The Sleep Room

by F. R. Tallis

  Jane pressed her palms together beneath her chin, as if in prayer, and I noticed that she was wearing a wedding ring. I could smell her perfume. It was Chanel No 5.

  ‘James,’ said Maitland. ‘Wake up. Wake up. Your wife is here to see you.’ But I could not respond. My tongue was stuck to the roof of my mouth.

  ‘What happened to his hand?’ Jane asked.

  ‘An accident, I’m afraid,’ Maitland replied. ‘One of the trainee nurses was careless and he slipped over. The cut was quite deep. I’ll get one of the nightingales to change the dressing this afternoon.’

  Their eyes met. Maitland’s brow creased and his expression communicated deep concern. But the longer they looked at each other the more I detected other registers of feeling. Tenderness, self-interest, guilt and desire.

  ‘James?’ said Jane, rocking me gently again. ‘It’s me.’

  Maitland stepped to the end of the bed and examined a chart. ‘I’m sorry. He’s only just been medicated.’

  ‘I should have let you know I was coming.’ She bent her knees and lowered herself to my level. ‘James? Can you hear me?’ I wanted to reply, but my eyelids felt heavy and closed over my pupils.

  ‘He’ll be like this for some time.’

  ‘I should have called,’ Jane repeated.

  ‘It’s all right. I wanted to see you anyway.’ There was a long pause. ‘Have you decided?’ Maitland’s voice contained a suggestion of eagerness. Hope?

  ‘You’re right, of course,’ Jane replied, obliquely.

  Maitland made a noise, a sudden release of breath that I was sure – if only I could have seen his face – must be accompanied by a smile of satisfaction. ‘It’s for the best. You can’t . . .’ He hesitated, and Jane finished his sentence for him: ‘Go on. Yes. I can see that now.’

  ‘Shall we go to my office? There are some papers you should sign.’ When Maitland spoke again, he sounded less confident. ‘Although, you don’t have to do the paperwork right now. If you want to spend some time with him, on your own I mean—’

  ‘No,’ Jane cut in. Then, more firmly: ‘No. That won’t be necessary. I have many faults, but hypocrisy isn’t one of them.’

  Maitland lowered his voice to a whisper. ‘Jane. Not here.’

  ‘I’m sorry,’ she replied. ‘It’s just, sometimes . . .’

  ‘You don’t have to explain. Really. Come on. Let’s go to my office.’

  I could hear Jane’s wooden beads rattling as she moved away. With considerable effort, I was able to raise my eyelids again. Jane was wearing trousers that were very wide at the bottom. Maitland’s arm was extended, horizontally, behind her. It would have been an innocent gesture – and one much favoured by paternal physicians – had his fingers not made contact with her waist. Jane did not protest, and the last thing I saw was the nurse’s private scowl of disapproval.

  When I surfaced from the dream, it was as though I had been drowning. I awoke, gasping for air, and kicking wildly. It was some time before I calmed down.

  I sat up in bed and lit a cigarette. Through the net curtains I could see the sulphurous luminescence of a street light. I remembered Chapman’s Chinese conundrum: ‘A man dreams that he is a butterfly, and in the dream he has no knowledge of his life as a human being. When he wakes up, he asks himself two questions: am I a man, who has just dreamed that he was a butterfly? Or am I really a butterfly, now dreaming that I am a man?’ I pinched myself. And then I pinched myself again.

  Dr Hugh Maitland

  Department of Psychological Medicine

  St Thomas’s Hospital

  London SE1

  12th December 1972

  Dr Peter Bevington

  Oak Lodge

  Nr Biggleswade

  Bedfordshire

  Dear Peter,

  You will forgive, I hope, some lapses of formality in a communication that for all intents and purposes must serve as a letter of referral. But it concerns an individual with whom I have worked closely for two years: my senior registrar, James Richardson. I believe you met him on two occasions, once at the club, and once again when you were visiting our department.

  He was, I am sure you will recall, a serious minded and able fellow. Unfortunately, he is now very ill. I have always enjoyed close, almost familial relationships with junior colleagues, and Richardson is no exception: therefore, I find it incredibly hard to write with detachment about an impressive young man who until very recently had everything to live for and now faces an uncertain and very questionable future. Nevertheless, I will endeavour, as best I can, to set out the salient facts.

