The Sleep Room: A Very British Medical Scandal, Jon Stock, The Bridge Street Press, 2025, £25.00.
William Sargant (1908-1989) was an eminent and hard-line physicalist psychiatrist, which is to say that he viewed all human thought and behaviour, including so-called mental illness, as the product of the brain, a physical organ no different, fundamentally, from any other organ. It followed, according to him, that treatment of mental illness could only be physical (or chemical). To this end, he used, and in part devised, treatments that now strike us as drastic, brutal, cruel and worse than the conditions that they were supposed to cure. At one time, he bestrode the little world of psychological medicine as a colossus but is now regarded as having been more of a sadistic mad scientist than a healer.
In this book, Mr Stock is counsel for the prosecution. He describes the methods used by Sargant such as prolonged narcosis, usually combined with frequent electroshocks, and insulin coma, in which a patient was injected with insulin until his (or more usually her) blood sugar levels were dangerously lowered, and the patient became unconscious. He was a proponent of lobotomy, and he used what were sometimes called ‘heroic’ (which is to say dangerously large) doses of drugs. He seemed to have regarded talking to patients almost as unnecessary, a distraction from real treatment, and abominated all kinds of psychotherapy. To readers now, his treatments will seem more like torture than genuine therapeutic endeavour, and if they often seemed to have an immediate calming effect on the most disturbed patients – well, so would a punch in the face have done.
Can anything be said in his defence? It has to be remembered that when he started his career, the asylums were full to bursting of patients who had been more or less incarcerated in them for years, sometimes for decades. They lived in abominable conditions, without any dignity or privacy, and with hardly any efforts made to alleviate their suffering. Their medical notes often contained only a perfunctory annual remark, and such phrases as ‘Dirty in his habits’ were standard. Almost anything would have seemed better than that, and Sargant was an evangelist against what was called therapeutic nihilism, the view that nothing could be done.
He came to the view that delusions, hallucinations or other symptoms of deranged thought were like physical objects, that could be removed or even smashed up by his various treatments. He also thought that, if you emptied minds of pathological and repetitive patterns of thought by shocks, drugs and aversive stimuli, you could replace them by healthier ones. It was his version of the dream of creating the New Man (or far more often the New Woman). Anthony Burgess’s famous novel The Clockwork Orange was an attack on Sargant’s crude way of thinking.
Sargant was a successful author, publishing The Battle for the Mind in 1957, that sold millions worldwide. It was a study of, among other things, possession states and it is rather odd that, given that he acknowledged the power of suggestion in bringing about extreme psychological states, it never occurred to him that his militantly physicalist attitude to mental and behavioural dysfunction might be mistaken. He was too committed to his world outlook to change it; and possibly, having early in his career having himself suffered what was once called a nervous breakdown, he wanted desperately to believe that he had been the victim of a physical disorder rather than of a psychological quirk or fault of character.
Tall and striking, he evinced such certainty that he was able to convince others – though not everyone – that he must be on the right track. He brooked no contradiction and was able to take advantage of the deference to authority that was standard at the time. He was fortunate, as many of his patients were not, that the importance of objective evidence in the practice of medicine was not as much appreciated then as it is now, so that personal experience and conviction was taken as sufficient reason to continue using a technique or treatment. This was particularly dangerous in the management of psychological disorder.
The author suggests that Sargant was, at least in part, in the pay of British and American intelligence services, who were interested in brainwashing and interrogation techniques, and that he was a sexual predator if not pervert, taking advantage of his power over patients to take sexual advantage of them. With regard to the former allegations, the evidence seems suggestive rather than conclusive, and the author seems to take compatibility with a hypothesis for evidence of its truth.
In attacking Sargant’s type of psychiatry (Sargant was the first author of a book, An Introduction to Physical Methods in Psychiatry, which went through four editions from 1944 to 1972), the author contrasts him with Freud and R.D. Laing, as if they were nothing but heroes, without mentioning that they had feet of clay as well, their theories being as groundless as Sargant’s, and sometimes with cruel consequences.
Interspersed through the book are accounts written by former patients of Sargant, and I mean no disrespect if I say that I found them unsatisfactory because so incomplete. They gave no clear idea of what, if anything, was wrong with them when they came under his ‘care’. And the author tells us that many of his patients felt gratitude towards Sargent: from them, we do not hear.
Nevertheless, the charges against him stand. His mode of thought was scientistic rather than scientific. He had no idea of, or respect for, scientific method. He was in love with his own charisma, and truth for him was whatever he thought was true. He believed that you can’t make an omelette without breaking eggs, but he seemed not to care very much what kind of omelette resulted. Avid for fame and money, he avoided utter disgrace only by dying just in time. He is remembered mainly by those whose memory he tried to destroy, in some cases destroying a good part of it. This book is an eloquent warning against unbridled authority, wherever it is exercised.
