Tuesday, December 5, 2023
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Before modern psychotherapy, before Prozac®, before deep brain stimulation, there were cranial drills, hot showers, and tooth extractions. The annals of psychiatric medicine trace all the way back to the ancient Greeks and Egyptians and contain—perhaps more so than in any other field of medicine—an array of unusual treatments that today would send ripples throughout even the most tolerant medical licensing board. A few make a degree of scientific sense, some were genuine breakthroughs, and most were disasters. We've put together a collection of some of the more outlandish psychiatric therapies proposed throughout human civilization.
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The oldest known neurosurgical procedure, trepanation is the process by which a hole is drilled into the skull and a piece of bone removed, thereby exposing the intracranial contents. Archeological evidence indicates that trepanation was performed as far back as the Mesolithic era using crude stone tools, and in nearly every corner of the world. The exact motives of our ancient ancestors in performing this operation are lost to time, although it probably had ritualistic or spiritual origins. Written evidence of its medical application first appeared in the fifth century BC in Hippocrates' book On Injuries of the Head, in which trepanation is described as a treatment for cranial injuries sustained in military campaigns. Its use was expanded to treating mental illness and epilepsy (both probably grouped under the umbrella term "madness") during the Middle Ages and Renaissance, when it was believed that the removed bone would allow the "evil to escape." But trepanation is far from consigned to the history books. A small but vocal contingent of modern-day adherents continue to espouse its New Age benefits in expanding consciousness and attaining enlightenment.
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Despite his deserved title as the "father of Western medicine," in hindsight Hippocrates' theory on mental illness in women inspired many centuries of medical misogyny. The ancient Greek healer attributed female psychiatric symptoms to "hysteria," or the wandering of the womb throughout the body. One "cure" involved exposure to foul-smelling substances intended to repel the uterus from the upper regions of the body. Plato proposed that patients simply get married and become pregnant, because gestation, he believed, ensured proper uterine positioning. The Christian era saw a new prime suspect for hysterical symptoms: demonic possession. Famed French neurologist Jean-Martin Charcot felt that "hysteria" resulted from cerebral cortical dysfunction, whereas his student Joseph Babinski believed it to be psychological in nature. The diagnosis lasted well into the 20th century; however, the condition is now seen as a "conversion disorder," in which psychological stress manifests as physical symptoms.
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In the long history of psychiatric treatments, there are also deviations from the customary practices of the day that stand out for their progressiveness. One noteworthy example is the approach of French physician Philippe Pinel. Since their emergence, asylums for the mentally ill had been nearly inseparable from prisons, and witness to untold acts of punishment and exploitation. In 1792, Pinel was appointed superintendent of the Bicêtre Insane Asylum in Paris. Although Pinel's story pivots between fact and legend, he is widely credited with instituting a theory of "moral therapy" at Bicêtre, which supposedly included unshackling patients, barring their public display for entertainment, and generally treating them with then–unheard-of dignity. Outlined in Pinel's history of psychiatry, Medico-Philosophical Treatise on Mental Alienation or Mania, moral therapy also included building trust into the doctor/patient relationship, decreasing stimuli, and encouraging routine activity. With their encouraging results garnering glowing coverage in the French press, Pinel's theories gained traction in small pockets of England and the United States. This would prove fleeting, as war, social changes, and entrenched prejudices restored more punitive measures. It took nearly two centuries more before the ethical treatment of asylum patients became a popular cause once again.
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One of the better-known follies in psychiatric history, phrenology or "the science of the mind" proposed that the separate areas of the brain controlled unique functions relevant to personality and mental faculty. First developed in the late 18th century by the Viennese physician Franz Joseph Gall, phrenology can be considered something of an advance over old-world superstitions in establishing the first comprehensive, premodern theory of cerebral localization.[1] In practice though, phrenology quickly mutated into something closer to a parlor game. Phrenologists believed that different areas of the brain, exercised like muscle, would be proportionally represented in the skull, and could be "read" to determine strengths and weaknesses of character. The practice inevitably took on the ugly colonialist and racial biases of the time—with early proponents, such as 19th-century Kentucky physician Charles Caldwell, invoking it as evidence of Native American inferiority. Phrenology fell out of favor in the medical community when it was determined to have no predictive power, but its negative impact on history would prove more pervasive.
