Thomas A. Ban: The Ewen Cameron Story
Edward Shorter’s comments
Ewen Cameron: Scientist or Monster?
It would be hard to think of a psychiatrist, with the possible exception of the Nazi concentration camp doctors, who has been more vilified in the media than Ewen Cameron, chair of psychiatry at McGill University from 1943 to 1964.
Few phrases quicken the journalists’ pulse more than “psychiatric experimentation” or “massive amounts of LSD.” Best of all is “CIA-sponsored.” On the basis of such trigger phrases, Cameron’s reputation was destroyed, the reputation of the Allan Memorial Institute blackened for years and waves of successful litigation launched on behalf of former patients. A typical example: “He experimented on his human guinea pigs with various paralytic drugs, as well as electroconvulsive therapy at 30 to 40 times the normal power. His ‘driving’ experiments consisted of putting subjects into a drug-induced coma for weeks at a time (up to three months in one case), while playing tape loops of noise or simple repetitive statements. His experiments were typically carried out on patients who had entered the institute for minor problems, such as anxiety disorders and postpartum depression. Many suffered permanent damage from his actions. His treatments resulted in victims’ incontinence, amnesia, forgetting how to talk, forgetting their parents and thinking their interrogators were their parents.”(i) While only parts of the statement are absolutely false, the spin is towards “Dr. Strangelove” and against psychiatry and its lust for “experimentation.”
These journalistic images of reckless experimentation are difficult to reconcile with Cameron’s ascent over the years to international recognition. Born in Scotland in 1901, he graduated MB from Glasgow University in 1924 (MD Glasgow in 1936). He trained in psychiatry at the Phipps Clinic at Johns Hopkins University under Adolf Meyer and at the Zurich Cantonal Psychiatric Hospital under Eugen Bleuler. After some peregrinations he ended up in 1936 as director of research at the Neuroendocrine Research Foundation of the Worcester State Hospital in Massachusetts where he and Hudson Hoagland studied the use of insulin coma therapy (Hoagland 1967). From the group’s treatment of the first 17 cases emerged a largely favorable opinion (Cameron and Hoskins 1937). It may well have been here that Cameron acquired an appreciation for physical interventions in psychiatry. There was certainly nothing reckless or “experimental” about this work (although he had used the word “Experimental” in the title of an earlier handbook [Cameron 1935]) In 1938, he became professor of psychiatry and neurology at the Albany Medical School and in 1943 came to McGill University as director of the Allan Memorial Institute. (He was the first director of psychiatry at McGill and the Royal Victoria Hospital).
In Montreal, he blossomed. As RA Cleghorn pointed out in a 1967 obituary: “The Allan Memorial Institute was the first psychiatric division of a general hospital to be opened in Quebec and the first in Canada to be opened on an ‘open door’ basis.” Here Cameron established in 1946 what is thought to be the first day-care hospital in the world (Cameron 1956). At the Third World Congress of Psychiatry, which Cameron brought to Montreal in 1961, he established the World Psychiatric Association and served as its first president. He was also president of the American Psychiatric Association. It would be fair to say that no other Canadian psychiatrist ever achieved this measure of distinction.
In therapeutic terms, Cameron was not some kind of driven physicalist but was quite mindful of the need for psychotherapy. In treating anxiety, for example, he said: “The first principle is listening” (Cameron 1954). On another occasion he came out on behalf of screening young people for illnesses such as schizophrenia: “It is simply an extension of the ideals of preventive medicine. It is not the principle which is new but its application to the field of mental health” (Cameron 1954).
What history remembers him for, however, is not the day hospital or the psychotherapeutic treatment of anxiety but “the depatterning treatment of schizophrenia” and the techniques used in the eradication of previous pathological memories. At first, the researchers investigated the use of intensive electroshock in order to regress patients back to their patterns of childhood (and it is this that aroused so much outraged comment). Then they abandoned this tactic in favor of inducing some kind of “disturbance in the space-time image.” This depatterning was achieved through rapid, successive electroshocks while the patient was in a condition of “continuous sleep.” In 30 patients, they gave an average of 66 electroshocks per patient (Cameron, Lohrenz and Handcock 1962).
Of course, even the most noted scholars can make grievous therapeutic mistakes. Distinction does not necessarily safeguard against error. Yet, were his therapeutic decisions arround “psychic driving” entirely erroneous? There was some justification in the literature for the components of depatterning, although the concept itself was Cameron’s.
In 1948 “regressive” ECT was introduced at Kings Park State Hospital in New Yortk, involving two to four convulsions a day. Paul Blachly’s 1966 term “multiple monitored electroconvulsive treatment” (MECT) has survived, and is done ethically and successfully today (Shorter and Healy 1997). So Cameron did have models for the use of a series of shocks to draw upon, although few approaches have been as extreme as his.
As for “sleep therapy,” in which the duration of the sleeps lasts days and even weeks, there were models aplenty to draw upon going back to the turn of the century. “Deep sleep” was the major treatmemnt of schizophrenia before the introduction of insulin coma in the 1930s (Shorter 1997). I am not aware of any previous work combining sleep therapy and ECT. But the point is that the components of the treatment were well established in the literature.
