Gracefully Insane (11 page)

 

 

 

A
ddressing the American Psychiatric Association in 1933, Presi
dent James May bemoaned the state of the profession. Few medical schools employed professors in the field of psychiatry. Mental illness, May said, was “a medical playground” in which neurologists, neurosurgeons, and psychiatrists competed with gynecologists and ophthalmologists in speculations on the causes of psychoses. From about 1930 until the introduction in 1954 of Thorazine,
the first usable antipsychotic drug, the curative landscape resembled not a playground so much as the Wild West. Every few years, a new sheriff would ride into town, promoting a new wonder cure that eventually yielded to the next, short-lived fashion.

In the 1930s, for instance, a Trenton psychiatrist named Henry Cotton pulled patients’ teeth and removed their large intestines to cure mental illness, which he believed to be caused by “autointoxication.” (Stanley McCormick’s psychiatrist, the well-regarded Adolf Meyer of Johns Hopkins, hailed Cotton’s work as a “remarkable achievement of the pioneer spirit.”) For a while, fever was thought to be restorative for mental patients, especially for the stiff-gaited victims of general paresis, the physical and mental paralysis that accompanied the advanced stage of syphilis. Some hospitals—McLean was not one of them—kept malarial mosquitoes or diseased rats on hand to bite treatment subjects and induce fever. Others injected blood from fever victims into the paretics, who crowded the mental hospitals until the discovery of penicillin. For the ostensible purpose of boosting patients’ white blood cell count, some doctors injected horse blood into their subjects’ lumbar cavities, mixing the blood with spinal fluid. Then sleep therapy, or “prolonged narcosis,” came on the scene. In theory, a week-long, drug-induced nap would help restore a patient’s exhausted nervous system.

In 1941, two McLean doctors, John Talbott and the bumptious Kenneth Tillotson, reported encouraging results from a therapy they called hypothermia. Like Dr. Willard’s drowning regimen of a century and a half before—and like the various shock therapies coming into use during the twentieth century—the hypothermia cure reduced the body to a near-death state by lowering the patient’s body temperature. It was not hibernation, the doctors emphasized, and was decidedly not refrigeration. “We object to the word refrigeration,” they wrote, “because it implies that the object treated is refrigerated and that the temperature is reduced considerably lower than is compatible with life.” Their modus operandi and their conclusions seem comic to us now, all the more so because
they cited an 1805 cold-water dunking of an English convulsive as an important precursor for their experiment. But Talbott and Tillotson produced two important results: Four of the ten patients whose body temperatures they lowered by twenty degrees or more for periods of up to sixty-eight hours (!) showed marked improvements. The mental state of one sixteen-year-old boy cleared to the point where he could leave the hospital and go home. And one patient, a forty-six-year-old male paranoid schizophrenic whom they kept cold and semiconscious for fifty hours, died when his lowered blood pressure never came back again. The doctors injected him with adrenaline and caffeine, to no avail. “It is hoped that this would not have occurred,” Talbott and Tillotson wrote. But it did.

The procedure sounds, well, chilling. After sedating the schizophrenic patients with a barbiturate (Nembutal) and a muscle relaxant (Evipal), the doctors wrapped them in special blankets manufactured by the Therm-O-Rite Products Company of Buffalo, New York, through which they circulated a refrigerant. A stomach tube pumped glucose into the patient to keep him or her alive, and a thermocoupled rectal thermometer transmitted bodytemperature readings every other minute. The patients were garden-variety catatonic, paranoid, and hebephrenic (the “laughing disease”) schizophrenics. One young woman, a twenty-five-year-old medical student, had already received
Dauernarkose
(continuous sleep), insulin shock, metrazol, and typhoid vaccine therapies before coming to McLean. She had an unusual reaction to the cold: Her mental acuity cleared when her body temperature was more than ten degrees below normal, and she then reverted to her disturbed condition as the thermometer approached 98.6. She had three hypothermia treatments and was classified as a success, although she remained at the hospital. Overall, the doctors claimed success in four cases, temporary improvements in four others, and no discernible effects in the remaining two. The younger patients with shorter histories of mental illness responded better than the older patients; it was the oldest patient who died.
Talbott and Tillotson derived a “modicum of hope” from their work: “The results would seem to be at least equally as promising as insulin and metrazol in the treatment of schizophrenia,” they wrote. They felt compelled to add that “hypothermia does not cause morphologic damage,” meaning bodily harm. That is true, unless one includes death by cardiac arrest.

