Chelmsford’s Legacy: Regulating Experimental Brain Interventions in the Public Interest (Abstract)

The former Chelmsford Private Hospital (this photograph from 1990). Source: The Daily Telegraph.

I paste below an abstract, with the above title, that I’ve recently submitted to the organisers of a neuroscience and society conference in Sydney. It combines two projects that I’m currently working on: the first, a paper on “the public interest” under the Health Practitioner Regulation National Law (NSW); and the second, a paper on the Chelmsford scandal from the perspective of the legislative and regulatory history of psychiatry and medicine in NSW in the ’60s through to the ’90s.

Barbiturate-induced deep sleep therapy (DST), electroconvulsive therapy, and cingulotractotomies to lesion the brain’s cingulate gyrus were among the many controversial brain interventions used, often in combination, by psychiatrist Harry Bailey and colleagues in Sydney’s Chelmsford Private Hospital from 1963 until the 1980s. Prompted by the Church of Scientology’s Citizen Commission on Human Rights, and later the NSW-based Public Interest Advocacy Centre, a Royal Commission into Bailey’s use of DST was established in 1988. Although Bailey committed suicide before giving evidence at the Commission, the resultant report found that the psychiatrist had been responsible for the deaths of more than 24 patients at Chelmsford, together with the suicides of another 19 previously under his care.

In this paper, I will briefly trace Bailey’s unethical misuse of various neuroscientific theories of the mind and brain he had learnt from, among others, Manfred Bleuler, the son of pioneering schizophrenia nosologist Eugen Bleuler, before detailing, in clear terms, the momentous regulatory changes that occurred in NSW after Chelmsford.

When reports of Bailey’s conduct reached authorities in the 1970s, the NSW regulator took no disciplinary action against the psychiatrist, finding that while the Medical Act 1938 proscribed “infamous conduct,” it did not allow interim orders against doctors for poor performance. Subsequent regulatory changes would transform the state’s approach to regulating health practitioners, leading to a new Medical Practice Act in 1992. Drawing on research recently commissioned by the NSW Medical Council on the public interest, this paper will show how regulatory reform after Chelmsford continues to shape health regulation today, including through public interest-based amendments recently made to the 2009 Health Practitioner Regulation National Law across all Commonwealth jurisdictions. Citing hypothetical and real examples, I will also explain what these important reforms mean for practising brain specialists who use or abuse novel experimental brain interventions, such as deep brain stimulation.

Update: A Report (in Progress) and Two Book Chapters

Well, it’s certainly been a long time since I’ve written anything here—almost 8 months, in fact. For that reason, I thought I’d better put together a quick update on my goings on. I am currently working on a report on the meaning of “public interest” for a NSW regulatory body; and I’m also finalising a chapter on Huxley and neuropsychiatry for a book that shall be published this year, presumably by Lit Verlag for their “Human Potentialities” series, edited by the German Huxley scholar Bernfried Nugel. (This special book in the series will be guest edited by Julian Piras and Dana Sawyer.)

I have also finally been provided proofs of my chapter on Philip K. Dick, L. Ron Hubbard, and psychiatric devices, which I believe will be published in a Lexington edition this year. Once the Huxley chapter is out of the way, I look forward to continuing to work on my articles in law and medicine.

I continue to manage Philament, and was pleased to have successfully applied for and received some very helpful funding for the coming issues, taking the journal through to 2019. The current editor is working hard on producing two issues this year, and I have recently reached out to a talented web designer and hope to have the journal’s new website designed later in the year.

That’s all for now.

Emotions and Device-Oriented Psychiatry in the Early Twentieth Century

In July, 1907, the Swiss psychiatrist Carl Gustav Jung and American neurologist Frederick Peterson published the results of their investigations into the galvanometer and the pneumograph in BRAIN, the journal of neurology. The pair had subjected various people to these instruments—people they had identified as “normal” and “insane”—in an attempt to record and quantify certain “emotional” and “psychical changes” in their moods “in connection with sensory and psychical stimuli.”1 At this time, only a few years into the twentieth century, these scientists—and many others like them—were eager to develop a systematic means of measuring emotion. They sought to demystify and provide a scientific explanation for the enigmatic interface between the body’s nervous system (both the peripheral and central nervous systems) and the presentation of varied human emotions. To this end, instruments such as the galvanometer and pneumograph, then understood as effective “measurer[s] of the emotional tone,” promised to illuminate the physical meanings, mechanisms and perhaps even causes of what they called the “emotional complexes.”2

Among the most extreme of the “emotional complexes” was the category of dementia praecox. This was a condition whose “chief characteristic” was, as George H. Kirby noted, “a particular disturbance of the emotions.”3 Kirby was the first American to develop a classification of psychoses, and his system was later adopted by the American Psychiatry Association in something of a precursor the Diagnostic Statistical Manual of Mental Disorders, the authoritative diagnostic manual used by psychiatrists today. But Kirby was not the first twentieth-century psychiatrist to undertake a modern classification of the psychoses. That honour belonged to Eugen Bleuler, the Swiss psychiatrist under whose supervision Jung and Peterson had conducted their work on the galvanometer and the pneumograph. In fact, Jung and Peterson undertook their research in Bleuler’s laboratory, within the huge University Clinic for Psychiatry at Zurich known as Burghölzli (fig. 1), a building that was idyllically depicted in 1917 by swiss painter Max Gubler (fig. 2), who would tragically later move and die there.4 In Burghölzli, Jung and Peterson also used Bleuler’s apparatuses—his galvanometer and the pneumograph—to produce their study of the relations between the nerves and emotions. Jung had been awarded his PhD in 1902 based on Bleuler’s reports, and the tense relationship between the two men has been a subject of some scholarly interest.5

Figure 1. The Burghölzli psychiatric clinic in Switzerland (1880s). Image: Public Domain.

