BACK FROM INSANITY

Dominion, Volume 37, Issue 20, 19 October 1943, Page 4

BACK FROM INSANITY

New Mental Hospital Treatments NEW ZEALAND ACTIVITIES Relatives of New Zealand mental hospital patients who were thought to be hopelessly insane have been discovering in some eases surprising and even dramatic improvements in the patients. People who have been inmates of mental hospitals for years have been returning to homes and work. The hospitals had always been able to discharge as cured or improved a large proportion of the patients admitted, but only in the last few years have they been able to discharge inmates of such long standing or who had sunk so far from the normal mental condition.

These cures and partial cures have been the result of the hospital satffs’ adopting improvements in the treatment of mental disorders which have been initiated overseas and have followed rapidly one after another. They include the insulin coma treatment, which was originated 11 years ago in Vienna and the newer shock therapy, which consists of the administration of a drug or an electric current. Most remarkable of all has been the performing by a distinguished visiting neurosurgeon on two Porirua Hospital patients of surgical operations that have rescued them from complete insanity. Few members of the general public, except relatives of the patients concerned, realize .the progress iu psychiatry. Ohl Methods Still Used.

The new treatments are not tried on all of the many types of patients in a mental hospital, for senility, congenital idiocy and insanity that is the result of injury have not yet been cured, but they do hold out hope for the large class of people who, after living a comparatively normal life, become unbalanced and have to enter a mental hospital. Even for them the newer treatments are resorted to only when a patient does not respond to the more conservative forms of treatment. A member of the staff of the Porirua Hospital described them as adjuncts to the more conservative psychiatric treatments that were established in mental, hospitals. Doctors had assisted patients by discussing their troubles with them and showing them how to rid themselves of their worries, enlisting perhaps the co-operation of relatives, and had tried to induce patients to occupy their time with work or sport. That psychological treatment and occupational therapy remained the background of all treatments in the institutions, and the new treatments were used in cases where there was no response to those older methods. The insulin coma treatment was introduced in 1933 by Manfred Sakei, in Vienna, and in 1934 von Meduna commenced convulsive shock therapy in Budapest, injecting a drug known as cardingo!. In 1937 Orletti and Bini, in Italy, demonstrated that, the same end could be attained with electricity.. Jt is more generally accepted that the. insulin coma treatment produces a considerable advance over spontaneous recovery rates in the common mental disorder of younger people known as schizophrenia, and that the shock therapy produces dramatic recoveries in depressed patients and to a lesser extent in excited patients. The cardiazol treatment has been used extensively at Porirua since May, jJ-Ju, over 150 patients having been treated, and a large percentage have responded favourably. Perhaps the most striking of the cases was that of a chronic melancholic patient who had spent five years and a half iu hospital in a most depressed state and was quite resistive to the more ~conservative methods of treatment. lie made a rapid improvement with the injections and has now been home, well, for IS months. Modifications of the cardiazol and insulin treatments are also used. The newer electric treatment is expected to become the general. method when the equipment can be obtained. Visiting Surgeon’s Work.

The two surgical operations already mentioned were performed by LieutenantCommander W. J. Gardiner, of the Cleveland Clinic, Ohio. The patients were women aged 62 and 65, who, judging by the reports of tlie cases that have been published in the “New Zealand Medical Journal,” were pitiable unhappy beings who showed no fijgn of spontaneous recovery. Both operations-were perlormec in September, 1942. The elder, who had been a mental hospital patient since 1936, began to show improvement Witinn a few days, and last January was discharged. The younger woman, who had been“a mental hospital patient since 1933, has not recovered sufficiently to be discharged, but her symptoms have been ameliorated very considerably and she now works in the hospital and is more emotionally composed. As with the coma and shock methods, tlie treatment does not end with the operation and there has to be a re-education of the patient by the nurses. . , There are no agreed-on theories t.s to how coma or shock changes a patients mental condition, and the theory on which the surgical operation is based is rather beyond the comprehension c.f _ a layman. Fibres are severed and the influence of one part of the brain over tlie rest is reduced, balance being restored. It is called prefrontal lobotomy, and since 1936 has been performed hundreds of times. Mental disorders have been attacked from the physical side since the earliest days- of I lie human race, but never witli the siidfcess that is now bein’-' oblained. The new treatments show that an effective attack can be made on some of tlie more severe forms of mental disordor. nnd psychiatrists feel that, a movement has started which may go a long way.