1930s Insulin Shock Therapy - Snippet from the work of Edward Shorter

Ladislas Meduna,, 1955,
 UofIllinois Archives

Before the days of electroconvulsive therapy, experimentation was conducted in the interwar years inducing convulsions in schizophrenic patients.  In the late 1920s, Polish psychiatrist Manfred J. Sakel had experimented with insulin coma therapy for use on schizophrenics and others.  Camphor was one drug that was used, but it was found unreliable in its reactions, and patients reported great feelings of anxiety before the fits, not to mention the drug's tendency to induce vomiting. Metrazol, or Cardiazal was discovered by Ladislas von Meduna to be a superior drug to induce therapeutic seizure.

Before the 1930s, it was largely sedatives and hypnotics that were being used on psychiatric patients, with opiates and barbiturates coming to the fore in the nineteenth and twentieth centuries respectively.  If one counts laxatives as drugs, evidence exists for their use as psychiatric treatment as far back as the middle ages, and one could likely find similar uses in ancient times.  While we might like to think of Prozac as a revolutionary change in mental health treatment, it certainly had its forebears.  

Insulin shock therapy is given in
 Lapinlahti Hospital, Helsinki in 1950's

In the 1930s there were brief experiments with convulsive drug treatments, before these were swept away by the tide of electroconvulsive therapy.  Ladislas von Meduna was a Budapest psychiatrist who in 1934 was breaking ground in the use of insulin induced comas for the treatment of schizophrenia.  Seizures were an occasional side-effect of insulin comas, and some psychiatrists thought these were therapeutic, and induced them using cardiazol or camphor.  An account of one of Meduna's early patients gives an idea of the gap between the sanitized official record and the lived experience of the patient.  Meduna noted of his thirty-three-year-old patient that he had been committed to the Budapest State Hospital in 1930 on the basis of his delusions and hallucinations.  He had reportedly spent 1933 hidden under his bedcovers, and in January 1934, he had stopped eating.

Meduna administered camphor, and 45 minutes later the patient had his first seizure.  In the next couple of weeks, he would have five more injections.  Meduna reported:

 On the morning of February 10, the patient spontaneously arises from bed, is lively, speaks, and asks for something to eat.  He is interested in everything going on about him, asks about his illness and realizes that he has been sick.  He asks how long he has been in the hospital, and as we tell him that he has already been there four years he cannot believe it. (Shorter, 214-217)

Edward Shorter’s work A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: 1997) relays the after-effects of the treatment:

In reality, the patient felt so good that he escaped from the institution, went home, ‘and found out that the cousin living with his wife was not a relation at all but his wife’s lover.  He beat up the cousin and kicked him out of the house; proceeded to beat up his wife and told her that he … preferred to live in the state mental hospital where there is peace and honesty.’ (Shorter, 214-217)

Shorter's work argues against the disciples of Foucault who since the 1970s have damned psychiatry as a state tool to incarcerate the disruptive.  Shorter emphasizes that mental illness was real, and could be cured by various biology-based methods.  It is interesting to note, that Meduna's 1934 convulsive shock experiments reported that of 110 patients treated (presumable schizophrenics), half went into remission.  As the above account suggests, "cure" was not always synonymous with completely positive outcomes, and the dangers of inducing seizure and the low vital signs connected to insulin sleep therapy were always clear.

Southern Albertans interested in psychiatry and its history may wish to attend a couple upcoming talks.  Edward Shorter is in Calgary for a few days in early February 2015, and presenting two public talks at the University of Calgary.

The second talk is at 3:30pm. Monday February 9th at the Community Health Sciences department on the third floor of the Teaching Research and Wellness (TRW) building on the University of Calgary's Foothill's campus.  RSVP to Beth Cusitar bcusitar@ucalgary.ca.  The talks is as follows:

“DSM:  The History of a Train Wreck”

Diagnosis in psychiatry was once dominated by the German heavyweights.  After the Second World War, the United States becomes the world champion of psychiatry, and American diagnoses take over, first in the DSM-1 in 1952, then in the revolutionary DSM-3 in 1980, which was a dramatic break from psychoanalysis and offered hope for the diagnostic future.  But buffeted by institutional politics, the demands of patient organizations, pressures from niche marketers within the field, and the profit horizons of the pharmaceutical industry, the diagnostic promise of DSM-3 failed to be realized, and the entire diagnosis machine of DSM has started to run out of control.  We are now at DSM-5 (2013).  There probably will not be a "DSM-6."

