Obituary: Professor Robert Cawley

ROBERT CAWLEY was a man of outstanding gifts, both as a scientist and as a clinician. He was a profound and creative thinker within his chosen discipline of psychiatry who regarded himself as first and foremost a practitioner of the complex art of psychiatric treatment.

An insight into his therapeutic skills is afforded in the autobiographical novels (made into the film An Angel at my Table in 1990) of the writer Janet Frame. He helped her in the struggle back to health after many years of incarceration in mental institutions in New Zealand. She devoted a chapter to him in The Envoy From Mirror City (1985) entitled "Dr Cawley and the Luxury of Time". Cawley in turn learned from his gifted patient. He later wrote:

Janet Frame taught me much about the examination of the mental state; the limitations of psychiatric nosology; the overwhelming importance of the patient's inner world; the evanescent nature of the arbitrary boundaries between knowledge and imagination, and art and science.

Born in Birmingham in 1924, the son of a headmaster, Cawley won a scholarship to Solihull School, where at first he specialised in English literature and modern languages. But a series of catastrophic physical illnesses in adolescence, during which his examinations were taken from hospital beds, set him back three years in his education.

These experiences inspired him to change direction and prepare himself for a medical career. However, at the very last moment he was judged too frail to withstand the rigours of a medical course. Bitterly disappointed, he took a degree in Zoology at Birmingham, proceeding immediately to PhD in Lancelot Hogben's department of medical statistics.

Hogben, the quixotic and brilliant polymath, quickly perceived Cawley's special qualities, pointing him towards a series of tempting posts but ultimately helping him to make a renewed onslaught on the medical school. He worked his way through medical school, aided by part-time research posts in medical statistics and social medicine. Thus he acquired the unusual breadth of outlook which was to inform his subsequent career.

Sir Aubrey Lewis, then Professor of Psychiatry at London University, immediately attempted to lure him into the field of medical statistics at the prestigious Maudsley Hospital and Institute of Psychiatry in London. But still bent on clinical work Cawley chose instead to undertake formal training as a psychiatrist at the hospital. Thereafter he helped to found the department of psychiatry at his Alma Mater in Birmingham, acting as first assistant to Sir William Trethowan.

Some five years later, in 1967, he returned as a consultant to the Bethlem Royal and Maudsley hospitals, providing leadership in the training of the cream of British psychiatrists. In 1975 he was appointed foundation Professor of Psychological Medicine jointly between King's College Hospital, London, and the Institute of Psychiatry, a demanding post as the activities of both institutions developed with lively rivalry between them.

Undaunted by repeated episodes of life-threatening illness, he responded to further pressing calls upon his energy and expertise. He worked for many years in his spare time for the Medical Research Council, becoming chairman of the neurosciences grants committee and ultimately, from 1979 to 1981, chairman of the neurosciences board itself. Among other positions of high responsibility he was consultant adviser to the Department of Health and Social Security from 1984 to 1989.

Extensive work for the Royal College of Psychiatrists included a seven- year spell as Chief Examiner and chairman of the examinations sub-committee, during which he effectively revamped the requirements for the final hurdle of the examinations which launched young psychiatrists upon their careers. He was also civilian consultant to the Royal Air Force. In all of these activities he brought not only his breadth of vision but endless painstaking work, carried out modestly and persistently and mostly behind the scenes.

Perhaps the most notable aspect of these years, however, was his continuing devotion to clinical work. This is what brought him the deepest and most lasting satisfaction. No call upon his assistance was neglected. What gave his practice its definitive stamp was his capacity for empathy, a deep understanding of suffering, and the generosity in his nature which enabled him to give endless time to patients. Somehow he never seemed hurried or flustered. He was particularly sought after by colleagues in times of trouble.

He was a staunch advocate equally of psychotherapy and of drug treatments, and undertook research into both. An early multi-centre trial of drug treatments in depressive illness occupied an immense amount of time, likewise bold attempts at the scientific evaluation of the effectiveness of dynamically oriented psychotherapy. These were ground-breaking investigations, well ahead of their time. Other studies centred on the natural history of neurotic illness and the assessment of the mental after-effects of coronary thrombosis. He wrote important theoretical treatises on the planning of district psychiatric services and on psychiatric education.

While fascinated as a scientist by the accumulating evidence concerning brain functioning in relation to behavioural disorder, he insisted that psychiatry was concerned with a great deal more than science alone. Beyond science, strictly speaking, were fundamental aspects of psychiatric practice - empathy, the assessment of subjective experiences and inner feelings, the appreciation of the uniqueness of the individual and of his or her interactions and alliances with others. Thus he saw the underpinnings of psychiatry as lying with the humanities as well as with science, and urged that philosophy in relation to psychiatry stood to strengthen the conceptual basis of the subject.

The formidable intellect which Bob Cawley brought to bear on such matters was carried lightly and with great joy of spirit. He was witty, entertaining, charming, the best of friends and company. Literature, poetry and music were the stuff of life to him.

After retirement in 1989, he continued with clinical work until a few months before his death. This somewhat astonished his contemporaries who were aware of his perilously fragile health. He was supported by his devoted wife, Ann, as progressive heart troubles overtook him. Indeed his marriage, at the age of 60, brought immense shared happiness and joie de vivre and was undoubtedly the culminating success in his life.

W. A. Lishman

Robert Hugh Cawley, psychiatrist: born Birmingham 16 August 1924; Research Scholar, Birmingham University 1947-49, Research Fellow 1949-54, Halley Stewart Research Fellow 1954-56, Senior Lecturer and First Assistant in Psychiatry 1962-67; House Physician and Surgeon, Queen Elizabeth Hospital, Birmingham 1956-57; Registrar, then Senior Registrar, Bethlem Royal and Maudsley Hospitals 1957-60, Physician 1967-75, Consultant Psychiatrist 1967-89; Clinical Lecturer, Institute of Psychiatry 1960-62; Professor of Psychological Medicine, London University 1975-89 (Emeritus); Consultant Psychiatrist, King's College Hospital 1975-89; married 1985 Ann Doris; died London 21 April 1999.