Sadism as Psychotherapy

Jon Stock’s recent book examines the deplorable career of prominent psychiatrist Willam Sargant and his brand of bio-therapeutics.

By Andrew ScullMarch 4, 2026

• Science & Technology

• History

WHEN WILLIAM SARGANT died in 1988 at the age of 81, he was hailed by the Royal College of Physicians as “the most important figure in post-war psychiatry” and as “the outstanding clinician and teacher of his generation.” His work at one of London’s leading teaching hospitals, St. Thomas’, was deemed “legendary.” The longtime editor of The British Journal of Psychiatry, Eliot Slater, with whom he co-authored An Introduction to Physical Methods of Treatment in Psychiatry (1944), had earlier praised him fulsomely for doing “so much to help patients, to teach, and to keep British psychiatry on a sane road.” A psychiatrist whom he trained, David Owen, who went on to serve as Britain’s foreign secretary, lavishly celebrated Sargant as a man who “understood the awful pain of depression which drove him to take risks for those who were depressed—because he knew they would take risks with their lives.” Laudatory obituaries appeared in the most important daily newspapers and medical journals of the time as the nation mourned the passing of a great man.

Readers of Jon Stock’s new book The Sleep Room: A Sadistic Psychiatrist and the Women Who Survived Him (2025) will come away with a rather different impression of Sargant. He is, in my view, one of the great moral monsters of 20th-century psychiatry. In the Anglo-American world, he ranks alongside neurologist Walter Freeman (who taught him about lobotomy) and psychiatrist Donald Ewen Cameron, Sargant’s close friend who was infamous for his devastating experiments on Canadian mental patients in Montreal—savage interventions funded by the CIA that paralleled (and perhaps borrowed from) Sargant’s work. In recent years, it has become fashionable among some historians to excuse the excesses of men like these as motivated by therapeutic zeal. Their actions ought to be understood, so the argument goes, in the context of a time when mental patients were mostly seen as incurable. I don’t agree: I think the horrors they perpetrated give the lie to such claims. These men insouciantly wrecked lives in the name of something they called “therapeutics.”

It is not quite clear what first drew Stock to examine Sargant’s career. He spent years as a foreign correspondent, which may have brought him into contact with the world of espionage, and he previously published (under the pen name J. S. Monroe) a series of spy novels and psychological thrillers. A long-standing interest in the murky world of spying may also explain the inordinate amount of time Stock spends trying to tie Sargant to the CIA and the British secret service. In any event, for a first work of nonfiction, The Sleep Room is an engrossing and well-researched book, combining archival work, interviews with those who worked under Sargant, and testimony from patients who survived his ministrations.

¤

Born into a wealthy Methodist family, Sargant was, like most of his British peers, sent away to boarding school at the age of seven. Rebellious by nature, he had some of his bad behavior beaten out of him. He managed to gain admission to Cambridge, where he was a rather poor scholar who repeatedly failed his anatomy exams but excelled at sports—a combination that brought him the approval and sponsorship of Charles Wilson, later to become Lord Moran, as well as Winston Churchill’s personal physician. When Sargant launched his career, he had ambitions to be one of England’s gentlemanly physicians, not a lowly psychiatrist. In his eagerness to advance his career, he published an almost certainly fraudulent paper on the use of high doses of iron to treat pernicious anemia. Fraudulent or not, his assertions were roundly dismissed by his senior colleagues. The upshot was a mental breakdown, a deep depression that led to some months of incarceration in 1934 in London’s oldest lunatic asylum for paupers, Hanwell, alongside some 2,000 other patients.

The hospital’s deadly routines scarred Sargant, but rather than leaving the hospital when he recovered, he chose to work there as a junior psychiatrist. His own breakdown, he was convinced, had been caused by a bout of tuberculosis. All mental illnesses, he then surmised, were fundamentally biological disorders that should be treated medically rather than with psychotherapeutics. His fierce rejection of psychoanalysis brought him to the attention of Edward Mapother, who shared his distaste for Freud, and the result was an appointment to the Maudsley Hospital, the epicenter of British psychiatry. A new career beckoned.

