Treatments:
Trepanation
Religion
Bloodletting
Asylums
Hydrotherapy
Seizures
Insulin Shock
Electroshock
Surgery
Sterilization
Extermination
Fever Therapy
Lobotomy
Sleep
Others
Drugs
Prospects



No idea is so antiquated that it was not once modern; no idea is so modern that it will not someday be antiquated.- Ellen Glasgow

History of Treatments for Schizophrenia and other Madness

John Conolly, superintendent of a mental hospital in England and author of the book Indications of Insanity defined schizophrenia as "a disease of perception combined with an inability to tell whether these perceptual changes were real or not".

This is a brief history of the treatments for people with this perceptual malady. Any compassionate person will probably be appalled at many of the remedies doctors devised to "cure" madness in the past. So too a time will come when the curious will look aghast at the chemical straitjackets of current neuroleptics.

Trepanation

Perhaps the earliest surgeries man ever performed were called trepanations, or boring holes in the skull with saws, picks, manual drills, or axes to cure headaches, treat mental illnesses, and bring about enlightenment. People living in prehistoric periods believed that evil spirits inside the body caused illness and that drilling a hole into the person's skull would release the evil spirits, thereby curing them. Evidence indicates this procedure was practiced in Europe, South America, and Africa. Recovered trepanned skulls indicate that as many as 70 percent of the patients survived the procedure. Some skulls even have multiple holes, indicating several successful procedures. Trepanations could be performed in either a single session, lasting 30 to 60 minutes by expert estimates, or over several sessions spanning up to 12 days. It is believed that patients most often died of post-surgical infection rather than from the procedure itself. It is astonishing but there are still proponents for this procedure.



Religion

All forms of sickness, both physical and psychological, were attributed to possessing spirits in ancient Mesopotamia. The number of possessing spirits and demon led to a fear described as "one of the most important factors in the daily life of a Babylonian." Ancient Babylonian priests served as exorcists who performed their ritual by destroying a clay or wax image of a demon thereby destroying the attached spirit. Assyrian tablets offer the first written accounts for the treatment of illnesses. Treatment included incantations and prayers to the gods, as well as direct challenges to the demons who were believed to inflict diseases of every type. The Hindu scriptures called the Vedas composed around 1000BC tell of evil beings that interfere with the work of Hindu gods and harm the living. Accounts from ancient Persia, 6th century BC, offer evidence of exorcism using prayer, ritual, and holy water by the religious leader Zoroaster, who was considered the first magician, and who founded the religion Zoroastrianism. It is known that Homer spoke repeatedly of demons, "A sick man pining away is one upon whom an evil spirit has gazed." Socrates spoke of the insane as those who are under the influence of demons; Plato affirmed that demons obsessed mortals.

Divine Madness

The ancient Greeks took a great interest in the human psyche and especially in madness. Plato who lived in the 5th and 4th centuries BC speaks about two kinds of madness, one with a divine origin and another with a physical origin. The divine madness may create prophets, relieve the generation of impurity, inspire poets, or provoke an intense desire for beauty, according to Plato. The idea of the divine madness was firmly rooted in the Greek culture even before Plato. It also appears in the Greek tragedies, for instance in Heracles by Euripidos, from the 5th century BC. The ideas of a connection between madness and prophecy recur in ancient Israel. The highly esteemed religious prophets were often regarded as mad because of their odd utterances and deviant clothes and behavior. The same conceptions later appear in the Koran in the Islamic countries. The Koran uses the word majnoon to describe mad persons as well as prophets. Religious insanity could be holy, manifest in ecstasies and prophetic powers, but mostly it was evil, provoked by the Devil. It is possible that early Christian saints who heard voices and saw visions were in fact having hallucinations; however their experiences were treated as divine rather than demonic.

Christianity and Madness

Religion was always a strong influence on early treatment of the mentally ill. Fortunate people were taken to a shrine, prayed over or sprinkled with holy water but the less fortunate might have been starved and flogged, to harass the devil within. It is recorded in the Gospel according to St Mark, chapter 5, that Jesus went into the country of the Gadarenes and cured a madman by casting out the devils within him into a herd of swine. The swine forthwith stampeded and fell to their deaths in the Sea of Gallilea. The idea of supernatural madness was reinforced by Christianity, spiritual disturbance being seen as a symptom of the war for the soul waged between God and Satan. Christianity has traditionally taught that Satan and his hordes of demons roam about the world attempting to harm, harass, and destroy humans. There are many dozen Christian Scriptures that describe the belief that demons can indwell a human being and cause them to behave strangely. Much mental and physical illness was attributed to this origin in the 1st century CE. A major part of the Gospel message concerns Jesus' healing ministry of exorcism. He is recorded as having cured numerous sick people by banishing one or more demons from their body. The Middle Ages (500-1500AD) saw the treatment of mental illnesses left to the clergy who believed evil spirits were the cause. The rites of exorcism have included the use of prayers, commands, fumigations (burning of dung), holy water, hellebore, rue, salt, and roses. The devils were also exorcised through a variety of techniques which caused physical pain, including scourging. In 1276, Pope John XXI, who wrote several medical treatises, suggested that eating a roasted mouse "doth heal frantick persons."

Witchcraft

In the late 16th and early 17th centuries, when madness and suicide appeared to be reaching epidemic proportions the cause of insanity was traceable to divine retribution, demonic possession, witchcraft or astrological influences. The cure was believed to lie in removing the cause, a duty that fell to clerical doctors and to an assortment of wizards, apothecaries and medical astrologers. Witches were hunted down and the church hierarchy in Rome endorsed the hunts as did the new Protestant churches. Within the 200-year period, it is estimated that 100,000 people were executed as witches including but not exclusively the mentally ill.


