William Walters Sargant (24 April 1907 – 27 August 1988) was a British psychiatrist who is remembered for the zeal with which he promoted treatments such as psychosurgery, deep sleep treatment, electroconvulsive therapy and insulin shock therapy.
Sargant studied medicine at St John's College, Cambridge, and qualified as a doctor at St Mary's Hospital, London. His ambition to be a physician was thwarted by a nervous breakdown, after which he turned his attention to psychiatry. Having trained under Edward Mapother at the Maudsley Hospital, in South London, he worked at the Sutton Emergency Medical Service during the Second World War.
In 1948 he was appointed director of the department of psychological medicine at St Thomas' Hospital, London, and remained there until (and after) his retirement in 1972, whilst also treating patients at other hospitals, building up a lucrative private practice in Harley Street, and working as a media psychiatrist.
Sargant co-authored a textbook on physical treatment in psychiatry that ran to five editions. He wrote numerous articles in the medical and lay press, an autobiography, The Unquiet Mind, and a book titled Battle for the Mind in which he discusses the nature of the process by which our minds are subject to influence by others. Although remembered as a major force in British psychiatry in the post-war years, his enthusiasm for discredited treatments such as insulin shock therapy and deep sleep treatment, his distaste for all forms of psychotherapy, and his reliance on dogma rather than clinical evidence have confirmed his reputation as a controversial figure whose work is seldom cited in modern psychiatric texts.
Early life and medical career Sargant was born into a large and wealthy Methodist family in Highgate, London. His father was a City broker, his mother, Alice Walters, was the daughter of a Methodist minister from a family of wealthy Welsh brewers. Five of his uncles were preachers. He had two brothers—human rights campaigner Thomas Sargant and Bishop of Mysore, Norman C. Sargant, and five sisters.Sargant 1967, 11 Sargant went to the Leys School in Cambridge and then studied medicine at St John's College, Cambridge. He did not excel academically but played rugby for St John's College, was president of Cambridge University Medical Society and collected autographs of famous medical men.Dally 2004 Sargant obtained a rugby scholarship to complete his medical education at St Mary's Hospital. His father lost most of his money in the depression in the late 1920s and the scholarship allowed Sargant to continue his medical education.Sargant 1967, 12 After qualifying as a doctor he worked as a house-surgeon and house-physician at St Mary's and looked set for a successful career as a physician. But in 1934—four years after qualifying as a doctor—a nervous breakdown and spell in a mental hospital cancelled his plans. Sargant would later attribute this period of depression to undiagnosed tuberculosis,Sargant 1967, 1 although research which he conducted on the use of iron, in very high doses, for the treatment of pernicious anaemia was not well received and this disappointment may have contributed to his breakdown.
After his recovery, Sargant worked as a locum at Hanwell Hospital, and then for a while helped his brother-in-law at his Nottingham general practice, before deciding on a career in psychiatry.Sargant 1967, 31 In 1935 he was offered a post by Edward Mapother at the Maudsley Hospital. In his autobiography Sargant describes how Mapother's views coincided with his own: 'the future of psychiatric treatment lay in the discovery of simple physiological treatments which could be as widely applied as in general medicine'.Sargant 1967, 33–4 Soon after he arrived at the Maudsley, Sargant was involved in testing amphetamine as a new treatment for depression and took it himself while studying for the diploma in psychological medicine.Sargant 1967, 45 Sargant would take a variety of drugs to treat his depression throughout his life. Another treatment introduced at the Maudsley while Sargant was there was insulin shock therapy.Sargant 1967, 52–5
In 1938 Sargant was awarded a Rockefeller Fellowship to spend a year at Harvard Medical School in Boston, Massachusetts, under Professor Stanley Cobb. Whilst there he did some experiments on over-breathing and developed a theory that the difference between normal and neurotic people is that the latter have lost their suggestibility.Sargant 1967, 61–2 On a visit to Washington he arranged to meet Walter Freeman and see three of his patients who had undergone psychosurgical operations. Although the results were not altogether successful, Sargant resolved to introduce the operation into Britain.Sargant 1967, 65–6
Second World War At the outbreak of war in September 1939 Sargant returned to Britain to find that the Maudsley had been evacuated and divided into two—one half going to Mill Hill School in North London and the other half setting up a hospital in the old Belmont Workhouse near Sutton, Surrey. Sargant was sent, along with H.J. Shorvon, clinical director Eliot Slater, and medical superintendent Louis Minski to Belmont workhouse—renamed the Sutton Emergency Medical Service (in 1953 the name of the hospital would revert to Belmont).Sargant 1967, 77 The hospital, which took both civilian and military patients, was jointly controlled by the Ministry of Health and London County Council. Sargant described his frustration when London County Council medical advisors tried to curb his experimentation with new treatments such as electroconvulsive therapy and psychosurgery (also called leucotomy) but, as he said "we generally got our own way in the end".Sargant 1967, 78 They were, for example, only allowed to carry out individual psychosurgical operations with the approval of the Council advisors. When the doctors advised against operation, Sargant got round this by sending patients to be operated on by Wylie McKissock at St George's Hospital, (where Eliot Slater was temporarily in charge of the psychiatric department). It was, he said, "doing good by stealth".Sargant 1967, 84–5 But critics saw him as someone of extreme views who was cruel and irresponsible and refused to listen to advice; some suggested that he was motivated by repressed anger rather than a desire to help people.Sargant 1967, 121
Sargant selected neurotic patients, especially those with obsessional ruminations, for operation, which carried with it a significant risk of death, personality deterioration, epileptic seizures, and incontinence.Jackson 1954 After the Dunkirk evacuation the Sutton Emergency Medical Service received large numbers of military psychiatric casualties and Sargant developed abreaction techniques – patients would relive traumatic experiences under the influence of barbiturates.Sargant 1967, 87–88 He also used modified insulin treatment, electroconvulsive treatment and sedation in the treatment of military patients.Sargant 1967, 89–91 During the war Sargant wrote, together with Eliot Slater, a textbook, An introduction to physical methods of treatment in psychiatry; five editions were published, and it was translated into several languages. In 1940 he married Peggy Glen, who he had met at the Laboratory at Belmont, where Peggy worked as a volunteer. The couple had no children.
St Thomas' Hospital After the war, Sargant found it difficult to settle at the re-united Maudsley Hospital and applied – unsuccessfully – for positions elsewhere.Sargant 1967, 123 In 1947 he was invited to spend a year as a visiting professor of psychiatry at Duke University. He returned to Britain 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 1967, 144 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".Sargant 1967, 146 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.Sargant 1966
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".William Sargant, Paper to the Samaritans, 11 September 1971. 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 [which] 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 and Slater 1972, 89–96
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.Bromberger, Brian and Fife-Yeomans, Janet, Deep Sleep: Harry Bailey and the Scandal of Chelmsford, Simon & Schuster Australia (East Roseville, New South Wales), 1991. 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).Streatfeild, 247-8 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'.Streatfeild, 248 There were, however, several deaths.Streatfeild, 256