Manfred Joshua Sakel

The Austrian psychiatrist Manfred Joshua Sakel began to experiment with insulin as a treatment for schizophrenia in 1933 (Braslow, 1999; Colp, 2000; Gask, 2004; Getz, 2009; Noll, 2007; Rollin, 2000; Shorter, 1997; Shorter, 2005; Szasz, 1994). He had previously used insulin in high doses to treat the agitation that was associated with withdrawal from morphine. Insulin was a relatively new treatment for anything, having only recently been isolated (Nicolae Paulescu of Rumania having patented his discovery in 1922 (Lica, 2008). Nevetheless, Sakel discovered that when it was administered to some schizophrenic patients (particularly those who were experiencing their first episode of psychosis) symptoms did abate, with a success rate of around 70 per cent (Sabbatini, n.d.). He published these results in 1934 and soon afterwards insulin coma therapy became a common treatment (Fink, n.d.). Basically it consisted of the induction of a hypoglycemic coma, which, theoretically at least, would shock the patient out of his madness. Even if the coma itself failed to work, sometimes patients experienced convulsions during the therapy, and this also appeared to be advantageous (in fact recent commentators aver that the convulsions were the chief source of therapeutic intervention rather than the drug itself (Shorter, 2005). It required several months of treatment, with highly trained staff, as one of the potential risks associated with it was death. Chronic schizophrenics did not benefit from the treatment at all. Nevertheless, when Sakel emigrated to the United States in 1937 (Shorter, 1997), he took with him this treatment, which continued to be used there for the next twenty years. Further studies by others determined that real cure was not achieved and that any improvement in mental state was, in most cases, only temporary (Sabbatini, n.d.).

Manfred Sakel

References:

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Colp, R.  (2000). History of psychiatry. In Sadock, B.J & Sadock, V.A. (eds.), Comprehensive text book of psychiatry. (7^th edition). Baltimore, MD.: Lippincott, Williams & Wilkins.

Fink, M. (n.d.). Insulin coma therapy. Retrieved from http://www.pbs.org/wgbh/amex/nash/filmmore/ps_ict.html

Gask, L. (2004). A short introduction to psychiatry. London, England: Sage Publications Ltd.

Getz, M.J. (2009). The ice-pick of oblivion: Moniz, Freeman and the development of psychosurgery. Trames 13, 2, 129-152.

Lica, M. (2008). The true inventor of insulin - Nicolae Paulescu. Retrieved from http://www.rounite.com/2008/09/12/nicolae-paulescu/

Noll, R. (2007). The encyclopedia of schizophrenia and other psychotic disorders. (3^rd edition). New York, NY: Facts on File Inc.

Rollin, H.R. (2000). Psychiatry at 2000: a bird’s eye view. Psychiatric Bulletin 24, 11-15.

Sabbatini, R.M.E (n.d.). The history of shock therapy in psychiatry. Retrieved from                 http://www.cerebromente.org.br/n04/historia/shock_i.htm

Shorter, E. (1997). A history of psychiatry: from the era of the asylum to the age of Prozac. New York, NY: John Wiley & Sons.

Shorter, E. (2005). A historical dictionary of psychiatry. Oxford, England: Oxford University Press.

Szasz, T. (1994). Cruel compassion: psychiatric control of society’s unwanted. New York, NY: John Wiley & Sons Inc.