Bloodletting

Galen, a Greek physician who practiced in the 2nd century AD, proved that the body's arteries contained blood and not air, as was commonly thought in those days. He thought that blood was created and then used up - it did not circulate and so it could 'stagnate'. Because of this belief, the practice of bleeding the mentally ill became popular. Dr. Daniel Oxenbridge (1576-1642) a London physician, employed the latest methods in 1628 when trying to cure the young wife of a clothier of mental illness. First he gave her an enema, then he bled her arms, her feet, and her forehead. After that, once every three or four days, I either bled her or vomited her strongly. He then shaved off all the hair on her head to which he applied the warm lungs of lambs, sheep and young whelps. The practice of bleeding for emotional and physical disorders persisted into the nineteenth century, a span of nearly 1700 years.


Asylums

In 1841, when a young clergyman asked her to begin a Sunday school class in the East Cambridge (Massachusetts) House of Correction, Dorothea Dix accepted the challenge. In the prison she first observed the inhumane treatment of insane and mentally disturbed persons, who were incarcerated with criminals, irrespective of age or sex. They were left unclothed, in darkness, without heat or sanitary facilities; some were chained to the walls and flogged. For the next forty years Dix crusaded and she inspired legislators in fifteen U.S. states and in Canada to establish state hospitals for the mentally ill. Her unflagging efforts directly inspired the building of thirty-two institutions in the United States.

In the asylums, many experimental methods of treatment were tried. One method was terror. Dr. Benjamin Rush, sometimes called the father of American psychiatry, was the first president of the American Psychiatric Association and his face still appears on the official seal. The most renown doctor of the time, Dr. Rush (one of the signers of the Declaration of Independence) wrote in 1818, "Terror acts powerfully upon the body through the medium of the mind and should be employed in the cure of madness. Fear accompanied with pain and the sense of shame has sometimes cured the disease." Dr. Rush advocated and practiced terror by designing and using the straitjacket, the tranquilizer chair and "fear of death" on numerous inmates in 19th century lunatic asylums. Another of Rush's methods was called swinging. Dr. Rush argued that mental patients should be strapped into "gyration devices", i.e., chairs suspended from the ceiling by chains, and that attendants should swing and spin them for hours. He believed that the spinning would reduce the force of the blood flowing into the brain, thereby relaxing the muscles and lowering the pulse. He also cited other positive effects from "the spinning", pointing out that the induced vomiting would generate a healthy circulation.

Dr. Rush introduced the Tranquilizer Chair in 1811 - the most complete restraint of a patient's every move that was ever devised. It consisted of a board attached to the back of the chair that was made to rise and fall according to the height of the patient. To the end of the board was attached a wooden box lined with stuffed linen in which the patient's head was held immobile so it could not move backward or forward, nor incline to either side. Flat leather chest and belly-bands which confined and limited the body's movement in the chair and strong leather bands which imprisoned the arms and hands of the patient to the arms of the chair. Pieces of wood, which protrude slightly from the chair encased the patient's feet, prevented their moving in any direction. Finally, a stool-pan (half-filled with water) was attached that could be drawn out from behind the chair and emptied and replaced, without removing or disturbing the patient. The chair was fastened to the floor so as to remain solid.

Rush, also thought mental illnesses were caused by circulatory defects. He believed bloodletting (up to four-fifths of a patient's blood) and spinning patients on a board were appropriate treatments. Despite some of his more bizarre cures, Rush is admired for being one of the first to believe that mental illness was a disease of the mind, rather than a possession of demons. Rush forced the hospital to cease its policy of chaining the most serious cases of the mentally ill in unheated basement cells despite the common belief that the insane could not feel hot or cold and he stopped the practice of letting the townspeople come to the hospital to watch the insane patients as a form of entertainment.

Other cures included forcing vomiting by emetics or the spinning chair which produced nausea and vomiting as well as inducing hemorrhages to the indescribable pain of skin irritants like mustard plasters and the application of ants, scabies and stinging nettles in order to regain consciousness of... his true self. Other treatments ranged from exorcism to therapeutic terror--including immersion in a tub of eels. Commenting on the asylums or "madhouses" novelist Charles Dickens wrote in 1852: "Chains, straw, filthy solitude, darkness and starvation; jalap, syrup of buckthorn, tartarised antimony and ipecacuanha administered every spring and fall in fabulous doses to every patient, whether well or ill; spinning in whirligigs, corporal punishment, gagging, continued intoxication; nothing was too wildly extravagant, nothing too monstrously cruel to be prescribed by mad-doctors."

Perhaps no single group has undergone more widespread experimentation than the destitute "mentally-ill" in state-run institutions. One such experiment was a chair in which a patient was strapped and then exposed to gallons of freezing water being poured on them for up to ten minutes, or being submerged up to the neck until the early stages of hypothermia would quiet the patient. Various methods of sensory deprivation were employed to achieve the same result. The Lunatic Box, sometimes called the English Booth, the Coffin or the Clock Case, was used during the 18th and 19th centuries. The victim was placed in the device and had to remain in a standing position until he or she became calm. A wooden piece could be dropped over the opening of the face leaving the patient in complete darkness. The patient stood in his own excrement for extended periods of time. The Glore Museum houses many of these devices.


Hydrotherapy

The first widely acknowledged therapy of the twentieth century was hydrotherapy. This treatment consisted of several devices and techniques that made use of water. The two most popular means of administering hydrotherapy were the continuous bath and the wet sheet pack. Following a doctor's order for a "pack" (since it was a "medical" intervention, a doctor's order was always required), an attendant would dip a sheet in water ranging from 40 to 100 degrees Fahrenheit, then snugly wrap it around the patient and tie the patient to the bed if they resisted. Patients remained in this cocoon-like state for several hours. At first, the individual might experience cooling as water evaporated off the dripping, water-soaked cloth but, as his or her body began to generate heat, the pack would warm. Often, an attendant would swaddle the packaged patient in an outer blanket, tying the more resistant patient securely to a bed.

