At the beginning of the 1960s, the Irish psychiatrist Thomas Bewley, who has died aged 95, did not agree with the prevailing view that addiction was purely a moral issue, arising from a dissolute lifestyle, or that it was outside medicine’s remit. His research brought lasting change, creating an enlightened, more humane view of drug dependency.
In 1960, Bewley was working at Tooting Bec hospital, a vast mental asylum in south London. When his colleague Griff Edwards said he knew of people living rough who would like treatment for their alcohol addiction, Bewley stepped forward to take care of them.
He rapidly became interested in other types of addiction, treating 20 heroin-addicted patients at Tooting Bec, at a time when most psychiatrists in Britain had only come across one or two. He became a national authority on opiate dependence, publishing his findings in a series of groundbreaking papers in the Lancet and the British Medical Journal from 1964 to 1967. The government-appointed Brain committee (named after its chair, Sir Russell Brain) used his evidence as the basis of its 1964 report on drug addiction.
Bewley described addiction as “a chronic relapsing disorder” and stressed that doctors had a fundamental duty to treat those who relapsed so that they could cope more successfully. He also introduced the concept of “harm reduction”, which today is a pivotal principle in treatment. It involved admitting patients for short periods to stabilise them, addressing their physical needs, which might include treating abscesses and sepsis, and sometimes prescribing methadone to take orally, to avoid the highs and lows they experienced when injecting drugs.
He also believed it was important to understand patients’ hopes and fears and to take all their needs into account: some may benefit from literacy classes, for example, to equip them to get a job, or bereavement counselling if they had a traumatising grief from which their addiction stemmed.
In an early survey, Bewley asked 50 patients how they injected and was horrified at the insanitary methods used. He started by cleaning their syringes with bleach and then got the outpatients department at Tooting to dispense sterile syringes.
But it was also vital to address the number of drug addicts, which at the beginning of the 60s was rising fast. While there had always been long-term patients who became addicted to pain medication, and healthcare professionals who had become addicted because their jobs brought them into contact with drugs, now there was a new type of user. Young people were seeking out private doctors in London who would prescribe huge daily doses of heroin and cocaine with few questions asked. Bewley found one young man being prescribed 1,000mg of pure heroin a day. Some were selling their excess on to others.
As part of his advice to the Brain committee, Bewley said there should be controls on prescribing and compulsory notification of drug addiction, as otherwise it was impossible to get accurate numbers of opiate addicts. He also said there should be specialised treatment centres, not least because withdrawal from drugs such as cocaine could induce huge mood swings and agitation, making it impossible to care for a patient on an ordinary hospital ward.
In 1971 the Misuse of Drugs Act was passed and doctors needed a licence to prescribe controlled drugs. Dependence units began to be set up across the country. As well as being in charge of the inpatient unit at Tooting Bec, which was the largest in the UK, Bewley set up drug dependence units at St George’s hospital in Tooting and at St Thomas’ hospital in central London.
Bewley was born in Dublin, the elder of two children. It was a distinguished Quaker family: one branch ran the Dublin-based Bewley’s cafe and beverages company, while the other side were doctors. His father, Geoffrey, and grandfather, Henry, were leading Dublin physicians, both working at Bloomfield, a small Quaker mental hospital. His mother, Victoria (nee Wilson) trained in medicine and his sister Mary became a psychiatrist.
As a small child, he and Mary were taken by their grandfather to Quaker meetings in Dublin, and he would later describe himself as a “Quaker atheist”: though he didn’t believe in God, his approach to psychiatry and life in general were rooted in Quaker values such as tolerance, pacifism and caring for the most needy.
Aged eight, he was sent to Arnold House, a boys’ prep school in Wales, where he developed a love of chess. A term at Rugby school in England followed, but the second world war broke out and he returned to Dublin to finish his schooling at St Columba’s college. From 1944 to 1950 he studied medicine at Trinity College Dublin, before working at the Adelaide hospital in the city and training in psychiatry at St Patrick’s hospital.
In 1951 Bewley met the medical student Beulah Knox, whom he married in 1955. Her career took her to England, and Bewley followed. He took up a position in 1956 at the Maudsley hospital in London, a prestigious institution in psychiatry but one that left him underwhelmed, as he believed it failed to provide the kind of wraparound care that patients needed. In 1957 he left, moving to Cincinnati in the US for a year, where he was able to study alcoholism in different ethnic groups.
On his return to the UK, Bewley got a job at Tooting Bec hospital. He and Beulah lived in the grounds of the hospital for the next eight years, before moving to their own house in nearby Streatham. They had five children, one of whom, Sarah, had Down’s syndrome and a heart condition. It was not possible for her to live with them, which was a great sadness, but the family used to visit her every week.
Bewley became greatly involved with the Royal College of Psychiatrists, becoming its dean and, from 1984 to 1987, its president. He used the platform of his presidency to promote evidence-based medicine, setting up a research unit at the college as well as a faculty for substance misuse. He also became an adviser to the World Health Organization on drug dependence. When he retired, he wrote a history of the college called Madness to Mental Illness (2008).
A cerebral man who always wore a polka dot bow tie, Bewley read voraciously and his living room was furnished with several thousand books. He had a dry wit and obtained great satisfaction from writing a satirical column, Ezra the Scribe, in the Royal College of Psychiatrists’ Bulletin.
Latterly he and Beulah lived in Victoria, in central London. He was prouder of her achievements than of his own, and when she developed dementia they both moved into a home in Wimbledon, where he could look after her until she died in 2018.
Sarah died aged 44 in 2003. He is survived by his other four children, Susan, Louisa, Henry and Emma, and his granddaughter, Hannah.
• Thomas Henry Bewley, psychiatrist, born 8 July 1926; died 26 June 2022
