Ewen Cameron and The Allan Memorial Psychiatric Institute: A Study in Research and Treatment Ethics
Simon Fraser University
"Psychic driving is a potent procedure - it invariably produces responses in the patient,
and often intense responses" (Cameron, 1956, p. 508)
With these words, Dr. Ewen Cameron began the summary to Psychic Driving, the paper that introduced his treatment of the same name to the world. Cameron�s remark was a drastic understatement; for the psychiatric patients at the Allan Memorial Psychiatric Institute, whom he treated with psychic driving and its adjuncts, had their lives were changed forever. This paper will provide background about went on at the Allan Memorial Institute in the 1950s and 1960s, as Dr. Cameron performed brainwashing experiments that were funded by the American CIA. I will examine Cameron�s use of electroconvulsive therapy (ECT) along with psychic driving, in a historical context, in an attempt to understand why he went to the extremes that he did. Finally, I will look at attitudes toward mental patients - lest they be forgotten among all this - and how these attitudes have changed in the last 30 to 40 years. In doing so, I will examine the thin line between research and experimentation.
As an aside, on the surface it may not appear that this topic relates to the history of psychology in Canada. Dr. Cameron was a psychiatrist, and the Allan Memorial was a psychiatric institution. Cameron, himself, was not even a Canadian; he was born in Scotland and later immigrated to the United States. Despite working for 28 years in Canada, he never became Canadian and even maintained his residence south of the border in Lake Placid, New York (Collins, 1988). However, this topic bears on the discussion of the history of psychology in Canada because it looks at how modes of treatment have changed, how attitudes toward patients have changed, and, most importantly, because it was Canadians who were affected by what went on at the Allan Memorial.
Psychic Driving, Ewen Cameron, and the Allan Memorial Psychiatric Institute
Dr. Ewen Cameron was a very well known psychiatrist who worked for 21 years at the Allan Memorial Psychiatric Institute in Montreal, Quebec. He was highly esteemed among his colleagues and his peers; Gillmor (1987) suggests that Cameron was, when he died in 1967, "one of the most respected psychiatrists in the world" (p.1). At different times, he was head of the Quebec, Canadian, and American Psychiatric Associations, and he was a co-founder and the first president of the World Psychiatric Association (Gillmor, 1987). He became the head of the Allan Memorial upon its opening in 1944, and made it famous for his stance that "no doors in the Allan would be locked . . . [for] even if one ward was locked, society would judge the institution by that ward" (Gillmor, 1987, p. 1). He believed that "madness" - his own term - was something that needed to be treated rather than feared, and that patients could not be locked up if they were to realize that they still belonged to society (Collins, 1988). Cameron, then, was very humane in his treatment of patients - at least early on - and, as we shall see later, very progressive in his views regarding the mentally ill, both when compared to other members of society and other health professionals.
Cameron was an ambitious man. As Collins (1988) points out, he saw what was going on with the soldiers who were returning from the Second World War, and he wanted to be able to ease the stress and anxiety from which they were suffering. A loftier goal of Cameron�s was to conquer the process of aging. In time, he set up different research programs at the Allan Memorial. Of special interest to Cameron was the idea of sleep teaching. He had been in correspondence with Max Sherover, an American who had conquered his patients nail-biting habits by continuously playing a tape recording to them while they slept (Collins, 1988). Cameron began to experiment with the idea himself. He would, during a normal therapy session, record what he thought was a key statement that one of his patients had made (Gillmor, 1987). Later, Cameron would replay the statement repeatedly to the patient, in an attempt to break down the patient�s defense mechanisms and reach deeper material. Over time, Cameron developed this technique into a therapy that he called psychic driving. He introduced his form of therapy in a paper published in the American Journal of Psychiatry in January, 1956. As he explained it, psychic driving allowed for "the penetration of defenses, the elicitation of hitherto inaccessible material, and setting up of a dynamic implant" (Cameron, 1956, p. 503) or recurring thought that influenced the patient�s behaviour even after playback of the key statement had been stopped for some time. Cameron also reported that at times, the patient resisted listening to the repetition of the statement; this was handled by administering sodium amytal, a disinhibitant or "truth drug" (Collins, 1988), or by exposing the patient to the repetition during a period of prolonged sleep (Cameron, 1956). In his article, Cameron also admits to using stimulant drugs and LSD - without the patients� consent - to disorganize the patient and thus allow the driving technique full access to the patient�s psyche. Collins (1988) explains that Cameron, keeping with the climate of the day, referred to his treatment as brainwashing; this term was en vogue in the 1950s, with the Cold War and Korean War fresh in everyone�s minds.
