By Aggi Yates

In 1936, António Egas Moniz proposed the Lobotomy, a form of brain surgery that physicians believed would provide a cure for the baffling condition of schizophrenia. According to a reputable medical journal, The Lancet, a ‘long hollow needle… to which is attached a loop of strong wire’ was inserted into the brain and blindly rotated to ‘cut a core of white substance’ in the prefrontal cortex. This description causes extreme discomfort for the modern-day reader. With what we know today, it is clear that the only thing this surgery achieved was extensive brain damage in patients. For contemporaries, however, this was considered an innovative, miracle cure. In fact, the treatment was so acclaimed, it won Egas Moniz a Nobel Prize in 1949, thirteen years after his first conception of the idea. 

Lobotomy, whilst most widely condemned today, was not the only questionable treatment to emerge in the early twentieth century. A less well-known, but equally unfruitful, treatment was ‘Insulin Coma Therapy’ (ICT), first introduced by Manfred J. Sakel in 1927. The patient was injected with insulin over six days, inducing regular comas (a.k.a. hypoglycaemia) for two- or three-hour periods. This approach risked an irreversible coma, brain damage, and even death. In The Lancet, ICT was often used as a comparison point for newer methods, a demonstration of the authority it managed to achieve in this period.

A drug that was less readily accepted, but still prominent in medical texts, was Cardiazol treatment (or Metrazol in the US). Injecting Cardiazol induced an epileptic fit in patients, based on a medical belief that epilepsy and schizophrenia could not occur together in one person. Far less research existed in support of this therapy but, as it was cheaper than ICT, it was in regular use. Due to immense fear expressed by patients that underwent this treatment, Cardiazol injections were soon replaced with electroshock therapy (ECT), still in use today. In its early days, electroshock therapy was significantly more dangerous than it is now. Ugo Cerletti’s original method involved placing electrodes on the temple of the patient, shocked with 80- or 90-volts to produce an epileptic fit. It is interesting that this was the slowest somatic treatment to gain credibility, considered far inferior to ICT.

Clearly, these treatments did not work, and were even cruel, by today’s standards – so why did contemporaries hold them in such high esteem?

The answer is twofold:

Psychiatrists in this period aspired to achieve legitimate medical status, forced to make their approaches more ‘scientific’ to gain approval. Of course, by today’s standards, somatic treatments were not ‘scientific’ at all. However, being ‘scientific’ had different criteria for contemporaries, with less of a focus on objectivity in favour of empirical evidence. Research was largely in the form of case study which, at the time, was perfectly acceptable in medical circles. One article even comprised of a letter from a lobotomy patient himself, posing the question ‘what use was it to live at all if one was only half alive?’ The value of empirical evidence in medical research is clear, as the patients’ (subjective) first-hand account was lauded in an esteemed medical journal.

Outside of the psychiatric profession, it was still widely held that psychosomatic treatments ‘worked’. This belief is understandable after considering that the definition of being ‘cured’ also differed in this historical context. In 1954, an article in The Lancet declared with glee that ‘young schizophrenics no longer fill the hospitals’. In many ways, this was a marked improvement to a patients’ quality of life, the alternative being a bleak lifetime in hospital to ‘wait out’ the illness. If a patient was able to cope in their community, they were in a much better situation than if they were detained in a mental ward. Furthermore, hospitals were expensive, which made the mentally ill a great burden in ways they are not today. If the outcomes of psychosomatic treatments are weighed up against the realities of the time, it is easier to understand why contemporaries so willing accepted these treatments as the ‘cure’ for schizophrenia. 

Our perceptions of the past are often shaded by the standards of the modern day. Empirical evidence was highly valued in medicine, allowing psychiatrists to achieve their aspirations of making psychiatry a medical profession. According to historian Jack D. Pressman, psychosomatic treatments were simply a last resort. These treatments were accepted because they provided an alternative to a disease that had long been considered incurable. For contemporaries, these treatments allowed schizophrenic patients a life outside of the hospital. In this way, they ‘worked’.

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