Insulin shock therapy

Overview
Insulin shock therapy (IST, also called Insulin Coma Therapy) was used as a treatment for schizophrenia, psychosis and drug addiction, involving injecting the patient with massive amounts of insulin, which causes convulsions and coma. Typically, after being in the comatose state for about an hour, the procedure was terminated by administering a warm saline solution via a stomach tube or by the intravenous injection of glucose.

Insulin Shock Therapy is often viewed as a cruel practice with no reliable evidence of efficacy beyond a simple shock or placebo effect. IST had a higher apparent success rate in schizophrenics who were ill for less than two years, as this was also the time period when ‘spontaneous recovery’ was most common. Nowadays, psychiatric medications and variations in psychotherapy (e.g. cognitive behavioural therapy) or family therapy or supportive interventions are the main treatments used. Electro-convulsive therapy is still sometimes used, attracting controversy.

History
Insulin shock therapy was developed by Polish researcher Manfred Sakel in 1933 and was used well into the 1950s, being replaced by tranquilizing drugs and then later anti-psychotic drugs as well (which also have a sedative effect). This form of shock treatment, along with Electroconvulsive Therapy (ECT), derived from the notion (later disproved) that epileptic convulsions and schizophrenic symptoms were never present at the same time in one patient. Methods of administering the treatment varied and there was no precise way of doing it.

Complications
Epileptic seizures occur during the beginning stages of treatment, roughly 45–100 minutes into the procedure, but before the onset of the comatose state. Seizures occurring during the coma are more dangerous, requiring immediate interruption of the procedure and the ending of the comatose state, and may be followed by delayed recovery or severe shock.

Various complications would also occur from the comatose state reaching excessive depth, which also called for immediate termination of the procedure. Administrators would monitor the patient’s vital signs, among other things, to determine the level of danger.

Irreversible Coma
There was an obvious danger of unconsciousness persisting even after the administration of the proper amounts of saline solution and/or glucose. Severe cases resembled Anoxia (a condition where the entire body, or isolated areas, aren’t receiving enough oxygen), with the patient writhing about, hypertonia, and vascular shock. The milder cases involved delayed local recovery, such as the paralysis of certain limbs, aphasia, and confusion. Even some cases involved many days of unconsciousness afterwards, but death was usually avoided.

In fiction
Insulin shock has been described in various novels and movies with psychiatric context as an example of cruel treatment of patients. A well-known example is the novel One Flew Over the Cuckoo’s Nest and its screen adaptation. Frederick Exley describes receiving insulin shock therapy in 1958 at Harlem Valley State Hospital in his semi-autobiographical novel A Fan's Notes.