Thomas Bewley
Influential psychiatrist who brought a new rigour to British drugs policy from the 1960s onwards
DR THOMAS BEWLEY, the psychiatrist, who has died just short of his 96th birthday, was a key force in shaping British drug policy in the second half of the 20th century and served as President of the Royal College of Psychiatrists from 1984 to 1987.
From a prominent Irish Quaker family, Bewley began practising in London at the dawn of the 1960s, when heroin and cocaine addiction affected only a few hundred.
Since the 1920s, the so-called “British System” had applied – more a light-touch regime than a system, based on the recommendations of a committee chaired by Sir Humphry Rolleston, the King’s physician. The 1926 Rolleston report had concluded – in contrast to the penal view then favoured by the Home Office – that addiction was a disorder requiring medical treatment, and not just a moral failing. GPS were allowed to prescribe heroin to an addicted patient, so long as they judged that maintenance on a steady dose was the only way the patient could “lead a useful and fairly normal life”.
In an interview with the journal Addiction Bewley explained with dry humour how he settled on this new field of medicine:
“Tooting Bec was the most central mental hospital which accepted patients from anywhere in London. I used to admit alcoholics of no fixed abode and we had an alcoholism programme. One of my registrars described it as patients coming in for their 1,000 gallon check-up…
“A small number of heroin addicts were also admitted as no one else wanted to have much to do with them at that time. When I first wrote to The Lancet I think I had seen about 20. I don’t think anyone else in the country had seen more than two then. This was how I became an ‘expert’.”
A few private practitioners were willing to treat addicts; some were mavericks, the most flamboyant of them being Lady Frankau, who was said to write prescriptions in the back of her Bentley when needed. In his memoirs, the jazz trumpeter Chet Baker gives a flavour of her consultations: “I went to 32 Wimpole Street… She didn’t ask me for much information about myself… She simply asked for my name, my address, and how much cocaine or heroin I wanted per day.”
Bewley believed that patients with such problems deserved treatment, but he wanted to regularise medical practice. He also believed that, even though nearly all heroin came from doctors and the illicit market had yet to develop, a potential epidemic of drug dependency was brewing – transmitted, he argued, through social contact.
He recorded his clinical findings in a series of influential letters and papers in journals; these, combined with his recommendations to the Brain Committee’s second inquiry in 1964, became the planks of the new policy – bringing in specialist units, a system of notification (to give an idea of numbers), controls on prescribing (further tightened by the 1971 Misuse of Drugs Act), and an advisory committee.
By dispensing sterile syringes he also introduced a novel concept, now universally accepted in medicine, of “harm reduction”.
The next inquiry to be guided by Bewley’s contributions was Baroness
Wootton’s, into cannabis. The 1969 Wootton report concluded that “cannabis [was] less dangerous than the opiates, amphetamines and barbiturates, and also less dangerous than alcohol”; the penalties were therefore grossly disproportionate.
Bewley’s academic work was grounded in day-to-day contact with patients. He believed in taking a detailed history (“let the patient talk, even blether on”) and cleared two hours in the diary for each first appointment.
This was followed by stabilisation, initially with heroin (he soon abandoned prescribing cocaine). He later switched to the long-acting opioid methadone, having seen it being used successfully in America by Vincent Dole. On a steady dose, the patient could function normally, freed from a life dominated by drug-seeking, chaos and crime.
Getting someone off drugs was not an end in itself, however, since as Bewley observed, “it’s easy to stop drugs, but doesn’t achieve anything.” More important was “to help people to make a go of their lives despite their illness”.
In 2006 Bewley told the Psychiatric Bulletin: “I had a simple belief, that much of what one does is care rather than cure. If someone gets better it’s a bonus and you don’t see them again. If they never get better, you will have a responsibility for the rest of your life. I never minded that, because that is what medicine is about... The biggest difficulty is that society does not wish to accept that these problems are long-term, damaging, relapsing, chronic disorders.”
Thomas Henry Bewley was born in Dublin on July 8 1926 into a colourful family. His Quaker great-grandfather Henry made a fortune creating products with the treederived plastic substance gutta-percha, and joined the Exclusive Brethren.
Henry’s son, Thomas’s grandfather (also Henry), was one of the leading physicians in Dublin. Another branch of the family set up
Bewley’s cafés, well-known to Dubliners. Thomas’s father Geoffrey was a physician, while his mother, Victoria (née Wilson), qualified as a doctor but never practised. Geoffrey’s three brothers included Charles, an eccentric bachelor who was born a Quaker but converted to Catholicism – and when dispatched as a diplomat to Berlin also got converted to Nazism and ended the war in an Allied prisoner-of-war camp.
Young Thomas was educated at Arnold House, North Wales, inspiration for Evelyn Waugh’s Llanabba Castle in his novel Decline and Fall. After a term at Rugby he returned to Ireland, to St Columba’s College, then to the School of Medicine at Trinity College, Dublin, from 1944-50.
Psychiatry appealed to Bewley, and there was some family tradition, since his father and grandfather had both been involved with a Quaker “Retreat” at Bloomfield.
He met his future wife Beulah Knox in his father’s outpatient clinic; he was a great supporter of her, and her career as a distinguished epidemiologist took off after their children were all at school.
He encountered his first alcoholic patients as senior house officer at St Patrick’s Hospital, Dublin, 1950-51, and followed Beulah to England, working at various London hospitals before taking up a post as a registrar at the Maudsley.
A year (1957-58) was spent in Cincinnati, where his studies of alcoholism in different ethnic groups were successfully submitted for an MD thesis. In 1961 he became consultant at Tooting Bec, an asylum housing about 2,000 patients, mainly with “senile dementia”. He acquired some spare beds for younger patients with alcohol problems, detoxified them and nudged them towards Alcoholics Anonymous.
Alongside those with drink problems he admitted some drug-dependent patients, stumbling on a rich new seam for research: “I knew little, but everyone else knew less. Although I wasn’t thinking like this, it turned out to do my career a power of good.”
In the 1970s he became visiting consultant psychiatrist at Wandsworth Prison, and consultant and lecturer at St George’s and St Thomas’ hospitals, where he set up drug dependence units.
Psychiatric politics also absorbed his energies and in 1971 he helped to set up the Royal College of Psychiatrists (of which he wrote a history in 2008). He was elected dean and then president.
Appointed honorary CBE in 1988, he was a founding member of the Medical Council on Alcoholism, and of the Institute for the Study of Drug Dependence (later called Drugscope); and an adviser to the Department of Health and the WHO.
Invariably in a polka-dot bow-tie, Bewley was a likeable man, a self-described “Irish atheist Quaker”, with less of a tendency to rigidity than some of his colleagues.
He married, in 1955, Beulah Knox (DBE, 2000); when she developed dementia he moved with her into a home to look after her. She died in 2018. They had five children, one of whom, Sarah, had Down’s syndrome and died in 2003. He is survived by his other children, Susan, Louisa, Emma and Henry.
Dr Thomas Bewley, born July 8 1926, died June 26 2022