Lessons from the Insulin Story in Psychiatry

Abstract

For nearly 20 years, from the mid-1930s until the mid-1950s, early cases of schizophrenia were treated, and surprisingly successfully treated, by deep insulin coma therapy. This paper is an attempt to explore what, if any, lessons there are to be gained for us 30 years later from a treatment regime that turned out to have nothing to do with insulin per se. Such lessons as there may be from our recent historical past may help us to foster our critical acumen and commonsense as we try in our daily practice to understand how we can best help our patients in safety.

The natural history of male mental health: Health and religious involvement

“…After the discovery of an effective neuroleptic, investigators became bold enough to conduct adequately controlled studies on insulin coma. By excluding all confounders, they demonstrated that the crucial ingredients were the vastly greater care the insulin coma patients received and the better morale of their doctors and nurses (Cramand, 1987) rather than the "religious" adherence to insulin induced coma per se (Ackner, Harris & Oldham, 1957). We suspect that the world literature reviewed by Koenig et al (2001) is correct in uniformly asserting that greater religious involvement reduces depressive symptomatology.…”

Evidence for linkage between regulatory enzymes in glycolysis and schizophrenia in a multiplex sample

“…Between 1930s and 1950s (when neuroleptics were introduced), insulin coma therapy was a treatment of choice for schizophrenia [Cramond, 1987]. While it fell into disfavor for several reasons, its effectiveness in some patients has never been understood fully.…”

Psychopharmacology and the Ethics of Resource Allocation

“…The fact that authorities pronounced favourably on this treatment may also have led those involved with the care of patients to take risks they might not otherwise have taken -leading to an Oedipus effect, whereby oracular pronouncements act to bring about the state they pronounce on (Shepherd, 1990). In due course, when enthusiasm fades and the oracle stops pronouncing, the rate of response to the treatment in question falls -this is certainly what happened with insulin (Cramond, 1987).…”

“…Indeed, a consideration of such issues might prompt a comparison between dozapine and insulin. The evidence that insulin was more effective than other treatments for schizophrenia at the time of its introduction was never compelling (Cramond, 1987;Shepherd, 1990). Yet the treatment was introduced widely; it appears that few self-respecting treatment facilities needed much persuasion on the question of setting aside considerable funds to establish insulin units (Cramond, 1987).…”

“…These units in turn had a certain success rate. Retrospectively, however, it would seem that that success probably owed more to enthusiasm about a revolutionary new treatment and a general improvement in staff morale than anything else (Cramond, 1987). The fact that authorities pronounced favourably on this treatment may also have led those involved with the care of patients to take risks they might not otherwise have taken -leading to an Oedipus effect, whereby oracular pronouncements act to bring about the state they pronounce on (Shepherd, 1990).…”