Continuous baths also required a doctor's prescription, but were more elaborate than the pack, necessitating specially designed facilities with large rooms containing numerous tubs. A large control console festooned with dials, knobs, and gauges allowed the attendant to manipulate temperature and water flow as specified by the psychiatrist. Often a daily ritual, a patient would be placed in a tub, fastened to a hammock suspended above the bottom of the tub. A canvas sheet covered all but the patient's head while valves and gauges regulated the temperature and flow of water during a treatment that could last from hours to days. Some institutions used needle cabinets that were steel boxes in which patients sat in while high-pressure water was pumped directly onto their skin. Hydrotherapy was viewed as a scientifically "proven" therapy, acting directly upon the biology of mental illness, by relieving "cerebral congestion" via its influence on the peripheral vascular system or by eliminating "toxic impurities." Research based on precise measurement of blood pressure, pulse, respiratory rate, and differential blood count supported these biological explanations. These findings, in turn, reinforced physicians everyday perceptions in the therapeutic effectiveness of hydrotherapy. Reflecting the prevailing consensus, a psychiatrist in 1920 declared that hydrotherapy "is the only scientific treatment for the acute excitement of the insane that has yet been discovered." By the 1910s, most psychiatric institutions in the United States were using hydrotherapy, and it remained common until the 1940s and 1950s.


Epileptic Seizures

There once was a theory, that epileptics could not be schizophrenic. Therefore, several doctors concluded, epileptic seizures should be induced in mental patients to undo the insanity. Methods involved the injection of chemicals such as insulin, camphor or metrazol to create seizures and coma. Leopold von Aurenbrugger revived a treatment by Swiss physician-alchemist Paracelsus (1493-1591) that induced convulsions by drinking camphor, believed to be a cure for lunacy. Although the cure was tried again in 1785 and then 1798, it was not widely adopted and died out completely in the nineteenth century.


Insulin Shock

In 1933, Manfred Sakel introduced insulin shock treatment (Insulinshockbehandlung) for psychotic patients. Sakel got the idea for this treatment when he treated heroin addicts in Berlin with small doses of insulin during their withdrawal periods. Once, one of the addicts, who also suffered from schizophrenia, accidentally went into hypoglycemic coma and later showed improvement of his psychotic symptoms. Massive doses of insulin were administered to patients to induce a state of hypoglycemic shock resulting in coma and near-death states before doctors resuscitated them with sugar solutions. Injections of insulin plunged the patient into a coma for several hours 50 or 60 times in the course of several months. Since patients were often brought to the brink of death before resuscitation, the procedure required the close attention of nurses and physicians. Although 1% to 2% of patients died from complications, the method spread rapidly, and by 1941, 75% of public and private institutions in the United States were using it. A 1944 text on insulin therapy is very confident of the usefulness of this therapy. Hypoglycemic treatments were not without risk, since, not infrequently, the insulin coma became irreversible. Widespread application of insulin shock therapy was short-lived, and was quickly replaced by the much easier to administer Metrazol treatments introduced by Ladislas von Meduna of Budapest. He believed that "a certain biochemical antagonism exists between the convulsive state and the schizophrenic process" and that convulsions could improve psychosis. In early 1934 and after animal experimentation, he artificially induced seizures first with intramuscular injections of camphor and later with Metrazol that is chemically similar to camphor. This new treatment gained wide acceptance, quickly rivaling that of insulin. Compared to insulin, an individual Metrazol treatment was easier to administer, required less observation, took much less time, and produced fewer complications although is produced violent convulsions which frequently caused bone fractures. As with insulin, most physicians used Metrazol on patients diagnosed with schizophrenia, but by the late 1930s, researchers discovered that it worked better on patients with depressive disorders.


Electroshock

The first experiments with electricity began in the 18th century when Benjamin Franklin, who sustained two electric shocks himself, inflicting minor retrograde amnesia, suggested "trying the practice on mad people." So in 1787, Dr. John Birch, a British doctor, did just that, trying to cure a popular but suicidal singer suffering from depression. In 1849, British psychiatrist John Charles Bucknill used electrical stimulation of the skin and potassium oxide to help asylum patients with melancholic depression. Electrical stimulation became widespread during the late nineteenth century, but safety concerns reduced its use for a time. In 1936, aware of the success of Metrazol convulsive therapy, Italians Ugo Cerletti and Lucio Bini began developing a method to electrically induce convulsions in psychiatric patients. They noticed that workers in a slaughterhouse used electric shock to send pigs into convulsions in order to make killing them easier. After perfecting a safe technique on dogs, they shocked their first human subject in 1938. Treatment had fewer complications and was even easier to administer than either Metrazol or insulin, so ECT (electroconvulsive therapy) spread rapidly, replacing both insulin and Metrazol shock therapies. Just three years after the first human trial, over forty percent of U.S. psychiatric hospitals had purchased or built their own electroshock machines. While insulin and Metrazol have long since been abandoned, ECT continues to be administered using electricity. Electroshock generates a nerve-wracking convulsion of long duration (hence the acronym ECT/electro-convulsive therapy), frequently inducing amnesia and both long and short term memory loss. Inadequate anesthesia sometimes resulted in bone fractures. It did serve as a means of enforcing discipline in state psychiatric hospitals. The "blitz" method, reserved for particularly recalcitrant patients, entailed administering shocks as often as every four hours.