The term "brainwashing" caught the eye of members of the American Central Intelligence Agency (CIA). During the Korean War, 70% of the 7,190 American prisoners of war "either made confessions or signed petitions calling for an end to the American presence in Asia" (Gillmor, 1987, p. 78), and the CIA believed that the only possible explanation for this was that the Chinese had brainwashed the American prisoners. As such, the CIA wanted to study brainwashing. Rather than directly fund research, the CIA funded cover organizations who would not be scrutinized as the CIA would be (Collins, 1988). One of these cover organizations was the Society for the Investigation of Human Ecology (SIHE); this group funded Cameron�s research into psychic driving from 1957 to 1960 (Collins, 1988).
Cameron, meanwhile, was becoming increasingly extreme in his attempts to develop psychic driving into a successful therapeutic technique. Some patients were still able to resist the treatment, and consequently Cameron was not quite getting the results he wanted. He began using electroconvulsive therapy in association with psychic driving, and referred to this as "depatterning". His aim was to disorganize disturbed or resistant patients, to allow psychic driving to have its full effect. He believed that "you could regress patients, particularly schizophrenics, back to their infancy" (Gillmor, 1987, p. 56). This was done by administering ECT at much higher levels than it had ever been applied before. Under Cameron�s plan, patients received ECT "up to three times daily" (Gillmor, 1987, p. 56), and this pattern of treatment would continue for thirty days (Collins, 1988). After this, he would attempt to "repattern" his patients with psychic driving. However, by this point, the patient was often "unable to walk or feed himself, and [was] likely incontinent" (Gillmor, 1987, p. 56).
Despite the objections of some of his colleagues, Cameron carried on trying to perfect his psychic driving technique (Gillmor, 1987). In 1961, he lost the financial support of the SIHE, and by 1964, his treatments were beginning to prove useless. He himself referred to psychic driving as "a ten-year trip down the wrong road" (Gillmor, 1987, p. 136). He left the Allan Memorial later that same year.
Fifteen years later, a group of nine former patients at the Allan Memorial brought suit against the CIA for funding research that led to harm of the patients at the Allan (Collins, 1988). Their lawyer, American civil rights lobbyist Joseph Rauh, wanted to settle out of court because of the advanced age and declining health of his clients (Collins, 1988). However, the CIA was willing to neither settle nor negotiate. Rauh subsequently filed a formal complaint, requesting one million dollars per plaintiff. He then tried to get the Canadian government to support the plaintiffs in their suit against the CIA, [but] to no avail. During the filing of depositions, "CIA and U.S. Justice Department lawyers . . . were . . . stopping testimony where they could on the grounds that it might be damaging to national security" (Collins, 1988, p. 220-21). The Canadian government still would not help, passively saying they "couldn�t release any American-originated documents without the approval of its correspondent" (Collins, 1988, p. 221). The CIA offered a "nuisance settlement" of $25,000 per plaintiff, which was summarily refused. Finally, in 1988, the case went to trial. The lawsuit, however, was fruitless; the CIA never paid any money to any of the plaintiffs, nor did they issue an apology.