Mental States and Discipline in 3rd Canadian Infantry Division, 1942-43

Second World War psychiatric evaluation in the Canadian Army exposes the institution as an modern disciplinary apparatus where the lines between medical evaluation and criminal sentencing are blurred.  A number of medical evaluations in the Army were directly linked to crimes, the most obvious being self-inflicted wounds.  Medical officers were always on the watch for malingering, balancing the age old tension of care for their soldier-patients and supplying the military machine with healthy manpower.  In the 3rd Canadian Infantry Division, a number of letters in February 1943 show how personnel testing and medical evaluation could greatly influence a soldiers' disciplinary outcomes.

3rd Canadian Infantry Division Shoulder Patch http://www.rcasc.com/world_war_ii_1939-1945/3rd_canadian_division_1939-1945

Recruit Undergoes Medical Examination,
 Saint John, New Brunswick - 1939-1945
New Brunswick Museum
Louis Merritt Harrison Collection (1989.83.1165)

Large numbers of men were allowed to enter the army that never should have been enlisted in the first place.  Before the 3rd Division left Nova Scotia, it was estimated that around 10% of personnel needed to be medically boarded and downgraded out of fighting units which demanded high grade personnel.  As the division set sail in July 1941, however, it is clear that this process was not complete.  The medical war diary wrote that "All soldiers not showing definite disability will be categorized A." (3rd Canadian Infantry Division, Assistant Director Medical Services, War Diary, Library and Archives Canada, RG24 Vol. 15,660)
  
More than a year later, men who were not fit for army life remained.  One soldier who had lost his kit and gone away without leave several times was judged in the psychiatric lingo of the day, a "low grade moron".  He was sentenced to serve 21 days detention, but due to the psychiatrist's report, medical officers recommended that he be struck off strength.  The officer commanding a Field Dressing Station wrote, "he seems totally unfit to look after himself."

Maj. TC Gibson, OC 5 Field Dressing station, RCAMC to [...] Cdn Detention Barracks, “F 88716, Pte. Maclean, G.A. – Disciplinary Action”, 3CID ADMS War Diary Appendix, 25 February 1943.

 Other soldiers had mental difficulties and neurological disorders with more grave and violent consequences.  It was not uncommon for epileptics to conceal their symptoms so that they could join the army.  One soldier who appeared to be having a manic episode or seizure had to be forcibly removed from his home.  His wife had called the authorities when the private had been knocking his head on the floor and kitchen sink and pulling handfuls of hair from his head. She had to trick him into believing they were going for a walk, so that provost and ambulance staff could seize him. 

The details of a another tragic case are few, but clearly indicate signs of mental collapse.  Jonathan Scotland has indicated (on the Active History blog) that soldier suicide is an important field hardly explored by historians.  The case of a suicide in the Regina Rifle Regiment in July 1942 shows strong connections between mental instability and suicide in the army.  The verdict of the coroner's report stated, "Death from [Gun Shot Wound] of head by own hand while of temporarily unsound mind."

Capt. RE Ralph, MO, Regina Rifle Regiment to Col. LH Leeson, ADMS 3CID, “REPORT ON FATALITY L28177 Rfn. Gilliland, A.”, 3CID ADMS War Diary, LAC RG24 Vol 15,660, 4 July 1942.

Tapscott, Globe and Mail,
17 December 1941, p. 5

One final case from February 1942 shows a unique example of what today would be called post-traumatic stress disorder.  The soldier in question was serving with the Royal Canadian Army Service Corps, but had come to that service through a tragic mishap at sea.  Private Robert G. Tapscott was originally from Bristol, and had served in the merchant marine until August 1940 when his ship was sunk through enemy action.  With six other survivors, he managed to find a life-boat which went adrift for two months in the South Atlantic.  When they were found by a native of the Bahamas, only Tapscott and another man were alive.  Tapscott subsequently was shipped to Halifax and found his way into one of the 3rd Canadian Infantry Division's petrol supply companies.

After arriving in England, Tapscott overstayed his leave to visit his family in Cardiff, and racked up a series of away without leave charges along with one for theft of an army truck.  His medical examination suggests that he had not recovered from his harrowing experience after the Atlantic sinking.  "He is a very nervous individual and states that he has been so since his experience at sea.  He states that he is afraid of the dark and, especially when he is left alone, this dates back from the time of the sea incident."  Tapscott had problems with his officer commanding, who insisted on putting him on night sentry duty, despite his lingering phobias. 

