Biological Psychiatry

Question 1

What came out in psychiatry in the 1930s?

Answer 1

New somatic treatments.

Question 2

Before 1930, how many treatments were there for mental illness?

Answer 2

Hardly any. Blood-letting, yes. But that wasn’t really a treatment.

Question 3

Before 1930, what was the consequence of having few treatments in psychiatry?

Answer 3

The mental hospitals would fill up and no one got better.

Question 4

In the mid 20th century, what kind of mental complaints became popular?

Answer 4

The “lesser” complaints, but ones that were still troublesome.

Question 5

In the 20th century, out-patient treatment became more common, but for who?

Answer 5

• For YAVIS people: young, attractive, verbal, intelligent, successful.
• For WEIRD people: white, educated, industrialised, rich, democratic.
• NOT for HOUND people: homely, old, unsuccessful, non-verbal, dumb

Question 6

Why were/are the treatment of mental health problems mainly target at wealthier demographics?

Answer 6

Because the wealthier people were easier to treat AND they had less serious problems than those from lower socio economic areas.
Also, there are generally more doctors/psychiatrists located in areas of affluence.

Question 7

Where did somatic treatments take place?

Answer 7

In mental hospitals.

Question 8

What was types of mental issues were targeted with somatic treatments?

Answer 8

Severe and persistent forms of mental illness.

Question 9

Who was the target of somatic treatments?

Answer 9

The poor/low SES.

Question 10

Why were somatic treatments delivered in the first place?

Answer 10

• For medical respectability (so psychiatrists looked like they were doing something)
• To provide treatment (of some sort).
• To help with overcrowding (at the mental hospitals).

Question 11

A question that has been asked a lot is whether poverty leads to mental illness, or if mental illness causes poverty.

Answer 11

It has been decided that if you have a severe mental illness, you will end up poor. (Although, it does work both ways to some extent).

Question 12

What are the differences in diagnosis between poor individuals and upper-middle class individuals?

Answer 12

Poor individuals –> somatic illness.
Upper-middle class –> neurosis.
There are also differences in prevalence of mental illness depending on socio-economic status.

Question 13

What are 5 somatic treatments before 1940?

Answer 13

1. Malaria fever therapy.*
2. Insulin coma therapy.
3. Metrazol shock therapy.
4. Electroshock therapy (ECT).
5. Lobotomy.*

*Won a nobel prize.

Question 14

Although many, if not most, somatic treatments are considered terrible these days, how were they perceived when they were first used?

Answer 14

• They were hailed as breakthroughs.

- success rates were reported as being very high (although this was definitely not accurate).

Question 15

Why were the success rates of early somatic treatments considered to be so high?

Answer 15

• selective observation

- placebo effect from doctors enthusiasm

Question 16

Eventually a popular somatic treatment would fizzle out, why is that?

Answer 16

Further research would fail to corroborate the results. New interesting treatments would pop up.

Question 17

Before the 1930s , what was one of the most common mental illnesses seen in mental hospitals?
What were its three stages?
What disease was it eventually linked with?
How was it identified?

Answer 17

• General paralysis of the Insane (GPI)
  Three stages:
  1. Mild paralysis.
  2. Mania but paralysis worsens.
  3. Paralysis and the patient wastes away.
  It was eventually linked with syphilis.
  It was identified with the Wassermann-test, or a post-mortem of the brain.

Question 18

Although GPI (general paralysis of the insane) was a genuine disease of the brain (where it essentially wasted away). What theories did it inspire in prominent psychiatrists?

Answer 18

Freud linked GPI with his Sex and Death theories. This idea that wealthy gentlemen knew of the risks from fornicating with prostitutes but could not resist their urges.

Question 19

What percentage of male admissions to mental hospitals was because of GPI in Europe and the US?

Answer 19

Europe: 45% of male admissions.
US: 20% of male admissions.

Question 20

Who established the link between GPI and syphilis in 1913?

Answer 20

Hideyo Nugochi a Japanese physician at the Rockefeller Institute in New York.

Question 21

What is the bacteria of syphilis called?

Answer 21

Treponema Palidum.

Question 22

Who invented the cure to syphilis?

Answer 22

Paul Ehrlich, the cure was called Salvarsan.

Question 23

What did the connection between syphilis and GPI do for psychiatry?

Answer 23

It created new hope for psychiatry because:

1. showed the biological origin of mental illness.
2. created medical respectability.
3. started the search for somatic cures.

Question 24

Paresis was seen as the holy grail in psychiatry, gave the field new hope, but…

Answer 24

… it turned out to be an exception to the rule.

Question 25

After the connection between syphilis and GPI was established, what happened?

Answer 25

Psychiatrists started looking for other somatic cures for mental illness.

Question 26

Who was Julius Wagner von Jaurregg?

Answer 26

A physician in Vienna who, in 1917, said that creating a fever using malaria would cure mental illness in the patient. They would induce a fever of 42c, and he claimed a success rate of over 50% - but this is most likely false.

Question 27

Why was fever therapy considered a viable solution to treating mental illness?

Answer 27

Because it had been shown that heat killed the syphilis bacteria, but this was an exception to the rule.

Question 28

Who was Manfred Sakel, and what did he come up with?

Answer 28

Manfred Sakel was a biologically orientated doctor, he came up with the “Insulin Shock” treatment in 1927.