In retrospect, after the storms had broken and Cameron had been driven from Montreal in 1964, a number of colleagues found grievous fault in his work. Heinz Lehmann, who from his perch at the Douglas Hospital had passing professional relations with Cameron, found his work “ludicrously simplistic.” (But Lehmann [1996] had no ethical problems with it.) George Simpson, who as a young Scottish physician trained in psychiatry at Cameron’s institute, said: “He was a terrible researcher . . . He was very innovative and energetic but he just had wild ideas – naïve and simplistic.” Of the CIA-sponsored research, Simpson called it “just awful… Some of it was bizarre. I remember a woman who should have worn a helmet with a radio receiver in the ear, transmitting, ‘I like peopkle, people like me.’ When I came in to see her one day, she was sitting on the bed, soaked in urine with her foot in the helmet, which was still going on making pronoucements (Simpson 1996).” This does not, it must be said, sound like the acme of science, although whether it adds up to the terrible trauma that supposedly remained with patients their life long is another matter.
Several observers have remarked that Cameron’s research was uncontrolled. Yet before the Kefauver-Harris legislation of the US Congress in 1962, controlled research was unusual in psychiatry.
As stated, these negative assessments were all made post facto, after the balloon had gone up. The clinicians of the time didn’t seem all that upset. Regarding the drugs, the barbiturates were launched in 1903 and used in Cameron’s time as widely as the SSRIs today. In the early 1960s, LSD was still seen as having therapeutic applications in the treatment of alcoholism and in psychotherapy. So treatment with these agents seemed de trop only to later generations.
Yet, some of Cameron’s former patients believed they had been injured by the barbiturates and LSD that Cameron had administered in his research. Facing litigation, in 1979 the Central Intelligence Agency, which had sponsored some of this research, asked the FDA what might be the long-term effects of some of these drugs? J. Richard Crout, director of the Bureau of Drugs at FDA pooh-poohed the risks: “Since most of these drugs are marketed products, and have been for many years, the probability of drug related injuries seems low.” Crout thought that follow-up studies of the patients were probably a waste of time: “It is quite inconsistent to recommend such follow-up for patients involved in research studies when the same drugs are prescribed every day to patients as part of the practice of medicine and have been for many years” (Crout 1979). (Nonetheless, in subsequent litigation, patients were able to collect substantial sums of money.)
One doesn’t know what to make of all these complaints that emerged in litigation. In court, it is often difficult to disentangle the effects of a chronic illness from the side effects of treatment. Such issues have not troubled the journalistic indictments of Cameron as a monster.(ii) Yet, Tom Ban’s judgment was: “”He succeeded on his own in creating the leading department of psychiatry in Canada, a department which was at that time one of the best in the world. No one in those years would have denied that Cameron was a great man” (Ban 1996). We thus have the historical record of Cameron’s accomplishments and his colleagues’ appreciation of the work of this international figure, set against the horror of a later generation at the idea of “CIA-sponsored experiments” and “brainwashing.” Is it time to redeem.
References:
Ban TA. Interview. In: David Healy, editor. The Psychopharmacologists. 1996. London: Chapman and Hal.
Cameron DE. Objective and Experimental Psychiatry. 1935. New York, NY, US: MacMillan Co.
Cameron DE, Hoskins RG. Experiences in the Insulin-Hypoglycemia Treatment of Schizophrenia. JAMA, 1937; 109:1246-49.
Cameron DE. The Recognition and Treatment of Anxiety States. Postgraduate Medicine. 1954; 15:134-138.
Cameron DE. The Day Hospital. In AE Bennett et al., editors., The Practice of Psychiatry in General Hospitals. Berkeley: University of California Press. 1956; 134-150.
Cameron DE, Lohrenz JG, Handcock KA. The Depatterning Treatment of Schizophrenia. Comprehensive Psychiatry, 1962; 3:65-76
Cleghorn RA. D Ewen Cameron: Obituary. Canadian Medical Association Journal, 1967; 97, 985-986.
Crout JR. Memo to The Commissioner [Herbert L Ley, Jr.,]. US Federal Archives, General Subject Files, 1979.
Hoagland H. Donald Ewen Cameron Obituary. Recent Advacnes in Biological Psychiatry, 1967; 10, 221-222.
Lehmann H. Interview. In: David Healy, editor. The Psychopharmacologists. 1996. London: Chapman and Hal.
Shorter E, Healy D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. 1997. New Brunswick: Rutgers University Press. pp. 136-141.
Shorter E. A History of Psychiatry. 1997. New York: Wiley. pp. 200-207.
Simpson G. Interview. In: David Healy, editor. The Psychopharmacologists. 1996. London: Chapman and Hal.
August 29, 2019
(i)http://www.renegadetribune.com/mkultra-scientist-ewen-cameron-prize-subject-rudolf-hess/
(ii) Typical is Virginia McClaughry, “Donald Ewen Cameron: A Man for Whom There is no ‘Positive’ Side,” https://mikemcclaughry.wordpress.com/the-reading-library/specific-persons/donald-ewen-cameron/