A kinder, gentler form of therapy was the various water treatments
that had been administered to mental patients since the end of the eighteenth century. (A young psychiatrist once asked Paul Howard, who joined the McLean staff before World War II, why patients comported themselves better after hydrotherapy treatment. “Don’t you always feel more relaxed after a nice, warm bath?” was Howard’s commonsensical reply.) The 1922 McLean nurses’ manual lists no fewer than seventeen different hydrotherapy regimens, from the foot bath to the shampoo. Most are categorized as “tonic baths” and administered in the “hydriatic suite” in the basement of the women’s gymnasium. Here are a few of the treatments and a partial list of the illnesses they were supposed to assuage:

One of the most common hydrotherapies was wrapping the patients in cold (forty-eight to fifty-six degrees Fahrenheit), wet sheets. These so-called packs were used to pacify agitated patients up through the 1970s. In 1922, the packs’ effect was divided into action (“sensation of chilliness ... cooling of the skin ... shivering”) and thermic reaction (“chilliness disappears ... skin become warm ... muscular relaxation occurs”). Hypothermia was of course a risk: “If there is any unusual paleness of the face, blueness of the lips or shivering, the patient ... should be warmed by the application of hot water bags to his sides and feet. He should also be give a hot stimulating drink. (A teaspoonful of whiskey in hot water is considered good because whiskey dilates the blood vessels in the skin.)”

Another ubiquitous remedy was the “continuous bath.” According to the nurses’ manual, the prolonged bath could be “administered for hours, days, weeks or months.” “In some hospitals [and this is a tip-off that we are
not
speaking about McLean], it is customary to keep the patients in the tubs 18 hours daily and
some very disturbed patients are kept in the baths without removal for periods of 2 or 3 weeks.”

Director Franklin Wood’s desk notebook of course codified every last concern about the continuous baths, from the proper temperature (ninety-four degrees Fahrenheit) to the possible dangers: “I. Heat prostration; 2. Chilling; 3. Scalding; 4. Drowning; 5. Convulsions.” The following instruction would indicate that some patients did spend day-long cycles in the baths: “If a patient is very noisy, restless, or flushed, or if the pulse rate is 88 or more rapid, supply an ice collar. Sponge the face of each patient with cold water once or twice during the bath. Omit during sleep.”

The real action, however, was in the shock therapies—insulin coma,
metrazol, and electric—which were widely used at McLean and elsewhere at midcentury. “All the theories attempting to explain how these treatments worked proved to be wrong,” writes Elliot Valenstein in his delightfully readable psychiatric history,
Great and Desperate Cures,
“and, as they were stated, so vague as to be impossible to take seriously.”

Insulin coma was discovered by accident by the colorful Viennese physician Manfred Joshua Sakel, who claimed to be a direct descendant of the twelfth-century rabbi, physician, and philosopher Moses Maimonides. Sakel unintentionally gave a diabetic mental patient an overdose of insulin, lowering her blood sugar to the point where she fell into a coma. When she emerged from unconsciousness, she felt considerably better. In clinical trials, Sakel reported an astonishing 88 percent success rate, and he even treated the famous Russian dancer Vaslav Nijinsky. Success, of course, is always relative in psychiatry; Nijinsky did not figure in the lucky 88 percent and was not able to resume a normal life after Sakel’s treatment.

Insulin coma caught on quickly in the United States, as did metrazol shock, which had precisely the opposite effect on patients. After examining the cadavers of epileptics and schizophrenics, a Hungarian researcher named Joseph Ladislas von Meduna had concluded that epilepsy and schizophrenia were mutually antagonistic. Thus, theoretically, an induced epileptic seizure would “cure” a psychotic patient. Meduna found that a synthetic chemical called metrazol would send patients into the desired convulsions. (Other doctors similarly enamored with the epilepsyschizophrenia connection tried injecting epileptics’ blood, drawn immediately after a seizure, into mental patients. These conjectures have little basis in scientific fact.)
⁹
Meduna, like Sakel, Freud, and many ambitious European doctors before him, eventually made a U.S. landfall, and popularized his treatment around the country.

Metrazol shock naturally led to electroshock therapy, which also caused patients to go into convulsions. “Medical electricity” was nothing new. Scribonius Largus, who lived in the first century A.D., treated the Roman emperor’s headaches with electric eels. In the eighteenth century, a French physician used electroconvulsive therapy on a patient with psychogenic blindness. In his early neurology practice, Freud experimented with low-grade electric shock, “only to find [it] grossly ineffective and lacking any sound foundation,” according to one history of psychiatry. “Freud realized [perhaps “hypothesized” would be a better choice of word] that the electric-current therapy was only a form of covert suggestion
and had no lasting therapeutic effect.” But its widespread use on psychiatric patients originated in Italy in 1938, when the police commissioner of Rome sent an apparently dazed schizophrenic to doctors Ugo Cerletti and Lucio Bini for treatment. Cerletti and Bini had seen hogs killed at a Rome slaughterhouse after being stunned with electric current. They experimented with the hogs to determine a nonlethal dose of current; this prompted them to theorize that the brain produced a “vitalizing substance” called “acro-amines” in response to a convulsion. The police commissioner’s referral provided them with their first human subject.

Valenstein describes the ensuing opera buffa: