Pedro-Enrique Muñoz Rodríguez: A social psychiatrist in times of confusion

Pedro Enrique Muñoz was born in Zamora in 1936 and began his professional career as a psychiatrist in Pamplona between 1960 and 1982, and completed his training in social psychiatry with Paul Sivadon in Paris. In 1968, he left his position at the University of Navarra to head up, together with most of his colleagues who belonged to the University’s department, the founding of the Argibide Foundation. In 1976, together with José Luis Vázquez-Barquero, he completed the report on the psychiatric epidemiological study of the Baztán Valley,¹ which gave rise to their respective doctoral dissertations.^2,3

For those who did not experience first-hand the final years of Franco’s regime and the transition, it is not easy to gauge the impact that this report has had on the development of mental health in Spain. The study was published at a time when the discipline was basically divided into two opposing positions, that of traditional psychiatry embedded in university hospitals, and that of community mental health with an ideological slant and resistant to scientific evaluation, which was entrenched in out-of-hospital planning and provision. The Argibide Foundation was one of the few exceptions to this rule, and both its model of psychiatric care in the community and the pioneering study of the Baztan Valley were a benchmark for those who were then embarking on their scientific training in social psychiatry. This study was the first to propose a two-phase assessment accompanied by the validation of the Spanish versions of the General Health Questionnaire (GHQ)⁴ and the Present Status Examination (PSE). Two years, later Pedro Enrique published the prevalence analysis in the urban setting of Pamplona as well as in other rural districts of Navarra,⁵ thereby laying the groundwork for data-driven psychiatric planning in Spain.

Pedro Enrique moved to Madrid in 1982, although he was always linked to the Argibide Foundation as president of its board of trustees. In the following three decades, Pedro Enrique Muñoz was the General Technical Director of the Mental Health Institute of Madrid (1982–84), Director of Research at the Institute of Health Studies (1984–85), Commissioner for the Regional Drug Plan (1986–87), Director of Studies at the Department of Social Integration (1988–92), and finally, Director of Epidemiology, Evaluation of Services and Research at the Department of Mental Health of the Autonomous Community of Madrid (2003–2010). During his long tenure, Pedro Enrique demonstrated his ability to translate scientific information into health planning and skilfully navigated the delicate relationship between research, policy, and clinical practice. He was also a lecturer at the National School of Health, Associate Professor of the third cycle and the University Centre of Public Health of the Autonomous University of Madrid. Despite his intense work in health administration and planning, Pedro Enrique never abandoned his interest in research and the promotion of mental health. In 1989, he founded the Spanish Society of Psychiatric Epidemiology, of which he was the first President until 1998. He was also a founding member of the Psicost Scientific Association, of which he was its Vice-President until 2015.

More than anything else, Pedro Enrique was a lucid and independent thinker, who, with his colleagues at Argibide, the Community of Madrid, the SEEP, the Spanish Society of Psychiatry, and Psicost, laid the foundations of public mental health, social psychiatry,⁶ psychiatric epidemiology,^1,3 studies of patterns of service use in mental health,⁷ and decision support systems in psychiatric planning.⁸ He was also a pioneer in mental health ecology research in urban and rural areas.⁹ His purpose was always to apply the scientific method to actual problems and his willingness to instruct and assist both colleagues and graduate students in the various fields that comprise social psychiatry. His seminars at SEEP conferences trained several generations of epidemiologists and health planners.

In the last period of his career, he received wide recognition, including his appointment as a member of the College of Emeritus Psychiatrists of the Spanish Foundation of Psychiatry and Mental Health. After his retirement in 2010, he began a trilogy on the great issues that plague mankind from the historical and social perspective. In 2016, he published the first volume of this series entitled, “Living in times of confusion”,¹⁰ a text of great phenomenological depth, totally unlike what he had taught us about epidemiology and health planning. Unfortunately, his usual parsimony when it came to publishing and the inexorable clock of time left no room for more. Pedro Enrique passed away in Seville on March 3, 2022.

They say that Diogenes walked around with a lighted lamp in broad daylight looking for a single honest man in Athens. It is possible that Diogenes did not carry his lamp to find anyone, but to guide anyone who wanted to develop critical, rigorous, and independent thinking. Like Diogenes, Pedro Enrique was the beacon that guided many of us in times of confusion. In the end – life’s law – his light was extinguished, but his memory and example remain alive in all of us who had contact with him.

Funding

The authors have not received any funding for the drafting of this commentary.

Acknowledgements

We thank Vicente Madoz and Juan Cabasés for their comments and invaluable contribution to this text.