363:
but due to the impressions it made on the minds of the medical practitioners within the local world in which it was administered and the dramatic recoveries observed in some patients. Today, she writes, those who were involved are often ashamed, recalling it as unscientific and inhumane. Administering insulin coma therapy made psychiatry seem a more legitimate medical field. Harold Bourne, who questioned the treatment at the time, said: "It meant that psychiatrists had something to do. It made them feel like real doctors instead of just institutional attendants".
367:
collective risk-taking established "especially tight bonds among unit staff members". She finds it ironic that psychiatrists "who were willing to take large therapeutic risks were extremely careful in their handling of adverse effects". Psychiatrists interviewed by
Doroshow recalled how insulin coma patients were provided with various routines and recreational and group-therapeutic activities, to a much greater extent than most psychiatric patients. Insulin coma specialists often chose patients whose problems were the most recent and who had the best
185:
165:, began to use low (sub-coma) doses of insulin to treat drug addicts and psychopaths, and when one of the patients experienced improved mental clarity after having slipped into an accidental coma, Sakel reasoned the treatment might work for mentally ill patients. Having returned to Vienna, he treated schizophrenic patients with larger doses of insulin in order to deliberately produce coma and sometimes convulsions. Sakel made his results public in 1933, and his methods were soon taken up by other psychiatrists.
42:
2135:
315:, in which he argued that there was no sound basis for believing that insulin coma therapy counteracted the schizophrenic process in a specific way. If treatment worked, he said, it was because patients were chosen for their good prognosis and were given special treatment: "insulin patients tend to be an elite group sharing common privileges and perils". Prior to publishing "The insulin myth" in
2145:
244:
286:. The most severe risks of insulin coma therapy were death and brain damage, resulting from irreversible or prolonged coma respectively. A study at the time claimed that many of the cases of brain damage were actually therapeutic improvement because they showed "loss of tension and hostility". Mortality risk estimates varied from about one percent to 4.9 percent.
212:) until comas were produced, at which point the dose would be levelled out. Occasionally doses of up to 450 units were used. After about 50 or 60 comas, or earlier if the psychiatrist thought that maximum benefit had been achieved, the dose of insulin was rapidly reduced before treatment was stopped. Courses of up to 2 years have been documented.
393:, which accurately portrayed the seizures associated with his treatments. In a review of the Nash history, Fink ascribed the success of coma treatments to the 10% of associated seizures, noting that physicians often augmented the comas by convulsions induced by ECT. He envisioned insulin coma treatment as a weak form of convulsive therapy.
466:, young Kildare uses the new "insulin shock cure for schizophrenia" to bring a man back from insanity. The film dramatically shows a five-hour treatment that ends with a patient eating jelly sandwiches and reconnecting with his wife. Other films of the era began to show a more sinister approach, beginning with the 1946 film
301:
Insulin coma therapy was used in most hospitals in the US and the UK during the 1940s and 1950s. The numbers of patients were restricted by the requirement for intensive medical and nursing supervision and the length of time it took to complete a course of treatment. For example, at one typical large
255:
Sakel suggested the therapy worked by "causing an intensification of the tonus of the parasympathetic end of the autonomic nervous system, by blockading the nerve cell, and by strengthening the anabolic force which induces the restoration of the normal function of the nerve cell and the recovery of
401:
In the UK, psychiatrist
Kingsley Jones sees the support of the Board of Control as important in persuading psychiatrists to use insulin coma therapy. The treatment then acquired the privileged status of a standard procedure, protected by professional organizational interests. He also notes that it
385:
became psychotic and was first treated at McLean
Hospital. When he relapsed, he was admitted to Trenton NJ State hospital. His associates at Princeton University pleaded with the hospital director to have Nash treated in the insulin coma unit, recognizing that it was better staffed than other
366:
One retired psychiatrist who was interviewed by
Doroshow "described being won over because his patients were so sick and alternative treatments did not exist". Doroshow argues that "psychiatrists used complications to exert their practical and intellectual expertise in a hospital setting" and that
362:
Recent articles about insulin coma treatment have attempted to explain why it was given such uncritical acceptance. In the US, Deborah