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In the early 1770s, the Austrian physician and theologian Franz Friedrich Anton Mesmer put forward his notion of "animal magnetism," later to be termed "mesmerism." Mesmer theorized that any number of ailments were caused by naturally occurring magnetic fields, which could then be realigned to improve health. He initially administered high-dose iron to patients, which would be guided through the body by Mesmer with the aid of strategically placed magnets. Other variations called for patients to be seated in chemical-filled tubs with iron rods applied to the affected areas of the body. Eventually, Mesmer claimed to possess magnetic powers of his own, and would use the suggestive energy of his hands alone to treat patients. With a flair for dramatic presentation (the wearing of magician-like purple robes was not uncommon) and claims of having cured hysterical blindness with his therapies, Mesmer charmed his way into the upper echelons of Parisian society. His persuasiveness met its limits in a skeptical King Louis XVI, who created a royal commission of scientists (including then US ambassador to France, Benjamin Franklin) that eventually debunked Mesmer's claims. Though personally chastened, Mesmer's theories would prove durable, laying the groundwork for the practice of hypnotism and various strains of American psychospiritualism.
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The early 19th century saw a brief, confounding fad for using centrifugal force to treat mental illness. "Rotational therapy," as it was known, is credited to Erasmus Darwin, grandfather of Charles, who proposed that excessive spinning would lessen "brain congestion" by increasing pressure. Darwin's theories found an eager adopter in Dr Joseph Mason Cox, who developed a novel technique for rotating patients' bodies in a specially designed chair. Reports of patients reaching a tranquil state after the procedure encouraged its spread across Europe. Doctors in Germany and Ireland using variations on Cox's design reported miraculous cures for patients with hysteria, as well as the beneficial induction of sleep in mania of recent onset.[2,3] Although the medicinal benefits of these therapies were probably nonexistent, they are nonetheless notable for providing the very first descriptions of G-force–induced biomedical effects.[3]
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In the first years of the 1900s, psychiatry was positioned awkwardly between entrenched notions that mental illness represented hereditary, character-based failings, and the more vanguard Freudian concept of psychoanalysis. Those seeking another way forward had an unfortunate role model in Henry Cotton, the superintendent of the New Jersey State Hospital at Trenton. Cotton believed that mental illness had one cause alone: bodily infections whose toxins were responsible for poisoning the brain. Cotton sought to remove these chronic infections at their source, which he took to be his patients' teeth, tonsils, spleens, uteri, and other organs. Claiming cure rates of more than 80%, Cotton was in fact obscuring mortality rates for some procedures of approximately 45%.[4] Although no one is clamoring for a return to the brutal methods proposed by Cotton, renewed research on the role of inflammation in mental illness indicates his idea that mental illness is linked to infection may, in some cases, carry some weight.
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Many early 20th-century psychiatrists—particularly those at the London Asylum for the Insane—embraced the potential healing powers of water. It was thought that extremely hot or cold showers, water wraps, and baths could treat a variety of mental maladies, including insomnia, suicidal ideation, aggression, and manic depression. Baths could last as long as several days and often took place in dimly lit, soothing locations, and may have provided the psychiatric benefits of various forms of meditation appreciated today. A 1908 document from the Illinois Board of State Commissioners of Public Charity reads, "Reports from a large number of public and private hospitals for the insane in the United States show that hydrotherapy has been most extensively used for the past three years, and invariably each medical director speaks in the highest terms of this hypnotic and eliminative [treatment]."