It is here that Stock’s real interest in Sargant picks up. In 1938, a few years into his time at the Maudsley, Sargant was offered a fellowship to study at Harvard Medical School by the Rockefeller Foundation, which had made psychiatry the focal point of its investment in medical research. Harvard was not much to Sargant’s taste—in part because Stanley Cobb, who headed the department, was sharply critical of the new physical treatments and retained some sympathy for Freud. Sargant soon managed to escape (briefly) to Washington, DC, to meet lobotomist Walter Freeman, who was more to his liking. In addition to promoting lobotomy, Freeman advocated the use of electroshock, an intervention Sargant would later use as part of his transorbital or ice pick lobotomy. Freeman helped cement his guest’s enthusiasm for the desperate remedies that were then becoming part of psychiatry’s stock-in-trade.

With the outbreak of war, Sargant sailed back to Europe, bringing with him the knowledge of these new physical treatments—and a determination to apply them in his own practice.

For many people, the experience of modern industrialized warfare is incompatible with sanity. The shell shock that had baffled both psychiatrists and the military brass in World War I was newly relabeled “combat neurosis” or “combat fatigue.” But whatever the label, its incidence once more became a major problem for the military, particularly in the aftermath of Dunkirk and the rescue of remnants of the broken British Army. The Maudsley psychiatrists were split between two British hospitals established in London to treat these psychiatric casualties. The hospital in Mill Hill in North London was staffed in part with proponents of psychotherapeutics. (Aubrey Lewis, who headed that unit, banned the use of insulin comas and lobotomies, which the British preferred to call “leucotomies.”) By contrast, the hospital in South London at Belmont was staffed by Sargant and his friend Slater, among others, and their enthusiasm for physical treatments ruled. Faced with thousands of casualties, they used the somatic treatments they had already embraced (insulin coma therapy; Metrazol to induce convulsions; electroconvulsive therapy, or ECT; and even lobotomy). But they also began to experiment with a variety of drug therapies: barbiturates (including the extremely toxic Somnifaine), the highly addictive sodium pentothal, and sodium amytal, not to mention the paraldehyde that had long been used in mental hospitals to quiet unruly patients. It was Sargant’s unconstrained enthusiasm for this panoply of interventions that caused some to call him “the beast of Belmont.”

Mill Hill and Belmont hospitals were run—nominally—by the Health Ministry and London County Council. Concerned early on about reports of ECT-induced bone fractures, dislocated jaws, and broken teeth, the politicians decided to ban lobotomies. Stock records Sargant’s fury at this overweening bureaucratic obstructionism, and his determination to continue “doing good by stealth.” Sargant forthwith bought and used his own electroshock machine and evaded the prohibition on lobotomies by sending patients first to the Burden Neurological Institute in Bristol and then to his neurosurgeon friend Wylie McKissock, a man with whom he would enjoy a long and (in his view) productive relationship. (McKissock personally performed over 3,000 lobotomies during his career, according to his anesthetist.) The results were generally catastrophic, but the failures left Sargant unmoved. And what he counted as “success” might strike an outsider as bizarre. I still remember coming across one such case when I spent time, some years ago, reading Sargant’s papers. A few weeks after one of his patients was lobotomized, the man’s home and everything he owned were blown to smithereens by a German bomb. Sargant’s notes on the case recorded the man’s utter indifference to this devastation. For Sargant, this response meant that the operation was a grand success.

Sargant discovered that if he prolonged sleep with barbiturates, he could administer more rounds of ECTs along with insulin comas. Unconscious patients, he boasted, were in no condition to protest—not that such protests would have deterred him. When the patients regained consciousness, he had them relive the traumas that had prompted their breakdowns. Such abreaction, he asserted sans evidence, was met with remarkable therapeutic results. The historian Ben Shephard has documented the gullibility of the military brass when faced with these experiments—no one challenged Sargant’s assertions. Subsequently, his claimed therapeutic rearrangement of his patients’ psyches formed the basis for his postwar reputation as an expert on brainwashing, and his experiments with the whole panoply of physical treatments carried over into his long career in civilian life.