Doroshow wrote that insulin coma therapy secured its foothold in psychiatry not because of scientific evidence or knowledge of any mechanism of therapeutic action,
337:
In 1958, American neuropsychiatrist Max Fink published in the
Journal of the American Medical Association the results of a random controlled comparison in 60 patients treated with 50 iatrogenic insulin-induced comas or chlorpromazine in doses from 300 mg to 2000 mg/day. The results were
227:
or cardiazol/metrazol convulsive therapy during the coma, or on the day of the week when they didn't have insulin treatment. When they were not in a coma, insulin coma patients were kept together in a group and given special treatment and attention. One handbook for psychiatric nurses, written by
175:
visited Vienna in 1935 and 1936, and by 1938, 31 hospitals in
England and Wales had insulin treatment units. In 1936, Sakel moved to New York and promoted the use of insulin coma treatment in US psychiatric hospitals. By the late 1940s, the majority of psychiatric hospitals in the US were using
251:
A few psychiatrists (including Sakel) claimed success rates for insulin coma therapy of over 80% in the treatment of schizophrenia. A few others argued that it merely accelerated remission in those patients who would undergo remission anyway. The consensus at the time was somewhere in between,
341:
In 1958, Bourne published a paper on increasing disillusionment in the psychiatric literature about insulin coma therapy for schizophrenia. He suggested there were several reasons it had received almost universal uncritical acceptance by reviews and textbooks for several decades despite the
219:
and coma—if the dose was high enough—would follow. Each coma would last for up to an hour and be terminated by intravenous glucose or via naso-gastric tube. Seizures occurred before or during the coma. Many would be tossing, rolling, moaning, twitching, spasming or thrashing around.
260:
and schizophrenia rarely occurred in the same patient. The premise was supported by neuropathologic studies that found a dearth of glia in the brains of schizophrenic patients and a surplus of glia in epileptic brains. These observations led the
Hungarian neuropsychiatrist
204:
and the physical strength to withstand an arduous treatment. There were no standard guidelines for treatment. Different hospitals and psychiatrists developed their own protocols. Typically, injections were administered six days a week for about two months.
232:, instructs nurses to take their insulin patients out walking and occupy them with games and competitions, flower-picking and map-reading, etc. Patients required continuous supervision as there was a danger of hypoglycemic aftershocks after the coma.
409:
British lawyer Phil
Fennell notes that patients "must have been terrified" by the insulin coma therapy procedures and the effects of the massive overdoses of insulin, and were often rendered more compliant and easier to manage after a course.
1939:
277:
levels) that resulted from insulin coma therapy made patients extremely restless, sweaty, and liable to further convulsions and "after-shocks". In addition, patients invariably emerged from the long course of treatment "grossly
371:; in one case discussed by Doroshow a patient had already started to show improvement before insulin coma treatment, and after the treatment denied that it had helped, but the psychiatrists nevertheless argued that it had.
420:
who underwent 50 forced insulin coma treatments combined with ECT, described the treatment as "the most devastating, painful and humiliating experience of my life", a "flat-out atrocity" glossed over by psychiatric
349:
Although coma therapy had largely fallen out of use in the US by the 1970s, it was still being practiced and researched in some hospitals, and may have continued for longer in countries such as China and the
265:
to induce seizures in schizophrenic patients with injections of camphor, soon replaced by pentylenetetrazol (Metrazole). Another theory was that patients were somehow "jolted" out of their mental illness.
306:
in Essex, insulin coma treatment was given to 39 patients in 1956. In the same year, 18 patients received modified insulin treatment, while 432 patients were given electroconvulsive treatment.
1924:
1547:
334:. There was no difference in outcome between the groups and the authors concluded that, whatever the benefits of the coma regimen, insulin was not the specific therapeutic agent.
2103:
1934:
1854:
916:
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published the results of a randomized, controlled trial where patients were either given insulin coma treatment or identical treatment but with unconsciousness produced by
215:
After the insulin injection patients would experience various symptoms of decreased blood glucose: flushing, pallor, perspiration, salivation, drowsiness or restlessness.
460:
Like many new medical treatments for diseases previously considered incurable, depictions of insulin coma therapy in the media were initially favorable. In the 1940 film
346:, and insulin coma therapy "provided a personal approach to the schizophrenic, suitably disguised as a physical treatment so as to slip past the prejudices of the age."
