Abstract
This paper examines the early history of biological treatments for severe mental illness. Focusing on the period of the 1900s to the 1950s, I assess the everyday use of somatic therapies and the science that justified these practices. My assessment is based upon patient records from state hospitals and the contemporaneous scientific literature. I analyze the following somatic interventions: hydrotherapy, sterilization, malaria fever therapy, shock therapies, and lobotomy. Though these treatments were introduced before the method of randomized controlled trials, they were based upon legitimate contemporary science (two were Nobel Prize-winning interventions). Furthermore, the physicians who used these interventions believed that they effectively treated their psychiatric patients. This history illustrates that what determines acceptable science and clinical practice was and, most likely will, continue to be dependent upon time and place. I conclude with how this history sheds light on present-day, evidence-based medicine.
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REFERENCES
Ackerknecht, E. (1979). The history of drug treatment of mental diseases. Transactions and Studies of the College of Physicians of Philadelphia, 1, 161–170.
Adler, H. M., & Ragle, E. H. (1913). Note on the influence of hydrotherapy on the red blood cell count in the insane. Boston Medical and Surgical Journal, 169, 425–426.
Aldrich, C. K. (1950). Problems of social adjustment following lobotomy. American Journal of Psychiatry, 107, 459–462.
Alverno, L. (1990). The origins of electroconvulsive therapy. Wisconsin Medical Journal, 89, 54–56.
American Psychiatric Association. (1997). Practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 154, 1–63.
American Psychiatric Association Steering Committee. (1996). The Expert Consensus Guideline Series. Treatment of schizophrenia. Journal of Clinical Psychiatry, 57, 3–58.
Barahal, H. S. (1958). 1,000 prefrontal lobotomies—A five-to-10-year follow-up study. Psychiatric Quarterly, 32, 653–678.
Barnacle, C. H., Ebaugh, F. G., & Ewalt, J. R. (1936). Treatment of dementia paralytica: Comparative study of combined artificial hyperpyrexia and tryparsamide versus therapeutic malaria: A preliminary report. JAMA, 107, 1031–1036.
Baruch, S. (1920). An epitome of hydrotherapy for physicians, architects and nurses. Philadelphia: Saunders.
Benjamin, H. (1925). New clinical aspects of the Steinach operation. Medical Journal and Record, 122, 452–457, 515–518, 592–594.
Bennett, A. E. (1938a). Convulsive (pentamethylenetetrazol) shock therapy in depressive psychoses. Preliminary report of results obtained in ten cases. American Journal of the Medical Sciences, 196, 420–428.
Bennett, A. E. (1938b). Evaluation of artificial fever therapy for neuropsychiatric disorders. Archives of Neurology and Psychiatry, 40, 1141–1155.
Bennett, I. (1966). Changing concepts in insulin coma therapy. In M. Rinkel (Ed.), Biological treatments of mental illness (pp. 782–792). New York: Page.
Black, D. W. (1982). Psychosurgery. Southern Medical Journal, 75, 453–458.
Braslow, J. T. (1995). The effect of therapeutic innovation on perception of disease and the doctor patient relationship: A history of general paralysis of the insane and malaria fever therapy, 1910–1950. American Journal of Psychiatry, 152, 660–665.
Casey, J. F., Lasky, J. J., Klett C. J., & Hollister, L. E. (1960). Treatment of schizophrenic reactions with phenothiazine derivatives: A comparative study of chlorpromazine, triflupromazine, mepazine, prochlorperazine, perphenazine, and phenobarbital. American Journal of Psychiatry, 117, 97–105.
Chapin, J. B. (1891–1892). On the abuse of hypnotics. American Journal of Insanity, 48, 202–208.
Cohen, L. H., Novick, R. G., & Ettleson, A. (1942). Frontal lobotomy in the treatment of chronic psychotic overactivity. Psychosomatic Medicine, 4, 96–104.
Damasio, A. M. (1975). Egas Moniz, pioneer of angiography and leucotomy. Mount Sinai Journal of Medicine, 42, 502–513.
Delgado, H. F. (1922). The treatment of paresis by inoculation with malaria. Journal of Nervous and Mental Disease, 55, 376–389.
Diefendorf, A. R. (1906). Etiology of dementia paralytica. British Medical Journal, 2, 744–748.
Dowbiggin, I. R. (1997). Keeping America sane: Psychiatry and eugenics in the United States and Canada, 1880–1940. Ithaca, NY: Cornell University Press.
Drapes, T. (1889). Hyoscin in insanity. British Medical Journal, 1, 942.
Driver, J. R., Gammel, J. A., & Karnosh, L. J. (1926). Malaria treatment of central nervous system syphilis. JAMA, 87, 1821–1827.
Editorial. (1915). Sex organ changes in insanity. JAMA, 65, 254–255.
Elkes, J., & Elkes, C. (1954). Effect of chlorpromazine on the behaviour of chronically over-active psychotic patients. British Medical Journal, 2, 560–565.
