Psychiatric Treatments

Early 1800s: Rotation therapy - The Swing

Inspired initially from the grandfather of Charles Darwin, Erasmus Darwin, there were two main methods of implementing the swing in psychiatric hospitals.

An ordinary chair, suspended from the ceiling, with ropes attached to the legs. The ropes were used to spin the chair until it was set in motion.

A pole fixed from the floor to the ceiling by iron rods. It had a horizontal arm attached, which was used to hang a chair or bed and to spin the patient.

Both methods procured the same results: the patients were spun in a circular motion until they no longer suffered mental health symptoms. The doctors would release them from the chair/ bed and allow them time to sleep and recover. However, when the nausea and shock had worn off, the patients were still mentally ill, forcing another session on 'The Swing' and therefore repeating the process.

1800-1850: Moral Therapy

Moral therapy emerged in the treatment of mental illnesses in the late 1700s, and became prominent in asylums across the world by the 1800s.

One of the first 'pioneers' of the treatment regime was a Quaker in England named William Tuke. Following the death of a fellow quaker in an asylum in1790, Tuke established an asylum which functioned like no other of that period. In 1796, the York Retreat was opened and 30 mentally ill patients were admitted, where they lived as a part of a small community in a large country house.

The treatment regime consisted of some light manual work, talking and socialising ,and a great deal of rest. Mechanical restraints were seldom used, and the aim of the asylum was to focus on cultivating rationality and moral strength, as opposed to containing those who were deemed 'dangerous' or 'mad.' Tuke moved his family into the institution, and the entire family became known as the founders of moral treatment. They created a family style ethos, where the patients were given chores to perform through the day and spent most evenings as leisure time. It gave the institution a sense of normality, instead of feeling like a prison, making the patients feel at home.

Early 1900s: Hydrotherapy

Hydrotherapy became a popular form of psychological treatment at the beginning of the 20^th century and was used for several decades before hospital overcrowding became a serious problem.

Inspired from the old German spa therapies, Hydrotherapy was deemed to be an effective form of treatment for a variety of mental disorders, including anxiety, insomnia, depression and aggression. Hot or warm water was used to calm and relax patients, whilst cold water was used on hyperactive patients as it slowed the blood flow to the brain and decreased activity.

Hydrotherapy predominantly consisted of a bathtub covered by a thick canvas to maintain the temperature of the water. This canvas had room for the head to stick out from, plus patients could be allowed their arms outside it at mealtimes. Attendants would monitor the water before and during the patients’ sessions, ensuring the prescribed temperature was kept to at all times. The length of the session depended on the mental condition of the patients and ranged from a few hours to several days. Many patients found this form of therapy extremely constricting, and particularly cruel, especially when cold water was applied.

1934: Chemically Induced Seizures

Ladislaus von Meduna, a Hungarian pathologist, came to the conclusion that there was a distinct correlation between epileptics and schizophrenics. He discovered that schizophrenia was quite rare in patients suffering from epilepsy and derived the hypothesis that it was seizures which prevented the mental disorder.  This was further supported by the notion that epileptic patients often felt a sense of euphoria after a seizure, indicating the same affect would be felt be a schizophrenic after a seizure also.

Whilst this link between the illnesses is prominent, the methods used by von Meduna were questionable and deemed by today’s standards as dangerous. Patients were given an array of seizure-inducing drugs, such as absinthe, caffeine and  strychnine, but none of these produced the desired effect. Finally, Metrazol was selected as the drug of choice, and given to patients for several decades. Whilst von Meduna argued that many of his patients were cured by this form of treatment, his critics saw a trail of patients who were left with broken bones and distorted memories. It was for this reason that the treatment eventually died out, as both doctors and patients agreed that the risks far outweighed the benefits.

1935: Lobotomy

The lobotomy was first performed in 1935 by a Portuguese neurologist named Egas Moniz. He believed that patients with obsessive behavioural traits were suffering from fixed circuits in the brain. He believed that severing the connecting fibres of the neurons activity would eliminate the vast proportion of mental disorders, and conducted a procedure that consisted of:

Drilling two holes in the patient's skull, either at the top or at the side. A sharp tool known as a leuctome would be forced through the holes and into the brain, where it would be swept from left to right, ensuring the connections between the frontal lobe and the rest of the brain were severed.

Moniz reported that the first 20 patients of the lobotomy displayed significant improvements, and encouraged other doctors to witness his success. Walter Freeman, an American neurologist, became an advocate of the Lobotomy after an encounter with Moniz, and took the procedure back with him to the US where it quickly became a mainstream form of treatment by 1936. As the procedure was limited by the need of a neurosurgeon, Freeman adapted it so it could be performed by regular doctors, allowing it to become more accessible to those in need.

1937: Electro Convulsive Therapy (ECT)

Convulsion Therapy was becoming increasingly popular within mainstream psychiatry, and many doctors experimented with their own versions of the therapy. One professor of neuropsychiatry, named Ugo Cerletti was developing his own idea of using electricity to shock patients as opposed to  Metrazol. His first human experiment was in 1937, and according to Cerletti, the treatment began showing positive results after 10-15 sessions.

The ECT procedure consisted of powerful shocks being sent to the brain via two electrodes known as paddles. Mouth guards, body restrains and drugs all had to be used to prevent damage to the patients' bodies during the sessions, making this form of treatment particularly violent. The onset of World War II saw a drastic increase in societies technological development, and the ECT was one of the beneficiaries. The procedure became much safer and more comfortable for the patients, but questions were asked in regard to the treatment's moral implications: As the patients could not remember having the ECT, how does this affect their informed consent?

1950s: Pharmaceutical Drugs

Although there is substantial evidence to show that medication has been used for at least a century, but it was only in the 1950s when pharmaceutical drugs became widespread. The introduction of anti-psychotic drugs such as chlorpromazine (thorazine) offered patients an alternative form of treatment, and began to eliminate the need for the drastic treatments such as the lobotomy and ECT.

Thorazine was first created by a team of French researchers who were aiming for a cure for malaria. Although they were unsuccessful in their attempts, they did discover that the drug had sedative side effects, and produced a 'medicinal lobotomy.' Thorozine was reported to reduce aggressive behaviour, anxiety, hallucinations and the desire to self-mutilate or harm others, and quickly other drugs based around its chemical compound were being produced on mass.

The popularity of pharmaceutical drugs, and chlorpromazine in particular, continued to soar throughout the 1960s and 70s. By the mid 1980s, doctors and scientists believed that there was sufficient evidence to indicate the fundamental importance of chlorpromazine within mental healthcare. A new disciple, neuropsychopharmacology, was then dedicated toward the study of mental pathology via the use of centrally acting medication .

Since then, the diversity of pharmaceutical drugs has grown increasingly complex, leading to a mass market on a global scale.