," says the young man.

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