On March 17 2018 Buzzfeed published a story by news reporter Hannah Al-Othman about a woman who in 1972 had undergone narcosis and electroconvulsive therapy (ECT) at St Thomas’ Hospital in London. Eleanor (not her real name) had been 22 when she had the treatment, which had been devised by psychiatrist William Sargant. The same year Eleanor was admitted to ward 5 of the Royal Waterloo Hospital for Women and Children (which was given over to Sargant’s use after the amalgamation of the Royal Waterloo Hospital with St Thomas’ Hospital) Sargant had written an article about his experiments “Modified narcosis, ECT and antidepressant drugs: a review of technique and immediate outcome”. The co-authors were C.J.S. Walter and N. Mitchell-Heggs (one of the few women to be a major name in psychosurgery and ECT) and the article appeared in the British Journal of Psychiatry, published by the Royal College of Psychiatrists.
Sargant and his co-authors described the technique for keeping patients asleep for about twenty hours a day over a period of weeks to months, using a variety of drugs which included chlorpromazine, barbiturates, chloral hydrate, Mandrax, diazapam, etc. The patients were also given ECT two or three times a week, antidepressant drugs, which in those days meant tricyclics and monoamine oxidase inhibitors, and sometimes insulin treatment. What was the rationale for keeping patients asleep during a course of ECT? This was not made entirely clear – there was vague talk about it alleviating anxiety or perhaps increasing the effects of ECT. It was also dangerous – four of the 484 people treated between 1962 and 1968 died because of complications from the treatment. Sargant and co-authors found the results “encouraging” and talked about a future longer-term follow up of patients, which does seem to have materialised. In fact the treatment was quietly abandoned.
When Eleanor was treated in ward 5 in 1972 William Sargant had already retired, and it was his successor, John Pollitt, who was responsible for her treatment. John Pollitt died in 2005, but the Buzzfeed reporter tracked down two junior doctors who had been involved in Eleanor’s treatment. Neither agreed to be interviewed. St Thomas’ Hospital refused to answer questions, the Department of Health said they had no records and the Royal College of Psychiatrists told Buzzfeed: “There are no reports or position statements on this form of treatment, so nothing to suggest that the College supported it or opposed it.” As Eleanor says: “They seem to have forgotten that we’re still alive. They talk about it as if we just dropped dead the next day and there is no one left with this.”
The Royal College of Psychiatrists may not have published a report or position statement on narcosis and ECT, but they did publish at least one article about the treatment in their journal. And they accepted money from William Sargant on his death to inaugurate an annual lecture in his name. “Dr William Sargant was recognised as an outstanding psychiatrist, who made an extremely valuable contribution to psychiatry, and the lecture is funded by his bequest” says the Royal College website.
While I was searching for a position statement on the use of narcosis and ECT I came across one from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) on deep sleep therapy (as narcosis is called in Australia): “The Royal Australian and New Zealand College of Psychiatrists (RANZCP) presents this position statement to avow its strong and continuing opposition to the practice of deep sleep therapy. The RANZCP recognises that psychiatrists have a critical role to play in acknowledging historical harmful practices and committing to learn from them.”
Perhaps the Royal College of Psychiatrists in Britain could consider devoting the annual William Sargant lecture in future to the acknowledgement of historical harmful practices, starting with Sargant’s own practice of narcosis and ECT.