News came a few months ago that a woman in Canada had received compensation from the Canadian government for the damaging treatment her mother had been given by psychiatrist Ewen Cameron at the Allan Memorial Institute at McGill University in Montreal, Quebec, in 1957. It is now more than 50 years since the Cameron retired and thirty years since the first compensation payments to his patients were paid out but the story rumbles on. How is it that someone who was given an award for his “outstanding contribution to the mental health of the Canadian people” could leave such a legacy of suffering and legal wrangling behind him?
Donald Ewen Cameron, always known as Ewen, was a Scottish-American psychiatrist who had a glittering career. Having qualified in Scotland, he spent some time in Switzerland and Canada before moving to the United States and working at Worcester State Hospital and then becoming a professor at Albany Medical School. In 1943 he was invited to become the founding director of the Allan Memorial Institute and chairman of the department of psychiatry at McGill University in Montreal, Quebec, Canada. It was here, that over the next 21 years until his retirement in 1964, his career was to flourish. There were books and articles, and he was successively elected president of the American Psychiatric Association (1952-53), Canadian Psychiatric Association (1958-9) and World Psychiatric Association (1961).
Cameron developed techniques which he called “depatterning” and “psychic driving”. The idea was to wipe a patient’s mind clean by using drug-induced prolonged narcosis and intensive electroconvulsive therapy (ECT), and then refill the mind with healthier thoughts by playing taped messages, the tape recorder being at the time cutting-edge technology. He described the technique of depatterning at the annual Maudsley Lecture in London in February 1962 (later written up with J.G. Lohrenz and K.A. Handcock for the April 1962 issue of Comprehensive Psychiatry). Firstly he gave credit to doctors in Britain and the United States who had pioneered the use of intensive ECT (multiple treatments a day instead of the usual three times a week) as a way to deliberately produce an organic brain syndrome in patients “with acute confusion, disorientation and interference with learned habits of eating and bladder and bowel control”; then he explained how seven years previously they had “decided to explore the potentialities of this procedure”. They had, he said, already had extensive experience with deep sleep treatment (where people are kept continuously – or nearly continuously – asleep with drugs for prolonged periods) and maintenance ECT (where patients were given monthly ECTs after their initial treatment). So the three techniques were combined in order to produce a person who had lost all feeling and was often unable to walk, feed themselves or go to the toilet, or remember things, but would also be free from “all emotional disturbance save for a customary mild euphoria”. The idea was that they would recover from the organic brain syndrome and the psychiatric symptoms would not return. Cameron and colleagues claimed good results with most of their patients “improved” and the permanent amnesia caused by the treatment was not seen as a serious drawback, merely as a “source of trouble or annoyance” for patients for six months or so, after which they could get by with what they had “been told of events which happened during the amnestic period”.
I have written in a previous post about how the technique of intensive ECT was developed by British psychiatrists Drs Russell and Page from the Three Counties Asylum at Arlesey, Bedfordshire. It was given to thousands of patients there (and at other hospitals). Robert Russell set up his own company making ECT machines, Ectron Ltd, which still exists but I think has passed out of ownership of the Russell family.
Two years after delivering the Maudsley lecture, Cameron retired from the Allan Memorial Institute and returned to a professorship at Albany, where he was still in place when he died in 1967. Obituaries in the medical press paid tribute to him. In one journal it said:
“As a diligent seeker after new knowledge, a gifted author, a renowned administrator and inspiring teacher he brought, not only to his professional colleagues but also to the community at large, a wider and deeper understanding of the importance and significance of the emotional life of man.”
And “W.S.” (probably William Sargant), writing in the British Medical Journal said:
“Ewen Cameron, by his work and example, helped not only many psychiatrists to become much better doctors but directly and indirectly helped hundreds and hundreds of patients…”
Obituaries of course have a tendency to glow, but even the FBI (Federal Bureau of Investigation) file that was opened on Cameron in 1948 when he was being considered for “employment in Canada on duties which will require access to secret data” contains similar sentiments. One former colleague considered Cameron “a man of excellent character and morals” and another “recognized him as one of the top psychiatrists in this country and stated that he unquestionably was regarded as the best man in his field in Canada.” Someone who had lived next door to the Cameron’s for a couple of years said that “she and her husband regarded them as about the finest individuals they had ever met.”
