Insulin shock therapy

Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s. It was one of a number of physical treatments introduced into psychiatry in the first four decades of the 20th century. These included the convulsive therapies (cardiazol/metrazol therapy and electroconvulsive therapy), deep sleep therapy, and psychosurgery. Insulin coma therapy and the convulsive therapies are collectively known as the shock therapies. In 1927, Sakel, who had recently qualified as a medical doctor in Vienna and was working in a psychiatric clinic in Berlin, began to use low (sub-coma) doses of insulin to treat drug addicts and psychopaths, and after one of the patients experienced improved mental clarity after having slipped into an accidental coma, Sakel reasoned the treatment might work for mentally ill patients. Having returned to Vienna, he treated schizophrenic patients with larger doses of insulin in order to deliberately produce coma and sometimes convulsions. Sakel made his results public in 1933, and his methods were soon taken up by other psychiatrists. Joseph Wortis, after seeing Sakel practice it in 1935, introduced it to the US. British psychiatrists from the Board of Control visited Vienna in 1935 and 1936, and by 1938, 31 hospitals in England and Wales had insulin treatment units. In 1936, Sakel moved to New York and promoted the use of insulin coma treatment in US psychiatric hospitals. By the late 1940s, the majority of psychiatric hospitals in the US were using insulin coma treatment. Insulin coma therapy was a labour-intensive treatment that required trained staff and a special unit.