2001 edition of Two Survived

Interestingly enough, Tapscott's story was turned into a book by Guy Pearce Jones called Two Survived (Macmillan, 1941).  A review of the work in the Globe and Mail of August 23rd 1941 (p.10) wrote, "Tapscott, a stolid type, was plunged into melancholia after his rescue and took far longer to recover."  The book itself highlights other items regarding mental health.  The Globe columnist notes that in the life raft the "mentally deficient cook had gone insane and finally tumbled overboard. Twice Widdicombe and Tapscott had decided to end it all together, but in them the love of life was strong and each time they lowered themselves into the sea they felt so refreshed that they climbed back aboard to struggle further."  Another newspaper account suggested that two other men in the life raft were, "crazed by the heat and thirst, jumped overboard.  They were left with a companion who finally committed suicide by cutting his throat." (Globe and Mail, 14 January 1941, p. 9)

Mental health and discipline,then, were connected in important ways in Canadian Army administration during the Second World War.  While the army had ramped up its attempts to "weed out" formations of those that were considered too mentally unstable, or unintelligent to soldier, the 1942-43 records of the 3rd Canadian Infantry Division, and indeed the later reports of psychiatrists from active theatres of war, show that there were still a number of men in the Canadian Army who, for a variety of reasons, could not handle the strains of army life.  Many of these men would not receive a medical diagnosis, and would be simply recorded as disciplinary statistics, and sent to the detention barracks.  Others would be medically down-graded and sent to a pioneer company which sought to harness their labour away from the stresses of combat.

The Great Fly-Killing Competition: Sudan 1941

A recent edited volume of primary documents, Combat Stress in the 20th Century is an excellent addition to the literature on psychiatry at war.  Editors Terry Copp and Mark Humphries have selected a broad range of articles from medical journals, archived reports, and accounts by medical officers and laymen alike which show the development (or some would say lack thereof) of military thought on mental breakdown and treatment in the commonwealth armies.

For those of more eccentric historical taste (you've come to the right place!), there are plenty of accounts of the more extreme sides of the subject, including electroshock therapy, barbituate sedation, or insulin shock therapy.  On the scale of strange, however, it is hard to top the account of FM Richardson's competitive health preservation.  It seems that to remove the risk of malaria and the sheer annoyance of the omnipresent fly, all Second World War British officers needed to do was start counting:

In a camp in Sudan where fly infestation was very bad and made life intolerable despite intensification of all the usual measures and the efforts of a strong daily fly-swatting patrol almost unbelievable results were achieved in little over a month by a fly-killing competition.  The unit was divided by tents and other convenient groups into teams of ten to twelve men and a running total of the number of flies killed by each team was published weekly.  A standard tin of which the fly content was known was kept by the G.M. Havildar to whom the teams brought their daily bag to be counted, recorded and burned.  The results soon became apparent and it was not long before the 100,000 mark was passed.  The I.H.C. sepoy would do a lot for a few rupees and a good curry bat, and enthusiasm soon rose so high that the best hunting grounds had to be allotted on an official programme like the blocks in a shooting jungle.  Finally the few remaining flies were being stalked by the more resolute competitors and one could see none where recently they had been swarming.

Allied Advances in the East African Campaign. Image by historicair

 This may all sound rather ridiculous but I was later discussing it with a man who had lived in Rumania, where, he said, flies had been innumerable.  A similar competition on a village basis for big money prizes was organized by the Government, and the results, he assured me, were so remarkable that flies virtually disappeared from the country and the disposal of the rubbish which the flies would have eaten became quite a problem.  I accept no responsibility for this statement which may have been merely a dramatic way of emphasizing the success of the scheme, but it is a stimulating thought for medical entomologists.  (FM Richardson, "Competitive Health Preservation in the Army", text of a presentation at the USAREUR and Seventh Army Medical Surgical Conference at Garmisch, Germany, 18 May 1981.)

In civilian life, cold hard cash was necessary to promote fly-killing! 
 Mansfield Advertiser, Mansfield, Penn., June 24, 1914
via State Library of Pennsylvania via
 Questionable Advice and Advertisements

Richardson is best known for his work Fighting Spirit which is a socio-psychological look at men in combat.  He suggested applying the  health competition to battle exhaustion cases.  This seems like a questionable cure for the malady.  If soldiers took the competition seriously, and paid attention to the publicized battle exhaustion rates of various competing units and formations, they would condemn those with symptoms of breakdown.  Hence, it is more likely that those suffering from combat stress would be under even more pressure from their peers, complicating their malady further.  In consideration of how important acceptance by the group is to soldiers, letting their unit down further in the competition may have increased their shame, reducing the already low chances of rehabilitation and return to unit.