¤

Stock’s treatment of Sargant’s return to civilian life is a bit sketchy. When the Maudsley staff reassembled after the war, Sargant found himself subordinate to the new director, Aubrey Lewis. Their relationship is best characterized as one of mutual loathing, with Lewis wanting no part of Sargant’s cavalier employment of physical treatments. In 1948, after several failed attempts to find better prospects, Sargant landed an appointment at one of London’s oldest great teaching hospitals, St. Thomas’, located across the Thames from the Houses of Parliament. The appointment came with a fancy title—“Physician in Charge of the Department of Psychological Medicine”—but not with fancy digs. Reflecting his field’s low status in the medical establishment, Sargant was given dank, rat-infested rooms in the hospital basement for his outpatient clinic.

Whatever else can be said about Sargant, shyness and passivity were not part of his makeup. Finding two powerful allies on the board of governors, he soon smartened the place up. And he turned himself into a wealthy man by setting up a private practice on Harley Street, in the heart of medical London. A grateful patient from the Middle East presented him with a Rolls-Royce. He also acquired the entire top floor of the nearby Royal Waterloo Hospital for Children and Women, where he was able to create a substantial inpatient psychiatric unit. The completely isolated unit enabled Sargant to do as he pleased. His activities in Ward Five, as it was called, and in what came to be called “the Sleep Room,” form the core of Stock’s book.

Between 1950 and 1953, Sargant deployed his preferred physical treatments on some 270 people, most of them young women. Among his treatments were insulin comas, modified insulin treatment, aversion therapy, seizures induced by Metrazol, ECT, narcosis, and experiments with hormones, and if patients didn’t respond to his satisfaction, they were sent out for lobotomies. One patient received as many as four lobotomies, and another, suffering from obsessive-compulsive disorder, five. By now, Sargant had become the major source of referrals for lobotomies, and Stock records that 462 patients were given more than one lobotomy.

In 1954, during a visit to the United States, Sargant collapsed. Diagnosed with a recurrence of tuberculosis, he once again succumbed to a serious bout of depression. Packed off to Mallorca to convalesce, he would return home a year later. Bedridden for six months of this time, he dictated what became Battle for the Mind: A Physiology of Conversion and Brainwashing (1957), an international bestseller that confirmed him as an expert on the titular subjects. But, in truth, this success was mostly due, Stock tells us, to the book’s complete overhaul by the war poet and novelist Robert Graves. Chronically short of funds, Graves served as its ghostwriter, receiving a third of the royalties for transforming the incoherent mess into a polished manuscript. The moment was inordinately propitious for the book’s reception: stories of American prisoners of war being brainwashed by their Korean captors had created something of a moral panic. The CIA was enchanted by what the book described, mesmerized by Sargant’s techniques for breaking down and reconstructing military men’s psyches. This made him seem—from the CIA’s perspective—like the man for the hour.

His spirits revived by his sojourn in the Mediterranean, Sargant returned to London and resumed his work with a vengeance. He now had a new weapon to add to his therapeutic armamentarium—Thorazine (dubbed Largactil in Europe), the first of the new antipsychotics, which provided another means of subduing his patients. In 1955, he began to use it alongside barbiturates to induce prolonged narcosis. Stock reports Sargant as arguing that “what we’re doing is breaking up long, set patterns of behaviour.”

One of the nurses whom Stock interviewed provided a graphic description of what this entailed. Her example describes the case of an alcoholic: “We had to wake him up and give him a tumbler of neat whisky, followed by an emetic to make him throw up, at which point we would play a tape recording. I’m pretty certain it was Sargant’s voice—Sargant made sure he wasn’t actually in the room during the treatment.” Stock continues, in his own words:

Afterwards, everything that Mr Smith had evacuated from his body was left in the room with him for twenty-four hours. [According to Julia, the nurse,] “As he was throwing up, he was told on the tape recording to look around, see what a disgusting, unpleasant human being he was.” Once he had finished vomiting, Julia turned off the recording and let him sleep. Six hours later, the whole routine started again.