172:
338:
essentially the same in relief and discharge ratings but chlorpromazine was safer with fewer side-effects, easier to administer, and better suited to long-term care.
293:
was said to have lost much of his long-term memory from this treatment, performed on him for bipolar disorder, preceding a life of substance abuse and depression.
252:
claiming a success rate of about 50% in patients who had been ill for less than a year (about double the spontaneous remission rate) with no influence on relapse.
129:
It was one of a number of physical treatments introduced into psychiatry in the first four decades of the 20th century. These included the convulsive therapies (
2110:
2093:
1904:
476:
plays a doctor who plots to murder a patient using an overdose of insulin in order to keep the fact that he was a murderer a secret. More recent films include
196:
Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit. Patients, who were almost invariably diagnosed with
1859:
342:
occasional disquieting negative finding, including that, by the 1930s when it all started, schizophrenics were considered inherently unable to engage in
2194:
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1678:
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1061:
Revitch Eugene (1 January 1954). "Observations on organic brain damage and clinical improvement following protracted insulin coma (1955)".
1914:
1899:
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1049:
913:""To fight dementia with insulin" Newspaper Morning Journal. August 19, 1937. Dr. Ralph E. Stevens claims 80 percent recovery rate"
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1929:
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323:; after a 12-month delay, the Journal informed Bourne they had rejected the article, telling him to "get more experience".
1995:
1944:
1879:
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320:
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In "modified insulin therapy", used in the treatment of neurosis, patients were given lower (sub-coma) doses of insulin.
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66:
516:'s book The German Wife the character Henry Davis undergoes insulin shock therapy to treat 'combat fatigue'.
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1965:
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Treatment
Without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845
493:
1960:
1818:
1798:
1778:
1696:
1262:
Ackner, B; Harris, A; Oldham, AJ (1957). "Insulin treatment of schizophrenia; a controlled study".
448:'s first wife (and Eduard's mother), and the way Sakel's therapy had been given to Eduard, who had
382:
229:
2134:
171:, after seeing Sakel practice it in 1935, introduced it to the US. British psychiatrists from the
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729:
525:
309:
In 1953, British psychiatrist Harold Bourne published a paper entitled "The insulin myth" in the
303:
262:
138:
1500:
1104:
Ebaugh, FG (1943). "A review of the drastic shock therapies in the treatment of the psychoses".
896:
704:
Doroshow, DB (2007). "Performing a cure for schizophrenia: insulin coma therapy on the wards".
2138:
2022:
1788:
1578:
1528:
1520:
1501:"A Beautiful Mind and Insulin Coma: Social Constraints on Psychiatric Diagnosis and Treatment"
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2007:
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by the head of the insulin coma unit at the Hillside Hospital in New York from 1952 to 1958
223:
Some psychiatrists regarded seizures as therapeutic and patients were sometimes also given
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2017:
1975:
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hospital units. He responded to treatment and treatment was continued with neuroleptics.
256:
the patient." The shock therapies in general had developed on the erroneous premise that
2052:
1838:
1833:
1239:
1212:
833:
808:
781:
749:"Insulin Units and Conversion Factors: A Story of Truth, Boots, and Faster Half-Truths"
748:
656:
MJ Sakel (1956) The classical Sakel shock treatment: a reappraisal. In F. Marti-Ibanez
629:
616:
483:
478:
429:
1275:
1186:
502:, House puts himself in an insulin shock to try to make his hallucinations disappear.
243:
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123:
119:
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940:"Insulin Coma Therapy of Schizophrenia: Some Critical Remarks on Dr. Sakel's Report"
733:
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2012:
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513:
508:
503:
441:
351:
331:
270:
112:
1299:"Comparative study of Chlorpromazine and insulin coma in the therapy of psychosis"
145:. Insulin coma therapy and the convulsive therapies are collectively known as the
1652:
1136:
1034:
247:
A patient subjected to the practice in Lapinlahti Hospital, Helsinki in the 1950s
72:
100:
1117:
824:
747:
Knopp, Jennifer L.; Holder-Pearson, Lui; Chase, J. Geoffrey (13 October 2018).
