Cycling History

The history of psychiatric treatments has, in the words of Leland V. Bell:

remained in a state of flux.  Indeed, institutional psychiatry has supported a bewildering array of therapeutics that have followed a roller-coaster pattern of fashionability.  A new therapy is introduced with great excitement and enthusiasm.  Sophisticated, detailed reports verify its effectiveness and show remarkable cure and improvement ratios.  This excitement and interest soon fade.  Follow-up studies and additional research challenge the initial reports and reveal that the therapy has limited applications, that it should be given only a modest place in psychiatry’s armamentarium.   Even the most dramatic therapeutics have followed this cycle of hope and disillusionment.”

Pick the treatment – insulin coma, Metrazol, malarial treatment of tertiary neurosyphilis (for which a Nobel Prize was awarded), ECT, lobotomy (for which another Nobel Prize was given) – the cycle has repeated. More recently the same pattern has emerged, to a lesser degree, with SSRIs and second generation antipsychotics. It’s not that these are ineffective treatments – they were and are of benefit! It’s just that when each first arrived they were overvalued and overused. They become another tool, not the only tool.

Why bother studying history? Because it raises our awareness of where we came from, where we are and, hopefully, makes us think where we’re going.

It is all too easy to forget the kind of lives many clients had not so long ago.  With onset of a psychotic illness, usually in early adulthood, they would’ve been admitted to an asylum, might well have lived their entire lives there, died there and been buried in the asylum’s cemetery.

While there’s still a long way to go in finding effective treatment tools our clients are, for the most part, living radically different lives than they would have had they been born 100 years before.

The attached video shows Dr. Heinz Lehman with three men suffering with catatonic schizophrenia. I wrestle with the ethics of posting this as I doubt these men ever gave consent for the use of their images. At the same time this footage has been in the public domain for decades. The images are powerful; keep in mind what Dr. Lehman says in the intro – these men have been in this state for between 5 and 15 years and that their symptoms are less severe than they had been.

 

Heinz Lehman was a distinguished Canadian psychiatrist who is credited with bringing chlorpromazine – Thorazine to Americans, Largactil to Canadians – to clinical practice. He did not invent or discover it but was the first to start using it, in his own admission out of desperation to help patients.

Most of psychiatric history is a history of psychiatrists. There is another history that needs to be told – that of patients. Pat Deegan’s film The Politics of Memory powerfully presents this.

To help clients find their voice, to speak their history, will remain one of the most important tasks for ACT clinicians.

Shalom Coodin

PS: To find a copy of Treating The Mentally Ill; From Colonial Times to the Present by Leland V. Bell,  check on Amazon.

 

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