Six ways that humanity once treated mental illness (which would probably kill you today) – Part 1

In the course of doing research on mental illness and treatments, I have come across some absolutely wild methods of treating mental illness from older times. Some had roots in science of the moment – others were just really, really bad guesses. Most were very cruel, but in all fairness, it’s easy to say that now.

Anyway, here’s a look at six ways which humanity once treated mental illness. Today is Part 1, and Part 2 will publish Thursday.

1. Electroshock therapy

You may know shock therapy from plays like One Flew Over the Cookoo’s Nest or that episode of Quantum Leap which gave me nightmares for years:

How they thought it worked:

With shock therapy, the premise was simple: They hooked you up to a machine and sent as many as volts as possible into your screaming, aching body. The electrocution would induce a seizure; this, in turn, was thought to improve mental illness like depression and schizophrenia.

The therapy wasn’t usually quite as ugly as portrayed in popular media, but according to Jonathan Sadowsky, who wrote a book on electroshock therapy, it wasn’t too far off: Electroshock therapy was often used in mental hospitals to “control difficult patients and to maintain order on wards.”

Oh, and not for nothing, but electroshock therapy was also used as a way to “cure” homosexuality. Yeah.

But, actually…

The idea behind the practice was sound; it’s the execution of shock therapy that caused the damage. Even in the 1960s, there was ample evidence that electroshock therapy could be successful. However, patients who underwent the practice at the time were often did not give informed consent (agree to the treatment with a full understanding of its potential risks and benefits) and reported the process to be terrifying and painful. Severe memory loss and brain dysfunction often occurred as a result of the treatment.

Thankfully, this practice has been reformed significantly. It’s still used for severely and treatment resistant depression, as well as a few other select disorders. According to the Mayo Clinic, patients are placed under general anesthesia (as opposed to being very awake and very much in pain) and a small electrical current is sent straight to their brain, resulting in a small seizure. And, unlike prior versions, ECT has shown real promise in fighting depression, with success rates as high as 83%.

2. Insulin Shock therapy

Getting electrocuted not enough fun for you? My friend, allow me to introduce you to insulin shock therapy, the process by which patients were intentionally overdosed with insulin and sent into a coma. Yes, that’s right, it’s diabetes…on purpose.

How they thought it worked:

The therapy was first discovered by accident in 1927 by Dr. Manfred Sakel, who injected a morphine-addicted woman with insulin and noticed a remarkable recovery. Said Dr. Sakel:

“My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells … a reduction in the energy spending of the cell, that is in invoking a minor or greater hibernation in it, by blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the reinforcement of the cell.”

Over the course of a two month period, schizophrenics were injected with a massive dose of insulin until they slipped into a coma. Patients were selected based on those who had a good prognosis for recovery and were thought to have the physical strength to endure the therapy.

Studies in the 1930s and 40s showed that as many as 70% of people showed improvement with insulin shock.

But, actually…

A paper in 1953 by Dr. Harold Bourne debunked the therapy, noting that any recoveries likely occurred because the patients were already on their way to a recovery. Further studies with randomly selected patients showed that insulin therapy showed absolutely zero difference with medication…except, you know, the self-induced diabetes coma.

The therapy disappeared from the United States by the 1970s.

3. Lobotomies

Not sure what the word “lobotomy” means? Well, let’s look at its origins: “lobe” means part of the brain, and “tomy” is a medical suffix for cutting. So, that means…

…oh. Oh, dear.

Yes, a lobotomy is just that: Removing a piece of the brain in order to make the rest of it function better.

Clearly, the logic here is wanting. Broken arm? Cut it off. Twisted your ankle? Time to amputate!

How they thought it worked:

Back in the day (as recently as the 1950s), lobotomies were used for the treatment of a variety of mental illnesses, including schizophrenia and bipolar disorders (then called manic depression). It was invented in by Dr. Antonio Egas Moniz in 1935. Fun fact: Moniz was awarded to Nobel Prize for Medicine in 1949 for the lobotomy – a move so out of step with reality that there was an unsuccessful effort to revoke the Prize from Moniz.

In the first lobotomies, known as “ice-pick lobotomies” (yes, really):

“As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient’s eyeball through the orbit of the eye, into the frontal lobes of the brain, moving the instrument back and forth. Then he would do the same thing on the other side of the face.”

In the end, an estimated 50,000 lobotomies were performed in the United States.

But, actually…

According to Dr. Barron Lerner, a medical historian and professor, “The main long-term side effect was mental dullness,” which included damage to a person’s “personality, inhabitations, empathy and ability to function on their own.” Another contemporary source found that a mere 1/3 of people benefitted, while 1/3 had no change, and 1/3 were made worse. So, a cure with a 1:1 chance of doing more harm than good. Neat.

Some patients did show an improvement in their mental illness. But many showed an overall loss in emotions. It got so bad that the Soviet Union – not exactly known as a vanguard of human or civil rights – banned the practice in 1950. Fortunately, as a result of increasing concerns over the operation and the advent of successful anti-psychosis drugs, lobotomies largely fell out of favor in the 1950s.