607:
208:
The daily insulin dose was gradually increased to 100–150 units (1 unit = 34.7
1940:
Working Commission to Investigate the Use of Psychiatry for Political Purposes
1719:
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311:
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1009:
963:
772:
764:
1808:
1438:
Kalinowsky, LB (1980). "The discovery of somatic treatments in psychiatry".
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47:
17:
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717:
662:
The great physiodynamic therapies in psychiatry: an historical reappraisal.
625:
1657:
1459:
1017:
1424:
257:
103:
treatment in which patients were repeatedly injected with large doses of
1548:"Psychiatry's Unholy Trinity--Fraud, Fear and Force: a personal account"
1408:
1074:
274:
104:
82:
162:
158:
1627:
24. "House M.D" "Under My Skin" episode 23, Season 5. Plot synopsis
111:
over several weeks. It was introduced in 1927 by Austrian-American
884:
An introduction to the physical methods of treatment in psychiatry
279:
242:
183:
157:
In 1927, Sakel, who had recently qualified as a medical doctor in
1658:
1944 textbook extract on 'The Insulin Treatment of Schizophrenia'
496:
undergoing insulin treatment. In an episode of the medical drama
406:
encouraged psychiatrists to experiment with physical treatments.
1603:
108:
1692:
1688:
1393:"Insulin coma therapy: Decrease of plasma tryptophan in man"
1213:"Profile: Dr Bourne's identity - credit where credit's due"
1925:
Royal Australian and New Zealand College of Psychiatrists
1577:(french ed.). Paris: Flammarion. pp. 128–131.
326:
In 1957, when insulin coma treatment use was declining,
118:
and used extensively in the 1940s and 1950s, mainly for
46:
Insulin shock therapy administered in Långbro Hospital,
1685:
A poem by insulin/electro shock survivor Dorothy Dundas
706:
Journal of the History of Medicine and Allied Sciences
675:
Psychiatric shock therapy: current uses and practices.
122:, before falling out of favour and being replaced by
1935:
Taiwanese Society of Child and Adolescent Psychiatry
898:
Modern mental treatment : a handbook for nurses
2081:
1953:
1855:
American Academy of Child and Adolescent Psychiatry
1847:
1726:
432:wrote an historical novel about the tragic life of
65:
55:
34:
381:In 1959, the 1994 Nobel Prize winner in Economics
512:refers to insulin coma therapy in chapter 15. In
440:. He related the encounter between Dr Sakel and
319:, Bourne had tried to submit the article to the
1391:Baumann, P.; Gaillard, J. -M. (December 1976).
1629:"House" Under My Skin (TV Episode 2009) - IMDb
1029:
1027:
986:"Meduna and the origins of convulsive therapy"
699:
697:
695:
693:
691:
689:
687:
685:
683:
200:, were selected on the basis of having a good
1905:Independent Psychiatric Association of Russia
1704:
8:
1676:Shock Treatment - The Killing of Susan Kelly
813:Proceedings of the Royal Society of Medicine
389:Nash's life story was presented in the film
1303:Journal of the American Medical Association
1206:
1204:
1159:Narratives of Severalls Hospital, 1913-1977
161:and was working in a psychiatric clinic in
1860:American Board of Psychiatry and Neurology
1711:
1697:
1689:
1641:The History of Shock Therapy in Psychiatry
753:Journal of Diabetes Science and Technology
282:", probably due to glucose rescue-induced
40:
1599:""House" Under My Skin (TV Episode 2009)"
1238:
878:
876:
868:Modern discoveries in medical psychology.
832:
780:
615:
425:, and a violation of basic human rights.
1133:"Townes Van Zandt - A Far Cry From Dead"
802:
800:
596:Journal of the Royal Society of Medicine
1476:. New York: Simon & Schuster, 1998.
1171:Bourne, H. (1953). "The insulin myth".
862:
860:
858:
856:
854:
852:
652:
650:
648:
646:
644:
642:
589:"Insulin coma therapy in schizophrenia"
582:
580:
578:
576:
574:
572:
546:
428:In 2013, French physician-and-novelist
188:An insulin treatment ward, circa 1951,
486:undergoes insulin coma treatment, and
31:
2094:Neurological conditions and disorders
1865:American Neuropsychiatric Association
558:
556:
554:
552:
550:
7:
1611:from the original on 26 January 2022
1915:National Institute of Mental Health
1653:Drug Treatment in Modern Psychiatry
78:
1900:Hong Kong College of Psychiatrists
1875:Campaign Against Psychiatric Abuse
25:
2143:
2133:
1890:European Psychiatric Association
1870:American Psychiatric Association
1315:10.1001/jama.1958.02990150042009
996:(9): 1034–1041. September 1984.
