Shridhar Sharma: Insulin coma treatment: Facts and controversies

Thomas A. Ban’s comments

I enjoyed reading your essay, Insulin Coma Treatment (ICT), in Controversies. After entering psychiatry, in 1954, in Hungary, my native country, my second assignment was to attend the ICT unit of our service at the National Institute of Nervous and Mental Diseases in Budapest. At the time, we still did not have chlorpromazine readily available in Hungary, and we managed our schizophrenic patients with a morphine and scopolamine combination, paraldehyde, potassium bromide, barbiturates and chloral hydrate. I had the impression at the time that the treatment helped some of our patients. Over the six months period I attended the unit, we had couple of prolonged comas, but no fatality.

With the introduction of chlorpromazine, ICT was abandoned.

In the mid-1990’s, I became involved in a project with the late Oakley Ray that was to become known as ACNP’s “oral history project”, in which first some of those members of the College who were involved in psychopharmacology in its early years were interviewed. Included among them was Joseph Wortis (JW), the psychiatrist, who translated Manfred Sakel’s monograph from German into English and introduced ICT in the USA in the late 1930’s. Wortis was interviewed on December 14, 1994 at the Annual Meeting of the College in San Juan, Puerto Rico by Leo Hollister (LH), a former President of the College and the transcript of his interview was included in the first volume, based on these interviews, published in 2011 (Wortis 2011).  The section of his interview relevant to ICT reads:    

“JW:  Now, to my amazement, Leo, when George Simpson, my friend, gave his presidential address here [Annual meeting of ACNP, San Juan , Puerto Rico] a couple of years ago [1991] on Treatment of Schizophrenia, he completely omitted any reference to insulin shock treatment that was one of the great historical developments in psychiatry. It was the first successful physiological treatment modality. We had of course Wagner-Jauregg’s treatment of general paralysis with fever therapy, but compared to schizophrenia, general paralysis was a relatively rare disease. And George Simpson omitted any reference to its treatment with insulin shock. When I criticized him later for his omission, he said there were no good controlled studies. But he was wrong! There were some very good controlled studies. It was not a universally accepted treatment but it was a remarkably good treatment that actually induced remissions.

LH: I guess the reason it never caught on too well was that it was fairly labor intensive.

JW: That’s right, and because of the introduction of pharmacological treatments, particularly chlorpromazine”.

Reference:

Wortis J. Interviewed by Leo E. Hollister. In Ban TA, editor. An Oral History of Psychopharmacology. The First Fifty Years. Peer Interviews. Volume 1 (Shorter E, volume editor. Starting Up). Brentwood: American College of Neuropsychopharmacology; 2011, pp. 311-26.  

Thomas A. Ban
December 31, 2015