Surgery

The 1920's brought several new modes of treatment. Picking up the notion that insanity was a solvable medical problem, some American doctors decided that it was a function of infected body parts, which, if removed, would affect a cure. In general, they started on the teeth, and if that didn't work, they moved on to the internal organs. Glands thought to be unbalancing the brain were surgically removed. The excisions covered the thyroid, adrenal and other endocrine glands. Later practitioners went on to remove the testicles or ovaries. But the prize award for somatic therapy should be given to the 'focal infection theory' of Dr. Cotton. Dr. Henry Cotton (1886-1933), acting on his theory that infections caused mental illness, surgically removed "potentially infected" body parts. "The insane are physically ill," he stated, arguing that if a doctor could locate and remove the infection, he could abruptly stop the lunacy. Dr. Cotton ordered 11,000 teeth removed from 1919 to 1921 from his patients at Trenton State Hospital in New Jersey. After studying his results, he decided to remove the tonsils; then the stomach and the colon. In women, he followed up with the cervix, the ovaries, the fallopian tubes and the uterus. To be fair, Cotton thought the seminal vessels in men were only 'occasionally' infected, but excised them nonetheless in some cases. If this didn't work, Cotton went back to the intestines, resecting the middle of the small intestine to the middle of the colon, removing the rest of the intestines if they looked infected. The death rate for this particular operation was 30%. "It was awful to work there", recalled one hospital employee. "There was a young girl who worked in the office right by the door where they had to roll the baskets past that carried the bodies and organs and stuff. One day she ran out screaming that she couldn't take it any longer." Between 1907 and 1922, when Americas Dr. Henry Cotton was inspired to treat psychotic patients with gastrointestinal surgery and by extracting teeth 43% of his patients died. Upon his death the American Journal of Psychiatry hailed his work as "an extraordinary record by one of the most stimulating figures of our generation."


Sterilization

Sterilization was another major intervention introduced in the early years of this century. Today it is difficult to regard sterilization as therapeutic, but many state hospital physicians once used it that way, operating under laws passed largely at the urging of a small but influential group of eugenists. California, for example, allowed physicians to sterilize patients "afflicted with hereditary insanity or incurable chronic mania or dementia." By 1950, 26,000 American psychiatric patients had been sterilized, 11,000 of them in California. Yet physicians in California did not sterilize for eugenic reasons, some, in fact, opposed eugenics. Rather, they thought it was good for the patients themselves. Women, so physicians told themselves and their patients, would be happier knowing that they need have no more children to care for. For men, vasectomy was supposed to diminish anxiety and depression and increase vitality. Castration and clitoridectomy were also common practices.


Nazi Extermination

In 1922 Karl Binding a Jurist and Alfred Hoche a psychiatrist wrote: "The Release of the Destruction of Life Devoid of Value". (Die Freigabe der Vernichtung lebensunwerten Lebens). They argued in favor of euthanasia - that the unfortunate are a burden to themselves and society and their parting would cause no great loss, the cost of keeping these useless people was excessive and that the State could better spend the money on more productive issues. They felt that the physically and mentally defective should be painlessly eliminated and demanded the abolishment of the religious and legal barriers that stood in the way. Hoche was an influential, authoritative psychiatrist and argued that the moral attitudes towards the preservation of life would soon drop away and the destruction of useless lives would become a necessity for the survival of society. There is now irrefutable, documentary evidence that it was the German psychiatrists, particularly prominent professors of psychiatry, and psychiatry department heads, who were chiefly responsible for initiating and administering the infamous T4 program, which involved the mass murder of over 200,000 mental patients and thousands of sick and disabled children and adults during the holocaust. Hospital patients, suffering from congenital and hereditary illnesses, as well as the "incurably mentally ill" were killed in gas chambers (disguised as showers), into which carbon monoxide was pumped.

On August 3, 1941, a Catholic Bishop, Clemens von Galen, delivered a sermon at Munster Cathedral attacking the Nazi euthanasia program calling it "plain murder." The sermon sent a shockwave through the Nazi leadership by publicly condemning the program and urged German Catholics to "withdraw ourselves and our faithful from their (Nazi) influence so that we may not be contaminated by their thinking and their ungodly behavior." As a result, on August 23, Hitler suspended Aktion T4, which had accounted for nearly a hundred thousand deaths by this time. The Nazis retaliated against the Bishop by beheading three parish priests who had distributed his sermon, but left the Bishop unharmed to avoid making him into a martyr. However, the Nazi euthanasia program quietly continued, but without the widespread gassings. Drugs and starvation were used instead and doctors were encouraged to decide in favor of death whenever euthanasia was being considered. The use of gas chambers at the euthanasia killing centers ultimately served as training centers for the SS. They used the technical knowledge and experience gained during the euthanasia program to construct huge killing centers at Auschwitz, Treblinka and other concentration camps in an attempt to exterminate the Jewish population of Europe.


Fever Therapy

Widely acknowledged as a major scientific and clinical breakthrough, malaria fever therapy was another treatment introduced in the first quarter of the 20th century. In contrast to most psychiatric interventions of this era, fever therapy was given almost exclusively to patients suffering from a late stage of neurosyphilis, called general paralysis of the insane (or, more simply, paresis). Syphilis in its later stages often causes general paralysis (paresis) and dementia. This disease posed one of the greatest clinical challenges for early twentieth-century physicians and up to 20 percent of state hospital admissions were so afflicted. The illness produced not only vexing neurologic and psychiatric symptoms, but invariably killed its victims. Not surprisingly, given how intertwined sex, sin and disease were, physicians viewed their neurosyphilitic patients as, perhaps, pitiful but, nonetheless, sinful transgressors.

