A review of the drastic shock therapies in the treatment of the psychoses

DURING the past decade we have seen progressive changes in medical education and practice which have led to closer relationships between psy-chiatry and general medicine. We now accept psychiatry as that part of medicine which deals with the pathology and therapy of the person, instead of thinking of it as an isolated specialty dealing with advanced psycho-pathological disorders usually already admitted to institutions for treatment in the later stages of development when therapy is most difficult, more pro-longed and less effective. Through this breakdown of the isolation of psychiatric medicine from basic general medicine we are now beginning to see the closest collaboration between the psychiatrist and internist in the study and understanding of the universal personal aspects of all medicine (shown in personality functions) and of the impersonal aspects shown in pathological expressions of disordered function of parts of the body (dis-eases of organs and systems). The effectiveness of present day clinical medicine, therefore, means an integration of these essential personal and impersonal components for examination and therapy of all types of illness. In this lecture on the drastic shock therapies it is my obligation to pre-sent a resume of their present results and status.1 The mode of action of these therapies is unknown, the clinical reactions are dramatic, the complications and contraindications are of great medical interest and import and should lead to a greater mutual dependence and collaboration between the psychiatrist and internist. The pharmacological shock therapies of insulin and metrazol as well as convulsive electro-shock therapy present numerous physiological, biochemical, psychological, electro-encephalographic, electrocardiographic and neuropathological problems for research. The use of these drastic therapies has been summarized recently by the United States Public Health Service in a survey of October, 1941. Ques-tionnaires were sent to 356 hospitals and 85.7 per cent or 305 responded, of which 260 hospitals or 85.2 per cent were using shock therapies. An esti-mated total of 26,335 patients were receiving insulin shock therapy durin