919:from the original on 2 July 2021
416:, an American activist from the
2195:Experimental medical treatments
2185:Physical psychiatric treatments
2144:
1895:Global Initiative on Psychiatry
1744:Child and adolescent psychiatry
882:WW Sargant and E Slater (1954)
2111:Psychiatric survivors movement
2001:Psychiatric survivors movement
1971:Controversies about psychiatry
1930:Royal College of Psychiatrists
1485:Howard, Ron and Brian Grazer.
1397:Journal of Neural Transmission
1350:American Journal of Psychiatry
990:American Journal of Psychiatry
564:Modern psychiatry in practice.
418:psychiatric survivors movement
302:British psychiatric hospital,
1:
1996:Political abuse of psychiatry
1945:World Psychiatric Association
1880:Chinese Society of Psychiatry
1276:10.1016/s0140-6736(57)91070-x
1211:Pimm, Jonathan (April 2014).
1187:10.1016/s0140-6736(53)90622-9
1505:Harvard Review of Psychiatry
1452:10.1016/0010-440X(80)90044-9
1131:Manion, Jim (16 July 1999).
402:has been suggested that the
289:Respected singer-songwriter
1344:Bourne, Harold (May 1958).
1297:Fink, Max (12 April 1958).
1106:Annals of Internal Medicine
2221:
1910:Indian Psychiatric Society
1499:Fink, Max (January 2003).
1489:. Universal Studios, 2001.
1118:10.7326/0003-4819-18-3-279
825:10.1177/003591575304600103
608:10.1177/014107680009300313
463:Dr. Kildare's Strange Case
107:in order to produce daily
2129:
1986:Electroconvulsive therapy
1981:Biopsychiatry controversy
1754:Cross-cultural psychiatry
1749:Cognitive neuropsychiatry
1346:"Insulin Coma in Decline"
1063:The Psychiatric Quarterly
944:Journal of Mental Science
886:, 3rd edition. Edinburgh.
531:Electroconvulsive therapy
404:Mental Treatment Act 1930
321:Journal of Mental Science
225:electroconvulsive therapy
135:electroconvulsive therapy
79:
39:
2033:Psychiatric epidemiology
2028:Philosophy of psychiatry
1920:Philadelphia Association
1759:Developmental disability
1573:Seksik, Laurent (2013).
1517:10.1080/hrp.11.5.284.290
1440:Comprehensive Psychiatry
1231:10.1192/pb.bp.113.046060
1218:The Psychiatric Bulletin
1040:22 December 2016 at the
938:Mayer-Gross, W. (1950).
809:"Death Due to Treatment"
765:10.1177/1932296818805074
492:, which depicted genius
482:(1982) in which actress
284:glycogen storage disease
176:insulin coma treatment.
2099:Psychiatric medications
1681:12 October 2008 at the
1668:15 October 2002 at the
1646:31 January 2023 at the
1362:10.1176/ajp.114.11.1015
456:Representation in media
2068:Psychosomatic medicine
1804:Nutritional psychiatry
1764:Descriptive psychiatry
1575:Le cas Eduard Einstein
1002:10.1176/ajp.141.9.1034
956:10.1192/bjp.97.406.132
438:Le cas Eduard Einstein
248:
193:
2190:History of psychiatry
1991:Insulin shock therapy
1966:Clinical neuroscience
1885:Democratic Psychiatry
1739:Biological psychiatry
562:Neustatter WL (1948)
246:
228:British psychiatrist
187:
93:Insulin shock therapy
35:Insulin shock therapy
27:Psychiatric treatment
2104:by condition treated
2043:Psychiatric hospital
2038:Psychiatric genetics
1784:Geriatric psychiatry
1774:Emergency psychiatry
1734:Addiction psychiatry
1663:Insulin Coma Therapy
1558:: 11. Archived from
1033:Phil Fennell (1996)
718:10.1093/jhmas/jrl044
635:on 20 February 2009.