Wagner von Jauregg, prominent Viennese neurologist, noticed that a few patients who contracted unrelated fevers were cured of their general paresis. Von Jauregg immediately began infecting patients with tuberculosis, typhus and erysipelas. The high temperatures these diseases induced killed the infection and sometimes the patient. Once infected, von Jauregg's patients experienced a series of fevers (up to 106 degrees Fahrenheit) and chills, which he terminated with quinine after several weeks. Appearing to be the first successful remedy for paresis, malaria fever therapy spread rapidly throughout the world and became one of the first somatic treatments for a mental illness widely acknowledged by the scientific community. Patients still occasionally died, and rare cases of the malaria spreading throughout a ward also occurred. In 1927 von Jauregg received the Nobel Prize, the first ever awarded for a psychiatric intervention. It was noted that people with schizophrenia recovered slightly when their temperature was high, so psychiatrists experimented by inducing fevers in their patients, often by injecting sulphur and oil, or causing abscesses. In the 1940's, one doctor injected oil of turpentine into the abdominal wall of a woman with schizophrenia producing a large abcess and accompanying fever. The woman seemed more rational for the two or three days the fever lasted. These abcesses were very painful but in some cases produced brief partial remission. Even as late as the early 1960s and after the introduction of penicillin, physicians continued to recommend the use of malaria fever therapy for paresis.


Lobotomy

In 1890 in an attempt to alter the behavior of six severely agitated patients, Dr. Gottlieb Burckhardt, superintendent of a Swiss psychiatric hospital, drilled holes in their heads and extracted sections of the frontal lobes. Two patients died. The surgery was considered morally reprehensible but belief in psychosurgery did not stay dormant long. Portuguese neurosurgeon Egas Moniz was among those attending a neurological conference in London in 1935 in which Yale University's John Fulton conducted a daylong symposium in which he demonstrated that two chimpanzees, after undergoing frontal lobe removal, were remarkably calm. No neurotic behavior could be induced. The question naturally arose about whether similar surgery in humans wouldn't eradicate anxious behavior. After learning of these results, neurologist Egas Moniz proceeded to develop the surgical technique for lobotomy in humans, performing the first human lobotomy in 1936. Moniz's technique entailed drilling two holes into the top of the scull and injecting alcohol into the frontal lobe white matter of the brain. Later, he replaced the alcohol injections with a device called a leucotome, a rod-shaped instrument with a steel band that severed the white matter fibers. Later that year, Moniz performed the first leukotomy on a female patient by destroying the fibers connecting the frontal lobes to the rest of the brain. Her agitation and paranoia diminished, but successive patients only seemed dull and apathetic.

After drilling two or more holes into the skull, surgeons inserted into the patient's brain any of a number of various instruments - some resembling an apple corer, a butter spreader, or an ice pick - and often, without being able to see what they were cutting, destroyed parts of the brain. The fibers of the frontal brain lobes were severed, causing irreversible damage. The hallmark of lobotomy was the deterioration of intellect and loss of personality-essentially the loss of self. The idea didn't gain much momentum until Dr. Walter Freeman and Dr. James Watts pioneered lobotomies in America. Dr. Freeman preferred entering through the eye socket with an instrument resembling an ice pick. One gloomy October morning in front of an audience of psychiatrists and photographers a group of female patients were wheeled into his operating room. After a brief lecture on the wonders of psychosurgery, Dr. Freeman went to work. As the first patient was wheeled in before him, he put electrodes on her temple and shocked her into a faint. He then lifted her left eyelid and plunged the ice pick into her head. As he pulled it out, another woman was wheeled in before him. Freeman recommended the procedure for everything from psychosis to depression to neurosis to criminality. He developed what others called assembly line lobotomies, going from one patient to the next with his gold-plated ice pick, even having his assistants time him to see if he could break lobotomy speed record. It is said that even some seasoned surgeons fainted at the sight. Even Watts thought he had gone too far. It was often used on convicts, and in Japan it was recommended for use on difficult children.

Rosemary Kennedy, sister to John, Robert, and Edward Kennedy, was given a lobotomy when her father complained about the mildly retarded girl's embarrassing new interest in boys. Throughout the 1940s and 50s, more than 100,000 mutilating psychosurgeries were performed around the world. While it did serve to tranquilize some agitated patients, it more or less deprived them of their social skills and judgment. At first, lobotomy appeared to be most effective on patients with agitated depressions and less effective on patients with chronic schizophrenia. This, as well as the strain on available resources and personnel due to World War II, slowed the use of the operation. After the war, aided by new reports of positive results on patients with schizophrenia, the procedure's popularity soared. By 1951, nearly 20,000 lobotomies had been performed in the United States, the large majority on women patients but by the 1960s, the surgery had only a few faithful believers left. The developer of this procedure, Egas Moniz, was awarded the Nobel Prize in Physiology and Medicine in 1949.


