Thursday, February 5, 2015

1930s Insulin Shock Therapy - Snippet from the work of Edward Shorter

Ladislas Meduna,, 1955,
 UofIllinois Archives
Before the days of electroconvulsive therapy, experimentation was conducted in the interwar years inducing convulsions in schizophrenic patients.  In the late 1920s, Polish psychiatrist Manfred J. Sakel had experimented with insulin coma therapy for use on schizophrenics and others.  Camphor was one drug that was used, but it was found unreliable in its reactions, and patients reported great feelings of anxiety before the fits, not to mention the drug's tendency to induce vomiting. Metrazol, or Cardiazal was discovered by Ladislas von Meduna to be a superior drug to induce therapeutic seizure.

Before the 1930s, it was largely sedatives and hypnotics that were being used on psychiatric patients, with opiates and barbiturates coming to the fore in the nineteenth and twentieth centuries respectively.  If one counts laxatives as drugs, evidence exists for their use as psychiatric treatment as far back as the middle ages, and one could likely find similar uses in ancient times.  While we might like to think of Prozac as a revolutionary change in mental health treatment, it certainly had its forebears.  

Insulin shock therapy is given in
 Lapinlahti Hospital, Helsinki in 1950's
In the 1930s there were brief experiments with convulsive drug treatments, before these were swept away by the tide of electroconvulsive therapy.  Ladislas von Meduna was a Budapest psychiatrist who in 1934 was breaking ground in the use of insulin induced comas for the treatment of schizophrenia.  Seizures were an occasional side-effect of insulin comas, and some psychiatrists thought these were therapeutic, and induced them using cardiazol or camphor.  An account of one of Meduna's early patients gives an idea of the gap between the sanitized official record and the lived experience of the patient.  Meduna noted of his thirty-three-year-old patient that he had been committed to the Budapest State Hospital in 1930 on the basis of his delusions and hallucinations.  He had reportedly spent 1933 hidden under his bedcovers, and in January 1934, he had stopped eating.

Meduna administered camphor, and 45 minutes later the patient had his first seizure.  In the next couple of weeks, he would have five more injections.  Meduna reported:

 On the morning of February 10, the patient spontaneously arises from bed, is lively, speaks, and asks for something to eat.  He is interested in everything going on about him, asks about his illness and realizes that he has been sick.  He asks how long he has been in the hospital, and as we tell him that he has already been there four years he cannot believe it. (Shorter, 214-217)

Edward Shorter’s work A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: 1997) relays the after-effects of the treatment:

In reality, the patient felt so good that he escaped from the institution, went home, ‘and found out that the cousin living with his wife was not a relation at all but his wife’s lover.  He beat up the cousin and kicked him out of the house; proceeded to beat up his wife and told her that he … preferred to live in the state mental hospital where there is peace and honesty.’ (Shorter, 214-217)

Shorter's work argues against the disciples of Foucault who since the 1970s have damned psychiatry as a state tool to incarcerate the disruptive.  Shorter emphasizes that mental illness was real, and could be cured by various biology-based methods.  It is interesting to note, that Meduna's 1934 convulsive shock experiments reported that of 110 patients treated (presumable schizophrenics), half went into remission.  As the above account suggests, "cure" was not always synonymous with completely positive outcomes, and the dangers of inducing seizure and the low vital signs connected to insulin sleep therapy were always clear.

Southern Albertans interested in psychiatry and its history may wish to attend a couple upcoming talks.  Edward Shorter is in Calgary for a few days in early February 2015, and presenting two public talks at the University of Calgary.

The second talk is at 3:30pm. Monday February 9th at the Community Health Sciences department on the third floor of the Teaching Research and Wellness (TRW) building on the University of Calgary's Foothill's campus.  RSVP to Beth Cusitar  The talks is as follows:

“DSM:  The History of a Train Wreck”

Diagnosis in psychiatry was once dominated by the German heavyweights.  After the Second World War, the United States becomes the world champion of psychiatry, and American diagnoses take over, first in the DSM-1 in 1952, then in the revolutionary DSM-3 in 1980, which was a dramatic break from psychoanalysis and offered hope for the diagnostic future.  But buffeted by institutional politics, the demands of patient organizations, pressures from niche marketers within the field, and the profit horizons of the pharmaceutical industry, the diagnostic promise of DSM-3 failed to be realized, and the entire diagnosis machine of DSM has started to run out of control.  We are now at DSM-5 (2013).  There probably will not be a "DSM-6."