Cameron�s Use of Electroconvulsive Therapy
Cameron�s use of electroconvulsive therapy would likely be judged barbaric by the standards of today, as ECT is now used in a much more humane way than it was in the past. As Holmes (1997) explains, before ECT begins, the patient is administered both a strong sedative and a muscle relaxant. The purpose of the sedative is to ensure that the patient is unconscious when their convulsions begin and the purpose of the muscle relaxant is to reduce violent muscular contractions during the convulsion. Indeed, Holmes (1997) states that "[b]efore muscle relaxants were used, patients often broke bones during the convulsions" (p. 268). The strength of the electrical current that is used varies between 70 and 150 volts, and lasts from between 0.1 to one seconds. Treatment is usually administered three times a week, and if the patient has not responded within five to eight administrations of ECT, "it is usually concluded that ECT will not be effective, and it is stopped" (p. 270). Cameron, in contrast, administered much higher doses of ECT. Gillmor (1987) reports that Cameron had been overseeing use of ECT at the Allan Memorial since 1951, but he "�felt that a more forceful application of it might produce more impressive results" (p. 55). Rather than administering a single shock to the patient, he would shock the patient six times in rapid succession (Collins, 1988). He would apply this technique -known as a "Page-Russell", after its inventors - twice a day for thirty days in a typical attempt to depattern one of his patients. At times, patients would even receive three treatments a day (Gillmor, 1987). Cameron used a current of 150 volts, which lasted for one second. At the Allan Memorial, patients received anywhere from 30 to 150 treatments of ECT.
It is easy to see that Cameron was more extreme in his use of ECT than psychiatrists are today. However, to determine if Cameron was misguided in his use of ECT, we must compare how his contemporaries used ECT, and how ECT use changed after Cameron developed his technique. The most obvious difference between Cameron�s application and current use of ECT is the number of shocks administered. Page and Russell, two British doctors, had developed the afore-mentioned Page-Russell technique, in which patients received a series of shocks, each four seconds apart (Gillmor, 1987). Two American doctors, Kennedy and Ancell, also were testing the effects of multiple applications of ECT. Thus, Cameron was not alone in his repeated use of ECT. Page and Russell, however, only recommended daily administration of ECT, as did Kennedy and Ancell. Mukherjee, Sackeim, and Schnur (1994), in their review of 50 years of use of ECT, report that in the studies they looked at, "treatment frequency varied from twice weekly to a 5-days-per-week schedule" (p. 172). This is still a much lower rate of application than Cameron was using. As such, Cameron�s use of the treatment two or three times daily does appear extreme. In 1985, Public Health Reports advised that "[r]egressive ECT (administration of a large number of treatments during a short period . . . ) is �no longer an acceptable treatment� . . . and multiple-monitored ECT . . . has not been demonstrated to be sufficiently effective�" (p. 549).
Another consideration is the voltage used in the application of ECT. As Strain, Brunschwig, Duffy, Agle, Rosenbaum, and Bidder (1968) point out, "electrical parameters have been demonstrated to be a factor in memory loss" (p. 294). This is significant because many former patients at the Allan reported chronic memory loss (Collins, 1988). Cameron again, however, used a voltage comparable to that of Page and Russell (Gillmor, 1987), and even within the range currently used (Holmes, 1997). Frankel (1975) and Strain et al. (1968) both report use of the same voltage, with Strain and his associates administering the shock for two seconds instead of just one.
Overall, then, Cameron was not using a shock that was too severe for his patients to handle. Where he became extreme in his use of ECT was in the frequency of application. Even if he believed that a "more forceful application . . . might produce greater results" (Gillmor, 1987, p. 55), he should not have increased the number of applications so greatly in such a short period of time. I believe that this was unconscionable. It shows a complete lack of regard for the well being of his patients, and a lack of understanding of the treatment that he was using. Cameron can perhaps be forgiven for not knowing beforehand what the effects of his use of ECT would be; one of Cameron�s successors defended him, saying that "Cameron�s work must be viewed from a historical perspective and should not be judged in light of current ethical practices" (Robertson, cited in Gillmor, p. 139). However, Cameron should have been able to recognize the adverse effect that his ECT use was having on his patients, and he should have ceased what he was doing long before lack of funding forced him to do so.
At first, it seems perplexing that Cameron would have pushed ahead with treatment, in light of the adverse effects he must have been seeing in his patients. Still more intriguing is why Cameron would persist in developing the treatment against the objections of his colleagues at the Allan. Gillmor (1987) points out that most of Cameron�s staff did not approve of the way Cameron was using ECT. One doctor said that the
"problem . . . was that there was never enough money to set up a proper rehabilitation program. That would . . . interfere with Cameron�s �quick fix� solution. It would be less of a breakthrough . . . if patients required six months of [post-treatment] therapy" (Gillmor, 1987, p. 57).