Sleep Therapy

Prolonged sleep therapy was believed to have originated with a Scottish physician who was asked in 1897 to transport a manic woman from Japan to Shanghai, a five hundred mile trip. Without any nurses to assist him, the physician decided to put the woman to sleep with a bromide. She reportedly was without mania when she awoke. Modern attempts at prolonged sleep treatment started in the 1920's with the Swiss psychiatrist Klasi who induced sleep through multiple injections of the barbituate, Somnifene. Patients were sent into a drug- induced unconsciousness for a week to a month, with daily awakenings for food and bowel movements. Prolonged narcosis, as it was called, was thought to aid in relaxing and resting the patient's mind. It generally resulted in opiate addiction. Some of the schizophrenic patients improved but sometimes the treatment proved fatal as patients developed pneumonia. Chelmsford was a private psychiatric hospital in Pennant Hills, New South Wales (NSW). Over the period 1962-1979, a form of "deep-sleep" treatment was employed. This treatment consisted of continuous barbiturate-induced comas for up to four weeks at a time. Deep sleep therapy was administered for everything from pre-menstrual tension to obesity, including depression, tension, schizophrenia, and drug addiction. It is not, strictly speaking, a therapy, since it induces a deep coma following the administration of very high doses of barbiturates. As a result there is a loss of bowel control, and an inability to remove secretions from the bronchi and lungs. During this treatment, electro-convulsive therapy (ECT) was administered, sometimes in repeated doses. Over this 17-year period 26 people died. These deaths were due to a number of causes, of which pneumonia was a principal one. Other causes included heart attacks and strokes. Fifteen other patients committed suicide following the treatment. Additional consequences of the treatment included: loss of weight, paralysis, respiratory and bowel problems, loss of self-confidence, personality changes, drug dependence, and alcohol problems. Not surprisingly, many lives were subsequently shattered.


Other Treatments

French and British doctors experimented with the transfusion of sheep's blood into their patients... hoping that the life force of a docile creature "might tame their mad passions." In France, Dr. Jean Denis tried it on a patient, with, at first, good results. In England, on November 23rd, 1667, an "insane" man named Arthur Coga was paid twenty shillings to undergo the transfusion, receiving up to twelve ounces of blood from the four-footed beast. "Some think it may have a good effect upon him as a frantic man by cooling his blood," wrote famed diarist Samuel Pepys. Following the transfusion Pepys was pleased to note that, "he is a little cracked in his head, though he speaks very reasonably." In January of the following year, back in France, Dr. Denis performed another transfusion on his patient who'd had a "mental" relapse. The patient died and Dr. Jean Denis was accused of murder. Sheep transfusion fell out of vogue shortly thereafter.

Dr. Jan Baptista van Helmont (1577-1644) a Flemish physician, argued that water shock - to the brink of near death - could extinguish a mad person's "too violent and exorbitant form of fiery life." Dr. Jan Baptista discovered this "cure" by observing that "many fools who accidentally fall into water and are dragged out for dead are not only restored to life... but also to the full use of their understanding."

In 1987 in his book Molecules of the Mind Professor Jon Franklin says:

During the 1940s and 1950s, hundreds of scientists occupied themselves at one time and another with testing samples of schizophrenics' bodily reactions and fluids. They tested skin conductivity, cultured skin cells, analyzed blood, saliva, and sweat, and stared reflectively into test tubes of schizophrenic urine. The result of all this was a continuing series of announcements that this or that difference had been found. One early researcher, for instance, claimed to have isolated a substance from the urine of schizophrenics that made spiders weave cockeyed webs. Another group thought that the blood of schizophrenics contained a faulty metabolite of adrenaline that caused hallucinations. Still another proposed that the disease was caused by a vitamin deficiency. Such developments made great newspaper stories, which generally hinted, or predicted out- right, that the enigma of schizophrenia had finally been solved. Unfortunately, in light of close scrutiny none of the discoveries held water"

Canadian psychiatrist Ewen Cameron (once president of both the World and American Psychiatric Associations) subjected people to repeated recorded messages after which electroshock was administered to break down their personalities. In addition to electroshock, his 1950s and 60s experimental procedures, which were funded by the Central Intelligence Agency (CIA), included giving patients LSD and curare, a drug that can cause paralysis. On October 5, 1988, the CIA, represented by the US Department of Justice, settled a suit by some of Cameron's former patients for $750,000. In 1968, the British Medical Journal had hailed Cameron for helping psychiatrists become better doctors.

In the 1940s and 50s, Dr. John Nathaniel Rosen developed a technique for treating schizophrenic patients that involved slapping them. In 1971, he received the Man of the Year Award from the American Academy of Psychotherapy.

Scientists stopped the blood flow to the brain in 100 prisoners and 11 chronic schizophrenics by pressing the carotid artery in their necks - to see what effect it would have, observing in a paper published in Archives of Neurology and Psychiatry in 1943 that "no significant improvement in the psychiatric status of the schizophrenia patients was noted after repeated and relatively prolonged periods of arrest of cerebral circulation."

Loevenhart and others reported in 1929 that surprising cerebral stimulation was occurring in catatonic patients who were exposed to carbon-dioxide inhalations. Five years later, 18 schizophrenic patients living in a sealed dormitory were maintained at a 50% (normal air is 21%) oxygen atmosphere and given short inhalations of carbon dioxide. Although researchers could not affirm any positive results, the public press reported on the gas cure of the insane. Besides carbon dioxide, injections of apomorphine or the barbituate, sodium amytal interrupted catatonic stupors in schizophrenics. Carbon-dioxide therapy was used in the 1940s and 1950s sometimes triggering near-death experiences.

In the 1990s, the New York Post exposed how National Institute of Mental Health partially funded research in which 16-year-old Maria remembers "researchers at the New York Psychiatric Institute (NYPI). put a clear cube around my head, tied around my neck. Then they pumped carbon dioxide into the cube". Maria would later write: "I had an oxygen tube in my nose.... The test was supposed to last for 40 minutes. I could only take it for 20 minutes...I started to cry...After the CO2 test, they said yes, I was depressed." More than 120 other children and teenagers ages 7 to 18 were subjected to the same experiment. In another case, authorities seized equipment from the office of a Manhattan psychiatrist, Dr. James Watt's, in April 2001 after one of his patients wound up brain dead following a session.

At the present time, E Fuller Torrey, the most widely published authority on Schizophenia believes the problem is cat pee.


