A Brief Review of 20th Century Treatments of Mental Disorders

By Shawn L.


Special notes: this post does not imply that institutions in Kentucky actually utilized the procedures outlined within this post. It is based on historical information about treatment methodologies utilized at the time for treating mental disorders. A number of non-invasive methods were used as well. This is not a comprehensive review of these historical methods. Advances in talk therapies, also known as psychotherapy, and other evidence-based approaches have largely replaced invasive approaches for treating mental disorders in today’s world. In the late 20th century, Deinstitutionalization resulted in shorter hospital stays while encouraging outpatient and community involvement as opposed to long-term hospital stays. The proceeding information should not be construed as medical advice. Please contact a physician if you have medical questions related to treatments of mental disorders or a licensed mental health practitioner.


Psychosurgery

The term ‘psychosurgery’ seems frightening in itself. However, this approach to treating mental illness was groundbreaking in the late 19th century throughout Western countries (Raz, 2008). We begin with the leucotomy. I know what you’re thinking; isn’t it called the lobotomy? Yes, it is. This approach precedes the lobotomy that many of us are familiar with today. The leucotomy was developed by Dr. Egas Moniz, a Portuguese neurologist, in the 1930s. The procedure, in essence, was aimed at removing the brain’s prefrontal cortex connections and the anterior (front) portion of the frontal lobes. Moniz targeted the frontal lobes based on previously published works by Yale University neuroscientists. Ultimately, however, numerous discrepancies exist in relation to Moniz, the Yale University neuroscientists, and other researchers which make it frustratingly difficult to pinpoint specifics of who actually invented the procedure and why it was developed this way. The procedure developed by Moniz was considered major brain surgery requiring hours of intervention and surgery. Moniz went on to be awarded the Nobel Prize for his discovery.

9bfe173e2291df23b3ed445981e0115eEnter doctors Walter Freeman and James Watts. Freeman became interested in the procedure Moniz developed but realized that it was both costly and time-consuming. Based on the conditions of asylums and institutions during this time, Freeman wanted to develop a method that would be as quick and painless as possible. Working together, Freeman and Watts developed the transorbital lobotomy, often referred to as the icepick lobotomy. In order to render the patient unconscious, electroconvulsive therapy was initiated and then Freeman would enter through orbital plate. Once the instrument entered through the orbital plate, prefrontal cortex connections and the anterior portion of the frontal lobes were destroyed.  As many as 15% of Freeman’s patients died as a result of the lobotomy and a significant amount more suffered irreversible effects as a result of the procedure (Raz, 2008). The success rates for both Moniz and Freeman are disputed and believed to be below 50% for each method. These approaches are no longer practiced. The lobotomy was eventually replaced by the introduction of first generation or typical antipsychotic medications like Thorazine.

Shock Therapies

Insulin Shock Therapy and Metrazol Therapy

Insulin shock therapy, known as IST, was developed by Dr. Manfred Sakel in the early 1930s. This approach to treating mental illness, like with the leucotomy, required both a specially trained hand, staff, and facilities; it was also time intensive. Patients were intravenously injected with insulin until unconsciousness and coma set in; coma was not uncommon in higher doses of insulin. The physician would maintain the coma for approximately one hour. After this period of time, glucose was administered intravenously to increase blood sugar levels and stabilize the patient out of the coma (Kragh, 2010). Side effects of IST often included tonic-clonic seizures, violent muscle spasms, and severe diaphoresis; this would sometimes continue post-glucose administration.

s-l1600.jpgs-l160022222Metrazol therapy, developed by psychiatrist Dr. Ladislas Meduna in 1934, was a potent respiratory and circulatory stimulant. High doses of Metrazol would induce violent tonic-clonic seizures. As with electroconvulsive therapy, inducing the tonic-clonic seizures was necessary. It was believed that Metrazol was less invasive than using an electrical current to induce seizure. The Metrazol would be injected intravenously inducing violent seizures, similar to those in electroconvulsive therapy. Patients would often come out of the convulsions scared and confused. As a result of the violent seizures, some patients thrashed about so violently that they would bruise or fracture/break bones (Kragh, 2010). While both of these approaches were utilized relatively briefly, Metrazol therapy was only used for approximately 10 years. Both of these approaches are no longer practiced.

Electroconvulsive Therapy

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Dr. John Bradley and Dr. Veronica Murphy administering electroconvulsive therapy, Milledgeville State Hospital, Milledgeville, Georgia. 20 February 1940. (Atlanta Journal-Constitution Photographic Archives. Special Collections and Archives, Georgia State University Library.)

Electroconvulsive Therapy, also known as ECT, is quite an old method of treatment for mental illness and many other disorders. As such, it is difficult to pinpoint who, precisely, developed the method. However, Ugo Cerletti and Lucio Bini formally experimented on a schizophrenic individual in the late 1930s. It was eventually discovered that the convulsions induced in ECT helped with decreasing levels of depression and other pathologies and stabilizing the patient to a higher functioning level. Electrodes would be placed bilaterally on the head and a brief electrical current would be initiated. This would, ideally, induce a tonic-clonic seizure and temporarily render the patient unconscious (Enns, Reiss, & Chann, 2010). As with other shock therapy methods, ECT would often cause injury as a result of the violent convulsions. In addition, patients would suffer from headaches and other neurological side effects including prominent retrograde memory loss, sometimes (rarely)  remaining permanent. In the 21st century, ECT continues to be used for treatment-resistant depression. Unlike the procedure more than half a century ago, modern ECT utilize anesthetic and paralytic agents to eliminate the violent thrashing. While the side effects continue to exist, researchers are examining the use of unilateral electrode placement to reduce retrograde memory loss (Enns, Reiss, & Chann, 2010).

 


The preceding information should not be construed as medical advice. Please contact a physician if you have medical questions related to treatment of mental disorders or a licensed mental health practitioner.


 

References

Enns, M. W., Reiss, Jeffrey P., & Chan, P. (2010). Electroconvulsive therapy. Canadian Journal of Psychiatry, 55(6), S1-S11,T1-T12.

Kragh, J. V. (2010). Shock therapy in danish psychiatry. Medical History (Pre-2012), 54(3), 341-64.

Raz, M. (2008). Between the ego and the icepick: Psychosurgery, psychoanalysis, and psychiatric discourse. Bulletin of the History of Medicine, 82(2), 387-420.

 

 

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