  Richardson comes from a medical family. His father was the Superintendent of Wyldehope, an asylum on the Suffolk coast. I don’t believe it is there any more, not even the building, as it was apparently destroyed by fire. Richardson senior died when James was a boy, and an uncle – the proprietor of a haulage business in Lowestoft – was kind enough to provide the widow and her son with an allowance. Richardson distinguished himself at Cambridge, first as a Rugby Blue, and then as an outstanding member of his college chess team. He went on to conduct some very interesting sleep research in Edinburgh, and just prior to his appointment, here, at St Thomas’s, he was at St George’s and the Royal Free.

  About ten months ago, James started to experience episodes of agitated depression. These episodes became increasingly frequent and, over time, were complicated by attacks of morbid sexual jealousy (which is perhaps best understood, I believe, as an atypical instance of paranoia). Apart from being a little less talkative than usual, I can’t say that I noticed anything amiss. He was rather good at concealing his agitation, and, as for his jealousy, there was no reason, one supposes, why this should have surfaced in the workplace. I only learned of his deteriorating health when his wife, Jane Richardson (a nurse at the Royal Free), wrote to me in confidence. She is a very conscientious type and was worried about the welfare of the patients in her husband’s care. It must have been extremely difficult for her to compose such a letter – to go against the grain of spousal loyalty, especially for a woman – and I am much indebted to her. We arranged to meet the following week and she explained that Richardson’s behaviour was becoming increasingly odd at home. He was restless, irritable, and prone to angry outbursts. He was interrogating her for hours (especially when she returned home late) and rummaging through her possessions. She even caught him inspecting her undergarments and the bed sheets for signs that might confirm her alleged infidelity. I felt sorry for her. She had obviously been coping with an extremely trying situation and had had little or no opportunity to unburden herself. I assured her that she had taken the correct course of action and immediately had a frank talk with Richardson. I insisted that he should take some time off work, which he accepted, rather reluctantly, and he voiced no objection when I said that I was willing to advise with respect to medication.

  I put him on the usual phenothiazine derivatives, but he was troubled by a number of side effects: low blood pressure, blurred vision, constipation, and pyrexia – to name but a few (all the regimens are detailed in his records). The fact is, I had a great deal of trouble finding anything that he was able to tolerate, and in the end I had to resort to Reserpine (3 mg by mouth, 5 mg intramuscularly). Even then, he still complained of constant headaches and nasal congestion.

  I continued to meet with Jane Richardson on a regular basis. Although the Reserpine had had a beneficial effect, the agitated depression and morbid sexual jealousy returned after only three weeks. Poor Mrs Richardson was, by this time, very distraught. Indeed, I began to have very grave concerns for her own mental health. They (that is, Jane and James) had only recently purchased a mansion house flat in Hampstead and the joint mortgage was substantial. Jane was having to work additional shifts to earn more money, but her extended periods of absence were, predictably, making Richardson even more suspicious.

  Things came to a head in September. Richardson became fixed on the idea that he must make his wife pregnant in order t
o save their marriage. Needless to say, Mrs Richardson did not agree. She resisted her husband’s advances but this only seemed to inflame his ardour, and on one occasion, when Jane returned in the early hours of the morning, he attempted to force himself upon her. It was all very unfortunate. I admitted Richardson onto Ward 5 at the Royal Waterloo Hospital a few days later. Narcosis was an attractive treatment option, because I was able to medicate him properly, irrespective of side-effects, and give him a course of 16 ECT. So far, I am sorry to report, there has been no change. His condition remains intractable. When awake, he sometimes refers to the child that he and his wife never had as if it were real.

  Mrs Richardson and I have discussed the current situation at length, and she agrees with me that it would now be better for James if he were transferred to Oak Lodge. Your lovely gardens, with their views of the low rolling hills of Bedfordshire, are as good a place as any to convalesce. And if James does not recover, I can rest assured that you and your team of excellent nurses will look after him.

