Insulin for Insanity

About 50% of the inmates of U. S. insane asylums are there on account of a deteriorated mental-emotional condition variously called dementia praecox, schizophrenia or split personality. Therefore the presence in Manhattan last week of a young Vienna psychiatrist, who cures such disoriented wits by means of insulin, created great stir among doctors, great hopes among relatives of schizophrenics.

Called dementia praecox because it strikes most victims between the "precocious" ages of 18 and 35, called schizophrenia because it reveals a split between the emotional and intellectual activities of the victim, the condition is the greatest mystery of psychiatry. The spirit tries to run away from reality. The tortured soul attempts to hide. The victim loses his will power, his ability to concentrate, his memory, bis judgment. Extreme cases become more abject and helpless than sick infants. About 10,000 of the 40,000 schizophrenic cases who develop in the U. S. each year acquire wild, paranoiac ideas of grandeur or of persecution. About half the new cases are merely too scatter-brained and gloomy to be allowed at large. U. S. doctors have been able to discover no rational, generally accepted cause for schizophrenia. And they have been generally unable to bring about cures.

Several years ago Dr. Manfred Sakel, 36, a University of Vienna psychiatrist, cured morphine addicts by dosing them with insulin. His theory: morphinism is due to too much adrenalin in the system; insulin counteracts adrenalin. By accidentally overdosing them with insulin, Dr. Sakel shocked some of his morphine patients into comas. When they recovered from the "hypoglycemic shocks," their personalities were remarkably changed. Since the problem of curing a schizophrenic is the problem of shaking up his ingrown personality, Dr. Sakel tried shocking doses of insulin on Viennese schizophrenics. Last week at the New York Academy of Medicine he frankly declared that he does not know how and why his cure works, that it is indubitably effective. He has cured hundreds of cases of schizophrenia at his Vienna clinic by means of insulin injections. Dozens have been cured in private and public mental hospitals in Switzerland, The Netherlands, Germany, Poland, Russia, England. Young Dr. Joseph Words of Manhattan, who brought the insulin treatment for schizophrenia to the U. S. two years ago, paved the way for Dr. Sakel's appearance in Manhattan, has had about a dozen cures in the past few months.

The Sakel cure is complicated, difficult and dangerous because the patient must almost die of insulin shock several times before he can collect and use his wits like a normal human being. Dr. Sakel applies his treatment in four stages. For two weeks or so, according to the patient's reaction, he administers increasingly large hypodermic doses of insulin. When the insulin doses become powerful enough to cause insulin shock (profuse sweating, coma), Dr. Sakel is ready for the second, or shock phase of his treatment. This consists of inducing coma for several hours a day for several days. This is the dangerous state. If the patient's pulse falls below 35 beats a minute (normal: 70) or if he develops an epileptic convulsion, he may die. However, only five of the several hundred schizophrenics treated so far have died. The others survived because Drs. Sakel, Wortis and colleagues were cautious enough to have sugared water or milk handy to give to their comatose patients the instant danger appeared.

After several days of profound insulin shocks, the patient is allowed to rest, free from insulin, for one to three days. Then he is put through a "polarization" or tapering off course of gradually diminishing doses of insulin. Summed up Dr. Sakel: "The results do not depend upon the size of the dose of insulin, but rather on the proper termination at the right time of each shock. ... I should like to add that I used to think that only recent cases would show a satisfactory response to treatment. But later I realized that in some chronic cases--not in all--more or less improvement was possible, and it was well worth trying for. . . ."

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