William Sargant - St Thomas' Hospital

St Thomas' Hospital

After the war Sargant found it difficult to settle at the re-united Maudsley Hospital and applied - unsuccessfully - for positions elsewhere. In 1947 he was invited to spend a year as a visiting professor of psychiatry at Duke University. He returned to England in August 1948 having been offered the position of head of the department of psychological medicine at St Thomas’, a teaching hospital in London. At that time the new department consisted of a basement with no in-patient beds, and no requirement on students to attend lectures on psychiatry. Sargant was to stay at St Thomas’s for the rest of his career, and he built the department up into an 'active treatment, teaching and research unit'. The basement was refurbished to use as an out-patient department (for electroconvulsive therapy, modified insulin treatment, methedrine injections, etc.), while the amalgamation of St Thomas’ and nearby Royal Waterloo Hospital provided Sargant with a 22 bed ward for his in-patients (this was to become his ward for continuous narcosis or deep sleep treatment). Sargant's work at St Thomas' was funded by the NHS with support from the endowment funds of St Thomas' Hospital and gifts from private individuals.

Both at Belmont Hospital and at St Thomas', Sargant subjected patients to up to three months' combined electroconvulsive therapy, continuous narcosis, insulin coma therapy and drugs. He said in a talk delivered in Leeds: "For several years past we have been treating severe resistant depression with long periods of sleep treatment. We can now keep patients asleep or very drowsy for up to 3 months if necessary. During sleep treatment we also give them ECT and anti-depressant drugs". Sargant used narcosis (sleep treatment) to overcome a patient's refusal of electroconvulsive therapy, or even deliver it without their knowledge. He wrote in his standard textbook An introduction to physical methods of treatment in psychiatry: "Many patients unable to tolerate a long course of ECT, can do so when anxiety is relieved by narcosis ... What is so valuable is that they generally have no memory about the actual length of the treatment or the numbers of ECT used ... After 3 or 4 treatments they may ask for ECT to be discontinued because of an increasing dread of further treatments. Combining sleep with ECT avoids this ...". Sargant also advocated increasing the frequency of ECT sessions for those he describes as "resistant, obsessional patients" in order to produce "therapeutic confusion" and so remove their power of refusal. In addition he states: "All sorts of treatment can be given while the patient is kept sleeping, including a variety of drugs and ECT together generally induce considerable memory loss for the period under narcosis. As a rule the patient does not know how long he has been asleep, or what treatment, even including ECT, he has been given. Under sleep ... one can now give many kinds of physical treatment, necessary, but often not easily tolerated. We may be seeing here a new exciting beginning in psychiatry and the possibility of a treatment era such as followed the introduction of anaesthesia in surgery".

Sargant's methods inspired Australian doctor Harry Bailey who employed deep sleep treatment at Sydney's Chelmsford Private Hospital, eventually leading to the death of 26 patients. Bailey and Sargant were in close contact and apparently competed to see which of them could keep a patient in the deepest coma. The death rate among Sargant's patients was lower than that among Bailey's, largely thanks to the nursing skills of the 'Nightingales' (St Thomas' nurses). Each sleeping patient was allocated a nurse or student nurse who would monitor their sleep every 15 minutes and wake them every six hours to feed and wash them and take them to the toilet. Some of the nurses disliked working in the narcosis ward, but a former ward sister defended the treatment, recalling patients as 'being pleased to be helped'. There were, however, several deaths.

It was Sargant's firm belief that anyone with psychological problems should be treated early and intensively with all available methods - combined if necessary. He referred to himself as "a physician in psychological medicine". The available methods, which Sargant also referred to as "modern" and "active" treatments, were drugs in large doses (antidepressants, amphetamines, barbiturates, tranquillisers, neuroleptics), electroconvulsive therapy, insulin coma therapy, continuous narcosis and leucotomy. Failures in treatment were put down to the patient's lack of a "good previous personality". (Sargant was fond of saying that you can't make a silk purse out of a pig's ear.) Such failures were sent from St Thomas' to the wards of mental hospitals.

The part-time nature of Sargant’s NHS contract at St Thomas' allowed him time to treat patients at other hospitals and establish a private practice on Harley Street (when he died he was worth over £750,000). He also wrote articles for the medical and popular press, appeared in TV programmes, and published an autobiography, The unquiet mind, in 1967. He was president of the section of psychiatry at the Royal Society of Medicine in 1956-7, and was a founding member of the World Psychiatric Association. In 1973 he was awarded the Starkey medal and prize by the Royal Society of Health for work on mental health.

A second bout of tuberculosis and depression in 1954 gave Sargant time to complete his book Battle for the mind (and also an opportunity for giving up his 30-year heavy smoking habit). He spent his convalescence in Majorca, and Robert Graves helped him edit the book. Battle for the mind, published in 1957, was one of the first books on the psychology of brainwashing. While this book is often referred to as a work on 'brainwashing', and indeed it is subtitled a physiology of conversion and brainwashing, Sargant emphasises that his aim is to elucidate the processes involved rather than advocate uses. In the book he refers extensively to religious phenomena and in particular Christian methodism, emphasising the apparent need for those who would change people's minds to first excite them, as did the founder of Methodism, John Wesley.

Sargant connected Pavlov's findings to the ways people learned and internalized belief systems. Conditioned behaviour patterns could be changed by stimulated stresses beyond a dog's capacity for response, in essence causing a breakdown. This could also be caused by intense signals, longer than normal waiting periods, rotating positive and negative signals and changing a dog’s physical condition, as through illness. Depending on the dog's initial personality, this could possibly cause a new belief system to be held tenaciously. Sargant also connected Pavlov’s findings to the mechanisms of brain-washing in religion and politics.

Some of Sargant’s former colleagues remember him with admiration. David Owen worked under Sargant at St Thomas' in the 1960s, before embarking on his political career, and recalled him as "a dominating personality with the therapeutic courage of a lion" and as "the sort of person of whom legends are made". But others, who preferred to remain anonymous, described him as "autocratic, a danger, a disaster" and spoke about "the damage he did".

Patients, too, recall their treatment at the hands of Sargant in very different terms. One man who consulted Sargant at his Harley Street private practice for depression in the 1960s later recalled "Will" with affection and respect. Visiting Sargant for a brief consultation every six months, he was given large doses of drugs and had a course of electroconvulsive therapy; he remembered his relief at being told that his depression was caused by chemical and hereditary factors and could not be resisted by an effort of personal will. But a woman who had been admitted to St Thomas' in 1970 with post-natal depression, and was left with memory loss after treatment with narcosis and electroconvulsive therapy, recalled her experience with anger.

British actress Celia Imrie was admitted to St Thomas' Hospital when she was fourteen for the treatment anorexia under the care of Sargant. She was given electroconvulsive therapy and large doses of the anti-psychotic drug Largactil and insulin. Imrie has written that her eventual cure was nothing to do with Sargant and his bizarre techniques.