L’Institut universitaire en santé mentale de Québec – Medical Treatments

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Early in the 20th century, new treatments were discovered and applied. While some of them seem “barbaric” to us at first glance, they were considered revolutionary at the time. New medical treatments such as malaria therapy, insulin therapy, lobotomy and the sleep cure were added to the moral treatment already extensively used since the institution of asylums in Quebec, but did not replace it. With strong recommendations for their being used simultaneously, cures, or at least improvements in patients’ conditions, seemed to increase remarkably.Malaria therapy, (C1) discovered in 1917 by Julius Wagner Von Jauregg (1857‑1940) in Vienna, was developed and introduced in Quebec in about 1925 and used starting in 1927 as a treatment for syphilitic dementia (general paralysis) at the Hôpital Saint-Michel-Archange. This treatment consisted in inoculating a patient who had general paralysis with the malaria organism. The aim was to bring about enough hyperthermic crises (paludal fever) to cure the disease. Jauregg thought that, since the disease was caused by an outside agent (the syphilis microbe), increasing a patient’s temperature could kill this external agent and bring about a cure. Doctor Charles-Saluste Roy, (C2) superintendent of the Hôpital Saint-Michel-Archange from 1923 to 1946, said in 1929 that results to that point were unexpected but that the treatment was still a high-risk one.1 There were statistics to back up this statement: of ten patients treated with malaria therapy, one had full remission, two cases were unchanged, three improved, and four died. His success was thus limited, in spite of expectations. A completely outdated treatment today, it was replaced in the 1940s with penicillin, which proved to be more effective and reduced the risks related to the treatment.Insulin therapy (C3-C4) was discovered in 1933 by psychiatrist Manfred Sakel (1900-1957). In the beginning, as today, insulin was mainly used to treat diabetes, but it was soon realized that it had beneficial effects when used to treat schizophrenia in particular. Insulin therapy was also the first treatment to have a positive effect on this illness, and it was used starting in 1934.2 This treatment was introduced at Hôpital Saint-Michel-Archange around 1937, but it was definitely used most in the 1950s. Schizophrenics are the patients who respond best to this medical treatment, but not the only ones; cases of paranoia and depression were also treated. On the other hand, insulin therapy causes problems for women. According to Doctor Armand Thibault of Hôpital Saint-Michel-Archange, they were more difficult to treat with this medication because their reactions to the drug were more violent than with men. This problem was dealt with by treating women in separate rooms.3 This medical therapy was used until the 1970s at Saint-Michel-Archange, and was then completely replaced by antidepressants.Other forms of treatment were developed at the same time, including convulsion therapy, also called chemically induced convulsions, developed by Ladislas Von Meduna (1896-1964). Meduna first used injections of camphor dissolved in olive oil to bring about convulsions in catatonic patients. Shortly after, he gave up this treatment and used metrazol (Cardiozolâ). (C5-C5a) Introduced to Quebec in 1934, this medication, which proved to be more effective than camphor, was first used as a diagnostic test for epilepsy, since it caused a series of convulsive crises in patients, and epileptics react strongly to convulsions. It had an effect on behavioural and character problems and its effects on all various psychoses, including manic depression, anxiety and schizophrenia, were soon recognized. While it did not completely cure the illness, metrazol brought about such an improvement that following treatment it was possible to take the patient to a common room and to ask him or her to perform small tasks. In a paper on shock treatment published in 1943, Doctor Charles-Saluste Roy said that metrazol was on the way to becoming the most popular drug for treatment of all kinds of psychoses.4However, there were some problems with convulsion therapy using metrazol. Firstly, some patients could not be treated with this medication – people with heart conditions, febrile disorders, and people who had suffered serious head trauma and had memory loss.5 In addition, convulsions sometimes caused patients to suffer numerous fractures, which can also cause problems. Thus, a few years after the discovery of metrazol for convulsion therapy, it was