Psychiatry

Abstract

IN a general way, progress in the field of psychiatry during the year 1938 consisted in further development of work which had already begun in previous years. By far the most important development is the .so-called shock treatment for dement 1,1 praecox and other psychoses. Readers have frequently been informed of the tremendous damage done by mental disease one bed for mental disease for each bed for all other diseases in America. Of those cases accumulating in state hospitals roughly 75 per cent have been diagnosed dementia praecox. latterly called for reasons not too obvious, schizophrenia.Until recently these cases presented a very hopeless picture. Occupational therapy, physiotherapy and other empirical procedures were largely palliative, and no specific attack was made on the diseased process itself. Organicists and psychogenesists vied with each other in elaborating the minutiae brought forth by their endeavors, but no one really claimed to understand the cause, nature or cure of this dread malady.Then came the insulin-shock treatment, empirical to be sure, but opening up leads and hopes heretofore unknown. Following this, came the use of various other convulsants, especially Metrazol. All of this has had a tremendously invigorating effect on the whole field of psychiatry. Whereas one often sent patients to state hospitals solely for care, it has now become possible to think in terms of treatment. During the past year there have been a number of excellent publications, some of them dealing with large numbers of carefully treated cases. Compared with the roughly 20 per cent of remissions in untreated cases of dementia praecox, with insulin the incidence of such remissions of cases of less than one year's duration has varied from 50 to 85 per cent.1 Conservative psychiatrists have hesitated to speak of cures, but there is a note of optimism in most of these reports. Similar results have been obtained with the use of M¿traz,ol,_ Each has its advocates and it is not yet possible to decide between rival claims.2,3 This work is not only of importance in the very practical matter of relief of patients, but its implications concerning the nature of mental disease are of fundamental importance. It has enlivened *Dean, Tufts College Medical School. state-hospital medicine in a very hopeful way. Incidentally, recent reports of the use of Metrazol in involutional depressions appear even more promising, some persons reporting 100 per cent of cures, after a relatively short period of treatment.As the year closes, this work is being extended in scope and area.4Of less practical importance, but theoretically illuminating, is the work which has been done in the study of "brain waves." The passage of electrical currents through the brain results in certain conventional findings. These vary under certain conditions and especially in various mental diseases. The work promises to increase our understanding of impaired mental function, and certain investigators appear to be able to localize organic lesions by this method. It wo...