Elkes, J., & Healy, D. T. (1998). Towards footings in a new science: Psychopharmacology, receptors, and the pharmacy within. In D. T. Healy (Ed.), The psychopharmacologists II: Interviews by Dr David Healy. London: Altman.
Endler, N. S. (1988). The origins of electroconvulsive therapy (ECT). Convulsive Therapy, 4, 5–23.
Epitome. (1915). Epitome, asylum reports. Journal of Mental Science, 61, 288–321.
Ewald, F. R., Freeman, W. J., & Watts, J. W. (1947). Psychosurgery; the nursing problem. American Journal of Nursing, 47, 210–213.
Feyhan, F. (1955). The immediate and long range effects of chlorpromazine on the mental hospital. In Smith, Kline & French Laboratories (Ed.), Chlorpromazine and mental health. Philadelphia: Lea & Febiger.
Finnerty G., & Corbitt, T. (1960). Hydrotherapy. New York: Ungar.
Foster, G. W. (1899). Hydric treatment of the insane. American Journal of Insanity, 55, 639–665.
Freeman, W. (1958). Prefrontal lobotomy: Final report of 500 Freeman and Watts patients followed for 10 to 20 years. Southern Medical Journal, 51, 739–745.
Freeman, W. J., & Watts, J. W. (1936). Prefrontal lobotomy in agitated depression: Report of a case. Medical Annals of the District of Columbia, 5, 326–328.
Freeman, W. J., & Watts, J. W. (1937). Prefrontal lobotomy in the treatment of mental disorders. Southern Medical Journal, 30, 23–31.
Freeman, W. J., & Watts, J. W. (1947). Retrograde degeneration of the thalamus following prefrontal lobotomy. Journal of Comparative Neurology, 86, 65–93.
Fulton, J. F. (1951). Frontal lobotomy and affective behavior, a neurophysiological analysis. New York: Norton.
Fulton, J. F. (1956). A textbook of physiology. Philadelphia: Saunders.
Gibbs, C. (1923a). Relation of puberty to behavior and personality in patients with dementia praecox. American Journal of Psychiatry, 80, 121–129.
Gibbs, C. (1923b). Sex development and behavior in male patients with dementia praecox. Archives of Neurology and Psychiatry, 9, 73–87.
Gibbs, C. (1924). Sex development and behavior in female patients with dementia praecox. Archives of Neurology and Psychiatry, 11, 179–194.
Gordon, H. L. (1948). Fifty shock therapy theories. Military Surgeon, 103, 397–401.
Grob, G. N. (1983). Mental illness and American society, 1875–1940. Princeton, NJ: Princeton University Press.
Harms, E. (1955). The origin and early history of electrotherapy and electroshock. American Journal of Psychiatry, 111, 933–934.
Healy, D. T. (1997). The antidepressant era. Cambridge, MA: Harvard University Press.
Impastato, D. J. (1960). The story of the first electroshock treatment. American Journal of Psychiatry, 116, 113–114.
In the Matter of the Investigation of Agnews State Hospital. (1919). California State Archives, Sacramento, California.
Jagielski, V. (1896). The therapeutic action of the Turkish bath. JAMA, 27, 413–416.
James, F. E. (1992). Insulin treatment in psychiatry. History of Psychiatry, 3, 221–235.
Kalinowsky, L. B. (1980). The discoveries of somatic treatments in psychiatry: Facts and myths. Comprehensive Psychiatry, 21, 428–435.
Kellogg, T. H. (1887). Hydrotherapy in mental diseases. New York Medical Journal, 46, 427–431.
Kinsey, J. L. (1941). Incidence and cause of death in shock therapy. Archives of Neurology and Psychiatry, 46, 55–58.
Kramer, M. (1954). The 1951 survey of the use of psychosurgery. In Proceedings of the Third Research Conference on Psychosurgery. PHS Publication 221. Washington, DC: U.S. Government Printing Office.
Laughlin, H. (1922). Eugenical sterilization in the United States: A report of the Psychopathic Laboratory of the Municipal Court of Chicago. Chicago: Psychopathic Laboratory of the Municipal Court of Chicago.
Lehman, A. F., & Steinwachs, D. M. (1998). Patterns of usual care for schizophrenia: Initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophrenia Bulletin, 24, 11–20; Discussion, 20–32.
Mabon, W. (1888–1889). Clinical observations on the action of sulfonal in insanity. American Journal of Insanity, 45, 493–499.
Macleod, N. (1900). The bromide sleep: A new departure in the treatment of acute mania. British Medical Journal, 1, 134–136.
Maudsley, H. (1895). The pathology of the mind. London: Macmillan.
Medical Research Council. (1948). Streptomycin treatment of pulmonary tuberculosis. British Medical Journal, 2, 769–782.
Meduna, L. J. (1938). The significance of the convulsive reaction during the insulin and the cardiazol therapy of schizophrenia. Journal of Nervous and Mental Disease, 87, 133–139.
