Biological Therapy

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  1. 0:15 Biological Methods
  2. 1:00 Medical Treatments
  3. 1:20 Electroconvulsive Therapy
  4. 2:58 Insulin Shock Therapy
  5. 3:50 Psychosurgery
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Taught by

Ellie Green

Ellie holds a B.A. with Honors in English from Stanford University. She is pursuing a Ph.D. in English Literature at Princeton University.

Do you think psychological problems can be fixed with electric shocks or brain surgery? Find out more about biological treatments for mental problems and the controversial role they played in treating patients.

Before psychiatric drugs were developed, psychiatrists sometimes used other biological methods to try to cure or improve their patients' mental health. Therapists understood that changing the body could change the mind, but they didn't have reliable ways of determining targeted biological treatments. Most of these treatments are either no longer used today, or are used as last-resort options for severe conditions. These psychiatric methods used in the past seem crude compared to today's treatments. But it's worth having at least a basic knowledge of the origin of biological treatments to gain perspective on current treatments and to think about the ethical issues that surround many of these methods. After years working only with talk-therapy approaches based on the teachings of Freud, psychiatrists were eager to have options for treating patients that were distinctly medical. These biological treatments seemed, at least at first, much more cut-and-dry than talking about feelings. However, many medically based treatments were largely ineffective and often cruel--but were pursued, often, because doctors felt like they were really doing something for their patients, rather than just talking to them or putting them in mental institutions to live out their days.

Electroconvulsive therapy, abbreviated ECT, became popular in the 1940's as a treatment for nonresponsive patients of many psychological disorders, including depression and schizophrenia. Technicians used electric shocks to give patients seizures that were intended to help them recover. Seizure treatments had been used before, but had required giving patients certain drugs that were expensive and sometimes caused unpredictable reactions. ECT gained notoriety in the 1970's due to high-profile negative portrayals in movies like One Flew Over the Cuckoo's Nest. The poet Sylvia Plath described ECT:

'By the roots of my hair some god got hold of me. / I sizzled in his blue volts like a desert prophet.'

You might be surprised, after hearing such a scary, painful-sounding description, to know that ECT is still used today in cases of severe depression. Though there are many people who feel ECT affected them negatively, others report that the treatment really did help them where modern antidepressants failed. A common side effect is memory loss; because of this, patients are rarely forced to undergo the treatment and are encouraged to weigh their decision carefully. For some, some memory loss is worth no longer feeling depressed. For others, this tradeoff is unacceptable. Author Ernest Hemingway complained of the treatment:

'Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient…'

For someone who wrote fiction for a living, the loss of memory was worse than the depression.

Another kind of shock therapy, called insulin shock therapy, was used to treat schizophrenia in the 1930's-50's. Patients would receive doses of insulin, a hormone which you may associate with diabetics. The dose would be high enough to put them into a coma. Doctors would carefully monitor the patients' comas, then eventually revive them. Though some studies showed that it helped, usually the patients selected for the treatment were those with the best chances of getting better anyway. Later doctors found that the insulin itself didn't seem to do anything; patients who were put into comas by other means had similar results. Insulin treatment had lots of nasty side effects, including massive weight gain, restlessness, and discomfort between treatments. It fell out of mainstream use by the 1960's, and is no longer practiced today.

A third kind of biological treatment is known as psychosurgery, or the practice of physically altering the human brain in order to bring about psychological results. This is an extreme treatment; imagine if a scrape on your leg were infected, and after trying lots of things to cure you, doctors eventually just decided to amputate it. Psychosurgery is an attempt to remove or disable a 'sick' part of the brain so that overall mental health is improved.

The most well-known type of psychosurgery is the controversial lobotomy, in which the frontal lobes of the brain are removed in an effort to control the violent and unpredictable symptoms of the severely mentally ill. The procedure typically left patients much more docile than before, but without much of their original personality or functioning. Arguments against lobotomies grew after it was graphically portrayed as punishment for a rebellious psychiatric patient in One Flew Over the Cuckoo's Nest. Lobotomies were largely stopped by the 1970's, but other types of psychosurgery are still performed, although rarely. If other treatments have been ineffective, some surgeons, with patient's consent, will target specific brain areas in order to help regulate their emotions.

Biological therapies gave early psychiatrists a chance to use some of the methods of other medical doctors; frustrated with committing mentally ill people to institutions for the rest of their lives, they tried extreme surgical and medical procedures to try to 'fix' their most difficult patients. Methods like electroconvulsive therapy are still used today in cases of severe depression that are not responsive to other treatments; insulin-shock therapy and lobotomies are no longer performed due to issues of effectiveness and ethics. Some limited forms of psychosurgery are still performed, but only with a patient's consent. All biological treatments rest on the idea that the mind and body are connected, and represent a move away from Freud's theories of the unconscious as the source of all mental illness.

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