Earlier this year I wrote about a court case in Australia in which two doctors who used deep sleep treatment (DST) and electroconvulsive therapy (ECT) at Chelmsford private hospital in Sydney were suing the author and publishers (Steve Cannane and Harper Collins) of a book which included a chapter about the Chelmsford scandal.
Last month (November 2020) Justice Jayne Jagot delivered a verdict in favour of the defendants, Steve Cannane and Harper Collins. You can read one of the many newspaper articles about it here, while journalist Esther Rockett has blogged about it here. The full judgement can be read here.
Whilst I couldn’t argue with Justice Jagot’s words that doctors who used DST at Chelmsford in the 1960s and 1970s were “negligent, unethical and engaged in medical malpractice”, I would take issue with some of the expert evidence for the defence, which conveyed the impression that, unlike the Chelmsford doctors, most psychiatrists in that era were ever mindful of the Hippocratic oath (“first do no harm”) and scrupulously made sure that patients gave informed consent to treatment. Certainly they weren’t in England, and I expect things were much the same in Australia. In spite of the introduction in the 1960s of “modern pharmacotherapy”, as it was called by one witness, ECT was still be used extensively, leucotomy was still used on hundreds of people a year, and informed consent wasn’t a legal requirement.
The applicants, GP Dr John Gill and former psychiatrist Mr John Herron (Mr rather than Dr because he was struck off the medical register for reasons unrelated to Chelmsford in 1997) made much of the fact that they were not the only doctors still using DST in the 1960s and 1970s. In England, William Sargant was using continuous narcosis on patients at St Thomas’ Hospital in London. Justice Jagot dismissed any comparsion between DST at Chelmsford and Sargant’s continuous narcosis: “the evidence is overwhelmingly to the effect that the therapy was different”. It was different in degree. In particular Sargant’s patients were roused at intervals to eat and go to the toilet, while Chelmsford patients were kept continuously sedated, tube fed and allowed to wet the bed. But Sargant’s treatment was still dangerous and people died, although not in such high numbers as at Chelmsford.
One expert witness, Professor Gordon Parker, who testified that “the way in which DST was implemented at Chelmsford doesn’t correspond strongly at all with Sargant”, admitted that some of his information about Sargant’s methods came from a Wikipedia article. Although not mentioned in the judgement, Professor Parker had even misquoted the Wikipedia article, saying that Sargant’s patients were “woken for at least six hours each day” (which would hardly constitute continous narcosis) whereas the article says they were woken “every six hours to feed and wash them and take them to the toilet”.
Both Sargant and the doctors at Chelmsford gave ECT to their sedated patients. Justice Jagot is critical of the fact that at Chelmsford it was sometimes used on a daily basis, was given without muscle paralysing drugs or oxygen and sometimes given without anaesthetic. This may not have been standard practice by the 1970s, but it was not unheard of elsewhere. A survey of ECT use in Great Britain in 1980 found some hospitals occasionally using ECT without anaesthesia or muscle paralysing drugs, and a few hospitals did not routinely use oxygen.
If the practices of the Chelmsford doctors were so far outside the bounds of the psychiatric standards of the day, how is it that they were allowed to continue for so long and how is it that it eventually took the Scientologists – rather than any more respectable organisation – to stop them? Justice Jagot touches on this briefly near the end of her judgement, attributing “gross negligence” to the various authorities that licensed and inspected the hospital. I suspect though that the answer is not in fact so simple. Sometimes, and this is as true today as it was in the 1970s, it may be difficult to distinguish between acceptable and unacceptable practice in psychiatry.
ECT statistics 