Obituary: Dr Mildred Creak

Eleanor Mildred Creak, child psychiatrist: born Manchester 11 August 1898; Assistant Physician, The Retreat, York 1924-28; Physician, Maudsley Hospital 1929-41; Women's Army Corps 1941-45; Physician in Psychological Medicine, Hospital for Sick Children, Great Ormond Street 1946-63; died Stevenage 25 August 1993.

AFTER QUALIFYING as a doctor at University College Hospital at the end of the First World War, Mildred Creak found it difficult to find a job in the London area. There was tremendous prejudice against women doctors and Creak applied for over 90 posts.

A Quaker, she worked from 1924 to 1928 as Assistant Physician at The Retreat, a mental hospital run by Quakers in York. But earlier experience working with children led her south again to a post at the Maudsley Hospital, London, which in 1929 had just established a Children's Department. Here she helped to lay the clinical and academic foundations for what is now a leading centre for the study of child psychiatric disorders. In 1932 she was awarded a Rockefeller Fellowship to visit the United States. On return, she took a particular interest in organic contributions to behaviour problems, and published articles on organic psychoses, choreatics, compulsive utterances and hysteria in childhood.

Shortly after the Second World War began, the Maudsley was transferred to Mill Hill Hospital and Creak worked there before joining the Women's Army Corps as a doctor. Part of her service was in India, engaged in officer selection. At the end of the war she was offered a post back at the Maudsley, but she wanted to practise in a children's hospital. In 1946 she was offered the first post as Physician in Psychological Medicine at the Hospital for Sick Children, Great Ormond Street, where she had previously worked voluntarily. It was here that she made her special mark.

From 1946 until her retirement in 1963, Creak was the child psychiatrist most strongly connected with paediatrics and paediatricians. Although, of course, many paediatricians, including Charles West, Great Ormond Street's founder, in 1852, and Frederick Still, the most eminent member of its staff at the turn of the century, had taken a close interest in the psychological care of children, it was Mildred Creak who established what might be called 'paediatric psychiatry', the practice of child psychiatry in a paediatric setting as a vigorous and influential speciality.

She developed excellent working relationships with the paediatricians, who valued her practical but insightful approach. When Alan Moncrieff, the Professor of Child Health, introduced her to visitors at Great Ormond Street, he would say, 'This is Dr Creak, our psychiatrist, but she is really very sensible.' This, she said, made her feel she had failed - she wanted to open the eyes of paediatricians to causes of children's problems that might seem to them improbable.

Perhaps Creak's best-known contribution to the speciality lay in her chairmanship in the early 1960s of a working party that established the nine-point criteria for the diagnosis of autism, then called the 'schizophrenic syndrome of childhood'. This work was partly based on a series of 100 children she had collected herself. Autism was then widely thought to be caused by parental inadequacy, a professional belief that caused considerable suffering to parents. Creak suggested, rather, that the condition was primarily due to genetic or, as she put it, constitutional factors, a view that has since been amply confirmed by scientific evidence.

Mildred Creak had a unit for autistic children named after her in Perth, Western Australia, where she lectured after her retirement and, in 1961, had the then unique distinction at Great Ormond Street of a unit named after her during her lifetime. Sadly, her retirement was marred by a particularly affecting form of Alzheimer's disease, but she continued to attend prayer meetings regularly until nearly the end of her life.

(Photograph omitted)