Millet, J., & Mosse, E. (1944). On certain psychological aspects of electroshock therapy. Psychosomatic Medicine, 6, 226–236.
Money, J. (1983). The genealogical descent of sexual psychoneuroendocrinology from sex and health theory: The eighteenth to the twentieth centuries. Psychoneuroendocrinology, 8, 391–400.
Moniz, E. (1937). Prefrontal leucotomy in the treatment of mental disorders. American Journal of Psychiatry, 93, 1379–1385.
Moniz, E. (1956). How I succeeded in performing the prefrontal leukotomy. In A. M. Sackler (Ed.), The great physiodynamic therapies in psychiatry (pp. 131–137). New York: Paul B. Hoeber.
Mott, F. (1922). The reproductive organs in relation to mental disorders. British Medical Journal, 1, 463–466.
National Advisory Mental Health Council's Clinical Treatment and Services Research Workgroup. (1998). Bridging science and service. http://www.nimh.nih.gov/research/bridge.htm#br1.
Niles, R. (1899). Hydrotherapy in the treatment of mental diseases. American Journal of Insanity, 55, 443–447.
Peck, R. E. (1909). Rational hydrotherapy vs. Turkish baths. Yale Medical Journal, 15, 455–462.
Pressman, J. D. (1988). Sufficient promise: John F. Fulton and the origins of psychosurgery. Bulletin of the History of Medicine, 62, 1–22.
Pressman, J. D. (1998). Last resort: Psychosurgery and the limits of medicine. Cambridge: Cambridge University Press.
Psychopharmacology Service Center Collaborative Study Group National Institute of Mental Health. (1964). Phenothiazine treatment in acute schizophrenia. Archives of General Psychiatry, 10, 246–261.
Rees, W. L. (1956). A controlled study of the value of chlorpromazine in the treatment of anxiety tension states. L'Encephale, 4, 547–549.
Reilly, P. (1991). The surgical solution: A history of involuntary sterilization in the United States. Baltimore, MD: Johns Hopkins University Press.
Robin, A. A. (1958). A controlled study of the effects of leucotomy. Journal of Neurology, Neurosurgery, and Psychiatry, 21, 262–269.
Robitscher, J. (Ed.). (1973). Eugenic sterilization. Springfield, IL: Charles C. Thomas.
Rose, A. S., & Solomon, H. C. (1947). Neurosyphilis. American Journal of Psychiatry, 103, 524–527.
Sakel, M. (1937). A new treatment of schizophrenia. American Journal of Psychiatry, 93, 829–841.
Sakel, M. (1938). Nature and origin of the hypoglycemic treatment of psychoses. American Journal of Psychiatry, 94(Suppl.), 24–40.
Schamberg, J. F., & Rule, A. M. (1927). Therapeutic effect of hot baths in experimental primary syphilis in rabbits. JAMA, 88, 1217–1218.
Selinsky, H. (1943). The selective use of electro-shock therapy as an adjuvant to psychotherapy. Bulletin of the New York Academy of Medicine, 19, 245–252.
Shepard, C. H. (1900). Insanity and the Turkish bath. JAMA, 34, 604–606.
Solomon, H. C. (1923). General paresis: What it is and its therapeutic possibilities. American Journal of Psychiatry, 79, 623–646.
Strecker, E. A. (1917). The continuous bath in mental disease. JAMA, 68, 1796–1799.
Strecker, E. A., Palmer, H. D., & Grant, F. C. (1942). A study of prefrontal lobotomy; neurosurgical and psychiatric features in 22 cases with a detailed report on 5 chronic schizophrenics. American Journal of Psychiatry, 98, 524–532.
Tiffany, W. J. (1921). Pathological changes of testes and ovaries in dementia praecox. State Hospital Quarterly, 6, 159.
U.S. Public Health Service. (1941). Shock therapy survey. Washington DC: Government Printing Office.
Valenstein, E. S. (1986). Great and desperate cures: The rise and decline of psychosurgery and other radical treatments for mental illness. New York: Basic Books.
Veterans Health Administration. (1997). Clinical guideline for management of persons with psychoses, version 1.0. Washington, DC: Author.
Walshe, F. (1963). Diseases of the nervous system described for practitioners and students (10th ed.). Edinburgh: Livingstone.
Wells, K. B. (1999). Treatment research at the crossroads: The scientific interface of clinical trials and effectiveness research. American Journal of Psychiatry, 156, 5–10.
Wolbarst, A. L. (1922). A report on the Steinach operation in senility and premature senility. New York Medical Journal and Medical Record, 115, 543–545.
Wright, R. (1940). Hydrotherapy in psychiatric hospitals. Boston: Tudor.
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Braslow, J.T. History and Evidence-Based Medicine: Lessons from the History of Somatic Treatments from the 1900s to the 1950s. Ment Health Serv Res 1, 231–240 (1999). https://doi.org/10.1023/A:1022325508430
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DOI: https://doi.org/10.1023/A:1022325508430