Drugs

Virtually all persons who go to psychiatrists are put on one or more drugs. The current theory is that the mentally ill are chemically imbalanced. Between 1850 and 1880 drugs such as chloroform, bromides, and ether were increasingly used to subdue patients. Alienists (as asylum physicians were known before the 20th century) used bromides, chloral hydrate, hyoscine, and other drugs to pacify agitated patients, but they never regarded these drugs as therapeutic. They were chemical restraints, not much better and sometimes worse than physical restraints - the straitjackets and muffs or tranquilizer chairs.

The first antipsychotic medication came on the market in the 1950s. An early precursor of chlorpromazine (Thorazine)was first manufactured as a synthetic dye made from coal-tar. The surgeon Laborit, looking to find an anesthetic that could control cardio-respiratory shock, asked Rhone-Poulenc to manufacture an antihistaminic drug with sedating effects for post surgical shock. He noted that the cocktail of sedating, hypnotic and narcotic drugs (chlorpromazine) caused his patients to become indifferent. He described the effect of the drug as a 'chemical lobotomy' and recommended it to his psychiatric colleagues. Chlorpromazine's properties became popular and within ten years of chlorpromazine hitting the market, over twenty other antipsychotic drugs were in the pipeline. The drugs purpose is to create "maximum behavioral disruption" but it was soon noted that these drugs caused numerous side effects: tremors, restlessness, loss of muscle tone and postural disorders (EPS) and so the group of drugs earned their name - neuroleptics, which means nerve seizing.

Chemical Imbalance

Between 1949-60, major developments in addition to Thorazine, were Valium (Mother's Little Helper), amphetamines, and barbiturates. Beginning in the 1950s, the accidental discovery of a few mood-altering drugs stimulated an enormous interest in psychopharmacology, resulting in staggering growth and profits for the pharmaceutical industry. LSD discovered while looking for a cure for migraine headaches introduced the idea that psychosis was a chemical problem. In 1954 the active ingredient in LSD was discovered to resemble serotonin and naturally led to the theory that psychotic hallucinations were caused by abnormal serotonin activity. In 1956 Eli Lilly patented LSD. LSD, the most notorious of the psychedelic drugs, was first marketed by Sandoz in Europe with the suggestion that it be used to chemically induce insanity in "normal subjects" to discover how mental illness is produced. Yet in December 1955, two months before Lilly obtained their patent on LSD in America, TIME featured the drug, declaring that LSD "may actually help psychiatrists clear up mental illness." It was also promoted as a cure for alcoholism and as an "aid in facilitating psychoanalysis". It was even considered a safe medication for pregnant women. The finest physicians once recommended LSD as a miracle cure. The serotonin theory of schizophrenia was abandoned when it was realized that some hallucinogens did not block serotonin while some drugs that blocked serotonin activity did not produce hallucinations.

Neuroleptics

Of the more than two dozen neuroleptics introduced in the mid 1950s, the most commonly used were Haldol (haloperidol), Compazine (prochlorperazine), Thorazine (chlorpromazine), Navane (thiothixene), Prolixin (fluphenazine), Mellaril (thioridazine), and Trilafon (perphenazine). It is common practice for pharmaceutical companies to search for drugs with similar properties that they can patent and market as competing products that are as effective but have less or different side effects. The newer atypical ones work on the same prinicple but claim to have fewer side effects according to the companies that produce them, although independent research does not agree. Drugs that are classified as neuroleptics include the following: Thorazine, Serentil, Mellaril, Permitil and Prolixin, Trilafon, Stelazine, Taractan, Navane, Clozaril, Haldol, Loxitane, Moban, Zyprexa, Orap, Seroquel, Risperdal, Geodon, Compazine, Etrafon, Triavil, Reglan, Inapsine, and Phenergan.

Simply put, the current prevailing theory is that the mentally ill are chemically imbalanced; depression is caused by too little serotonin and schizophrenia is caused by too much dopamine. People who are prescribed psychiatric drugs are not tested for levels of serotonin, dopamine, and other neurotransmitters because such tests don't exist. The search for abnormal dopamine in schizophrenics has been unsuccessful so theorists claim schizophrenics were hypersensitive to even normal dopamine levels. Debate goes on about the dopamine theory. Neuroleptics that block dopamine are effective in only 20% of schizophrenic patients although nearly all schizophrenic patients are administered them for their lifetime.

Side Effects
Dopamine is a substance involved with emotional and hormonal response and the integration of experience, emotion, and thought. Most of these drugs subdue many of the emotions that make one human such as love, concern for others, empathy, self-insight, creativity, initiative, autonomy, rationality, abstract reasoning, judgment, future planning, foresight, will power, determination, and concentration. Despite little knowledge of how neuroleptics work and some serious adverse effect, the drugs are readily administered to schizophrenics, dementia patients and prison populations.

Referring only to physical side effects, some psychiatric drugs, in particular the neuroleptics, have ADR (adverse drug reaction) rates of 50% during the first year of use. After long-term use the rates rise to nearly 100%. A large percentage of neuroleptic medicated patients develop a chronic neurologic disorder called tardive dyskinesia that is characterized by abnormal movements of the muscles characterized by tics, twitches, and twistings. It is an incurable deforming disease that becomes a lifetime sentence and makes the victim look crazy. Other side effects include powerful muscular cramps, blurred vision, restless pacing, nightmares, sudden outbursts of anger, agitation, memory loss, fainting, blood disorders, seizures, and sudden death.

Psychiatric drugs are not comparable to medicines prescribed for somatic ills because: most medicines are taken only a short period, whereas psychiatric drugs are continued indefinitely; most medicines do not cross the blood/brain barrier nor affect the central nervous system whereas all psychiatric drugs do; side effects from medicines commonly disappear when the drug is discontinued, whereas many side effects from psychiatric drugs are irreversible. In fact, some side effects from psychiatric drugs emerge after the drug has been discontinued. Mad in America author, and science writer for the Boston Globe, Robert Whitaker explains the massive problems with the current medications for schizophrenia.

