Madness: Treatments for Insanity


This post is a brief review of historical methodologies for treating mental disorders. In the latter half of the 20th century, a number of non-invasive methods were used as well. 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.


Visit this link on C-SPAN which provides a brief history of the treatment of mental illness filmed at the Oregon State Hospital Museum of Mental Health.


Marshfield_News_Herald_Sat__Oct_27__1928_.jpg

Psychosurgery

Dr. Antonio Caetano Deabreu Freire Egas Moniz
Dr. Antonio Caetano Deabreu Freire Egas Moniz

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 preparation and surgery. Moniz went on to be awarded the Nobel Prize for his discovery.

 

Dr. Walter J. Freeman with Dr. James Watts performing a lobotomy on a patient in 1942. From the George Washington University Archives.

Enter 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

The Courier-Journal (Louisville, Kentucky), 7 March 1954, p. 36.
Dr. Charles Feuss demonstrating insulin coma therapy with nurse Mrs. A. McCord and a patient aide at Eastern State Hospital, Lexington, Kentucky.

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.


Metrazol Therapy

Meduna
Dr. Ladislas Meduna, ca. 1949

Metrazol 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

ECT Unit.jpgElectroconvulsive 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).

ECT Darnell General
ECT demonstration at the U.S. Army Darnell (Darnall) General Hospital in Danville, Kentucky.

Honorable Mentions

Tranquilizer Chair

Philadelphia_Daily_News_Thu__May_19__1994_.jpgDeveloped by Dr. Benjamin Rush, the spinning tranquilizing chair required patients to be strapped in and with their eyes covered while the chair spun around in a circle. Based, in part, on the rotational theory, it was believed that spinning the patient in a controlled environment would help to reduce or eliminate congestion within the brain and, thus, curing mental illness. Obviously, this approach was not effective!


Hydrotherapy

The Courier-Journal (Louisville, Kentucky), 7 January 1938, p. 2.
Patients in the psychopathic ward at Louisville City Hospital taking hydrotherapy.

This was a commonly used standard in most psychiatric hospitals and facilities in the United States and the Western world. Water was, for the most part, a cheap and easy to access resource that could quickly be heated or cooled. Warm hydrotherapy, generally entailing baths, but also showers, were often used for mood-related pathologies such as depression (melancholia), actively suicidal, or those who were restless or agitated. The most effective approach for warm hydrotherapy were uninterrupted baths lasting hours in a calm, quiet environment. Cold hydrotherapy was often used for patients who had active psychomotor agitation and would include those with a variety of psychoses. It was believed that the cold water would constrict blood flow and thus calm the patient down.


Malaria Therapy

Lipschutz
Dr. Louis S. Lipschutz

This intervention was experimentally used for treating “general paresis (or paralysis) of the insane.” General paresis, caused by syphilis, resulted in progressive dementia and paralysis. Dr. Wagner von Jauregg discovered that patients with general paresis in a febrile state would come out of the fever as “cured.” So, he injected patients with malaria and, when malaria destroyed syphilis, he would provide them with quinine to cure the malaria. Malaria therapy was replaced by the much safer antibiotic treatment. Dr. Louis S. Lipschutz was also instrumental in introducing malaria treatment for treating neurosyphilis and chorea.

The Evening Independent (Massillon, Ohio), 16 May 1952, p. 27.
Staff physician at Massillon State Hospital attending to a syphilitic patient.

Phrenology

Phrenology Chart
Signs of Character, a phrenology poster published by Louisville company, Kling and Teschemacher, in 1843.

Developed by Dr. Franz Hall, the basic foundation of phrenology posited that the brain is the organ of the mind; it is composed of many distinct and inborn abilities. Because of this, each individual “ability” has a separate/individual organ in the brain. The power of the organ is based on its size and the shape of the brain is determined by the progression of these organs. In essence, examining the head could help divulge the developmental status of a particular organ responsible for different intellectual and character traits. Want to learn even more about phrenology? Then click here to view the 1841 guide, “Phrenological Chart, Presenting an Outline of Phrenology.”

 


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.


Insanity Treatment Gallery


The Pre-Frontal Lobotomy Procedure

The Press Democrat (Santa Rosa, California), 14 April 1949, p. 5.
A McKenzie twin-loop leucotomy instrument, also known as the leucotome, held by Dr. Berwald at Mendocino State Hospital.
The Press Democrat (Santa Rosa, California), 14 April 1949, p. 5.
First major step in the lobotomy operation as Dr. William Berwald, begins drilling a hole through the three outer layers protecting the brain.
The Press Democrat (Santa Rosa, California), 14 April 1949, p. 5.
The crucial point and climax of the operation as Dr. Berwald inserts the leucotome through the nerve fibers going from the frontal lobes to the thalamus.
The Press Democrat (Santa Rosa, California), 14 April 1949, p. 5.
The finish is reached when the scalp is drawn back over the T-shaped holes and sewed up with sutures. Adhesive tape is placed over the incisions, the blood towels thrown off, and the patient prepared for return to her room.
The Press Democrat (Santa Rosa, California), 14 April 1949, p. 5.
Bandaged and free from her covering of clothes and operating tray, the young patient will soon be wheeled back to her room. Within a few days she will be eating and talking. But it will be months before doctors can tell whether the operation was successful.

 


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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