Figure 2. Max Gluber, Winterlandschaft Burghölzli [Winter Lanscape at Burghölzli] (1917). Courtesy of the Eduard, Ernst and Max Gubler Foundation.
In 1911, only four years after the publication of Jung and Peterson’s investigation, Bleuler would coin the term schizophrenia, proposing that it should replace “dementia praecox.” That older term had been coined by the French physician or “alienist” Phillippe Pinel in the early nineteenth century, and popularised by the influential German psychiatrist Emil Kraeplin in his 1896 textbook Psychiatrie. In Bleuler’s 1911 monograph, titled Dementia Praecox or the Group of Schizophrenias, the Swiss psychiatrist would argue that the earlier term was misleading for practitioners, conveying as it did two deceptive associations. The term, he said, suggested that schizophrenia had something to do with the disease of dementia, as well as with the concept of “precocity,” when in fact it had nothing to do with either. Moreover, Bleuler argued that it was impossible to express the phrase “dementia praecox” as an adjective, which made writing about the disorder nearly impossible.6

Despite the fact that Jung and Peterson worked in Bleuler’s laboratory, the way in which these scientists described mental disorders differed markedly, at least in one respect. Strikingly, Bleuler’s paradigmatic psychiatric work of 1911, translated into English from the original German in 1950, almost entirely omits the word “emotion” or “emotional complex.” By contrast, Jung and Peterson’s study of 1907 uses the term “emotion” or “emotional” some 108 times (in a study of roughly 18,000 words). Of course, this is not to say that emotions are altogether excluded from Bleuler’s understanding of schizophrenia. On the contrary, emotions lie at the heart of his symptomatological description of the disorder. At one point in his monograph, Bleuler writes that “many schizophrenic symptoms originate from emotionally charged complexes” and that the “symptomatology is determined by the emotionally charged complex which, in turn, is often dependent on the Anlage [predisposition].”7 As such, the omission of the word emotion and the general concept of emotionality in Bleuler’s text is puzzling. Of course, it might be explained by the fact that there is no easy German equivalent to the word, and that the text would presumably employ the word “gefühl” (meaning feeling) or “affekt” (meaning affect) to denote the same concept.

Indeed, as psychiatry developed in the following decades, the concept of “feeling” and specifically of the “praecox gefühl”—the praecox feeling—would become one of the most important in the diagnosis of the psychoses. First named by the Dutch psychiatrist H. C. Rümke in the 1940s, the praecox feeling described the way in which the diagnostician would, in some circumstances, need to rely on intuitive reasoning—on their highly attuned and sensitive emotional senses, refined as they were by clinical experience—to reach a diagnosis of schizophrenia. It would be necessary to use this method when a patient was, for reasons related to their pathology, “fundamentally inaccessible,” such as when, because the basic structure of their “being-in-the-world” had altered, the practitioner could identify something about them that was hard to describe in words but “definitely incomprehensible.”8

Perhaps one of the reasons that Bleuler’s work so rarely refers to emotions and emotional states, whereas Jung and Peterson’s study describes “emotions” so often, is due to the divergent aims of and influences on their authors. Despite presenting itself as a work of psychiatry, Bleuler’s study inherits much from psychoanalysis and Freud, routinely referring to such Freudian concepts as symbolisation, resistance, and the Oedipus complex, among others. Jung and Peterson’s study, by contrast, focuses almost entirely on the quantification of emotions by means of their instruments; it is less a study in taxonomy than an attempt to break away from those symbolic concepts that Freud had introduced only six years earlier. Using instruments and devices, Jung and Peterson seek to bring these disorders of the mind out of the realm of the “invisible” and into the clear light of day. This, as Jeffrey Lieberman notes, was precisely what distinguished the work of neurologists from psychiatrists: “Physicians who specialized in disorders with an observable neural stamp became known as neurologists,” he writes, whereas “those who dealt with the invisible disorders of the mind became known as psychiatrists.”9

Historians and philosophers of science have identified the rise of a “device paradigm” in psychiatry from the mid-twentieth century and onward. They point to the invention of electroconvulsive therapy (ECT), the emergence of repetitive transcranial magnetic stimulation (rTMS) and, from the mid-1950s, the use of psychopharmacological drugs, as evidence of this newly device-oriented science of the mind.10 However, Jung and Peterson’s investigations—together with some similar, though more controversial, experiments with x-rays in chiropractic medicine—illustrate an earlier turn towards devices. In fact, not only was the shift toward devices well underway in the first decade of the twentieth century, but devices were, at this time, central to the study of emotion. Before psychiatrists such as Bleuler and Kirby established psychiatry’s classification systems, subsuming “emotional complexes” into their systematic taxonomies, measuring human emotions by means of physical tests had been a central object of neurological enquiry.11

Figure 3. The most recent version of the E-Meter (courtesy Scientology.org).

Ironically, Jung and Peterson’s methods would be revived in the 1950s, when, after attending a lecture delivered by L. Ron Hubbard, an American inventor named Volney Mathison patented a new device that he described as a “bio-electronic instrument which registers human dynamic emotion in a more accurate and sensitive manner than has been possible with any previous device of comparable simplicity.”12 Hubbard quickly embraced the device, which is now known as the E-meter (fig. 3, above), and a modified version of this same galvanometer today forms part of the Church of Scientology’s official practices, used to “audit” the emotional complexes of the Church’s adherents.13