Shocks Recommended

The first accounts of insulin shock treatment for dementia praecox (type of insanity characterized by split personality, delusions, self-absorption, etc.) seemed to make the old miracle of casting out devils come true (TIME, Jan. 25, 1937).* Last week New York State's hard-headed Temporary Commission on State Hospital Problems, whose job it is to find ways of reducing the enormous state hospital population (73,000), ignored the miracle angle, produced the first report on what insulin can mean in days & months, dollars & cents. It recommended to Governor Dewey that, if only for economy's sake, insulin shock be henceforth made available to all New York State hospital dementia praecox patients.

They Pay. The study was based on 1,128 patients treated with insulin at Brooklyn State Hospital between January 1937 and July 1942, compared with 876 from other hospitals who got no shock treatment. Results: 1) of the insulin-treated, 79.5% were able to leave the hospital, 55% were useful members of the community at the end of the study; 2) of the untreated, 58.8% were able to leave the hospital, 40.5% were useful members of the community. Only four insulin patients died during treatment, and only one death was directly traced to the drug.

Average hospital stay of insulin patients was 3.8 months shorter than for the others.

Though the Brooklyn Hospital had facilities for treating only 60 patients at a time, the use of insulin saved the hospital 286,695 patient days, over $80,000 worth of food & clothing, and an undetermined amount in building maintenance and new construction. Possible future savings in money and heartache are enormous : though only one quarter of the mental cases admitted to New York State hospitals are dementia praecox cases, the disease bedevils its victims so long, sometimes ending in hopeless deterioration, that such cases comprise 50 to 60% of the hospitalized mental patients. There are some 250,000 in U.S. hospitals.

They Mystify. The Commission made no report on metrazol and electric shock treatment, because they are too new to permit thorough follow-up studies. Both have the advantage that they take less time per treatment than insulin shock (electric shock is the cheapest type) and do not require watching a patient's every breath for hours -- insulin shock patients may go into irreversible shock and fatal convulsions. Both metrazol and electric shock have the disadvantage that the "fits" they produce are violent and may cause a patient to hurt himself. As many as half the metrazol patients used to get small fractures of vertebrae and other bones, but lately some doctors have used curare (TIME, Feb. 21) to relax muscles so that violent spasms will not occur.

It is not yet certain whether insulin shock brings about more ultimate remissions of dementia praecox (psychiatrists never speak of cures) than would occur anyhow. All that is certain is that it cuts the average hospital stay. And no one yet knows just how any kind of shock therapy works: some think results come from temporarily depriving the brain of oxygen or of sugar, its only food; some suggest that individual attention and the short psychiatric session following each shock are really what do the trick. Otherwise, because of the psychiatrist shortage, a therapeutic psychiatric interview is a rare event in a state mental hospital.

* A patient is given increasing doses of insulin each day until a day arrives when he goes into a coma. On succeeding days, he gets the same dose or slightly less, with the object of keeping him under about three hours. He is brought out by a sugary drink or injection, after which he has a psychiatric interview and a big, late breakfast.

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