b.22 October 1923 d.25 November 2010
MB ChB Cape Town(1945) BSc Oxon(1948) MRCP(1948) DPM London(1951) FRCP(1964) FRCPsych(1972)
Bertram Mandelbrote went to England as a South African Rhodes scholar to train as a physician and became one of the pioneers of social and community psychiatry. Mandelbrote grew up in Cape Town, where his father, Harry Joseph Mandelbrote, was professor of constitutional history and law at the university. His mother, Ann née Sachs, was the daughter of a chemist. As a medical student in Cape Town, Mandelbrote excelled academically and played rugby and cricket for his university. These all-round accomplishments led to the award of a Rhodes scholarship to study at Oxford. There he joined Merton College, where his father had studied before him, and carried out one of the first studies of copper metabolism in neurological disease, supervised by Ritchie Russell. From Oxford he moved to Hammersmith Hospital in London, where he trained under (later Sir) John McMichael [Munk’s Roll, Vol.IX, p.341]. He soon obtained the MRCP and seemed ready for a successful career in medicine, but decided instead to become a psychiatrist. Between his posts at Hammersmith and the Maudsley, Mandelbrote worked as a locum consultant at the Western Fever Hospital in London. It was the time of a poliomyelitis epidemic and at one point he was in charge of 30 severely ill patients in ‘iron lungs’.
After basic training at the Maudsley, Mandelbrote obtained the coveted post of senior register to (later Sir) Aubrey Lewis [Munk’s Roll, Vol.VI, p.284]. Soon after, he was awarded a Dominions fellowship to study at McGill University in Montreal. At McGill he carried out research into the psychological aspects of thyroid disease.
When he returned to the Maudsley, he was well prepared for an academic career in psychiatry, but decided instead on a further career change. He moved to Warlingham Park Hospital to work with T P Rees [Munk’s Roll, VolV, p.344], who had developed pioneering methods of rehabilitation for institutionalised psychiatric patients. Rees had opened locked doors, made relations between patients and staff less hierarchical, and involved members of the local community. Mandelbrote was impressed by what he saw and he decided to follow Rees’ example.
Thus at the age of only 32 years, Mandelbrote became the superintendent of two large mental hospitals in Gloucestershire (Horton Road and Coney Hill hospitals), both with an institutional regime. Within a short time, he transformed the organisation of the hospitals and the lives of the patients. He achieved this against initial resistance and despite his young age, through his lifelong qualities of impressive energy, strong leadership, decisiveness, determination, and an ability to delegate and to support his staff.
In 1959, Mandelbrote was offered the post of physician superintendent of Littlemore Hospital in Oxford, where he soon brought about changes similar to those in Gloucestershire. Within the hospital, he organised his own wards on therapeutic community principles, while leaving the other consultants to adopt a more conventional, though still forward looking, approach. Outside the hospital, he developed an innovative system of group homes and sheltered work placements. These were to become widely adopted components of community care, but at the time they were new and controversial.
Despite this intense involvement in clinical practice and administration, Mandelbrote never lost sight of his academic training. He believed passionately in the need to evaluate his work. In Gloucester, he used film to document the changes he brought about and used these films in the many lectures that he was asked to give in Britain and elsewhere. Soon after arriving in Oxford, he obtained funds for an evaluation of his therapeutic community. Later he persuaded Geoffrey Harris, one of the leading figures in the then developing field of neuroendocrinolgy, to join him in a study of the neuroendocrine effects of phenothiazine drugs. He also retained his interest in general medicine. He established a psychiatric clinic in the Radcliffe Infirmary and was an active member of the BMA. In recognition of these enterprises and of his role in teaching students, he was appointed as an honorary clinical lecturer in the medical school and in 1964 he was elected as a fellow of the RCP. When, in 1969, a university department of psychiatry was established, he was one of its strongest supporters and most active collaborators.
Mandelbrote was farsighted. He foresaw the need for specialist services for the elderly and for psychotherapy, and encouraged their development. He obtained charitable funds to establish a residential therapeutic community treatment programme for people with serious problems of drug dependence. Throughout his career he championed an extended role for nurses and occupational therapists, and he was for many years a trustee of the Dorset House School of Occupational Therapy.
In the last years of his professional career, Mandelbrote became increasingly frustrated by restriction of his freedom as a clinician as lay management replaced the role of the physician superintendent. In 1987, he suffered a near fatal car accident and was for many weeks in intensive care. Though he fought his way back to health with characteristic courage, he did not fully recover his former vigour, though he returned to full-time work until he retired in 1988. Thereafter he continued his work with drug dependent people and was pleased when, shortly before his death, the treatment centre that he had founded, the Ley Community, won an award from the Centre for Social Justice.
Mandelbrote was a family man. He preferred to spend time with his wife and sons rather than to travel to meetings overseas. He was closely involved in the life of the local community in Littlemore and was an active member of the Oxford Rotary Club. When Littlemore Hospital was closed and the site was redeveloped, his contributions to the community were marked by the naming of a road as ‘Mandelbrote Drive’. Bertram Mandelbrote was survived by his devoted wife Kathleen Joyce née Howard, to whom he had been married for 61 years, and by his two sons, Giles and Scott.
[The Independent 17 December 2010; The Oxford Times 23 December 2010; Oxford Mail 23 December 2010; The Guardian 23 January 2011]
(Volume XII, page web)
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