273:(pathologically low
126:drugs in the 1960s.
97:insulin coma therapy
1961:Behavioral medicine
1819:Palliative medicine
1799:Military psychiatry
1779:Forensic psychiatry
807:Maclay, WS (1953).
230:Eric Cunningham Dax
2205:1927 introductions
2170:Psychopharmacology
2063:Psychopharmacology
1794:Liaison psychiatry
1546:Frank, LR (2002).
1409:10.1007/BF01266307
1161:. Oxford: 197-199.
1075:10.1007/BF01567038
677:Williamsburg: p17.
526:Deep sleep therapy
397:Other explanations
304:Severalls Hospital
249:
194:
192:, Devizes, England
139:deep sleep therapy
131:cardiazol/metrazol
2157:
2156:
2089:Counseling topics
2023:Pentylenetetrazol
1789:Immuno-psychiatry
1356:(11): 1015–1017.
1309:(15): 1846–1850.
1157:D Gittens (1998)
587:Jones, K (2000).
472:, in which actor
414:Leonard Roy Frank
190:Roundway Hospital
90:
89:
16:(Redirected from
2212:
2175:Insulin delivery
2147:
2146:
2137:
2008:Imaging genetics
1713:
1706:
1699:
1690:
1621:
1620:
1618:
1616:
1595:
1589:
1588:
1570:
1564:
1563:
1562:on 2 March 2012.
1543:
1537:
1536:
1496:
1490:
1487:A Beautiful Mind
1483:
1477:
1474:A Beautiful Mind
1470:
1464:
1463:
1435:
1429:
1428:
1388:
1382:
1381:
1341:
1335:
1334:
1294:
1288:
1287:
1270:(6969): 607–11.
1259:
1253:
1252:
1242:
1208:
1199:
1198:
1168:
1162:
1155:
1149:
1148:
1146:
1144:
1135:. Archived from
1128:
1122:
1121:
1101:
1095:
1094:
1058:
1052:
1044:Routledge, 1996
1031:
1022:
1021:
982:
976:
975:
950:(406): 132–135.
935:
929:
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924:
909:
903:
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887:
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871:
870:London: 219-220.
864:
847:
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836:
804:
795:
794:
784:
744:
738:
737:
701:
678:
673:GL Jones (1948)
671:
665:
664:New York: 13-75.
654:
637:
636:
634:
628:. Archived from
619:
593:
584:
567:
560:
489:A Beautiful Mind
391:A Beautiful Mind
376:A Beautiful Mind
291:Townes Van Zandt
173:Board of Control
83:edit on Wikidata
75:
44:
32:
21:
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2125:
2121:Psychotherapies
2077:
2058:Psycho-oncology
2018:Neurophysiology
1976:Anti-psychiatry
1949:
1843:
1814:Neuropsychiatry
1769:Eating disorder
1722:
1717:
1683:Wayback Machine
1670:Wayback Machine
1648:Wayback Machine
1637:
1624:
1614:
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1552:The Freeman
1143:22 November
124:neuroleptic
101:psychiatric
2164:Categories
1720:Psychiatry
1472:Nasar, S.
1174:The Lancet
542:References
499:House M.D.
328:The Lancet
317:The Lancet
1809:Narcology
1525:1067-3229
1417:0300-9564
1370:0002-953X
1323:0002-9955
1010:0002-953X
964:0368-315X
773:1932-2968
494:John Nash
423:euphemism
383:John Nash
369:prognosis
202:prognosis
180:Technique
48:Stockholm
1679:Archived
1666:Archived
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1038:Archived
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917:Archived
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626:10741319
520:See also
258:epilepsy
57:ICD-9-CM
2149:Outline
1615:19 July
1460:7000433
1240:4115399
1091:2581189
1018:6147103
834:1918466
782:6501531
660:(eds.)
617:1297956
479:Frances
297:Decline
275:glucose
239:Effects
153:Origins
105:insulin
73:D003295
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312:Lancet
163:Berlin
159:Vienna
141:, and
2082:Lists
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730:S2CID
633:(PDF)
592:(PDF)
469:Shock
280:obese
217:Sopor
109:comas
81:[
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2200:Coma
1617:2019
1604:IMDb
1579:ISBN
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960:ISSN
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622:PMID
269:The
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