‘A landmark in psychiatric progress’? The role of evidence in the rise and fall of insulin coma therapy

This paper examines the evidence behind the use and decline of insulin coma therapy as a treatment for schizophrenia and how this was viewed by the psychiatric profession. The paper demonstrates that, from the time of its introduction, there was considerable debate regarding the evidence for insulin treatment, and scepticism about its purported benefits. The randomized trials conducted in the 1950s were the result, rather than the origins, of this debate. Although insulin treatment was subsequently abandoned, it was still regarded as a historic moment in the modernization of psychiatry. Then, as now, evidence does not speak for itself, and insulin continued to be incorporated into the story of psychiatric progress even after it was shown to be ineffective.

“To suit the occasion, I wore my schizophrenic fancy dress”1 – the life of Janet Frame

Objective: Janet Frame (1924–2004) was one of New Zealand’s most celebrated authors. Much of her work stems from her experiences as a psychiatric patient. She was hospitalised for about eight years with a diagnosis of schizophrenia. Treatments included insulin coma therapy and unmodified electroconvulsive therapy. Her doctors then planned for her to have a leucotomy, which was cancelled upon discovery that one of her works had won a prestigious literary award. She subsequently moved to England and was assessed at the Maudsley Hospital by Sir Aubrey Lewis. She was found to never have suffered from schizophrenia; her condition was instead attributed to the effects of overtreatment and prolonged hospitalisation. She reflected profoundly on these experiences in her writing, and those who are interested in psychiatry are truly fortunate to have access to her autobiographies, fiction and poetry. Conclusions: Janet Frame has written both autobiographical and fictional accounts of her many years of psychiatric treatment, describing individuals, interpersonal relationships, and everyday life in these institutions. Her own life story demonstrates extraordinary recovery and achievement.

5. The evolution of treatments

For many centuries, the only intervention for melancholia involved admission into an asylum, initially to keep individuals away from society and then, from the 18th century, to provide therapeutic care. ‘The evolution of treatments’ discusses the crude treatments that were first introduced for inpatients such as sedation (barbiturates and insulin coma therapy) and physical treatments (electroconvulsive therapy and psychosurgery). Next, it discusses the development of the medications that are used today for inpatients and outpatients, such as antidepressants and the mood stabilizer lithium. Finally, it looks at the evolution of psychotherapies from early Freudian models through to mindfulness and the potential barriers to providing psychological interventions in the real world.

Electroshock: On How and Why It Lingers on Long After Insulin Coma Shock and Lobotomy Are Gone

Mid-20th century psychiatry routinely touted and performed a trio of barbarisms on unwitting or unwilling citizens; insulin coma shock, ice pick lobotomy, and electroshock were treatments of choice. In the second half of that century, 2 of the 3 were stopped. Insulin coma shock ended because it became too difficult for even the glamour and mystification of psychiatric propaganda to cover up the fact that this horrific treatment was literally killing too many people. Not long after—despite a Nobel Prize to its founder, Egas Moniz, and a period of fame and notoriety to its main United States practitioner, James Freeman—the severing of people’s frontal lobes by an ice pick through their eye sockets was stopped. The leadership of psychiatrist Peter Breggin was key in forcing a halt to lobotomy. So 2 of this terrible 3 have joined a long history of psychiatric atrocities no longer practiced, yet electroshock somehow endures. The lobotomists have been disgraced, but the shock doctors, including people like Max Fink who infamously declared in 1996 that “ECT is one of God’s gifts to mankind” (as cited in Boodman, 1996), carry on. What are the facts about electroshock, also known as electroconvulsive treatment, or electroconvulsive therapy (ECT)? How and why is it still used today? In this essay, I will explore these questions and provide some answers.