The Sleep Room is an important book that should be read by psychiatrists, and if this is not possible, they should at least be aware of its contents.

The book describes an account of the treatments administered 50 to 60 years ago at St Thomas’ Hospital in London by a well-known psychiatrist, William Sargant. Following the end of the Second World War, at Belmont Hospital, Sargant had treated soldiers with acute shell shock, what we would now call post-traumatic stress disorder, by giving them sodium amytal in large doses. On recovery some patients were able to describe the horrific circumstances they had witnessed and by doing so they improved radically. This led Sargant to induce sleep in very distressed patients by giving them large doses of barbiturates and chlorpromazine, a process termed narcosis. Subsequently he ensured that patients were woken four times every 24 h, termed modified narcosis.

These treatments were carried out at an outpost of St Thomas’ Hospital, over which Sargant had complete control. At that time consent procedures for treatment had not been firmly established and patients were simply told that they would be put to sleep and treatment would then be implemented.

Six chapters in the book are concerned entirely with the accounts of patients who were treated in the Sleep Room by Sargant. Their memories of the treatment were universally unpleasant but in most cases are not revealing. As the patients were kept asleep for 24 h a day they were able to recall very little. The records of treatment were not available to the author and so we do not know exactly what treatments they received. We do know that electroconvulsive therapy (ECT) was given many times to virtually all these patients as well as narcosis. The patients were told that if they did not respond to these treatments they would be considered for leucotomy.

Although the procedures in the Sleep Room are described in detail, there are 36 chapters in all and the book is inappropriately titled. Most of the content is a biography of Sargant, from his birth to a wealthy Methodist family, a rugby scholarship at St Mary’s Hospital and his desire to be a prominent physician, which was thwarted when he had a likely nervous breakdown in 1933. Following recovery he decided to specialise in psychiatry, and he cemented his desire to carry out heroic treatments after working at Belmont Hospital.

He was a handsome but vain man and had no bedside manner, although some patients adored him. He simply told those under his care what treatment he was going to give them and ignored questions from his patients. Most of the patients whom he treated in the Sleep Room were young females and their accounts in this book strongly suggest he seduced some of them. I can confirm that he had an eye for young women as the only time I met him I was with a girlfriend whom he immediately quizzed without acknowledging me.

This book illustrates the profound changes that have occurred in psychiatry in the last 50 years. The nature of therapies is now explained and consent to treatment is required. This book warns us of the dangers when doctors are allowed unfettered access to novel and dangerous procedures without agreement.