Researchers with the University of Pittsburgh in the 1990s took people newly diagnosed with schizophrenia, and they started taking MRI pictures of the brains of these people. So we get a picture of their brains at the moment of diagnosis, and then we prepare pictures over the next 18 months to see how those brains change. Now during this 18 months, they are being prescribed antipsychotic medications, and what did the researchers report? They reported that, over this 18-month period, the drugs caused an enlargement of the basal ganglia, an area of the brain that uses dopamine. In other words, it creates a visible change in morphology, a change in the size of an area of the brain, and thatís abnormal. Thatís number one. So we have an antipsychotic drug causing an abnormality in the brain. Now hereís the kicker. They found that as that enlargement occurred, it was associated with a worsening of the psychotic symptoms, a worsening of negative symptoms. So here you actually have, with modern technology, a very powerful study. By imaging the brain, we see how an outside agent comes in, disrupts normal chemistry, causes an abnormal enlargement of the basal ganglia, and that enlargement causes a worsening of the very symptoms itís supposed to treat. Now thatís actually, in essence, a story of a disease process -- an outside agent causes abnormality, causes symptoms...


Future Prospects

When the World Health Organization in the 1970s compared schizophrenics' recovery rates in the U.S and in nations too poor to afford the latest psychopharmaceuticals, it found that a Third World patient was exponentially likelier than an American one to regain sanity. The study followed patients for five years and it found that 64% of the patients in the poor countries had good outcomes, versus 18% in the rich countries. Because the psychiatric profession raised so many objections, the World Health Organization repeated the study in the 1980s and found similar results. In 1979, Canadian investigators offered an explanation on why neuroleptic drugs make people more biological vulnerable to psychosis and may even cause psychosis. In response to the blocking of dopamine activity, the brain tries to compensate by increasing the number of its dopamine receptors, thus becoming supersensitive to this neurotransmitter. Once a person's brain undergoes this change, then he or she is at very high risk of relapse should the drug be withdrawn. As the Canadian investigators concluded: "Some patients who seem to require lifelong neuroleptics may actually do so because of neuroleptics."

Prospects for Change

Currently psychiatry is controlled by the psychiatric drug manufacturers. Psychiatric drugs are prescribed on the basis of conjecture or as a matter of policy to the socially shy, to overactive children labeled attention deficient, to the depressed, to the schizophrenic. Virtually all persons who go to psychiatrists are put on one or more drugs. The commercial motives of drug companies and their huge stake in expanding their markets led to the expansion of neuroleptics, Prozac, and Zoloft that have dramatically changed practice in the mental health profession. Physicians today prescribe them in huge numbers even though, as several major studies reveal, their effectiveness and safety have been greatly exaggerated. The biggest legal mood altering drug consumers are nursing homes and prisons. We now have an epidemic of brain damage caused by psychiatric drugs. How did this come about?

A large proportion of the psychiatric professional organizations income is from drug company advertising in its journals and newspapers. Drug company sponsored symposia and exhibitions dominate the conventions. The members of the drug review boards mandated by the FDA are highly paid consultants to drug companies whose protocols they review. University run drug trials required by the FDA use company provided drug protocol and the researcher receives grants from the drug company. One can not characterize them as evil, but they are primarily profit-motivated and immune from censure. The psychiatric organizations never criticize the overuse and misuse of psychotropic drugs and patients are unorganized and weak.

Unfortunately, any change happens slowly since the great majority of material is the uncontroversial application of whatever model happens to be in vogue and supportive material will be published before any critical material. New research is hard to fund in the U.S., largely because of the huge amount of money the pharmaceutical companies spend supporting the American Psychiatric Association, NAMI, CHADD, the medical journals, and academic researchers. Studies which don't reinforce drug companies' vested interests are very hard to fund, and harder to publish. New drugs are primarily "me-too" drugs - slight variations of other drugs. American psychiatry has become compromised at all levels - private practitioners, public system psychiatrists, and university faculty.

That the neuroleptics emptied the U.S. mental hospitals is a myth. The drugs were in widespread use as early as 1954 and 1955, but the hospital population did not decline until nearly ten years later, starting in 1963. That year the federal government first provided disability insurance coverage for mental disorders. The States could at last relieve themselves of the financial burden by refusing admission to new patients and by discharging old ones. The discharged patients, callously abandoned by psychiatry, received a small federal check for their support in other facilities, such as nursing or board and care homes. Some patients went home as dependents while others went onto the streets. Follow-up studies show that very, very few patients became independent or led better lives following these new policies.

Every generation believes in their scientific evidence and totally ineffective treatments may continue for decades. Clinical science evolves in ways that are not always predictable as witnessed by the awarding of two Nobel Prizes for interventions that later proved to have no therapeutic value. Knowledge of history should invite reflection on the present biological age in psychiatry since current clinicians are no more intelligent or humane than their predecessors. The goal of psychiatric treatments appears to be to protect society and keep the unpredictable mentally ill subdued rather than to help make life better for folks who are obviously suffering and struggling to be normal human beings. To quote C.S. Lewis, "There is no tyranny so great as that which is practiced for the benefit of the victim."

After watching the movie "A Beautiful Mind", (Nash improved without medication unlike the movie portrayal) I questioned a psychiatric nurse about Insulin Shock Therapy and she said, "It was the best knowledge of the time." That is a justification that can also be used to excuse nearly everything. It is too bad that the strongest objections are raised by weird scientologists who deny that mental illness exists.

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