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'Desperate times' in psychosis treatment
This article accounts how transorbital lobotomy came to be offered to patients at Eastern State Hospital in Williamsburg, Virginia. It is intended to recapture a paradoxical moment in the history of psychiatric nursing. The period after World War II was characterized by the development of psychodynamic and somatic psychiatric treatments, most of which were nursing intensive and carried out in psychiatric hospitals, both public and private.
The recognition that psychotherapy improved what was then called "shell shock" reinforced psychodynamic theory. That gave rise to the development of short-term psychotherapy, a more practical approach than classical deep psychotherapy in hospital practice. Psychotherapeutic "talking cures" developed around a wide range of theories of human existence, from behaviorism in the United States to existentialism, principally in Europe. Evidence accumulated, however, that psychotherapy did little to resolve psychiatric symptoms.
On the other hand, somatic techniques were developed in Europe in the 1930s that were tried, rapidly and uncritically, both abroad and in the United States. Among these, insulin coma therapy was the first to modify mental status and relieve the patient of psychiatric symptoms.
A Viennese physician, Manfred Sakel, first reported his results in 1933. He accidentally overdosed a diabetic drug addict on insulin, and when she recovered, her craving for morphine had subsided. He continued his investigation with other drug addicts, and extended his range to schizophrenic patients on the evidence that insulin coma modified mental status.
Convulsive Therapy
Convulsive therapy, both metrazol and electric, was based on the empirical observation that epilepsy and schizophrenia were incompatible diseases, a theory subsequently disproven.
The Hungarian psychiatrist Joseph von Meduna induced seizures by injecting patients with metrozol. Metrozol convulsive therapy ran a short course of acceptance in American hospitals. The results were equivocal and the risks were great.
The physicians at Eastern State Hospital abandoned the use of metrozol after a clinical trial of 29 patients. The Medical Superintendent concluded, "I am convinced that Metrazol is a hazardous form of treatment and is harmful in the majority of cases" (Brown, 1939).
Ugo Cerletti and Lucio Bini of Italy developed electroconvulsive therapy (ECT) also based on empirical observations of epileptic patients. They reported their technique and early results in 1939. Cerletti hypothesized that the improvement...