Physical treatments in psychiatry.

Abstract

It has been stated too frequently that new therapeutic developments in psychiatry are revolutionizing the field. While this did not turn out to be true for any of the treatment procedures, it can well be stated that those of us who entered psychiatry more than 25 years ago, lived through a period in which psychiatry changed from a specialty known for its therapeutic nihilism to a field of almost feverish therapeutic activity. Undoubtedly the physical treatments have played a decisive role in this change. They have also clearly changed the attitude on the part of the individual psychiatrist to his specialty. Our teachers were primarily concerned with attempts to organize and systematize our knowledge, while our generation, perhaps because too pragmatic, may easily be blamed for failure to link the newly-acquired information with the basic concepts developed by them, concepts which were neither confirmed nor disproved by our new knowledge. When I think of my own development as a neuropsychiatrist, I remember that I started out in psychiatry, but temporarily turned to neurology because at that time neurology seemed to give much greater therapeutic possibilities. It was only in the middle nineteen-thirties that this changed radically, and that so many more therapeutic possibilities developed in psychiatry that it became a challenge to return to this field. The introduction of the various physical treatments in close succession was an amazing coincidence. Although met by some with scepticism and even ridicule, and by others with unjustified over-enthusiasm or a competitive attitude improper for scientific progress, the new treatments evoked a beneficial optimism among psychiatrists. They helped to change the attitude of the mental hospitals in all countries and gave an entirely new impetus to the general public to become interested in matters concerning the mentally sick. It may also be said that the physical treatments gave a new stimulus to efforts at psychological and social treatments of the psychotic patient, and I dare say that the improvements in mental hospital management which are so conspicuous in your country could not have progressed so fast and met with so much public support if the physical treatments had not helped to improve the adaptability of patients in these hospitals. It is a historical fact which can be easily proved, especially in England, that those hospitals which are now the showplaces for modern hospital treatment, with open wards and social and recreational activities for almost every single patient, are also the ones in which pioneer work was done with insulin coma treatment, convulsive treatments and psychosurgery. I am going to discuss these treatments, while the newest approach, pharmacotherapy, will be left to another report and be mentioned only as far as it influences the application and indications of the other treatments.