Question 29

What was the Insulin Shock treatment considered similar to?

Answer 29

Water boarding that was taking place in mental hospitals.

Question 30

Why was Insulin Shock treatment used?

Answer 30

Because it was thought that the mentally ill needed their systems to be shaken up, and injecting insulin could do this.

Question 31

What happens when you inject insulin into a normal & healthy person?

Answer 31

All the sugar gets eaten up and the basic energy of the human body disappears, so the person enters a coma and a convulsion starts.

Question 32

How did patients who were injected with Insulin feel about the treatment?

Answer 32

They really didn’t like it, it was like a near death experience.

Question 33

How did the “Insulin Shock” treatment end?

Answer 33

When the doctor believed that the patient had enough, they would pour sugar water into their system through their nose.

Question 34

What was the ‘perceived’ and actual outcome of the Insulin Shock treatment?

Answer 34

The perceived outcome was that 70% of people got better. The actual outcome was that it had no effect at all AND some people actually died from the treatment.

Question 35

What did Ladislas von Meduna (from Budapest) come up with?

Answer 35

Ladislas von Meduna came up with Metrazol in 1933, to treat schizophrenia.

Question 36

What was Ladislas von Meduna’s theory about schizophrenia?

Answer 36

That epilepsy was incompatible with schizophrenia and treatment of the mental disorder should involve induced convulsions.

Question 37

How were the convulsions used to “treat” schizophrenia induced?

Answer 37

By injecting Metrazol, or Camphor.

Question 38

What were the claims of the effectiveness of Metrazol in its treatment of Schizophrenia? And was the reality?

Answer 38

It was claimed that over 50% of people recovered. The reality was that this treatment was incredibly risky. The patient needed cloth in their mouth to stop them from biting off their tongue, they would often break bones.

Question 39

What was an interesting effect observed in the behaviour of psychiatrists toward their patient after implementing a somatic treatment, even if it didn’t work?

Answer 39

They appeared much kinder toward their patient.

Question 40

Who was Ugo Cerletti? What did he come up with?

Answer 40

Ugo Cerletti was an Italian, he invented Electroshock Treatment.

Question 41

Why did Ugo Cerletti invent Electroshock Treatment?

Answer 41

Because he agreed that convulsions could reduce symptoms of schizophrenia, but instead of injecting Metrazol, he believed that using electricity was a better method.

Question 42

How did Ugo Cerletti begin his trials of electroshock therapy?

Answer 42

He got some pigs to try out the therapy and figured out the best place on the pigs body to give the shock therapy. He then tried it on a person being held overnight at the police station. And then, he went to the mental hospitals.

Question 43

Was the initial reception like for Electroshock Therapy in mental hospitals?

Answer 43

Electroshock Treatment was applied indiscriminately to patients in mental hospitals, and then after believing there were positive results, it became more and more popular.

Question 44

Electroshock Therapy is still around today, why?

Answer 44

Well, because it seems to still help people who have very severe depression, or even psychotic depression. Nobody knows how/why it works. Informed consent must be given, the treating physician needs to make a case to a mental health tribunal. But they get muscle relaxants and sleeping aids to help. There is a side effect of memory loss.

Question 45

Which is the only somatic treatment that has survived (if in modified form)?

Answer 45

Electroshock treatment.

Question 46

Who was Egas Moniz and what did he offer to the world of psychiatry?

Answer 46

Egas Moniz was a Portuguese physician and he invented the “lobotomy” as a form of treatment for mental illness in 1936.

Question 47

What did Egas Moniz receive in 1949 for his work?

Answer 47

A nobel prize.

Question 48

What was the theory behind the lobotomy?

Answer 48

The theory was that a person with mental illness has an extremely active frontal lobe, so taking out, or damaging the tissue there would cure them of their mental illness.
The idea is that the nerve fibers at the front of the brain store fixed ideas that trouble the mind

Question 49

When it was first introduced in the 1930s, how were lobotomy’s received?

Answer 49

Psychiatrists and physicians praised the procedure, and it was hailed in the press as a miracle cure.

Question 50

Who was a famous failed case of lobotomy?

Answer 50

Rose Kennedy, who had mental retardation. After her lobotomy, she lived the rest of her life as a vegetable in a wheelchair.

Question 51

What was the (so-called) science behind the lobotomy?

Answer 51

First trials involved experiments on chimpanzees, where the scientists were trying to see whether a lobotomy would lead to a learning impairment. While it did impair learning, it also appeared that the Chimp’s were happier. This was generalised to humans by Moniz.

Question 52

Who popularised the lobotomy in the USA?

Answer 52

Walter Freeman, he simplified the lobotomy procedure, so he wouldn’t need an anaesthetist, or neurologist, but created the ‘ice pick lobotomy’ that could be done without any anaesthesia. He used the ice pick from his hotel, and would put it up through the tear-duct.

Question 53

What happened to Walter Freeman’s patients?

Answer 53

After their lobotomy, they lost their anxiety and psychotic symptoms, but would become vegetables, a lot of them became incontinent.

Question 54

What were Hans’ concluding statements on somatic treatments?

Answer 54

That they were considered miracle cures for people with persistent and severe forms of mental illness. But they ended up stopping because of revolutions in psychopharmacology.