William Sargant, deep sleep treatment and ECT

BBC4 is currently showing a 3-part series called The Brain: a secret history. This is what the BBC says about it:

“Michael Mosley embarks on three journeys to understand science’s last great frontier – the human mind – as he traces the history of the attempts to understand and manipulate the brain”.

The first programme in the series, Mind control, featured British psychiatrist William Sargant (1907-1988), who wrote a book about mind control, but is mainly remembered for the evangelical zeal with which he promoted physical treatments in psychiatry – drugs, insulin coma, electroconvulsive treatment (ECT), psychosurgery, continuous narcosis or deep sleep treatment, etc. As head of the department of psychiatry at St Thomas’s hospital (from the 1940s to the 1970s) he conducted experiments on the effects of keeping patients asleep during a course of ECT, using massive doses of major tranquillisers and barbiturate-type drugs, sometimes for months at a time. The programme showed one former patient returning to the ward (now abandoned) where she had been treated. These experiments feature in Dominic Streatfeild’s book Brainwash, the secret history of mind control;  and a website has been set up by survivors of Sargent’s experiments.

Sargant did not set out to be a psychiatrist. But his intended career as a physician came to a halt when his attempts to treat pernicious anaemia with excessive doses of iron were criticised. This set-back led to a nervous breakdown and Sargant spent some time in a mental hospital. In his autobiography Sargant is reticent about this episode, attributing his problems to undiagnosed tuberculosis, but the full story emerged from Ann Dally, who wrote the Oxford Dictionary of National Biography entry on Sargant and started a biography of him. Michael Neve had access to Dally’s papers and discussed Sargant’s breakdown in a paper given at a workshop in Germany in 2004.

Sargant’s mantra was expressed in a letter he wrote to The Times towards the end of his career in 1967: “early intensive use of modern physical treatments.” His hatred of anything psychological was approached only by his scorn for controlled trials. In setting up the psychiatric department at St Thomas’s in 1947 he found a system that, with its strict hierarchies and deference to consultants, nurtured and supported his extreme views and offered him the freedom to conduct experiments – however bizarre – on NHS patients without their consent.

Sargant’s “modern physical treatments” had significant risks, which he brushed aside with claims that by “early intensive” treatment he was saving people from the long-stay wards of the old asylums. His department at St Thomas’s was essentially an out-patient department (although he later acquired a ward for his narcosis experiments at the Royal Waterloo Hospital when it became part of St Thomas’s) and his patients often had mild or recent illnesses from which they might have recovered without drastic treatments. If the treatments left patients worse off rather than better, Sargant would attribute this to their lack a “good previous personality”.

Sargant’s methods are set out in a book (co-authored with Eliot Slater) called An introduction to physical methods of treatment in psychiatry. This slim volume ran through five editions between 1944 and 1972. Much of the text remained unaltered but some treatments, for example malaria therapy, were discarded along the way whilst others, for example chlorpromazine and amitriptylene, made an appearance only in the later editions. Insulin coma therapy and unmodified ECT make it through to the final edition, the former because the authors still used it and the latter because they thought there might be occasions on which it was needed.

Deep sleep treatment, or continuous narcosis as the authors called it, makes its appearance in the first edition, but the authors show more enthusiasm for the recent discoveries of insulin coma and convulsive therapies, and leucotomy; continuous narcosis having by 1944 been in use for decades. The authors considered it to be of most use in neurotic patients, and also useful as a means of preventing a voluntary patient from leaving hospital. But by the fifth edition in 1972 they had discovered a new use for deep sleep treatment as a means of keeping patients unconscious during a course of ECT. They described giving this treatment to over 400 patients at St Thomas’s and Belmont in the 1960s. The patients had a variety of diagnoses: schizophrenia, depression, anxiety, obsessive-compulsive disorder,  and chronic tension state. The youngest patient, according to the chapter headed “modified narcosis and combined treatment with ECT and antidepressants”, was 16 years old, but in Eva Frommer’s chapter on the treatment of children there is mention of sleep treatment for children using largactil, stelazine and tryptizol (and also mention of children aged 12 and 14 who had more than 20 ECTs). Sargant and Slater describe how patients were kept asleep for one to 3 months (there is also mention of one patient whose treatment lasted 5 months) and given up to 20 or 30 ECTs. The authors talk about “therapeutic confusion” and say:

“What is so valuable is that they generally have no memory about the actual length of the treatment or the number of ECT used after the treatment is finished…. As a rule the patient does not know how long he has been asleep, or what treatment, even including ECT, he has been given”.

The aim of treatment was to keep the patients asleep for 20 hours out of 24, waking only for meals, physiotherapy and trips to the toilet (with the help of enemas). ECT would be given two or three times a week. The main drugs used by Sargant to induce sleep were chlorpromazine and mandrax. Anti-parkinsonian drugs were also given, barbiturates sometimes used in place of mandrax, or haloperidal added to chlorpromazine. MAOI and tricyclic antidepressants completed the drug cocktail. The authors admitted to five deaths in 679 courses of treatment.

Did any other hospitals adopt the regime that Sargant used at St Thomas’s? Did any psychiatrists read the 1972 edition of his textbook and decide to try out Sargant’s treatment on their own patients? If they did, they didn’t publish anything about it (as far as I know). Sargant retired in 1972. But in a letter to the British Medical Journal in 1973 he refers to ten beds in a nursing home where he was still treating patients with deep sleep treatment and ECT.

In recent years there have been attempts to link Sargant’s experiments with the CIA’s mind control programme, MKULTRA. Sargant certainly had dealings with Ewan Cameron, the Scottish-American psychiatrist whose experiments with deep sleep treatment and ECT were later found to have been financed in part by the CIA. For example, Cameron wrote an introduction to one of Sargant’s books. But both Sargant and Cameron were involved in setting up the World Psychiatric Association and their links may therefore have been normal professional contacts rather than anything more sinister. Their experiments with deep sleep treatment and ECT had similarities, but also differences. Cameron used the Page-Russell technique of intensive ECT (named after the two British psychiatrists who invented it) in which patients are given several shocks at a time on a daily basis. Sargant certainly gave his patients large numbers of ECTs, but generally talks about giving ECT two or three times a week. In his 1973 letter to the British Medical Journal he does however talk about intensive ECT, although he could just be using the term intensive as an adjective to describe ECT, rather than specifically referring to the Page-Russell technique or similar.

St Thomas’s is an NHS hospital, and most of the treatment of Sargant’s patients there was funded by the NHS. But in a 1966 article in the British Medical Journal, under the heading “research possibilities”, Sargant says that his department received no “official outside research support whatsoever. Fortunately, valuable help was obtained from the endowment funds of St Thomas’s and from gifts of money from private lay persons.” It would be interesting to know just who was contributing to the funding of Sargant’s experiments.