This account was confirmed by Peter Tyrer, one of Sargant’s assistants, who went on to become the editor of The British Journal of Psychiatry for over a decade.

It was at the Royal Waterloo Hospital, however, that Sargant was most fully able to deploy his “therapeutic” arsenal—in part because the hospital was isolated and mostly staffed with vulnerable and easily intimidated student nurses. One patient who had attempted suicide—Anne White, the depressed 28-year-old wife of a doctor—recounted that, on admission, she was informed that her “brain needed a rest.” A combination of Thorazine and barbiturates and two antidepressants launched her into a state of suspended animation for several weeks, during which she was aroused for brief periods to be fed and toileted before being once more rendered unconscious. And while comatose, she was subjected to a series of 26 courses of ECT, which effectively wiped out her memory. Her heavy doses of barbiturates were then abruptly withdrawn, and she was left to her own devices—a highly dangerous state of affairs because after such administrations, the patient is at risk of seizures and even death. White thinks she was subjected to this experience because she had the temerity to complain of her treatment. Small wonder that White ends by informing us that she has “been left with nothing but anger that Sargant was never held responsible for the torture he put young vulnerable women through, and that St Thomas’ covered it up.”

Stock interviewed several of Sargant’s female patients. Their unvarnished accounts constitute some of the most moving portions of his book. Celia Imrie, who in later life became a prominent stage and screen actor, was sent to Sargant at the age of 14 suffering from anorexia. She describes her confinement as “like being in a prison camp.” That probably understates its horrors. She received three heavy doses of liquid Largactil a day. The side effects were startling: “My hands shook uncontrollably for most of the day, and I’d wake up to find clumps of my hair on the pillow. But the worst consequence was that everything I saw was in double vision. When Sargant came into the room, there were two of him.” To add to her travails, she was injected with insulin daily to fatten her up, and she thinks she was probably given ECT. She was unable to confirm this because Sargant took steps to destroy his patient records when he retired. As for Sargant, “he had a face of thunder, like the devil, and had a horrible aura. There was almost something simian about his features […] After Sargant left the ward, the nurses would start preparing the horrors he’d prescribed for the day.” Later, Imrie was transported briefly to St. Thomas’ to be paraded naked before the medical students so they could see how thin this 14-year-old was.

Linda Keith has a different claim to fame. At 19, at the beginning of the Rolling Stones’ rise to fame, she was Keith Richards’s girlfriend, a relationship that became the basis for the song “Ruby Tuesday,” and she then hooked up with Jimi Hendrix as well as becoming a Vogue model. Sex, drugs, and rock and roll: Keith considered herself “a pleasure-seeking, music-obsessed drug addict.” Her parents thought she was sick and inveigled her into the care of Sargant. She had no memory of her admission to Ward Five, but once there, she “didn’t wake up for six weeks,”

[except] to be fed, washed or be given ECT. The room was in almost complete darkness, except for a small pool of light from a dim lamp. It was eerie. Silence apart from the moan of sleeping patients, as many as eight of us crammed close together. […]

It was a twilight world and I have a tinge of fear even now as I force myself to think about it—the enormous amount of ECT that I was given. […]

I had been rendered completely helpless, but I was strangely aware of my helplessness at some unconscious level. […]

There were so many patients being treated with ECT—it was like a conveyor belt. I must have had almost fifty ECTs in total […] I count myself lucky, blessed even, to have a full complement of faculties today.

Not everyone was so fortunate, of course. Many patients sent to the Sleep Room endured successive courses of comas lasting weeks at a time, along with multiple ECTs and insulin treatments. Some died. Sargant acknowledged five deaths, but there may well have been more, and those who failed to improve were often shipped off for lobotomizing before transferring as long-stay patients to a variety of mental hospitals.

