b.21 Sept 1926 d.1 Apr 1992
MB ChB Manch(1948) MRCP(1951)DPM(1954)FRCP(1967) FRCPsych(1971)
Kenneth Rawnsley was born in Halifax, Yorkshire, but brought up in Burnley and educated at Burnley Grammar School. Traces of his northern origins were sometimes manifest in a certain blunt directness of speech that brought acrimonious and fruitless debates to an abrupt end. A state scholarship took him to Manchester University and after graduation he made a propitious start in his medical training when he was appointed house physician in 1949 to Robert Platt, later Lord Platt [Munk s Roll, Vol.VII, p.470], at the Manchester Royal Infirmary. At this time the department contained a galaxy of gifted young men who were later to play roles of high distinction in British medicine: Douglas Black, later Sir Douglas and president of the Royal College of Physicians 1977-83, Malcolm Milne (q.v.) and Bill Stanbury, who were later to head respectively the departments of medicine at Westminster Hospital and Manchester University.
Experience in a laboratory of clinical pathology served rapidly to eradicate Rawnsley’s earlier ambition to become a bacteriologist. He embarked on training as a psychiatrist in Manchester, under the direction of E W Anderson [Munk’s Roll, Vol.VII, p.14], having previously obtained his membership of the College. This provided him with a broad base. He acquired the discipline of European psychiatric phenomenology, of which Anderson was a learned though perhaps rigid exponent, and also the pyschobiology of Adolf Meyer. To this and the training he received at the Maudsley, Ken brought his own personal synthesis and a deep rooted humanity and compassion in clinical practice, together with his field work in epidemiology. These were also prominent ingredients in the rich and distinctive character of his teaching.
After working for a few months as a field investigator on the Stirling County Epidemiological Project in Canada he returned to the Institute of Psychiatry as a member of Aubrey Lewis’s - later Sir Aubrey [Munk’s Roll, Vol.VI, p.284] - MRC social psychiatry unit first in London and then from 1957 in Cardiff.
In Wales his northern upbringing provided him with ready access to the traditions and mores of miners in the Welsh valleys of the Rhondda and the Vale of Glamorgan. In collaboration with Joe Loudon and Jack Ingham, he compared and contrasted psychiatric morbidity in these two settings, employing novel techniques. In Cardiff he enjoyed the friendship, support and guidance of Archie Cochrane [Munk's Roll, Vol.VIII, p.95], a redoubtable creative sceptic and iconoclast. It was Archie who had first provided Ken Rawnsley and his colleagues with opportunities to conduct their epidemiological studies in Wales. He was to exert a profound influence on Ken’s scientific outlook and general philosophy.
Rawnsley and his colleagues found that whatever measures of psychiatric morbidity they employed - hospital admissions, recognition by GPs or random sample surveys of the population - the prevalence of psychiatric disorders was significantly higher in the mining valleys than m the rural areas of the Vale of Glamorgan. They concluded that the differences largely stemmed from social attitudes towards psychiatric symptoms and illness in the two regions studied. The papers which embodied these findings made significant contributions to psychiatric epidemiology through the stringency of the methods employed in the surveys and the critical and disciplined manner in which analysis of results was undertaken and inferences drawn.
Another fascinating investigation was the study of psychiatric morbidity among the people of Tristan da Cunha who had been evacuated to Calshot, near Southampton, following a volcanic eruption on the island. The closed nature of this community - no one had either left or joined it for 50 years - endowed the epidemiology of neurotic disorders with a special interest. The prevalent rates and character of the symptomology proved to be bound up with the social structure and leadership patterns within this isolated community.
In 1964, while continuing as head of the MRC social psychiatry research unit, Rawnsley was appointed to the first chair of psychiatry in the Welsh National School of Medicine. He established a vigorous and widely based academic department closely integrated with the psychiatric services of South Glamorgan, with a special teaching and research unit at Whitchurch Mental Hospital. This last link enabled him to inject new strength into the scientific investigation which had flourished there since the early years of its history as an asylum. Rawnsley showed imaginative foresight in the integration of clinical practice, teaching and research, in the main University Hospital and local mental hospital.
In 1972 he was elected the first dean of the newly formed Royal College of Psychiatrists and he made a powerful contribution to its development in the early formative years. He played a major role in creating the system for inspection and approval of the quality of clinical and educational facilities in psychiatric hospitals, not only for those preparing for the membership examination but for all trainees in psychiatry. It was no easy task: many regional health authorities felt secure in their complacent assumption that the facilities provided were all that could be reasonably expected of them It took time for them to realize that unless standards were raised many hospitals would fail to secure recognition as training institutions and that applications for junior posts, indispensable for maintaining clinical services, would then decline and vanish. There were appeals, objections and protests. Rawnsley, with the full support of the College committees behind him, responded with sensibility and understanding. On subsequent visits, the great majority of the hospitals were approved and in the process of change not only training but the standard and quality of patient care were transformed throughout the land. The generosity with which he gave his time to trainees and the humane and practical concern with which he approached their problems became widely known. Ken’s outstanding example created a pattern of life and work in the deanship which was not easy to follow.
