Deep sleep therapy

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Deep sleep therapy (DST), also called prolonged sleep treatment or continuous narcosis, is a psychiatric treatment in which drugs are used to keep patients unconscious for a period of days or weeks.

History[edit]

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] 'Electronarcosis' was also developed and used for various psychiatric disorders, involving current passed through the brain to induce deep sleep.

Deep sleep therapy was popularised in the 1920s by Swiss psychiatrist Jakob Klaesi, using a combination of two barbiturates marketed as Somnifen by the pharmaceutical company Roche.[2][3]:p 203 Klaesi's method became widely known and was used in some mental hospitals in the 1930s and 1940s.[4]:pp 100-110 It was adopted and promoted by some leading psychiatrists in the 1950s and 1960s, such as William Sargant in the UK and by Dr. Donald Ewen Cameron, a North American psychiatrist of Scottish origin practising in Canada, some of whose research was funded by the CIA as part of their Project MKULTRA.[3]:pp 206-207

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".[4]:pp. 89-96

Australian Chelmsford scandal[edit]

Deep sleep therapy was also 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.[5]

Twenty-six patients died at Chelmsford Private Hospital during the 1960s and 1970s. 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 and television coverage on 60 Minutes exposed the abuses at the hospital including 24 deaths from the treatment. This forced the authorities to take action, and a Royal Commission was appointed.[6] The Citizens Commission on Human Rights, a psychiatric reform group established by the Church of Scientology, was an advocate for victims and received documents from the hospital copied by a nurse, "Rosa".[7]

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.[8] Legal action on behalf of former patients was and is still being pursued in New South Wales.[9][10][11]

In her book First Half, Toni Lamond described what it was like when she was admitted there in 1970. She had an addiction to prescription drugs and a friend told her about Dr Bailey who duly became her psychiatrist.

"I was given a semi-private room. On the way to it I saw several beds along the corridors with sleeping patients. The patient in the other bed in my room was also asleep. I thought nothing of it at the time. Although it was mid-morning, the stillness was eerie for a hospital that looked to be full to overflowing. I was given a handful of pills to take and the next thing I remember was Dr Bailey standing by the bed asking how I felt. I told him I'd had a good night's sleep. He laughed and informed me it was ten days later and, what's more, he had taken some weight off me. I was checked out of the hospital and this time noticed the other patients were still asleep or being taken to the bathroom while out on their feet."[12]

In New South Wales in 2011, following the publication of a story in the Sydney Morning Herald,[13] the Minister of Police and Emergency Services, representing the Minister of Health, in answer to a parliamentary question on notice, made a statement on the use of prolonged sedation with ECT:

"Prolonged sedation is used on rare occasions with the administration of ECT where there has been a clinical indication to combine the two procedures, such as in complex cases when the risk to the patient and others from severe mental illness is extreme and other treatments have been unable to safely contain this risk. The primary purpose of the sedation is to keep the patient and staff safe from the patient's severe aggression and to control agitation. The primary purpose of the ECT is to treat the underlying mental illness."

The Minister said that all three cases had positive outcomes and "accepted procedures and clinical governance processes available at the time were followed".[14] The New South Wales Mental Health Review Tribunal has power to approve or prohibit administration of ECT treatment in respect to both voluntary and involuntary patients.[15]

Notes[edit]

  1. ^ Shorter Edward (1996) "The beginning of psychopharmacology: deep sleep therapies". European Psychiatry 11: 236s
  2. ^ Windholz G. "Sleep as a cure for schizophrenia: a historical episode", History of Psychiatry 4.13, March 1993, pp. 83–93, doi 10.1177/0957154X9300401304.
  3. ^ a b Shorter, Edward. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, New York: Wiley, 1997, ISBN 978-0-471-15749-6
  4. ^ a b Sargant, William; Slater, Eliot; assisted by Kelly, Desmond. An introduction to physical methods of treatment in psychiatry (Edinburgh: Churchill Livingstone, 1972)
  5. ^ Garton S. Bailey, Harry Richard (1922-1985). Australian dictionary of national biography (online edition)
  6. ^ O'Neill J.; Haupt R. The last victim of the 'beautiful hospital'. Sydney Morning Herald, 2 August 1988
  7. ^ Bromberger, Brian; Fife-Yeomans, Janet. Deep Sleep: Harry Bailey and the Scandal of Chelmsford, Simon & Schuster 1991, page 111
  8. ^ Wilson E. (2003) "Psychiatric abuse at Chelmsford Private Hospital, New South Wales, 1960-1980s", in Coleborne C. and MacKinnon D. Madness in Australia: histories, heritage and the asylum. Queensland: 121-34
  9. ^ "Walton v Gardiner [1992] HCA 12". Australasian Legal Information Institute. Retrieved 2008-04-25. 
  10. ^ "Susan Jane Tweedale v Dr John Tennant Herron and Ors [1997] NSWSC 168". Australasian Legal Information Institute. Retrieved 2008-04-25. 
  11. ^ "Hart v Herron and Anor [1996] NSWSC 176". Australasian Legal Information Institute. Retrieved 2008-04-25. 
  12. ^ Lamond, Toni. First Half, Pan Books, Sydney, 1990, ISBN 0 330 27185 7, p 199
  13. ^ Phillips, Nicky with Corderoy, Amy. ECT patients under anaesthetic for two days, Sydney Morning Herald, 18 June 2011
  14. ^ Hansard Transcript, NSW Legislative Council, 6 September 2011, p.35 (folio 4931)
  15. ^ What orders can the tribunal make? at NSW Mental Health Review Tribunal, 12 June 2014. Accessed 13 July 2014

References[edit]