  I am convinced that the removal of Richardson to Oak Lodge will also be good for Mrs Richardson. Her husband’s presence, here, in London, is a constant reminder of what must have been a very traumatic period in her life. Moreover, a misplaced sense of duty obliges her to make frequent visits to Ward 5 – but these visits only make her upset. I do not think the marriage has any future and if James is taken to Oak Lodge I am sure that Mrs Richardson will be able to think more clearly about making a new start. What has happened to Richardson is bad enough. It would be unconscionable to allow his wife to suffer a similar fate. That really would be a tragedy.

  I have taken the liberty of completing some preliminary paperwork that you will find enclosed. Please feel free to give me a call if you have any questions.

  Yours Sincerely,

  Hugh

  Dr Hugh Maitland

  M.A., M.B.(Cantab.), F.R.C.P, F.R.C.Psych.

  Physician in Charge of the Department of Psychological Medicine and Lecturer in the Medical School, St Thomas’s Hospital.

  Sources and Acknowledgements

  I would like to thank Wayne Brookes, Catherine Richards, Clare Alexander, Dr David Veale, Steve Matthews and Nicola Fox for their comments on the first and subsequent drafts of The Sleep Room and Lorraine Green for some impressive proofreading. I would also like to thank: Philip Loring (Science Museum) for answering many questions about electroconvulsive therapy, but particularly about the operation of the model R1135 ECT machine, which was used in a Suffolk asylum between 1945 and 1960; Francis Maunze (Royal College of Psychiatrists) and Professor Malcolm Lader, for answering questions about the qualifications required to practise psychiatry in the 1950s; the Royal College of GPs archivists (and an anonymous veteran GP) for answering questions on the composition and layout of referral letters in the 1950s; Dr Diana Dixon (Southwold Museum) for answering questions on the condition of the Southwold pier in 1955; Peter Homan (Royal Pharmaceutical Society) for providing information about Reserpine and its uses in the late 1960s and early 1970s; Wendy Fox for answering questions on the everyday use of the BNF and the British Pharmacopoeia in the 1950s and 1960s; and Dr Naomi Fersht for sending me an extremely useful academic paper on the characteristics of sleep in disorders of consciousness.

  Concerning the plausibility of whether a consultant in psychiatry would take on his or her senior registrar as a patient – and whether or not this would be permitted – I’ve actually seen this happen. At the time, the propriety of such a peculiar arrangement was never questioned or debated.

  The character of Hugh Maitland is based on the psychiatrist William Sargant (1907–1988). It was not my intention to introduce the real William Sargant into my story; however, Sargant provided me with a near perfect model for Maitland and I have made extensive use of Sargant’s autobiography, The Unquiet Mind, and his book on brainwashing and indoctrination for the general reader, Battle for the Mind. The sleep-room procedures and drug regimens are authentic and taken from An introduction to Physical Methods of Treatment in Psychiatry (5th edition) by William Sargant and Eliot Slater.

  Sargant was a major figure in British psychiatry, who promoted ‘somatic’ treatments for ‘psychological’ problems. These included chemical sedation and stimulation, excitatory abreaction, brain surgery, insulin shock, electroconvulsive therapy (ECT) and narcosis (deep-sleep therapy). Sargant’s most controversial treatment project was undertaken in Ward 5 of the Royal Waterloo Hospital, otherwise known as ‘the sleep room’. Remarkably, given the rise of the anti-psychiatry movement in the 1960s, it was still operating in the early 1970s.

  Some sources suggest that Sargant’s activities at the Royal Waterloo Hospital were connected with a larger programme of research into brainwashing ultimately sponsored by the CIA (see Brainwash: The Secret History of Mind Control by Dominic Streatfeild for an evaluation of the evidence). Although Sargant’s links with the CIA are doubtful, he certainly worked for MI5. According to one intelligence historian, Sargant was MI5’s ‘in-house psychiatrist’. Interestingly, there are no records of the patients treated in Ward 5. Sargant removed and destroyed all the relevant files before his retirement.

  Maitland’s speech to James Richardson about physical illness, mental illness, and suicide is based on one of Lord Owen’s recollections of Sargant. As Dr David Owen, Lord Owen worked with Sargant in the 1960s. The original quotation can be found in Brainwash.

