In order to shed light on the first application of human functional stereotactic neurosurgery, whether it was in the realm of movement disorders, as has been claimed repeatedly, or in the realm of psychiatry, a review of the original scholarly literature was conducted. Tracking and scrutinising original publications by Spiegel and Wycis, the pioneers of human stereotactic neurosurgery, it was found that its origin and the very incentive for its development and first clinical use were to avoid the side effects of frontal leucotomy. The first applications of functional stereotactic neurosurgery were in performing dorsomedial thalamotomies in psychiatric patients; it was only later that the stereotactic technique was applied in patients with chronic pain, movement disorders and epilepsy. Spiegel and Wycis’ first functional stereotactic operations were for obsessive-compulsive disorder, schizophrenia, and other psychiatric conditions.
The English term “early psychosis” was coined in the 1930s to refer to feelings of irritability, loss of concentration, hypochondriac ideas, moodiness, and lassitude that were seen to precede the onset of clear-cut hallucinations and delusions. The history of thinking about “early psychosis” under names such as “latent,” “masked,” “mild,” “simple” or “sluggish” schizophrenia before World War II and afterwards on the different sides of the Wall and the Iron Curtain reveals “early psychosis” as a mirror of quite aged international biologist controversies that are still alive today and to the same extent as they are misunderstood, are influential in their implications in today's psychiatry.
The paper invites to reappraise the role of psychosurgery for and within the development of functional stereotactic neurosurgery. It highlights the significant and long-lived role of stereotactic neurosurgery in the treatment of severe and chronic mental disorders. Stereotactic neurosurgery developed out of psychosurgery. It was leucotomy for psychiatric disorders and chronic pain that paved the way for stereotactic dorsomedial thalamotomy in these indications and subsequently for stereotactic surgery in epilepsy and movement disorders. Through the 1960s stereotactic psychosurgery continued to progress in silence. Due to the increased applications of stereotactic surgery in psychiatric indications, psychosurgery's renaissance was proclaimed in the early 1970s. At the same time, however, a public fearing mind control started to discredit all functional neurosurgery for mental disorders, including stereotactic procedures. In writing its own history, stereotactic neurosurgery's identity as a neuropsychiatric discipline became subsequently increasingly redefined as principally a sort of "surgical neurology," cut off from its psychiatric origin.
Patient files, textbooks and published articles of the time show that the wide range of psychiatric therapies of the 1950s and 1960s was also used in the early German Democratic Republic (GDR). The use of insulin coma therapy, cardiazol and electroconvulsive therapies and especially of leucotomy in the GDR must not only be seen in the context of the international development and debate concerning these therapies up to the introduction of psychopharmaceutic therapy but also, in a similar way as in the Federal Republic of Germany, in relation to the locally sometimes different availability of insulin and cardiazol in the post-war period, different schools of academic thought and scientific research interest and priorities of the clinics concerned.
The emigration of Lothar Kalinowsky (1899-1992) might, at first glance, seem to be a history of coincidence and twists of fate, but it is shown to be a truly entangled and intertwined history and story. The international introduction of electroconvulsive therapy was not only closely involved with the political, scientific and economic conditions during World War II, but the story of Kalinowsky's relevance to it emerges from competing stories, told differently in Europe and the USA - and by Kalinowsky himself. Tracing these stories up to the end of the 1960s reveals Kalinowsky as an influential inheritor and patron of Berlin Biological Psychiatry, rather than telling the history of an émigré innovator of international neuropsychiatric research.
The history of ‘electroshock therapy’ (now known as electroconvulsive therapy (ECT)) in Europe in the Third Reich is still a neglected chapter in medical history. Since Thomas Szasz’s ‘From the Slaughterhouse to the Madhouse’, prejudices have hindered a thorough historical analysis of the introduction and early application of electroshock therapy during the period of National Socialism and the Second World War. Contrary to the assumption of a ‘dialectics of healing and killing’, the introduction of electroshock therapy in the German Reich and occupied territories was neither especially swift nor radical. Electroshock therapy, much like the preceding ‘shock therapies’, insulin coma therapy and cardiazol convulsive therapy, contradicted the genetic dogma of schizophrenia, in which only one ‘treatment’ was permissible: primary prevention by sterilisation. However, industrial companies such as Siemens–Reiniger–Werke AG (SRW) embraced the new development in medical technology. Moreover, they knew how to use existing patents on the electrical anaesthesia used for slaughtering to maintain a leading position in the new electroshock therapy market. Only after the end of the official ‘euthanasia’ murder operation in August 1941, entitled T4, did the psychiatric elite begin to promote electroshock therapy as a modern ‘unspecific’ treatment in order to reframe psychiatry as an ‘honorable’ medical discipline. War-related shortages hindered even the then politically supported production of electroshock devices. Research into electroshock therapy remained minimal and was mainly concerned with internationally shared safety concerns regarding its clinical application. However, within the Third Reich, electroshock therapy was not only introduced in psychiatric hospitals, asylums, and in the Auschwitz concentration camp in order to get patients back to work, it was also modified for ‘euthanasia’ murder.
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