Death for Sanity

Until recent times, the treatment of madness was a kind of desperate punishment. In medieval madhouses patients were sometimes bound in whirling chairs and spun till blood ran out of their ears. Others were plunged down steep chimneys onto a pile of writhing snakes.

Today psychiatrists again apply with scientific refinements something very like medieval shock treatment to victims of schizophrenia (dementia praecox). Most common form of insanity, schizophrenia packs 200,000 patients in U. S. mental hospitals. Whether social, psychological or physical difficulties cause schizophrenia no one knows. A schizophrenic may believe that he is Napoleon, or that his children are trying to kill him. Or he may fall into rigid positions, lasting for hours. For many schizophrenics there are no more human emotions--only a slow retreat from life into deathlike stupor. Less than 6% are lucky enough to come back to sanity without treatment.

Until 1934, medical science could do very little for schizophrenia. Then Dr. Manfred Sakel of Vienna, now in Manhattan, announced that since 1928 he had been shocking schizophrenics back to sanity with large injections of insulin. In 1935, Dr. Laszlo von Meduna of Budapest successfully shocked schizophrenics with metrazol, a camphor-like drug. Psychiatrists the world over hailed this revival of the old medieval technique, enthusiastically set to work to confirm the results of their European colleagues.

After ten years of experimenting, physicians take a soberer view of shock treatment. Last week the American Journal of Psychiatry printed no less than ten painstaking articles, by topflight workers in U. S. hospitals and laboratories, on the value of this treatment.

Metrazol. Metrazol is a powerful stimulant of the centres which regulate blood pressure, heart action and respiration. Technique of metrazol injections is simple. A patient receives no food for four or five hours. Then about five cubic centimeters of the drug are injected into his veins. In about half-a-minute he coughs, casts terrified glances around the room, twitches violently, utters a hoarse wail, freezes into rigidity with his mouth wide open, arms and legs stiff as boards. Then he goes into convulsions. In one or two minutes the convulsion is over, and he gradually passes into a coma, which lasts about an hour. After a series of shocks, his mind may be swept clean of delusions.

Usual course is three convulsions a week for five or six weeks. A patient is seldom given more than 20 injections, and if no improvement is noted after ten treatments, he is usually given up as hopeless.

So horrible are the artificial epileptic fits forced by metrazol that practically no patients ever willingly submit. Common symptoms are a "flash of blinding light," an "aura of terror." One patient described the treatment as death "by the electric chair." Another asked piteously: "Doctor, is there any cure for this treatment?"

More serious than this subjective terror are dislocations of the jaw, tiny compression fractures of the spine, which occurred to metrazol patients in over 40% of one series of cases. During their violent convulsions, patients arch their backs with such force that sometimes they literally crush their vertebrae.

So although metrazol is widely used, a large number of psychiatrists condemn it as a "very dangerous drug." Some use it only in alternation with insulin. Dr. John Robert Ross and Statistician Benjamin Malzberg of the New York State Department of Mental Hygiene, reviewing 1,140 metrazol cases last week, said that only 1.6% of the patients recovered, only 9.9% were "much improved," 24.5% were "improved." In a group which had no treatment at all, said the doctors, 3.5% recovered, 11.2% were much improved, 7.4% were improved. Most experts now agree that, despite a few spectacular cures, metrazol is far less effective than insulin. A few laboratory workers are experimenting with kindred drugs, trying to concoct a less dangerous substitute.

Insulin. Insulin, by reducing the amount of sugar in the blood, deprives the brain of its chief nourishment, somehow producing a coma--well-known to all diabetes sufferers who have ever given themselves an overdose of the drug. Usually about 20 units of insulin are injected into the veins of a fasting patient early in the morning. Next day the dose is slightly increased. For the first few days he sweats, blinks, complains of drowsiness. Finally, on a day when he receives about 70 to 100 units, he sinks into a coma. His skin may turn paper-white or cherry-red, and, snoring like a horse, he puddles his bed with perspiration. After three-quarters of an hour or an hour, he is given sweet foods or glucose injections to revive him. As he gradually awakens and crosses the border of consciousness, he shouts and bellows, gives vent to his hidden fears and obsessions, opens his mind wide to listening psychiatrists.

Great danger of insulin injections is "irreversible shock," caused by too little sugar in the blood. This shock may occur when a patient is allowed to remain in coma over an hour. Even glucose will not revive a deep shock victim, and he may remain in a coma for hours, days, even weeks. Finally he may die from respiratory failure. Standard treatment for irreversible shock is blood transfusion plus glucose injections. "The dramatic psychiatric improvement following prolonged coma," wrote Drs. Joseph Wortis and Richard Hooker Lambert of Johns Hopkins Hospital last week, "suggests that if a safe method for prolongation of coma could be devised, it would further extend the value of shock treatment."

Figures vary on the beneficial results of insulin treatment. Famed Psychiatrist Edward Adam Strecker of the University of Pennsylvania, who works at the best-equipped shock clinic in the U. S., claims that 30% and even 40% of insulin-treated patients return to normal living. "Insulin therapy," he believes, "offers more hope in the treatment of dementia praecox than was ever offered before by any other treatment." But Psychiatrist Stanley Cobb of Harvard, who has never personally administered shock treatment, holds that the risks far outweigh the advantages.

Only time can prove the value of insulin shock treatment. Most patients remain sane afterwards for at least a year; others, who show no good effects immediately after treatment, may take several months to "ripen" into sanity. Best results occur in young patients, between the ages of 17 and 25. But more stable is the sanity won by persons of more mature age, who do not have to contend again with the psychic hazards of adolescence. For schizophrenia victims who have been ill more than six months, there is little hope, although obstreperous patients may become gentler, more obedient after treatment. Quick treatment is important after symptoms emerge.

That insulin is a magic key to sanity, no psychiatrist believes. Says Dr. James Aloysius Flaherty, Dr. Strecker's young assistant: "It is carelessly gambling with a recovery hard-won to send a patient home without making real effort to stabilize the environment to which he must return or to exercise as many safeguarding precautions in planning his immediate course of action as are reasonably possible." Some doctors even press social responsibilities upon their patients in between injections, encourage them to work and play with other patients.

Theory. How "convulsant therapy" works, nobody knows. A score of theories have been offered, both physiological and strictly psychological. Boldest: 1) certain poisons invade the brain cells, cause schizophrenia, and shock treatment helps the body to combat these poisons; 2) the terrible fear of death caused by shock treatment inspires despairing schizophrenics to turn back to life.

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