¤

Stock makes the obvious comparison between Sargant’s work and the career of Ewen Cameron, the first chairman of the Department of Psychiatry at McGill University in Montreal. Cameron’s “depatterning” therapy involved the use of massive amounts of ECT designed to reduce the patient to a state of complete mental confusion and physical collapse, augmented and facilitated by insulin comas and prolonged narcosis. Left incontinent and unable to walk, talk, or feed themselves, his patients were allegedly then resocialized to become “normal” citizens—except that most were destroyed mentally and physically by what they had endured. Stock spends a good deal of time rehearsing Cameron’s chilling experiments—not unreasonably, given their close overlap with Sargant’s activities and given the friendship between the two men. His discussion here is hampered somewhat by Sargant having purged as many references to Cameron from his papers as he plausibly could. But there are enough materials preserved in American archives, together with records of the two men’s mutual back-scratching, to amply attest to their close collaboration. It was Sargant who wrote Cameron’s obituary in The British Medical Journal, describing his friend as having “helped hundreds and hundreds of patients, both personally and through those he had inspired and taught.”

Cameron’s ties to the CIA and its so-called MKUltra program have already received considerable publicity (and led to lawsuits against both the CIA and the Canadian government). His title notwithstanding, Stock devotes what many readers may consider an excessive amount of space to speculation on Sargant’s possible employment by the CIA and the British secret service. A great deal of circumstantial evidence suggests he may have indeed worked for them—but in the end, the usual official silence that surrounds the spooks leaves us with the Scottish verdict of not proven.

In many ways, Stock’s book is a powerful and well-researched account of Sargant’s depredations. But I thought he missed an opportunity to excavate more profoundly how this awful man came to dominate British psychiatry from the end of the war into the 1970s. Stock leaves the larger professional and cultural environment in which Sargant operated almost wholly unexplored. That so many of Sargant’s victims were women reflects the misogyny that gripped much of the male-dominated profession in these years. That is an obvious point, but it lies latent rather than being directly explored. The author’s strange reluctance to raise this topic is amplified by brief allusions to Sargant’s possible rape and sexual exploitation of his patients, which surely deserves more than passing mention.

It would likewise have been helpful to note that leading lights in British psychiatry reacted with fury when a relatively junior doctor suggested—rightly—that insulin coma therapy’s usefulness was a myth. Their reaction underscores the depth of their profession’s attachment to physical treatments for mental illness. Finally, it is important to emphasize that Sargant was anything but a marginal figure—as should be obvious from the fact that the co-author of his book on physical treatments in psychiatry, Eliot Slater, was also co-author of the standard textbook to which all neophyte psychiatrists were directed between the 1950s and 1970s, not to mention editor of The British Journal of Psychiatry from 1961 to 1972. That does not diminish but rather amplifies the importance of the story Stock tells. It is a great pity that this larger context goes unacknowledged and unexplored.

Long after lobotomy and insulin comas had been recognized as ineffective and barbaric, Sargant (like Slater) was still recommending and making use of them. He was not even particularly discreet. In his best-selling 1967 autobiography The Unquiet Mind, he tells of a woman who came to him in despair, her life made unbearable by being married to what he concluded was a “sociopathic” husband. Sargant’s prescription for her? Since she was trapped in a miserable situation and her husband’s sociopathy was incurable, she should have a lobotomy. That would make her “indifferent” to her husband’s mistreatment.

Apparently, Sargant thought there was nothing untoward about recommending such a “therapy.” To my knowledge, this prescription drew no professional reproof. More broadly, Sargant’s use of deep sleep therapy and psychic driving (in which patients are subjected to an endlessly repeated audiotape loop to alter their behavior), and his lack of concern about patient consent or the damage he was cavalierly inflicting, went unremarked on and uncontrolled during his lifetime. Indeed, his and Slater’s textbook on physical treatments in psychiatry continued to evangelize for these interventions more than a decade after they had been thoroughly discredited. At their deaths, both men were lionized for their contributions to psychiatry. For decades afterward, those who served under them remained silent.

What does that tell us about their profession? That it does an appalling job of guarding against the dangers of enthusiasm and the exploitation of desperate patients and their families.