Doctor Sargant and Me

1966 was an exciting year for me but a nightmare for my elder brother Martin. The previous Christmas everyone in our family, including me, had assumed I would go to Cambridge to begin my history degree, but now I  was abruptly changing direction and heading towards becoming a doctor. As my life climbed, Martin’s appeared to be falling. Severe depression had sucked him out of Cambridge during the middle term, just as it had the year before. We all knew, without admitting it, that the brilliant future we had imagined for Martin would never happen.

My brother’s youth now seems to belong to the remote past, but one problem I was facing more than half a century ago went on dogging me all through my time as a doctor. If you have been close to someone who is very ill you may have struggled with it yourself, whatever level of medical knowledge you have. There is a tension between two almost incompatible ways of looking at mental misery. Should I think of  Martin in those days as an unhappy person, an unbalanced mind or, as his psychiatrists stoutly maintained, a disordered brain? My parents wanted to see their son as sick, and they have me the habit of looking at Martin with a diagnostic eye, making him more difficult to see as a person.    My younger brother and I were both reading RD Laing’s Sanity, Madness and the Family at the time, which made the family feel like part of Martin’s problem. hhI never wanted to blame our parents, but blame was in the air that we all breathed.

Martin’s psychiatrist was Dr William Sargant. He told my parents that Martin’s illness as a disruption of brain chemicals. If we thought of it that way there was no need to blame anybody, which was a relief to my parents.  All through my adult life I have felt indignant about the way Sargant brushed Martin’s personal perspective aside. Laing, and Freud, had persuaded me that even the craziest people had something to say. Sargant’s attitude to psychotherapy verged on contempt. This theme keeps recurring in his memoir, The Unquiet Mind, starting with his memories of practice before the advent of modern psychoactive drugs. Even then, he insists, an ounce of bromide, a sedative, was worth a hundredweight of talking. His remedy for mental distress was not psychotherapy, which was slow, costly and ineffective, but physical methods such as drugs and electroconvulsive treatment (ECT). I think he imagined he was attacking  the patient's disordered brain in the way he would have kicked a slot machine if it failed to deliver his cigarettes.  Martin was given ECT several times a week for months on end, together with various mixtures of every class of psychoactive drug then available, in enormous doses. In addition, there were sessions of sleep treatment, requiring hospital admission for weeks on end. Yet another physical treatment, frontal lobotomy, was under consideration at one satge. The merest suggestion of cutting into Martin’s brain with a knife made our blood freeze.

 It won’t surprise you that I still have intense feelings about all this. They reached a new pitch in 2025 when a book called The Sleep Room, by thriller-writer Jon Stock, came out. Its breathless prose gives us a possible picture of Sargant, who is said to have ‘a whiff of sulphur about him’, with his ‘saturnine brows’ and eyes like ‘cold pebbles’.  I did not note these sinister features on few occasions when I saw Sargant while I was a St Thomas’ medical student. Was this because saturnine, pebbly, sulphorous doctors were two a penny there?  The Sleep Room of Stock’s title was on the top floor of the Royal Waterloo Hospital, where Martin spent many weeks. Jon Stock’s eyewitnesses describe a strangely quiet, almost domestic atmosphere on that ward. I visited my brother there at least once and remember it vividly, as well as knowing one of the nurses who worked there, but at the time I never thought of Ward 5 as sinister. Stock’s claim that Sargant’s activities amounted to ‘A Very British Scandal’ shocks me. An excerpt in the Guardian has a lurid headline: ‘“He Still Features In My Nightmares”: How A Sinister Psychiatrist Put Hundreds Of Women In Deep, Drug-Induced Comas’.  One woman gives a disturbing and all-too-credible account of Sargant assaulting her in his private consulting room. In her Observer review, Rachel Clarke describes Ward 5’s goings-on as ‘monstrous’ and says they make her flesh crawl.  Sargant has always triggered difficult emotions in me, but was I now to think of my beloved brother as in the hands of a monster? With Martin in mind, what disturbs me most is evidence in The Sleep Room from ex-patients who felt coerced, as teenagers, by their parents and doctors.   Even if Martin, who died 15 years ago, never talked to anyone about those stormy years. Could his memories have been erased by ECT?

 In his memoir, Sargant portrays himself as the sort of person who would favour physical action rather than reflective dialogue – not my type at all. He describes himself as curing the ‘battle neuroses’ of soldiers returning from Dunkirk with brutal-sounding techniques. In one, called abreaction, the traumatised soldier’s psychological defences were broken down by an injection of sodium amytal, with the doctor heightening the tension by describing a terrifying imaginary scene such as of a burning tank. An alternative was to give the soldier’s head some electric shocks. According to Sargant, the man of action, these methods worked wonders for neurotic or hysterical symptoms such as amnesia and limb paralysis.

 The Sleep Room adds to the negative picture of Sargant I started creating in my teenage years, but at the same time a strange ambivalence creeps over me, so that I somehow find myself tempted to identify with this very dubious character. Sargant expresses angry impatience with chronic illness, and dreams of liberating thousands of people who are languishing in asylums with schizophrenia. Shock their brains, he says, and set them free! Stock dismisses these feelings of  Sargant’s as phoney (how could someone who may well have assaulted a female patient, or who  perhaps did research funded by MI6 or the CIA have feelings?). I never have attacked a patient, but I was just as fervent an advocate as Sargant for people that health services and doctors neglect (in my case, those with progressive neurological conditions). The only doctor I have talked to who worked on Ward 5 recalls Sargant’s saying that he felt strongly about depression because he had suffered it himself.  He compared it to pain. Would you, he asked, fuss about side effects if you knew of an effective treatment  for someone in agonising pain? I would certainly have been tempted, in the way Sargant often was, by even the smallest chance that an incurable condition such as motor neurone disease might be cured by electric shocks, or insulin, or narcosis, or any half-credible drug I could get my hands on.

Stock suggests that Sargant was attracted to such treatments as ECT and lobotomy because they felt properly medical, with a curative aura that no form of psychiatry or psychotherapy could equal.  This is a feeling I had myself when I was exhausted by my efforts help patients think and talk their way through their endless difficulties. How much simpler it felt to inject a drug into a muscle or a spine!  A neurologist spends many hours trying to diagnose and relieve psychologically-based symptoms. I would sometimes catch myself fantasising about shocking the unfortunate person into wellness. Might Sargant have been right, now and then, about the futility of talking?

Sargant looks like a medical dinosaur in some ways but his dismissive attitude to all things Freudian would look thoroughly modern in contemporary psychiatry. Sargant was treating my brother at a moment in the history of British medicine when Freud quite abruptly disappeared. At this point  Sargant and I go our different ways, he with a syringe, or pair of electric terminals, or a scalpel, and me with a pair of ears, wondering how to understand what ill people want us to hear.