Lives of the fellows

Edward Henry Hare

b.21 August 1917 d.8 December 1996
MA MB BChir Cantab( 1943) MD(1951) MRCP(1966) FRCPsych(1971) FRCP(1973)

Edward Hare was among the group of remarkable clinicians at the Bethlem Royal and Maudsley Hospital who, though holding no formal academic appointments, fostered research and acted as role models for generations of trainee psychiatrists. In his Times obituary he was described as one of the outstanding scholars of British psychiatry during the second half of the twentieth century.

Edward was a man of modest demeanour and great intelligence. He was deeply thoughtful, somewhat stern, and uncompromising in the demands he made upon himself. Yet to his colleagues and pupils he displayed great charm, kindness and warmth.

He was motivated throughout his career by a deep and searching curiosity, coupled with the scepticism necessary in this difficult branch of medicine. His remarkable powers of observation were applied to many fields in psychiatry, but chiefly and influentially, to social and epidemiological aspects while this was still relatively unfashionable. He worked largely alone, as befitted the busy clinician, and made a long series of important contributions. Some of the most fascinating came from his rigorous delving into the historical literature. His influence is still clearly apparent in newer formulations of the aetiology of schizophrenia.

The son of a Church of England clergyman, Edward was educated at Haileybury College. He went on to win an open scholarship to Gonville and Caius College, Cambridge, where he gained a first class honours degree in biochemistry. Proceeding directly thereafter to read medicine, his clinical training was at University College Hospital (evacuated to Cardiff). There he came under such figures as Sir Thomas Lewis [Munk’s Roll, Vol.IV, p.531], Sir Harold Himsworth [Munk’s Roll Vol.IX, p.238], Lord Max Rosenheim [Munk’s Roll Vol.VI, p.394] and Sir Francis Walshe [Munk’s Roll Vol.VI, p.448] - the last impressing him particularly. On graduating he found himself debarred from military service on account of partial deafness, and soon embarked on a training in psychiatry which had interested him from student days. After junior posts in a succession of mental hospitals he arrived at Barrow Hospital, Bristol, as senior registrar and later senior hospital medical officer. His time at Barrow was remarkably productive, resulting in a MD thesis on the ecology of mental disease, and the two most prestigious awards of the Royal Medico-Psychological Association (now the Royal College of Psychiatrists) - the Gaskell bronze medal for research and the Gaskell gold medal for clinical excellence.

After a period as consultant at Warlingham Park Hospital he was recruited in 1957 to the staff of the Bethlem Royal and Maudsley Hospitals by Sir Aubrey Lewis [Munk’s Roll, Vol.VI, p.284] who had been impressed by his writings. There he remained deeply engaged in clinical work until his retirement in 1982, the main focus of his clinical practice being the major psychoses. His teaching was greatly valued, but his enduring record lies in his published research. He wrote on mental illness and social conditions in Bristol, and with G K Shaw carried out a detailed survey of mental health on a new housing estate in Croydon. The latter resulted in a Maudsley monograph in 1965. And he delved into the early psychiatric literature to clarify the changing content of mental illness over time. An early and fascinating paper traced the history of general paresis, with the conclusion that in all probability the disease had arisen by a new mutation of the syphilitic spirochaete, assuming epidemic proportions in France soon after the Napoleonic wars and spreading thereafter along the trade routes of Europe and to the New World.

In similar fashion he marshalled evidence that there had been a huge increase in mental illness during the nineteenth century, particularly during its second half, and principally due to what we now term schizophrenia. This led to the conclusion that important factors additional to genetic susceptibility must be operative in leading to the disease, and among environmental contenders he favoured infection dating from foetal life. Such matters were well argued in his Maudsley lecture of 1982. This striking conclusion rested in part on a long series of detailed studies into birth rank, parental age, marriage and fertility in psychiatric patients, and most important of all into season of birth of those who developed schizophrenia. Thus he showed decisively that persons born during the late winter and early spring months were more likely to manifest schizophrenia later in life. The powerful tools of epidemiology, when applied with scrupulous care, thus led to a reformulation of causative factors in this mysterious and common condition. More recent contributions to the debate, by way of brain imaging and detailed neuropathology, have derived in large measure from the swing of the pendulum set in motion by careful observations such as these.

Among many other fields which captured Edward Hare’s attention were trials of drugs when these were first introduced to the psychiatric scene, scholarly studies of such matters as Faraday’s loss of memory, and, remarkably, observations concerning the march of the visual spectrum during the course of his own migraine attacks. He used a blank sheet of paper and a ruler to chart the spread of his auras across the visual field, as a measure of the regularity and rate of spread of physiological dysfunction in the cerebral cortex. His searching curiosity and astute observation were again in evidence.

Edward meanwhile handled rather more than his share of administrative work. He wrote successive Triennial statistical reports concerning the throughput and nature of the patients at the Bethlem Royal and Maudsley Hospitals, and served with distinction as chairman of the medical committee and on the board of governors. In 1973 he was elected to the arduous task of editor of the British Journal of Psychiatry. In addition to maintaining the high standards set by his predecessor, Eliot Slater [Munk’s Roll, Vol.VII, p.541], he revitalized the finances of the journal by his industry and perspicacity.

Edward was a man of many hobbies and interests - hill walking, rug-making, embroidery, history, etymology and playing the piano. After retirement he became engrossed in computing as a vehicle for exploring his deep interest in mathematics. Throughout his adult life he kept detailed diaries of the day’s events, including the systematic recording of his dreams from his student days onwards. Perhaps above all his passion was for reading classical literature.

He first married Margaret Myddelton, who had been a fellow medical student at Cambridge. They had a daughter. After his wife’s untimely death he married Marjorie Levay, a fellow psychiatrist, now also deceased. Lasting joy came from his marriage to Fiby Gabbay, an outstanding ward sister at the Maudsley, who shared his life for 26 years and cared for him devotedly during his later incapacity from ischaemic heart disease.

W A Lishman

[Brit.med.J., 1997,314,609; The Independent, 23 Dec 1996; The Times, 10 Jan 1997]

(Volume X, page 193)

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