Can Shock, Drugs or Psychosurgery Solve the Problem?

TREATMENT of the mentally ill in most lands has made considerable progress. How were the mentally ill dealt with in times past? One authority says: “Starving, freezing, cramping, and terrifying were routine procedures, and one of the least cruel methods was just plain beating, beating with clubs, whips, wires, chains, and fists.”

Especially notorious was London’s Bethlehem Royal Hospital, which came to be known as Bedlam. There on certain days people paid a penny to watch mental patients being abused. To this day “bedlam” is used to refer to “a place or scene of wild mad uproar.” Not even royalty were spared if mentally ill, King George III of England being one such hapless victim.

The lot of the mentally ill changed from treatment by cruelty to treatment by neglect, unspeakable filth and vermin in prisons. But toward the early part of the nineteenth century certain humanitarians pioneered the treatment of the mentally ill with education, recreation, and human kindness, treating them as sick persons instead of as those possessed by devils. Since the late nineteenth century many new theories and methods of treating the mentally ill have come to the fore.

On the one hand there are the psychotherapies, often named after such men as Freud and Jung. And on the other hand, there are the “somatic” or “organic” methods, most widely used of which are shock and drugs. Psychosurgery, once very popular but then fallen into disrepute, is now again being revived though in a greatly altered form. Generally it is the custom to make use of more than one of these various methods when treating a certain patient.

The Use of Shock

Shock to treat mental patients might be said to have gone through three stages. First, there was shock induced by insulin, pioneered by Manfred Sakel. But it had its disadvantages. To be most effective the insulin-induced shock had to last from 30 to 50 hours, and at times the patient failed to come out of the shock. It was also costly, since it required much attention by nurses or attendants. Thus, after some ten years, it was largely dropped in the 1940’s for other forms of shock treatment.

Secondly, the use of the drug Metrazol was pioneered by psychiatrist Meduna. He found that Metrazol caused epileptic-like convulsions, and these, he theorized, could cure mental illness. However, this method was also found wanting for a number of reasons, not the least of which was that the convulsions at times caused bone fractures.

These shock treatments have been by and large replaced with electroshock treatment, which today is commonly prescribed. It consists of applying electric currents to the brain to cause the body to convulse; usually a drug is given so that the patient does not feel anything. It lasts about 50 seconds and results in a confused state of mind that may last for an hour, or in amnesia that may last for weeks. Many psychiatrists and patients credit it with doing much good.

But electroshock therapy, known as ECT, is not without its critics. Should it be used as frequently as it is? Not according to Dr. Perry C. Talkington (1972), president of the American Psychiatric Association. “Electroshock,” says he, is to be “used to cure deep depressions when other forms of treatment—chemotherapy [drugs], psychotherapy or combinations of those two—are not effective.”

None other than Professor Cerletti, the first one to use electroshock, termed it “unesthetic—ugly . . . gruesome” and said he was trying hard to find a substitute. And Drs. F. G. Alexander and S. T. Selesnick, in their work The History of Psychiatry, state: “Shock treatments effect only a relief of symptoms. They do not reach the basic psychological disturbance underlying the illness, and patients who receive electroshock without psychotherapy—which reaches the source of the illness—frequently relapse.”

A widely read autobiography of a psychiatrist noted that electroshock treatments may be so popular because they are covered by insurance, with the psychiatrists getting $35 (in 1972) every time they ‘press the button.’

The Use of Drugs

Early in the twentieth century, experiments were made with radical drugs the effect of which seemed well-nigh miraculous—but only for a matter of minutes or hours. Then the use of bromides became popular. But here also disillusionment set in. Concerning all such efforts we are told: “Despite the repeated shattering of the drug dream, physicians still hope eventually to alleviate man’s inner strife by chemical means.”

Particularly since the 1950’s are mind-controlling drugs being used in the Western world. Some are said to be of greatest value in treating the schizophrenias, others to combat depression and still others to reduce anxiety.

The use of these drugs has made patients easier to handle and has eased their sufferings. However, it appears that the use of these drugs is being overdone and especially in institutions for the mentally retarded. Thus The National Observer of January 11, 1975, quoted many psychiatrists who had harsh words for custodians who ease their task “by essentially bludgeoning the patient into semiconsciousness.”

“What we’ve done,” said Brandeis professor Dybwad, “is supplant mechanical restraint [straitjackets and solitary confinement] with chemical restraint. And this is even more vicious because you can’t see it.” Another authority is quoted as saying: “We’re going to have to break what has come to be an acceptable pattern of putting people off in institutions and then drugging them to keep them quiet.”

Drugs often are but a crutch. They may actually delay rather than hasten recovery, and may even harm the nervous system. Thus, regarding drugs used to suppress violent patients, one psychiatrist found that 20 to 30 percent of such patients were showing deficient muscular control.

Summarizing the psychiatric drug situation, a 1970 textbook states: “Despite the encouraging progress . . . much more effort is needed. We are woefully ignorant of [what causes] most of the illnesses we treat. We still understand little how drugs ameliorate these conditions, or why they may fail. And although we have many patients who get better, we still have too few who get well.”

Psychosurgery?

Psychosurgery, or efforts to cure the mentally ill by operating on their brains, dates particularly from 1936. It was in that year that a Portuguese researcher, Egas Moniz, observed that by severing part of the frontal lobes of the brain, anxiety could be relieved. But after he had performed twenty such frontal lobotomies the Portuguese government outlawed them. In spite of that, the operation caught on in the United States. Walter Freeman, its chief advocate, performed 4,000 of them.

The operation has been compared to “swishing an ice pick around behind the eyeballs to destroy portions of the brain’s frontal lobe.” Science News reports: “After perhaps 50,000 lobotomies in the United States, and 15,000 in England, the fad died down in the 1950’s, probably because of developments in electroshock and drug therapy.”

Lobotomies often resulted in far more serious personality disorders. In fact, even their American pioneer, Freeman, testified that they robbed a person of his “morale,” his ability to imagine, to foresee and to be altruistic. The patient experienced a “progressive loss of . . . insight, empathy, sensitivity, self-awareness, judgment, emotional responsiveness, and so on,” says a leading Washington, D.C., psychiatrist.

Recently, however, the issue of psychosurgery has again come to the fore, as more refined methods are being used to destroy portions of the brain. Reportedly some four to six hundred of these operations are being performed yearly in the United States, and, we are told, “every psychosurgeon agrees that we are just beginning to witness a massive increase in psychosurgery.” However it is of interest that these operations are banned throughout the Soviet Union, indicating their undesirable aspects.

The plans to perform psychosurgery on the criminally insane, provided they voluntarily consent, raised a furor in the United States in the spring of 1973. What many fear is that these operations will open the door to manipulating humans by means of brain surgery. Among those strongly speaking out against them is brain surgeon Dr. A. K. Ommaya. He feels that, far from being helped, mental patients are being harmed because “every part of the brain requires the other parts to function.”—New York Times, April 2, 1973.

Clearly, electroshock, drugs and psychosurgery all leave much to be desired in treating mental patients. There is, in fact, great controversy as to whether certain of these methods should be used at all. What, then, about alternatives?