Insulin Shock Therapy (IST) was a psychiatric treatment method widely used in the mid-20th century. It involved intentionally inducing a coma in patients by administering high doses of insulin. Though once a prevalent therapy for various mental health conditions, IST is no longer practiced. This article explores its historical use, treatment mechanics, and reasons for its discontinuation.
Understanding Insulin Shock Therapy
Insulin Shock Therapy, also known as Insulin Coma Therapy, was developed by Austrian-American psychiatrist Manfred Sakel in the 1920s. The procedure involved injecting patients with increasing doses of insulin to induce hypoglycemia, or extremely low blood glucose, leading to a coma. This comatose state was maintained for an hour or more before being reversed by administering glucose, often intravenously or via a stomach tube.
The treatment regimen spanned several weeks to months, with daily injections occurring six days a week. Patients underwent 50 to 60 coma episodes during a full course of therapy. IST was used for conditions such as schizophrenia, severe depression, and anxiety disorders. During the induced coma, patients exhibited various physical reactions, including restlessness, sweating, and convulsions.
Initial Adoption and Fading Relevance
Insulin Shock Therapy gained popularity in the 1930s and 1940s, despite lacking rigorous scientific evidence for its effectiveness or safety. At the time, psychiatric treatment options for severe mental illnesses were limited, and IST was perceived as a promising intervention. Proponents believed inducing a coma could “jolt” patients out of their psychoses, and some psychiatrists reported perceived improvements.
Its widespread adoption helped psychiatry gain medical legitimacy, as it involved a physical intervention. By the late 1940s, many psychiatric hospitals worldwide had established specialized “insulin units.” However, by the 1950s, the practice began to decline as questions regarding its efficacy and safety became prominent.
Why the Practice Ended
Insulin Shock Therapy was discontinued due to its dubious efficacy, substantial dangers, and the emergence of superior alternatives. Scientific studies demonstrated IST was no more effective than a placebo. Rigorous randomized controlled trials in the 1950s failed to provide conclusive evidence of its purported benefits, leading to widespread medical skepticism.
Beyond questionable efficacy, IST carried risks. Patients faced dangers like prolonged or irreversible coma, permanent brain damage, and life-threatening cardiovascular complications. The therapy had a fatality rate of 1 to nearly 5 percent. Patients also experienced violent convulsions, resulting in physical injuries like bitten tongues and broken bones. The therapy demanded constant, intensive medical supervision, making it resource-intensive.
Ethical concerns also contributed to its decline, as intentionally inducing a coma in vulnerable patients raised questions about well-being and autonomy. Some patients described the treatment as “torture.” Ultimately, the development of safer, more effective therapeutic options led to IST’s demise. The introduction of antipsychotic medications (neuroleptics) in the mid-1950s offered a pharmaceutical approach to managing severe mental illnesses with fewer risks and more predictable outcomes.
Evolution of Psychiatric Care
As Insulin Shock Therapy faded, mental health treatment underwent a profound transformation. This shift moved away from crude, high-risk physical interventions toward more nuanced, targeted approaches. The mid-20th century saw the rise of pharmacotherapy, with the development of effective antipsychotics and later antidepressants. These medications provided a less invasive means of managing symptoms, allowing for better patient stability and integration into society.
Alongside pharmacological advancements, emphasis increased on psychotherapy and various psychotherapeutic modalities addressing psychological and emotional aspects of mental illness. Psychiatric care also shifted to community-based models, focusing on outpatient services and support systems rather than prolonged institutionalization. This progression reflected a broader understanding of mental health, prioritizing effective and humane treatments, replacing therapies like IST that carried inherent dangers.