So how did it all go wrong for Cameron’s posthumous reputation? Three letters: C I A.
In the post World War II years the Central Intelligence Agency (CIA) was interested in psychological research that might be of of relevance to mind control. Through a front agency, they channelled funds to academic institutions and researchers whose research sounded promising to them. Although the CIA destroyed most of the records of the programme, known as MK-ULTRA, a few financial records survived and it is known thatthere were 80 institutions involved and over 185 researchers, some aware of where their funding was coming from, some not. A legal attempt to have the names of institutions and researchers made public was unsuccessful. Cameron’s work at the Allan Memorial Institute received about $60,000 funding between 1957 and 1960. There has always been debate about whether Cameron knew where the money came from. Whatever the truth of the matter, his FBI records show that he applied for security clearance from the Canadian Defence Research Board.
In 1980, after details of the CIA funding of Ewen Cameron had emerged, nine of his former patients sued the CIA. The case was settled in 1988 for a total of $750,000. That was just the beginning. If those people who had been left damaged by depatterning funded by the CIA deserved compensation, what about those whose treatment had been funded by the Canadian government? In 1992 the Canadian government decided, after an initial refusal, to compensate a further 77 former patients, who received $80,000 dollars each. But many more were turned down, because they didn’t meet the government’s arbitrary definition of sufficiently damaged. There were appeals: one woman, for example, who was treated for depression aged 19 in 1953 finally obtained compensation in 2004. And in October last year, CBC announced that Alison Steel had been awarded compensation for the treatment her mother underwent at the Allan Memorial Institute some sixty years earlier:
CBC News has learned that the federal government quietly reached an out-of-court settlement with Steel earlier this year, paying her $100,000 in exchange for dropping the legal action she launched in September 2015.
While a non-disclosure agreement prohibits Steel from talking about the settlement itself, the existence of the settlement and the amount was included in the most recent public accounts tabled by the government earlier this month.
Montreal lawyer Alan Stein, who negotiated the deal, said the government’s decision to compensate Steel could provide hope for the families of other patients who were subjects of Cameron’s “de-patterning” experiments but were initially denied compensation.
“They still have a possibility if their medical reports clearly establishes that they were substantially de-patterned.”
Although the official compensation program closed more than 20 years ago, Stein said the federal government has quietly settled claims from a handful of patients in recent years. He said Steel’s settlement is the second case of the government compensating the estate of a former patient.
What emerges from this saga is that it is not about the victims of a secret CIA experiment but about the victims of state-of-the-art psychiatry. Their stories of damaged lives are now told in the media while once, as “clinical material”, they featured in a Maudsley lecture, and there they would have remained if it wasn’t for a quirk of funding. (After all, the thousands of people who underwent intensive ECT in Britain never received compensation nor escaped from the pages of psychiatric journals.) Cameron’s patients are no longer “schizophrenics” whose treatment left them “improved” with just a little, manageable, memory loss. A media story on Alison Steel’s legal victory says:
“Alison couldn’t ask her mother for advice; she had nothing to give. She was present — she would make grilled cheese sandwiches for her daughter and her friends — but never fully there.”
It is easy to see how Jean Steel’s ability to make grilled cheese sandwiches might have put her into the “social recovery” category in Cameron’s assessment.
And an article in the Washington Post in 1985 about the first claimants quoted a member of parliament talking about his wife who had been treated by Cameron:
“I’d say Velma operates at about 20 percent of capacity,” David Orlikow says. “It’s horrific.”
As the “clinical material” of Cameron’s lecture becomes human, the glittering career and honours and tributes start to tarnish.
Deep sleep treatment and intensive ECT was ended at the Allan Memorial Institute in 1965, a year of so after Cameron’s departure. But there are aspects to the saga of Cameron and his depatterning that are still relevant today:
- Psychiatrists may decide that perhaps something wasn’t a good idea and abandon it, but patients still have to live with the consequences;
- The balancing of risks against benefits can be distorted if damage caused by treatment is dismissed as of minor importance and improvements exaggerated;
- Just because something uses cutting edge technology, whether it is tape-recorders or computers, it doesn’t mean it is necessarily good;
- Just because a psychiatrist is eminent and delivers lectures at the Maudsley or other prestigious institutions, it doesn’t mean their ideas are valid;
- The search for a cure for mental illness can be dangerous.