Deep sleep therapy

Deep sleep therapy (DST), also called prolonged sleep treatment or continuous narcosis, is a psychiatric treatment based on the use of psychiatric drugs to render patients unconscious for a period of days or weeks.

History

Induction of sleep for psychiatric purposes was first tried by Scottish psychiatrist Neil Macleod at the turn of the 20th century. He used bromide sleep in a few psychiatric patients, one of whom died. His method was adopted by some other physicians but soon abandoned, perhaps because it was considered too toxic or reckless. In 1915, Giuseppe Epifanio tried barbiturate-induced sleep therapy in a psychiatric clinic in Italy, but his reports made little impact.^[1]

Deep sleep therapy was popularized in the 1920s by Swiss psychiatrist Jakob Klaesi, using a combination of two barbiturates marketed as Somnifen by pharmaceutical company Roche.^[2][3] Klaesi's method became widely known and was used in some mental hospitals in the 1930s and 1940s.^[4] It was adopted and promoted by some leading psychiatrists in the 1950s and 1960s, such as William Sargant in the UK and by Donald Ewen Cameron, a North American psychiatrist of Scottish origin practicing in Canada, some of whose research was funded by the CIA as part of their Project MKULTRA.^[5]

Sargant 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 ... 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".^[6]

Australian Chelmsford scandal

Deep sleep therapy was also notoriously practised (in combination with electroconvulsive therapy and other therapies) by Harry Bailey between 1962 and 1979 in Sydney, at the Chelmsford Private Hospital. As practised by Bailey, deep sleep therapy involved long periods of barbiturate-induced unconsciousness. DST was prescribed for various conditions ranging from schizophrenia and depression to obesity, PMS and addiction.^[7]

Twenty-six patients died at Chelmsford Private Hospital during the 1960s and 1970s, with only perfunctory investigation by authorities. After the failure of the agencies of medical and criminal investigation to tackle complaints about Chelmsford, a series of articles in the early 1980s in the Sydney Morning Herald exposed the abuses at the hospital and forced the authorities to take action, and a Royal Commission was appointed.^[8]

In 1978 Sydney psychiatrist Brian Boettcher had convened a meeting of doctors working at Chelmsford and found there was little support for deep sleep therapy (Harry Bailey did not attend). However the treatment continued to be used into the following year.^[9] Legal action on behalf of former patients was and is still being pursued in New South Wales.^[10][11][12]

The New South Wales government recently admitted that three people over the last three years had been kept continuously unconscious for 48 hours whilst undergoing ECT.^[13]

Notes

1. ^ E. Shorter 1996 "The beginning of psychopharmacology: deep sleep therapies". European Psychiatry 11: 236s
2. ^ G. Windholz, "Sleep as a cure for schizophrenia: a historical episode", History of Psychiatry 4.13, March 1993, pp. 83–93, doi 10.1177/0957154X9300401304.
3. ^ Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, New York: Wiley, 1997, ISBN 9780471157496, p. 203.
4. ^ W. Sargant and E. Slater 1944 An introduction to physical methods of treatment in psychiatry. Edinburgh: 100-110
5. ^ E. Shorter 1997, 206-207
6. ^ William Sargant and Eliot Slater assisted by Desmond Kelly, An introduction to physical methods of treatment in psychiatry (Edinburgh: Churchill Livingstone, 1972), pp. 89-96.
7. ^ S. Garton. Bailey, Harry Richard (1922-1985). Australian dictionary of national biography (online edition)
8. ^ J O'Neill and Robert Haupt. The last victim of the 'beautiful hospital'. Sydney Morning Herald, 2 August 1988
9. ^ E. Wilson 2003 Psychiatric abuse at Chelmsford Private Hospital, New South Wales, 1960-1980s. In C. Coleborne and D. MacKinnon Madness in Australia: histories, heritage and the asylum. Queensland: 121-34
10. ^ "Walton v Gardiner [1992] HCA 12". Australasian Legal Information Institute. http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/HCA/1992/12.html. Retrieved 2008-04-25. 
11. ^ "Susan Jane Tweedale v Dr John Tennant Herron and Ors [1997] NSWSC 168". Australasian Legal Information Institute. http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/nsw/NSWSC/1997/168.html. Retrieved 2008-04-25. 
12. ^ "Hart v Herron and Anor [1996] NSWSC 176". Australasian Legal Information Institute. http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/nsw/NSWSC/1996/176.html. Retrieved 2008-04-25. 
13. ^ Full Day Hansard Transcript (Legislative Council, 6 September 2011, Proof), p.35; ECT patients under anaesthetic for two days, Sydney Morning Herald, 18 June 2011.

References

• The New South Wales Royal Commission into Chelmsford Private Hospital: Available in reference form at the N.S.W. State Library.
• Jones, D. Gareth. (March 1990) "Contemporary Medical Scandals: A Challenge to Ethical Codes and Ethical Principles." Perspectives on Science and Christian Faith. No. 42, pp. 2–14
• Anderson, Ian. (January 1991) "Nightmare on Chelmsford, Sydney." New Scientist magazine, 05 January 1991. No. 1750