Just Some Facts about Shock Therapy for Schizophrenia

When I was stuck in a long-term psychiatric unit at my rock bottom, my psychiatrist made me do Electroconvulsive Therapy. It is a form of “shock therapy”; where seizures are induced through light electric currents that “reset my brain”, according to what she said at the time. For me, it was to be done three times a week, Monday, Wednesday, and Friday, for ten sessions.  Luckily, my psychiatrist felt four sessions was enough, before putting me on medication. The fact it was only four treatments made me relieved, because for some reason it was one of the scariest things I had to do in my life. The fact that I was lying in a bed waiting to be knocked out just freaked me out.

But during my stay there, I read a bulletin about older treatments for schizophrenia. For my own interests, I decided to do some research and present it to you here. These forms of treatments occurred over the course of the 20^th century, the popularization of medications. Looking back, some of these methods are rather barbaric, especially from our point of view nowadays. I guess I wrote this post just to a curious read, and hope that you will see how much psychiatry has progressed. Not only that but it will help out with my unreasonable fear for avoiding electroconvulsive therapy.

Malaria-Induced Fever Therapy

One of the earlier forms of schizophrenia treatment was the malaria-induced fever, in the early 1900s. It had started from the observation that a malaria-induced fever could put psychosis from neuro-syphilis into remission. Remember this was a time when penicillin wasn’t even invented, so there was no way to treat syphilis. Over time, some psychiatrists believed this form of treatment could be used on mentally ill people suffering psychosis, as it put that schizophrenic psychosis into remission as well. This form of treatment was founded by Wagner-Jauregg.  I can imagine how much it would suck to be sick to the point of fever all the time.

Citing for this section:

Ban, T.A. (2001) Somatotherapy, History of. International Encyclopedia of the Social & Behavioral Science, New York, Elsevier

Cardiazol Shock Therapy

While it is hard to find information regarding malaria-induced fever therapy, there is much about Cardiazol Shock Therapy. This form of therapy, founded by Laszlo Meduna in 1934, became popular—like electroconvulsive therapy, seizures are induced, but it is done through medication. Essentially he noticed the trend that schizophrenics were less likely to have epilepsy than the average population, and thus believed that inducing seizures would help stabilize schizophrenic patients.

He chose to use the drug Cardiazol, a circulatory and respiratory stimulant, which in high dosages causes seizures. The injection process would start off in the early morning. Patients would receive an intravenous dose of Cardiazol, convulsing for around 50 seconds. To top it off, the patient would turn blue and eventually pass out. This form of therapy was believed to be so successful that one psychiatrist, Hahnemann, believed that this form of therapy was “a valuable remedy in the treatment not only of schizophrenia but also of mood disorders.” Many other psychiatrists found this treatment to be revolutionary as well.

However, it was a scary drug for the patients. There was this confiscated letter from a patient that read:

Lately I have had 5-7 injections with something called Cardiazol. It is injected in a vein in the right elbow joint. It is something new Dr Hahnemann says. It has a very strong effect, completely different from anything else I have been injected with up until now. About 10 seconds after having received the injection, it is as if you are pulled out of yourself and into another world, but you can still see the persons around you as if in a limpid fog. It is utterly unbearable and quite impossible to get out of. Sometimes the effect is stronger, sometimes weaker; when it is strong you have hallucinations … The room you are lying in begins to look like Hell, and it is as if you are burned by an invisible fire. It is very scary. But luckily it is over now.

This effect is from the latency between injection and convulsions. Another patient states: “fire was spreading through my entire body”, and yet another felt her “brain was trembling”. Most patients felt that the treatment put them at the verge of death, and that scared them severely. It was to a point that psychiatrists treated to use this therapy in order to control patients—they would say they could avoid this treatment if they did some task; e.g. write a letter to parents, work in the woodshop, etc.

Furthermore, the seizures were severe enough that joints could become dislocated, and bone fractures could occur. Death could occur for patients with heart problems.

Sounds scary.

Citation for this section:

Kragh, JV. (2010). Shock therapy in Danish psychiatry. Med Hist. 54(3):341-64.

Deep Insulin Coma Therapy

Also during the 20^th century, another form of therapy for schizophrenia existed, called deep insulin coma therapy. Manfred Sakel founded this when he noticed that injecting small doses of insulin helped alleviate some symptoms of schizophrenic patients. On top of that, he also believed that being put in a deep induced coma would make schizophrenic patients better.

The premise of this therapy is that insulin is administered until the patient falls into a hypoglycemic coma—a coma induced due to low blood sugar levels.

Over time, his work became wildly popular, and many other psychiatrists started using his method.

According to the guidelines, comas were induced five to six times per week, always in the morning. After being given enough insulin to fall into a coma, they were left for 15 minutes, before given a shot of glucose to wake them back up. Another danger of this therapy is that patients could fall back into hypoglycaemic “after shocks”, so they were required to be constantly monitored.

This form of therapy was extremely dangerous, as 1% of patients died, while others had permanent brain damage. All became extremely obese. However, in spite of this, doctors still recommended this form of treatment. They also increased the duration of the coma experimentally, “at a one hour coma, another four hours”.

This form of treatment was only discredited around 25 years later. Dr. Harold Bourne released a paper called “The insulin myth”, discussing the fact that “there is no found basis for the general opinion that insulin therapy counteracts the schizophrenic process”. He believed that the process of diagnosing patients was flawed, but other psychiatrists believed clinical experience was more important.  A blind study was done by him, discrediting it, but by then psychiatrists were in favour of the first anti-psychotic medications.

Citation for this section:

Kragh, JV. (2010). Shock therapy in Danish psychiatry. Med Hist. 54(3):341-64.

Electroconvulsive Therapy and Conclusion

MayoClinic does go over the Electroconvulsive Therapy treatment online. Essentially it still exists for treatment-resistant schizophrenics and those with severe depression, as there is clinical proof that it does change the brain’s chemistry. My only thing against this form of therapy is the loss of memory. I remember being in psychiatric unit with a girl who had severe depression. She had done electroconvulsive therapy so many times that she could not remember everything that had happened in the past few months.

That was the scariest thing, outside of the anesthesia.

I’m really glad I wrote this post, because it has taught me a lot about shock therapies and the fact that I went through wasn’t really as bad as it would have been in the past. It explains why a lot of horror movies, and even games like Outlast, typically go into psychiatric units of the past.

I intended for this post to be educational, and I hope you feel that same. Thanks for reading.

(Link to MayoClinic: https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894)