At the time the s , mental illness was often considered irreversible, and successful therapies were difficult to come by. Cerletti had not shied away from extreme treatments in the past.
In , he had begun using a stimulant drug called Cardiazol aka Metrazol to treat schizophrenia. When given in high doses, Cardiazol would induce seizures. This sounds like an undesirable—and potentially horrifying—side effect, but to schizophrenia researchers, it was exactly what they wanted to happen.
For the thinking at the time was that there was something about the convulsions of a seizure that could counteract the effects of disorders like schizophrenia on the brain. For some patients, the drug caused apprehension bordering on terror from the time it was injected until the time the seizure began.
This intense dread was not simply a fear of the oncoming seizure, but seemed instead to be a psychological side effect of the medication. The behavior of patients after the seizure could be problematic as well. Some became unpredictable, irrational, and—in rare cases— even suicidal.
These factors, combined with a paucity of evidence to suggest that Cardiazol actually was having an effect that was specific to schizophrenia it actually seemed that Cardiazol could jolt almost any patient out of a stuporous state —whether they suffered from schizophrenia, depression, mania or something else , caused Cerletti to tenaciously seek other treatments. After all, everyone knew that large doses of electricity could cause convulsions.
Maybe, then, electricity could also be used to induce the type of convulsions that were thought to have potential in treating schizophrenia. When Cerletti began testing this idea on dogs, however, he realized how dangerous the approach might be: about half of the animals subjected to electrical shock died of cardiac arrest. They soon learned that the original placement of the electrodes one in the mouth and one in the anus was a large reason dogs were dying after electrical stimulation.
This configuration caused the current to cross the heart, which not surprisingly sometimes caused cardiac arrest. When the electrodes were moved to the head, pulses of electricity produced convulsions—but rarely death.
After many tests on canine and porcine subjects, Cerletti was confident that electrical stimulation to the head was not a fatal procedure. It was time for the ultimate test: a human.
Which brings us back to the morning of April 11th, Cerletti was surrounded by a small group of other physicians, a nurse, and an assistant. They had sequestered themselves in a laboratory that had a bed in it, originally installed so the director of the laboratory could rest between experiments. But now on the bed was a homeless schizophrenic patient with a circular metal apparatus placed on his head.
Wires ran from the apparatus to a device on a table nearby. Everyone else stared intently at the patient, eagerly but apprehensively waiting for something to happen.
Then, his body just as suddenly fell back down—limp, but alive. That was the first proof a human could tolerate this type of controlled electrical stimulation to the head. He wanted to see convulsions reminiscent of a seizure, not just one spasm. He ordered another shock be given—this time at 90 volts. The patient stopped breathing—his diaphragm remained contracted—and he began to turn pale. The asphyxia continued for a few seemingly interminable seconds, but then the patient suddenly let out a deep breath.
He lay silent for about a minute, then abruptly sat up in bed and began to sing a bawdy song that was popular at the time. Its value was mainly observable in mild mental disturbances, particularly neuroses. But beginning in the s these methods began to be supplemented by physical approaches using drugs, electroconvulsive therapy, and surgery.
The knowledge that head trauma, convulsions and high fever could be good for improving mental disturbances is not new in Medicine. Hippocrates was the first to note that malaria-induced convulsions in insane patients was able to cure them. In the Middle Ages, some physicians observed the same phenomenon after a severe bout of fever; such as after cholera epidemics in insane asylums.
In , a physician named Roess claimed improvement in mental patients after inocculation with smallpox vaccine. Furthermore, many physicans along the centuries have noted that there are very few epileptics who are also schizophrenic, and a biological theory on the incompatibility of convulsions and mental disease slowly evolved. In addition, for centuries physicians had been fascinated with the idea of treating mental and neurological diseases by using electricity.
Between and , four methods for producing physiological shock were discovered, tested and used in the psychiatric practice, all of them in Europe:. The advent of treatment of the psychoses by using physiological shock increased the opposition between two schools of thought within psychiatry: the psychological and biological ones. The " psychological school " interpreted mental disease as being due to deviations in the personality, problems in rearing and childhood, discontrol of internal drives, etc.
This school was typified by psychoanalysis, founded by Sigmund Freud in the beginning of the 20th. The " biological school ", instead, considered that mental diseases, particularly the psychoses, were caused by pathological alterations of the brain, chemical or structural.