  Sargant was a larger-than-life character who we can easily demonize. Professor Malcolm Lader, a very distinguished and respectable member of the British medical establishment, is on record as having said, ‘There was a whiff of sulphur about him.’ Moreover, Sargant’s book Battle for the Mind is alleged to be a firm favourite at Al Qaeda training camps. In actuality, Sargant was one of many psychiatrists who believed that mental illnesses have a biological basis and should be treated with interventions that affect the brain directly. Today, Sargant’s methods appear crude and barbaric; however, psychiatry is a notoriously fickle discipline. Different approaches become fashionable and unfashionable in cycles. Recently, for example, persuasive arguments have been made for the more widespread use of ECT, which has hitherto been in decline for many decades (see Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness by Edward Shorter and David Healy). It is quite possible that at some time in the future, Sargant’s reputation as a ‘brilliant’ doctor and scientific visionary will be restored. At present, however, a positive revision of Sargant’s contribution to medicine seems a distant prospect.

  In the end, it was the ‘couch merchants’ (or at least those who inherited the psychoanalytic legacy of curing by talking) who won the clinical ‘battle for the mind’. There are no longer any sleep rooms.

  F. R. TALLIS

  London, 2012

  A conversation with F. R. Tallis

  What inspired you to write The Sleep Room?

  The point at which I realized narcosis had fictional possibilities was shortly after listening to a BBC Radio 4 documentary called ‘Revealing the Mind Bender General’, made by the reporter James Maw and originally broadcast in 2009. It was a fascinating programme about controversial psychiatrist Dr William Sargant (1907–1988) and his advocacy of deep sleep therapy. I found the image of a darkened room in which patients were kept asleep for extended periods of time (weeks, sometimes months) both powerful and haunting. Prior to listening to James Maw’s programme, I had become interested in William Sargant after discovering a battered 1959 Pan paperback edition of his magnum opus Battle for the Mind in a second-hand book shop. My curiosity was aroused by the glowing reviews on the back cover supplied by luminaries such as Aldous Huxley and the philosopher Bertrand Russell. I was also intrigued by the enigmatic and sinister subtitle, ‘A Physiology of Conversion and Brainwashing.’

  The Sleep Room is set in a psychiatric hospital in the 1950s. How much research did you have to undertake as preparation for this novel?

  I am an avid student of the history of ps
ychiatry, so I didn’t have to do a great deal of general research; however, I was keen to get the specific details of deep sleep therapy correct. In order to achieve this I had to track down a copy of an old text book authored by William Sargant which contained detailed treatment instructions. I made such a close study of the relevant chapter that, if asked to, I could probably manage a sleep room. Another aspect of the novel that had to be carefully researched was the location of the hospital. When I write, a sense of place is very important to me. I drove around Suffolk looking for a precise position where sea, reed beds and heathland meet. Dunwich Heath was perfect. I am sure that at the back of my mind I was also trying to identify The Sleep Room with some august literary predecessors. The Suffolk coast is strongly associated with the classic ghost stories of M. R. James and the name Dunwich comes with its own pleasing Lovecraftian resonances.

  Before writing fiction you were a clinical psychologist. How has your work as a psychologist influenced your writing?

  Virtually every aspect of my writing has been influenced by psychology. Firstly, I tend to favour clinical settings. For example, I have written a six-volume series of psychoanalytic detective thrillers set in Freud’s Vienna. Without an appreciation of Freudian theory and my experience as a practitioner I could never have written them. Secondly, a lot of my work blurs the boundary between imagination and reality. Sometimes I make it clear to the reader what is happening, but not always. For example, my novel The Forbidden can be read as a supernatural adventure, or the fantastic imaginings of a nineteenth-century French neurologist. This second reading removes the novel from the horror genre and makes it, instead, a kind of literary case study. There are no obvious clues in the text with respect to the second interpretation. Stanley Kubrick (my favourite director) did much the same in his film Eyes Wide Shut. It is an exploration of a marriage in crisis observed through the murky medium of the unconscious; however, Kubrick doesn’t employ a single cinematic device to signal departures from reality. In many respects, I don’t see myself as a former clinical psychologist but, rather, as a clinical psychologist now working in a different context.