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Once identified as "the disease of the century," neurosyphilis gripped the public's imagination with a particularly vivid neurologic presentation that often involved grand delusions, paralysis, and dementia. However, in the years leading up to World War I, the first tangible strategies for combating the illness began to arrive. The first such breakthrough occurred when the Austrian psychiatrist Julius Wagner-Jauregg noticed that residents of the asylum where he worked seemed to return to sanity after experiencing a febrile episode. Wagner-Jauregg tested various means of inducing fever. In 1917, he reported positive results after inoculating patients with intravenous injections of malaria, followed by quinine treatment after resolution of syphilitic symptoms. The treatment was later rendered obsolete by the discovery of penicillin. Nonetheless, Wagner-Jauregg's work was notable for linking psychosis to a potentially natural cause—a goal since the days of Hippocrates, but one that had failed to overcome more popular moralistic and stigmatizing ideas about how psychiatric disorders arise. His efforts garnered him a Nobel Prize, making him the first psychiatrist, and one of the very few to date, to receive the honor.[5,6]
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A decade after the discovery of insulin in 1922, German physician Manfred Sakel began using the hormone to treat the symptoms of opioid withdrawal. Not long after that, he set his sights on treating schizophrenia. Insulin doses were often so high that patients would fall into a stupor or coma, rendering them more cooperative and free of their psychiatric symptoms (in Sakel's eyes). The treatment caught on in the United States in the 1930s alongside electroconvulsive therapy, and was adopted by most respected American academic institutions (as well as the US military during World War II). Mortality rates varied from 1% to a not-so-reassuring 10%. With the introduction of chlorpromazine (Thorazine) in the 1950s—a safer, cheaper, and equally effective alternative—insulin shock therapy was eventually phased out across the country.
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In 1934, the Hungarian neuropathologist Ladislas Joseph von Meduna made an observation: Schizophrenia and epilepsy rarely co-presented in individual patients. This assumption has since been proven false; patients with epilepsy are now thought to have an eightfold increased risk for schizophrenia, and evidence also exists for a genetic overlap between the two disorders.[7,8] At the time, however, it proved persuasive enough for von Meduna to seek therapies that would induce seizures to cure patients of their schizophrenia. After initially trying to induce seizures by injecting the blood of epileptic patients into those with schizophrenia, von Meduna soon turned to chemical agents, beginning with camphor oil and eventually settling on cardiazol. von Meduna is credited with recognizing the value of inducing complete seizures and is considered a forefather of electroconvulsive therapy.[9]
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Wilhelm Reich, the famous (or perhaps infamous) psychoanalyst, was born in 1897 in Austria. By the time he died in a Pennsylvania jail cell in 1957, he had gone from one of Freud's most promising pupils to a pariah within the psychiatric community. Like his mentor's theories of the human libido, Reich determined humanity's sexual impulses to be a major source of its dysfunction. But whereas Freud prescribed a controlled inhibition of these impulses, Reich sought to unleash them. Like Franz Mesmer before him, Reich believed that life is dictated by external, quasi-supernatural energies—namely orgone, a sexual life force permeating the universe. Reich proposed that he could harness this force with a metal-and-steel wool-lined wooden box of his own devising: the orgone energy accumulator. Enough time spent in his contraption, Reich claimed, and a patient's repressions and ailments would melt away.
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Such was Reich's stature that he convinced Albert Einstein to spend 2 weeks studying his box's merits (Einstein couldn't find any). The US Food and Drug Administration eventually saw to it that Reich cease his dubious promotional claims about the orgone energy accumulator—an injunction he eventually broke, leading to his eventual imprisonment. Reich might be a footnote of psychiatric history if his ideas didn't dovetail so perfectly with the Age of Aquarius. In the 1960s, devotees from the world of the arts (including the writers Henry Miller, Norman Mailer, and William S. Burroughs) extolled Reich's theories to a receptive nation in the midst of the sexual revolution. The scientific community has been less enthusiastic. A 2006 poll ranked orgone therapy as the third most discredited psychological treatment, just behind past-life regression therapy and using crystals for healing.[10]
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The history of therapeutic experimentation is an inevitably checkered one, where even the greatest achievements can be the result of happenstance. This is perhaps no truer than in matters of the mind—the intricacies of which are just being revealed to us, thanks to technological breakthroughs that would have been unimaginable decades earlier. Rather than provoking a sense of superiority, overviews such as these ask us to think critically about our own contemporary practices. After all, today's trend could be tomorrow's travesty.
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