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Professor Trimble qualified at the University of Birmingham in 1970, achieving the University Vice Chancellor’s Prize as the best university student of the year. His first degree was in neuroanatomy, and he later became FRCP and FRCPsych. developing his future career in behavioural neurology and neuropsychiatry. His clinical development in neurology and psychiatry was carried out at the National Hospitals, the Maudsley Hospital and the Johns Hopkins University Baltimore. He is an Ambassador for Epilepsy (ILAE) and has been awarded lifetime achievement awards in Neuropsychiatry, Biological Psychiatry and from the British branch of the ILAE.
He has written 13 books and edited many more, the latter largely related to the interface between neurology and psychiatry.
1. What were my first impressions of Queen Square?
I was first at Queen Square in 1972, at a time when one of the consultants I worked for arrived in a Rolls Royce (Denis Williams) and another was met outside the hospital in his car and was escorted to the wards (Sir Roger Bannister). Several of the junior staff wore stiff detached white collars with their striped shirts, and a hierarchy of diagnostic opinion was carefully observed.
In 1976, I was appointed as a consultant. As a junior, I had to serve sherry at medical committees, and observed tabulated on the wall a long list of neurological giants. The committees were often heated in debate but impressive as at that time medical decisions made in them directed the running of the hospital. I had been appointed on the basis of an academic background, but with a special interest in epilepsy, and had clinical sessions at the Chalfont centre, then literally out of sight and virtually out of mind. Epilepsy was considered to be not quite a respectable subject for neurologists to be interested in, and neurologists were all general neurologists, special interests being frowned upon.
My first impressions were of being admitted to a demesne of highly talented, experienced but sometimes rather fearsome individuals, who were unable to absorb the psychological into the neurological, and who seemed to have little interest in the brain as such, with a great emphasis on abnormalities of peripheral nerve and muscles. Denis Williams was a delightful exception, who might begin a conversation with “My first King…”, and whose interest in people with epilepsy as opposed to epilepsy gave me insights that have lasted my entire career. I had the privilege to caress one of Gall’s skulls owned by MacDonald Critchley, who in discussion often provided anecdotes about famous neurologists he had known, or knew about; to witness Purdon Martin slip into the hospital for a bed for the night when he felt he needed one; and to be featured in one of Peter Gautier-Smith’s murder mystery novels.
2. Tell me more about the Raymond Way Unit
In 1979 I was appointed Senior Lecturer in Behavioural Neurology, and had an embryo research group working in offices in the newly opened Institute of Neurology building. At the time, there was no academic neuropsychiatry group, and the unit was within the University Department of Clinical Neurology. Roger Gilliatt was head of department, a formidable, daunting chief, who terrified junior staff, but because of the closeness of our offices I got to know from a social perspective, which revealed another side of him altogether.
Mr Raymond Way was a private patient, and after his death his widow, Mary Raymond Way called me and said she wanted to make a contribution to the Institute for research. At first she wanted to purchase a ‘new’ scanner (CT scan), but Roger Gilliatt and the Dean John Marshall persuaded her that in a few years the scan would be outdated, and so she gave generous funds to set up the Raymond Way Unit, with a special brief for research in neuropsychiatry. The money funded part of my salary and a clinical lecturer, seeding which over the years allowed me to build it up to the size it was when I retired in 2004. Over the following 16 years we had over 40 research staff, and eight lecturers and over 400 academic publications in quite diverse areas of neuropsychiatry. Mr Raymond Way was the founder of Raymond Way Motors, a formidable businessman, farmer, legendary motor racer, keen pilot and owner of Shackleton Aviation. He was also a collector of elegant cars – Mary would always arrive at the Square in a Rolls Royce – just like the old days!
3. What are you fondest memories of your time here?
My fondest memories were being in touch and knowing socially some of the best of the best in what is now part of the history of neurology and neuropsychiatry. George DuBoulay, Peter Gautier-Smith, William Goody, Macdonald Critchley, Purdon Martin, Chris Earle, John Morgan Hughes, Kevin Zilkha, Roman Kocen - the list goes on. Technological and clinical skills abounded, although few had much understanding as to what psychiatry, let alone neuropsychiatry might mean. There was only the ghost of Eliot Slater (one neurologist confided in me that he was one of the most intelligent consultants at the square), and the philosophy was one of neurological diagnosis, with limited therapeutic endeavour.
4. What do you think it takes to be a good clinician and researcher?
Combining a career in research and clinical practice used to be much easier than it is today. And yet any clinician who does not make every patient a potential research candidate, namely someone with a problem that needs a solution and so approached with curiosity, will have entered a simple routine of diagnosis, a habit of intellectual constriction. The opportunities to do good clinical research abounded at the Square, and the Institute was well staffed with congenial colleagues with whom I did much collaborative research. I was able to do one of the first CT series on psychotic patients and the first PET scans in epilepsy. I set up a neuropsychology lab with a special interest in cognitive function in epilepsy and developed the Gilles de la Tourette Clinic, which when I retired had over 2,000 patients.
5. Are there any people who have inspired you?
There were many I admired at Queen Square, but Dick Pratt, my consultant colleague who urged my appointment, was much admired by all. Kindly, softly spoken, he never gave up on treating patients, and in spite of his severe diabetes, rarely took time away from clinical work. Things that colleagues do outside their day job are important and to be admired. His adoration of sun-dials, rereading texts in their original Latin, and accurately proof-read by reading the lines backwards told much about him. I think the best neurologist I knew was David Marsden, and I frequently enjoyed discussing research ideas with him.
6. What do you view as your greatest achievements?
My greatest achievement may have been to help establish neuropsychiatry as a recognised academic and clinical discipline, especially internationally. I was for a long time the only officially recognised behavioural neurologist in the UK, and enjoyed discussing and lecturing on limbic neuroanatomy, such a neglected area of traditional neurological thinking.
7. What are the current projects that you are working on?
Since becoming emeritus, I have written several books, but of most significance for me have been those related to emotional experiences, from anthropological, neuroanatomical and philosophical perspectives. The Soul in the Brain – the Cerebral Basis of Language, Art and Belief, Why Humans Like to Cry – Tragedy, Evolution and the Brain, and The Intentional Brain – Motion Emotion and the Development of Modern Neuropsychiatry - all embrace my quest to understand the basis for our normal and abnormal feelings and creativity, with a dedication to neuroanatomy (my first degree), and a lament for a lack of interest in such areas by conventional neuroscience and neurology until recent times. Music is of much importance to me, and my current research is linked with our emotional responses to music, especially opera, especially Richard Wagner.
8. Whose contribution do you think has been overlooked
There will be many whose contributions are overlooked. Hughlings Jackson, for me, is a more important historical figure than William Gowers, his writings on how the brain must be viewed as a product of evolution, and is affected by lesions leading to positive and negative signs and symptoms, should be compulsory reading by any budding neurologist, and neuropsychiatrist. William Goody was one of the intellectual pioneers, now lost to time, a man who had diverse extra neurological interests, from lay-lines, to printing, to constructing harpsichords (he had a Bentley). He wanted to develop neurological thinking in its broadest way (Neurological Cosmology).
9. What does Queen Square mean to you?
The very name still echoes internationally, but there is concern that its association with the brightest stars in the firmament has dimmed somewhat. It is still a haven in the centre of an ever-busy London, where one can sit on sunny days, surrounded by buildings whose purpose is learning, and the Larder is still there.