replaced by electroshock therapy, developed by Ugo Cerletti (1877-1963) and Lucino Bini (1908- ).The principle of electroshock therapy is to bring about loss of consciousness, followed by convulsions, by passing an alternating current through the brain. The result was a spectacular decrease in the duration of mental illnesses, usually terrible for the patient, which previously lasted from six to nine months.6 In 1955, a study published on electroshock showed that the results of this medical treatment were at least as good as those for insulin therapy. But it could not replace metrazol as a diagnostic test for epilepsy, which is one of the negative aspects of this treatment. The other is the view of the anti-psychiatry movement of the 1970s, which spoke out against this method, saying that it was a barbaric procedure. This stand caused skepticism about electroshock therapy among the public. This treatment is still used today, but in less dangerous and more humane conditions. Curare is used to avoid convulsions and general anaesthesia prevents the patient from suffering. Moreover, the main indication for electroshock today is major depression that is resistant to other treatments and puts the patient in a life-threatening condition, so it is used as the treatment of last resort.Lobotomy, (C6) invented in Portugal in 1935 by Egas Moniz (1874-1955) and introduced to Quebec in about 1946, was considered revolutionary at the time. It involved severing the nerves that link the frontal lobe to the rest of the brain to cut off any interchange of signals. The first lobotomy carried out in Quebec was in 1946 at the Verdun hospital; it was later introduced at Saint-Michel-Archange. It was used to treat anxiety and pathological agitation, among other disorders. In spite of its spectacular successes, which astounded all the doctors, lobotomy had its drawbacks. In fact, it was very risky. Neurological science at the time was not well developed, and knowledge about the brain was minimal. There were sometimes incidents where the wrong nerves were mistakenly severed, causing the patient to fall into a vegetative state. Lobotomy could also have negative effects such as loss of affect and relapses.7 While patients appeared to improve, there were sometimes problems that did not show on the surface. While the tormented seemed to be soothed and the agitated appeared to be calm, they were sometimes left without moral judgment and social skills. The arrival of psychopharmacology (C7) in the 1950s meant the end of this practice, which did not reappear until a number of years later. In spite of everything, this medical treatment seems to have an appeal for the medical world, because it is still practised today in isolated cases. But lobotomy has had a name change, the word seeming to be too pejorative; the treatment is now stereotaxis. It is used these days on people suffering from chronic depression or serious compulsive disorders and has a response rate of 60% to 70% among patients who have undergone this surgery.8Finally, the sleep cure was also a medical treatment much used early in the second half of the 20th century. It consisted simply of systematically putting the patient to sleep for several days in bed in a room reserved for this purpose. This therapy was used to treat several types of illness – patients who were very depressed and both physically and mentally exhausted, patients with manic excitement or acute delirium, and those exhausted by overstress, sleeplessness and lack of nourishment.9When they appeared, people both admired and were repelled by the medical treatments mentioned above. While they were revolutionary at the time, when psychopharmacology arrived they were relegated to memory. (C8-C9-C10-C11-C12-C13-C17-C18)

1. Jules Lambert. Mille Fenêtres, op.cit., p. 60
2. Lambert Tremblay. Évolution des traitements en psychiatrie depuis la fondation de l’asile jusqu’à l’ère du Prozac dans la société moderne, p. 18.
3. Armand Thibault. Notes relatives à l’insulinothérapie, traitement en vigueur au cours des années 1950. Galerie historique Lucienne-Maheux, l’Institut universitaire en santé mentale de Québec, p. 1. 21 Lambert Tremblay. op. cit., p. 26.
4. Charles-Saluste Roy. La malaria thérapie et la thérapeutique par les chocs à l’Hôpital Saint-Michel-Archange. Auspices du Ministre de la Santé et du Bien-être Social, l’Honorable Henri Groulx, Québec, Galerie Lucienne-Maheux, l’Institut universitaire en santé mentale de Québec, 1943, p. 63.
5. Ibid.
6. Hubert A. Wallot. op. cit., p. 135.
7. Mario Girard. “L’émotion sectionnée”, in La Presse,January 9, 2005, p. 13.
8. Ibid.
9. Hubert A. Wallot. op.cit., p. 108.