In addition, Cameron�s fellow psychiatrists at the Allan did not approve of his treatment ideas (Gillmor). Collins (1988) explains why Cameron would push on in spite of all of this criticism; Cameron wanted to win a Nobel Prize for his research. Even Cameron�s son believes that Cameron was driven by this goal. I sincerely hope that this was not behind Cameron�s push to develop psychic driving and depatterning as a cure for schizophrenia. This does not seem to fit with the man who developed the open-door policy for his patients at the Allan. It is bad enough that his patients suffered severe memory loss, and were left as shells of their former selves. If this was the result of Cameron�s ignorance, at least we can say that Cameron was trying to cure them. However, if all of this is the result of Cameron�s quest for recognition and acclaim, then he has done a terrible injustice to the patients who were entrusted in his care, to other psychiatrists and psychologists who are to be scrutinized and distrusted more because of his actions, and to the Canadian public, who supported his work through government funding. If all of this happened because of his need for recognition, he cannot be called a humanitarian; rather, he could be said to show a complete lack of regard for mental patients and their care.
Attitudes Toward Mental Patients: Have They Changed?
If Cameron truly was more interested in achieving recognition than in caring for his patients, then he must not have had a very positive attitude towards mental patients. This can only be speculated - we cannot know for sure what Cameron�s motivating factors were. Perhaps we would not be surprised to find out that Cameron was driven by his ambition and had a negative attitude toward mental patients. However, we would be surprised to find out that his attitude did not differ greatly from that of society as a whole. Here we will look at whether attitudes toward mental patients have changed in the last 30 to 40 years - that is, whether such treatment could happen now - and try to delineate where research ends and treatment begins.
One would assume that Cameron must not have had a very high regard for his patients� rights if he was willing to inject them with LSD or administer repeated treatments of ECT. Morgan (1971) points out, however, that this fits with the attitude of Cameron�s time. Research ethics were previously not something one had to worry about; researchers were "�used to proceeding with their work without thinking or worrying about general ethical questions . . . [t]he usual rule has probably been: if you�re interested, investigate" (p. 276). The public would not have any objection to such treatment of mental patients; while Johannsen (1969) points out that the term "mental patient" can "�refer to anyone who has ever obtained help from a mental health professional." (p. 218), it is more often taken by the lay person to refer to an individual who has been admitted to a psychiatric hospital. Johannsen (1969) relates information regarding a study done by Cumming and Cumming in Canada in 1957, looking at attitudes toward the mentally ill. Rather than educating the public, the "experiment served . . . to solidify pre-existing attitudes of fear and defensiveness" (p. 219). In fact, every group Johannsen looked at - the public, general medical practitioners, employees in mental institutions, patients� relatives, employers, religious clergy, and political leaders - had negative attitudes toward mental patients. These negative attitudes ranged from "fear, distrust, and dislike" (p. 219) to an underestimation of "the seriousness of the constituent�s symptoms" (p. 222). Rabkin (1972) summarizes the problem nicely in stating that the "public tends to reject disturbed behaviour that is socially visible, even if it is not severe in terms of incapacitating effects on the patient" (p. 159).
Because such attitudes have been so prominent, research has been allowed that has ignored the rights of the individual. Morgan (1971) argues that this is because researchers working in hospitals were trained in a university setting. The emphasis in a university setting is to publish in scholarly journals, win research grants, and so on. When they transfer to the hospital setting, they take this "university mentality" with them. The researcher is faced with factors - such as the rights of individuals - which they are not accustomed to having to deal with. The result is that the patient�s rights are often ignored. Whether or not one believes that this is purposeful depends on how one views the academic system as it is set up. The scope of this paper is far too small to deal with this issue, but it is really no surprise that such a mindset has developed as a result of the academic ideal; that is, to publish.