There was greater turbulance and conflict during his first years with the new Royal College than might have appeared on the surface. There were harsh criticisms in council of the approval exercise. Some members from peripheral hospitals feared a Gadarene rush to the academic centres, leaving them bereft of staff. A few officers agonized about the burden the College would take on in trying to acquire premises from which to conduct its work. The treasurer feared the College would be rendered bankrupt. There were disputes about the membership examination. One of the senior officers, with a record of many years of valuable work for the Royal Medico-Psychological Association, resigned. The president had to go it alone and seek endorsement later in respect of urgent decisions that brooked no delay. They included the bid for 17 Belgrave Square, London, and floating the loan to acquire it; also the initiation of the long drawn out dialogues the College was to develop with the Department of Health. Rawnsley’s adamantine integrity and loyalty contributed substantially to the emergence of a unified, determined and enthusiastic leadership that succeeded in laying down solid foundations in the formative years. Ken’s talents as an administrator and chairman of committees, and his quiet strength, had made a deep impression. He was clearly of presidential stature and in 1981 he was elected in succession to Desmond Pond, later Sir Desmond [Munk's Roll, Vol.VIII, p.385]. He assumed the presidential role with modesty but with a natural authority. Being devoid of arrogance, he had no need of assertion or confrontation. The council of the College is vociferously eloquent, active, argumentative and dedicated but at times an obstinate and difficult body. Rawnsley’s unfailing respect for individuals, his clarity of mind and his gentleness, brought order and cohesion.
It was during his term of office that the Mental Health Act was put forward, first in the House of Lords and later in the Commons where the government had set up a special committee to evaluate and modify the Bill where required. Ken and the senior officers of the College devoted much time and energy in briefing and advising Peers, and giving both written and oral evidence before the House of Commons committee. They succeeded in securing the elimination of the more extreme constraints on clinical freedom. But they were struggling against a powerful anti-medical, anti-scientific prejudice in society and much loud and thoughtless clamour from civil liberties lobbies.
Wide recognition of Rawnsley’s many achievements is reflected in the units named after him in Wales and also in Manchester. The Welsh National School of Medicine honoured him by electing him vice-provost and awarding him an honorary doctorate, and the Royal College of Psychiatrists awarded him an honorary fellowship. He was a member of the Merrison committee of enquiry into the regulation of the medical profession, 1972-75, and the Warnock enquiry into human fertilization, 1982-84. He was awarded the CBE in 1984.
He took a leading part in the campaign to stop the abuse of psychiatry in the Soviet Union and proposed the motion for expulsion of the USSR from the World Psychiatric Association at the World Congress in 1984. He ensured that their return would be conditional upon evidence that wide ranging reforms had been introduced. His contributions appeared to flow from him without struggle or effort; such impressions were misleading.
During the retirement enforced on him by cancer, he gave unsparingly of his energy and used his tact, sensitivity and humane concern, to create and manage the National Counselling Service for Sick Doctors. This provided help of inestimable value, on a confidential basis, to support, restore and rehabilitate doctors incapacitated by illness.
Shortly before his retirement in 1985, Ken and I met by chance in a London club. What began as a chat developed into a three-hour talk, in which Ken unburdened his inner feelings and spoke about his plans for what - as he squarely faced it - might be a future of no more than a few years. The pain and discomfort had not proved much of a problem. He was concerned to make the right decisions about the way he was to live during the time that remained. His surgeons remained hopeful but he had noted their reservations. He had already decided to retire. He was engaged in a search for any meaningful links there might be between his own life and the general order of things. He was embarking on a long and arduous journey that was not to reach its destination until he was on his death bed.
In Kenneth Rawnsley’s premature death the discipline of psychiatry lost a man graced by distinction of mind and presence, with rare qualities of leadership. The seminal contributions he made to psychiatry and medicine will continue to exert their influence for many years to come. His talents advanced psychiatry on several fronts.
He inspired love and respect in all those who worked with him in his professional life, as well as in those with whom his deepest bonds had been forged. He had three children by his first marriage in 1950 to Margery Whittaker, and two by his second wife Elinor Kapp, herself a consultant psychiatrist. Sir Martin Roth
[Brit.med.J., 1992,305,111; Times, 13 Apr 1992;The Independent, 14 Apr 1992,19 May 1992;The Daily Telegraph, 12 May 1992;Photo]
(Volume IX, page 435)
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