Thomas Bewley – The Lancet

Psychiatrist and early specialist in addiction. He was born in Dublin, Ireland, on July 8, 1926 and died of respiratory failure in London, UK, on ​​June 26, 2022 aged 95 years.

It was in the spring of 1964 that Thomas Bewley, later to become President of the Royal College of Psychiatrists in the UK, wrote to The Lancet reinforcing its previously expressed concern over an increase in opiate addiction in the UK. “In the past year”, he wrote, “20 heroin and cocaine addicts were admitted to Tooting Bec Hospital under my care”. Pointing out that more than half were aged between 20 and 25 years, he commented that these patients “are likely to constitute a very difficult problem for a long time”.

The numbers then were still small, but Bewley’s comment was prescient. “Heroin addiction really took off in Britain in the late 1960s”, says retired psychiatrist Colin Brewer, who himself treated addiction in the public and the private sectors. “New addiction units were set up…but no one knew much about addiction’s natural history. The number [of drug users] increased, but funding didn’t increase to follow this.” The problem foreseen by Bewley became a reality. Professor Sir John Strang holds a Chair in the Psychiatry of Addictions at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, UK. As he puts it, Bewley was “one of those who, in the 1960s, helped to shape our understanding of what we were dealing with”. During his career Bewley will witness, and in many respects influenced, the emergence of professional interest in a field that medicine had hitherto neglected. Bewley was born into a medical family, both his father and grandfather having supervised Bloomfield, a Quaker psychiatric hospital on the outskirts of Dublin. Bewley himself studied medicine at Trinity College Dublin, qualified in 1950, completed his house jobs, and then consulted the psychiatrist Norman Moore on how best to train in that specialty. His choice of mentor proved a sound one. Moore, one of the few doctors who treated alcoholism, was Medical Director of St Patrick’s Hospital, a venerable institution associated with Trinity College Dublin. Bewley was offered a 2-year training post there in psychiatry.

Having moved to England, he spent a year learning about chronic mental illness at North London’s long-stay Claybury Hospital before transferring to the Maudsley Hospital in south London, where he worked with D.L. Davies, also a psychiatrist with an interest in alcohol use disorders. In 1960, Bewley joined Tooting Bec Hospital, another long-stay institution. He became a consultant in 1961, began to develop his thinking about addiction, and was soon regarded as an expert. “I knew little”, he later wrote with typically self-deprecating wit, “but everyone else knew even less.”

Bewley crystallised his thoughts on addiction in a 1965 Lancet paper, arguing that the methods then used to contain it would fail. “Special units are needed for patients”, he wrote. “Compulsory notification is desirable, and the practice of prescribing drugs for addicts outside hospital should be reconsidered”, he suggested. When the UK Government’s Interdepartmental Committee on Drug Addiction (the Brain Committee) published its second report that same year, its recommendations featured many of Bewley’s suggestions. As a pioneer of harm reduction, in addition to warning of the risks of sharing equipment he also dispensed sterile syringes. “He was a sensible and pragmatic prescriber who put keeping his patients alive before rhetoric and political posturing”, says David Nutt, Edmond J Safra Professor of Neuropsychopharmacology at Imperial College London, UK.

After a period of active engagement with the Royal College of Psychiatrists, and having served as its Dean, Bewley was elected President for 1984–87. Vanessa Cameron, the college’s then Chief Executive, describes him as “witty and not at all pompous…a man full of energy, and instrumental in bringing addiction more to the fore in the College”. Strang agrees: “It was good for the standing of the addiction field that there was someone from that field who held the highest office in psychiatry. And he was a great communicator.” After his Presidency, Bewley remained active in psychiatry, advising various national, governmental, and international bodies. Strang describes him as very likeable, and inspiring to junior staff coming into the field. Nutt adds that Bewley was “a kind and compassionate clinician, who cared for drug and alcohol addicts, the most disadvantaged people in society”. Bewley’s wife Beulah, a well known public health physician, died in 2018, and he is survived by children Emma, ​​Henry, Louisa, and Susan.

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