Thomas Bewley – The Lancet

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

It was in the spring of 1964 that Thomas Bewley, who would later become president of the Royal College of Psychiatrists in the United Kingdom, wrote to The Lancet reinforcing its previously expressed concern about an increase in opiate addiction in the UK. “Last 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, he commented that these patients “are likely to be a very difficult problem for a long time”.

The numbers were still low then, but Bewley’s comment was prescient. “Heroin addiction really took off in Britain in the late 1960s,” says retired psychiatrist Colin Brewer, who has treated addiction himself in the public and private sectors. “New addiction units were created… but nobody knew much about the natural history of addiction. The number [of drug users] increased, but funding has not increased to keep up with that. The problem Bewley predicted became a reality. Professor Sir John Strang holds a Chair in Addiction Psychiatry 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 shape our understanding of what we were dealing with”. During his career, Bewley witnessed, and in many ways influenced, the emergence of a professional interest in a field that medicine had hitherto neglected. Bewley was born into a medical family, his father and grandfather overseeing Bloomfield, a Quaker mental hospital on the outskirts of Dublin. Bewley himself studied medicine at Trinity College Dublin, qualified in 1950, completed his domestic work, then consulted psychiatrist Norman Moore on how best to train in this specialty. His choice of mentor turned out to be wise. Moore, one of the few doctors to treat alcoholism, was medical director of St Patrick’s Hospital, a venerable institution associated with Trinity College Dublin. Bewley was offered a 2-year training position there in psychiatry.

After moving to England, he spent a year learning about chronic mental illness at Claybury long-term hospital in north London before being transferred to Maudsley Hospital in south London, where he worked with DL 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 thoughts on drug addiction and was quickly considered an expert. “I knew little”, he later wrote with typically self-deprecating wit, “but everyone else knew even less”.

Bewley crystallized 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 writes. “Mandatory reporting is desirable, and the practice of prescribing drugs to drug addicts outside of hospital should be reconsidered,” he suggested. When the British Government’s Interdepartmental Committee on Drug Addiction (the Brain Committee) published its second report the same year, its recommendations included many of Bewley’s suggestions. As a pioneer in harm reduction, in addition to warning about the risks of sharing equipment, he also distributed 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 involvement with the Royal College of Psychiatrists and serving as Dean, Bewley was elected President from 1984 to 1987. Vanessa Cameron, then Chief Executive of the college, described him as “witty and not dumb”. all pompous… a man full of energy and who was instrumental in bringing drug addiction to the fore within the college”. Strang agrees, “It was good for the reputation of the addiction field that there was someone in that field who held the highest office in psychiatry. And he was an excellent communicator. After his presidency, Bewley remained active in psychiatry, advising various national, governmental and international bodies. Strang describes him as very personable and inspiring to junior staff coming into the field. Nutt adds that Bewley was “a kind and compassionate clinician, caring for drug addicts and alcoholics, 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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