When Psychiatry's Cures Were Worse Than the Illness

Stéphanie Lavaud; Patrick Lemoine, MD, PhD

Disclosures

April 12, 2017

How did psychiatry become complicit in Nazi and communist dictatorships? How was it once thought that malaria could cure psychosis? How could the "insane" have been used as scapegoats to such an extent—and, quite often, with the complicity of psychiatrists? If psychiatry has a bad image, it must be admitted that in the past, it applied remedies that were much worse than the disease itself, some of which are still in use today around the globe.

Patrick Lemoine, MD, PhD, looks at these outrageous, if not barbaric, treatments that have marked the history of psychiatry—and which in some cases have led, astonishingly, to effective methods. These treatments are the subject of a chapter in the collective work entitled La Folle Histoire des Idées Folles en Psychiatrie (The Crazy History of Crazy Ideas in Psychiatry), which he cowrote with Boris Cyrulnik, MD. Medscape recently interviewed Dr Lemoine about his new book.

Shocks to the System

Medscape: How did the idea for this book come about?

Dr Lemoine: Credit for the idea for this book goes to my colleague and friend Boris Cyrulnik. The objective was to document, rather than denounce, the follies and transgressions of psychiatry from antiquity to the present day. There is still much to say. In fact, a second volume is under way.

Medscape: In the history of crazy ideas in psychiatry, which one would you rank as number 1?

Dr Lemoine: One of the most startling ideas was shock theory, which was the belief that because one shock could lead to insanity, another could lead to healing. This theory was not completely wrong if you think about posttraumatic stress syndrome (PTSS). Francine Shapiro, a San Francisco nurse who was bluntly told that she had cancer, thereafter came up with an original method, EMDR (eye movement desensitization reprocessing). Using a technique similar to hypnosis, EMDR consists of having the patient relive, in the flesh, the trauma responsible for his or her clinical presentation of PTSS. Although EMDR is sometimes difficult to endure, the technique is remarkably effective.

Medscape: What are some of the most striking examples?

Dr Lemoine: Starting with the notion that epilepsy and insanity were two incompatible illnesses, from antiquity to 1937 psychiatrists were obsessed with triggering epileptic seizures with therapeutic shocks. There were a lot of horrors in this field, but also some interesting techniques.

One of these cruel treatments consisted of throwing the insane into water without warning. There was a long-standing practice of building hospitals close to the rivers in large cities. The Hôtel-Dieu de Paris and the Hôtel-Dieu de Lyon are two examples of this. And sometimes, according to legend, the insane were brought to the river's edge in the evening and thrust into ice-cold water. Fright and hypothermal shock were considered conducive to triggering a healthy healing response, although no serious scientific study had been conducted to assess the efficacy of this method.

Another example is malarization—a very risky but, it seems, partially effective technique devised by Julius Wagner-Jauregg, an Austrian neurologist. Upon observing patients with general paresis—which in this case was actually due to tertiary syphilis and characterized by delusions of grandeur—he noticed that their mental status seemed to improve when they had infections accompanied by a high fever, hence the idea that fever could cure delusions. Patients did in fact improve, because Treponema pallidum cannot withstand heat. The method consisted of inoculating patients with malaria via the bloodstream. The results stunned the medical community at the time because the patients improved, even though the infectious disease was fatal within a relatively short period.

This was the birth of malaria therapy. It even earned its creator a Nobel Prize in 1927. Before it was abandoned with the advent of penicillin and the eradication of smallpox, it had been tested unsuccessfully in all other types of insanity of noninfectious origin. One can easily imagine how many unfortunate schizophrenics perished in the process.

Medscape: What about insulin shock?

Dr Lemoine: It was another Austrian physician, Dr Manfred Sakel, who in 1933 devised another astonishing method: plunging schizophrenics into a hypoglycemic coma with high doses of insulin. While treating opium addicts with low doses of insulin, the psychiatrist discovered, when he made a mistake in the dosage, that the mental status of one such addict with dementia improved significantly. After this unintentional trial, he recommended high-dose insulin therapy in psychotic patients.

Today, we still do not know what the actual mechanism of action is of this type of therapy, whose discovery was an act of serendipity. Several more or less whimsical hypotheses have been proposed about the regenerative ability of dysfunctional brain cells during a coma. But it can be assumed that the treatment consisted mainly of the large amount of nursing care the patient received upon the reintroduction of glucose, when he or she was in a state of profound psychophysiologic regression.

Insulin therapy, no longer known as "Sakel's cure," was put a stop to in Nazi Germany; Hitler prohibited it simply because Sakel was Jewish. However, 10 years ago, certain clinics in France were still providing this treatment.

Medscape: And electroshock therapy?

Dr Lemoine: The use of electricity to treat mental illnesses goes back quite far; Egyptians were already using the electric catfish to generate curative electric discharges. But the idea of using electrical stimulation to trigger seizures originated with the Italian neuropsychiatrist Ugo Carletti, after he saw the electrocution technique used on hogs bound for the slaughterhouse. In 1938, he performed the first electroshock on one of his schizophrenic—and nonconsenting—patients. The results were spectacular, and it is still said that one half of the patients permanently committed in psychiatric hospitals were discharged at once. Psychiatrists quickly realized that the best outcomes were achieved, and still are achieved, in the extremely severe forms of depression, not in schizophrenia.

Once again, it turned out that a theory whose basis was totally incorrect (epilepsy cures insanity) led to, by pure happenstance, an effective method for treating depression.

State-Sanctioned Psychiatry

Medscape: What happens when the government appropriates psychiatry?

Dr Lemoine: When the government appropriates psychiatry and psychiatrists do not fight back, disasters occur, for the insane are often considered and used as scapegoats in times of crisis.

The Second World War provides a sad example. In Germany, psychiatrists—the physicians most involved in Nazi activism—had 400,000 mentally ill patients sterilized and allowed the extermination of 250,000 people locked up in German asylums, 70,000 of whom were gassed. France was no better. Although no eugenics program had been officially set up, a covert desire for social hygiene came about when the government asked that food be rationed to institutionalized patients, leaving 50,000 of them to die of hunger. At the time, most French psychiatrists did not object to these measures, and today, many people still refuse to accept that this was done intentionally.

Medscape: Totalitarian regimes have also used psychiatry for punitive purposes.

Dr Lemoine: In the Soviet Union, anyone who opposed the esteemed leader's decisions was considered insane. Punitive psychiatry was a system used to imprison dissidents in psychiatric hospitals (often annexes to prisons) under the pretext of "torpid schizophrenia," an illness with no symptoms (no delusions, no persecution, no inappropriate affect) except not agreeing with the leader's ideas.

Medscape: And today, is there any reason to be concerned?

Dr Lemoine: I have visited "wards" in China and Africa where the living conditions are rough, to say the least. In the future, with presidents Trump, Putin, and Erdogan in power, there is reason to be very concerned for the weakest, especially psychiatric patients.

Even outside politics, we are not immune to new, crazy ideas. Obtaining sufficient evidence before generalizing a technique provides a certain guarantee, except that it sometimes takes 10 or 20 years to recognize a problem.

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