There is some evidence that attitudes toward mental patients are changing. Waterman (1974) stresses that we must emphasize the rights of the individual, as "each [research] participant is a distinct individual entitled to the full protection of his rights" (p. 470). To value research findings above the individual, to state that "most subjects suffered no ill harm" is of no benefit to those who do suffer (Waterman, 1974) . Morgan (1971) points out that the individual must be regarded as an end, rather than a means to an end; the patient cannot be valued less than the research itself. This begs the question, where does research begin and treatment end? It seems obvious that Cameron�s work at the Allan Memorial was research; to call it treatment would be farcical, not to mention a complete disservice to all of the patients Cameron "treated". It would seem that treatment ends and research begins when the mental health professional / would-be-researcher values the research or experimentation more than the well being of the patient. Any time that the individual�s goal is to earn accolades, or win recognition, it is research. Research does need to be done; no science, including psychology, can progress without it. However, new treatments should not be developed if, during the development of treatment, the well being of those being experimented on is not given the greatest importance.
As mentioned, attitudes toward mental patients are changing, but not enough. Riverview, a psychiatric hospital in Coquitlam, B.C., has gone from having more than 4,000 beds in the 1960s to less than 800 at present (lecture, January 30, 1997), largely because of budgetary constraints. The public is often resistant to having former mental patients in their communities (Holmes, 1997); there is still a great deal of ignorance as to who "mental patients" are and what "mental illness" is, just as Johannsen (1969) described 30 years ago. What does all of this - the events at the Allan Memorial, the use of ECT, changing attitudes toward mental patients - mean for psychology? I think it means that psychology cannot really move forward as a discipline until it educates people as to what mental illness really is. So many people view mental illness as a sign of weakness, or an imperfection in the individual, when often (at times, at least) it is due to nothing more than a chemical imbalance in the brain. Without this type of education, it is conceivable that something similar to the events at the Allan could happen again.
Psychology also has to work at gaining back the trust of the public. Events like what went on at the Allan Memorial only make people critical and distrustful of psychologists. We need to educate the public as to what it is that we actually do now - and I hope that is, to try to help people - and work at gaining trust. Without trust, we will not have the support and cooperation of the public, and we cannot move forward as a discipline.
The events at the Allan Memorial Psychiatric Institute in the 1950s and 1960s set psychology back to its dark ages. As a discipline, psychology is still trying to work its way back into the trust of the public. Cameron said that "psychic driving [was] a potent procedure" (1956, p. 508); I do not think he realized just how potent it was. I believe, however, that if psychology can learn from Cameron�s mistakes, and if we can educate the public to the point that they understand mental illness and mental patients, then perhaps some good can come out of all this. It is unfortunate that it took the destruction of so many people�s lives for this to happen.
Cameron, E. (1956). Psychic driving. American Journal of Psychiatry, 112 (7), 502-09.
Collins, A. (1988). In the sleep room: The story of the CIA brainwashing experiments in Canada. Toronto: Lester & Orpen Dennys.
Electroconvulsive therapy useful in selected severe disorders, panel finds. (1985, Sept./Oct.). Public Health Reports, 100, 548-50.
Frankel, F. H. (1975). Reasoned discourse or a holy war: Postscript to a report on ECT. American Journal of Psychiatry, 132 (1), 77-79.
Gillmor, D. (1987). I swear by Apollo: Dr. Ewen Cameron and the CIA-brainwashing experiments. Montreal: Eden Press.
Holmes, D. S. (1997). Abnormal psychology (3rd ed.). New York: Longman.
Johannsen, W. J. (1969). Attitudes toward mental patients. Mental Hygiene, 53 (2), 218-28.
Morgan, J. (1971). Some reflections on the problems of research ethics. Ontario Psychologist, (5), 276-84.
Mukherjee, S., Sackiem, H. A., & Schnur, D. B. (1994, Fall). Electroconvulsive therapy of acute manic episodes: A review of 50 years� experience. American Journal of Psychiatry, 151, 169-76.
Rabkin, J. G. (1972). Opinions about mental illness: A review of the literature. Psychological Bulletin, 77 (3), 153-71.
Strain, J. J., Brunschwig, L., Duffy, J. P., Agle, D. P., Rosenbrum, A. L., & Bidden, T. G. (1968). Comparison of therapeutic effects and memory changes with bilateral and unilateral ECT. American Journal of Psychiatry, 125 (3), 294-304.
Waterman, A. S. (1974). The civil liberties of the participants in psychological research. American Psychologist, 29 (6), 470-71.