QUESTING MIND
Chris Freeman was a leading psychiatrist of his generation in Edinburgh who made a major contribution in Scotland and far beyond in training, pioneering services, teaching and research. His loss will be felt by his former patients, by a generation of young psychiatrists whom he trained and by colleagues who had the pleasure of working with him.
Imbued with natural intelligence, an enquiring mind and an innate tendency to challenge conventional wisdom in psychiatry, Chris would ask “is that really the case, do we know that’s true?” It is no surprise that his first publication in 1978, while still a junior academic, concerned the effectiveness of one of the most controversial treatments in psychiatry, electro-convulsive treatment (ECT). This was a double blind trial of real versus sham ECT – neither patient nor assessors knew whether real or sham ECT had been given. In fact the outcome in the group treated with real ECT was significantly superior to that in the sham ECT group. The ECT trial, successfully completed and published in The Lancet, was a remarkable achievement for a junior researcher.
Christopher Paul Lindsay Freeman was brought up in York. He graduated from Edinburgh University in 1971 and spent his professional career in the city. He began his psychiatric training at the Royal Edinburgh Hospital in 1973.
By 1976 he had obtained the Membership of the Royal College of Psychiatrists and three years later was awarded the prestigious and highly competitive Gaskell Gold Medal of the College. As his career developed, the same college would come to depend heavily on his leadership skills in its responsibilities for training and for setting standards in ethics and the delivery of treatments.
Chris was appointed senior lecturer at Edinburgh University and honorary consultant psychiatrist at the Royal Edinburgh Hospital in 1980. His clinical role was in general psychiatry but he was already developing a special interest in patients with eating disorders. In 1984 he surprised many with a move to a consultant post in psychotherapy. Exploring new territory in psychotherapy he changed the focus of the post from traditional psycho-analytically based psychotherapy to cognitive behavioural psychotherapy. He was able, with colleagues, to develop a training course for doctors, psychologists, nurses and other professionals in cognitive behavioural therapy (CBT). It grew to become the South of Scotland CBT course. The emphasis in therapy was on a positive collaboration with the patient, with the aim of developing the patient’s motivation to change.
Chris Freeman recognised there was a mismatch between treatment need and treatment availability in common psychiatric conditions such as eating disorders, depression and post-traumatic stress disorder. He sought to develop clinical services for these conditions that were accessible, available and practicable but most importantly were soundly evidence-based. He was intensely aware that unproven fads in psychiatric treatment frequently do more harm than good. His research was wide ranging and included controlled trials of different treatment approaches in bulimia nervosa, the value of brief psychotherapy and, with Dr Allan Scott, an important study of treatment outcomes of depression and personality disorder in Edinburgh primary care settings.
He also recognised that if new services were to be effective, patients needed to be involved in their development. In 1987 he founded the Cullen Centre, an outpatient and day patient facility for patients with eating disorders (named after the distinguished 18th Century Scottish physician, William Cullen). The Cullen Centre pioneered the development of an intensive home treatment team approach for anorexia nervosa, thus avoiding hospital admission whenever possible.
The Centre is also a training facility that has trained most, if not all, consultant psychiatrists in Scotland who specialise in treating patients with eating disorders. Chris championed the need to improve NHS services for these patients and his efforts resulted in the establishment of the Regional Eating Disorders Unit at St John’s Hospital, Livingston, in 2012.
In 1997, and in response to the increasing number of patients with symptoms of post-traumatic stress referred to the psychotherapy service, Chris, with psychologist Dr Claire Fyvie, established the Rivers Centre. This city-centre based resource treats combat victims and rescue service personnel in addition to victims of everyday civilian trauma. He chaired the UK Trauma Group, a managed clinical network of all the trauma services in the UK, both in the independent sector and in the NHS. Not surprisingly, Chris’s expert knowledge of post-traumatic stress disorder led to his being heavily in demand by lawyers and official bodies to examine and give expert opinion in a wide range of medicolegal cases. Chris contributed greatly to the work of the Royal College of Psychiatrists, most recently as Clinical Lead for Quality Improvement, a role he relinquished only as his illness took its toll. He undertook many important roles in the College including chairing its Ethics Committee, its ECT Accreditation Service and establishing the Scottish ECT accreditation network. He thus made an enormous contribution to the improvement of ECT services nationwide.
Chrishadmorethan150publications to his name, half of which were in peer-reviewed research journals. He served as an external examiner to Aberdeen and Newcastle Universities and the Royal College of Psychiatrists. He was the holder of an honorary professorship at Queen Margaret University, Edinburgh and an honorary Fellowship of the Royal College of Physicians of Edinburgh.
With his distinguished achievements Chris might have had every reason to be self-important. He was the reverse. Approachable, empathic, modest and kind, it is not surprising that trainees flocked to learn from him and that colleagues sought his advice on countless occasions.
Rarely idle when away from work, Chris displayed the same boundless enthusiasm in pursuing his hobbies. A lover of gadgets, he was always an early adopter of new technology, often arriving at the golf course with the latest equipment, hoping that it would improve his game.
Chris was a devoted father and grandfather. He died in the care of his family at home in Pencaitland from advanced cancer of the prostate. He leaves two sons, Paul and Robin, from his first marriage, and his wife, Dr Katherine Cheshire. DEREK CHISWICK, TOM BROWN, JAMES HENDRY The Scotsman welcomes obituaries and appreciations from contributors as well as suggestions of possible obituary subjects. Please contact: Gazette Editor n The Scotsman, Level 7, Orchard Brae House, 30 Queensferry Road, Edinburgh EH4 2HS; n gazette@scotsman.com
Imbued with a talent to challenge conventional wisdom in psychiatry, Chris would ask, “is that really the case, do we know that’s true?”