Consequently, the approaches to therapy by each school were markedly different. The success of shock therapy, which was evidently due to some drastic alteration in the internal environment of the brain and on the functions of the neural cells, was a strong argument in favor of the biological causation of many mental diseases.
The first researcher to systematically pursue the link between fever and mental disease was the Austrian physician Julius Wagner von Jauregg. He observed that insane patients improved considerably after surviving to severe typhoid fever, erisipella or tuberculosis infections.
Impressed by the coincidence that all of these patients had episodes of high fever and inconscience, he started to do experiments with many methods of inducing fever, such as infection by erisipella, injections of tuberculin, typhoid, etc. Wagner-Jauregg's first breakthrough came when he began treating general paresis, a exceedingly severe and common neuropsychiatric disease caused by advanced neurosyphillis, whose cause was unknown at the time.
Paresis, also called dementia paralytica, was an incurable and almost always fatal disease, and the insane asylums were full with patients with it, due to the inexistence of effective treatments for syphillis. It was accompanied by marked and progressive neurological and mental degeneration, including convulsions, ataxia motor incoordination , speech deficits and general and widespread paralysis.
Mentally, it caused mania, depression, paranoia and violent behavior, including suicide, delusions, loss of memory, disorientation, and apathy. The breaktrough was inspired by a startling series of medical discoveries in microbiology, In , Ronald Ross had discovered in India that malaria was caused by a parasite transmitted by the Anopheles mosquito.
In , Schaudinn, in Germany, discovered the pathogenic agent for syphillis, the Treponema pallidum. In the same year, Karl Landsteiner proved that fever was able to kill the syphillis-causing spirochetes. In the next year, Wassermann discovered the sorological test for syphillis which is used to detect the infection very early, and in it was used for the first time for testing the cerebrospinal fluid.
In , after attempts at the chemotherapy of syphillis, Paul Ehrlich achieved success with salvarsan or the " Compound", on the basis of arsenic, which was the first scientifically designed substance to be used against microbes. Finally, in , Noguchi and Moore demonstrated that general paresis was in fact an infection of the nervous system by syphillis, and this was the first time in medical history that a kind of mental disturbance, or madness, could be traced to a biological alteration of the brain!
The "biological" school of psychiatry had scored a tremendous victory. Wagner-Jauregg, who was keen in noting every association between fever and paresis, inocculated in July nine chronic paresis patients with the tainted blood of a malarial soldier.
He achieved complete recovery in four ot these patients and an improvement in two more. He then proceeded to devise and to test a complex treatment protocol in syphillitic patients who were at risk for paresis. First he tested their blood and CSF with the Wassermann reaction, then treated them with malarial blood, followed by quinine to quench malaria and alternating with injections of neosalvarsan, to clear the blood of spirochetes.
For this, Wagner-Jauregg was awarded the Nobel Prize in Nowadays, dementia paralytica is a rare complication of syphillis, and Wagner-Jauregg's treatment has been supplanted by the use of antibiotics.
T he second breakthrough in the shock treatment of psychosis was achieved in by a young Polish neurophysiologist and neuropsychiatrist named Manfred J. While an internist in the Lichterfelde Hospital for Mental Diseases, in Berlin, Germany, he provoked a superficial coma in a morphine-addicted woman, using an injection of insulin, and obtained a remarkable recovery of her mental faculties.
Insulin had been discovered in by two Canadian medical researchers, Frederick Banting and Charles Best , as the hormone fabricated by the pancreas which is responsible for maintaining the equilibrium of glucose in the body. The lack of insulin causes diabetes, or hyperglicemia excess of glucose , while its natural or artificial excess causes hypoglicemia, which leads to a coma and to convulsions, due to the deficit of glucose in the brain cells.
Electroshock therapy introduced Electric eels and fish were used by people in ancient times to treat headaches and mental illness. The practice came back in when Ugo Cerletti and Lucino Bini b. They did not base their ideas on those of the ancients, but rather on the work of a Hungarian psychiatrist who had found that epilepsy and schizophrenia seem to have opposite chemical effects on the brain. He theorized that if he could induce an epileptic seizure in a schizophrenic person, it might alter the brain chemistry enough to offer some relief.
He used drugs to cause the seizures, and it did seem to work. In , Cerletti a neuropathologist and psychiatrist and Bini an excellent clinician and Cerletti's assistant were researching this very idea.
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