Manfred J. Sakel (1900–1957)
What do the following notables have in common?: James Forrestal (first U.S. Secretary of Defense), John Nash (mathematician, Nobel Prize winner, A Beautiful Mind), Vaslav Nijinski (ballet dancer extraordinaire), Zelda Fitzgerald (novelist, wife of F. Scott). All received insulin shock therapy for treatment of their mental disorders.
To be both safe and effective for treatment of diabetes mellitus, the proper dose of insulin must be administered. If the dose is too low, elevated blood-sugar levels are not brought down, and the diabetic condition is not controlled. Too much insulin causes blood sugar levels to fall precipitously, causing coma and convulsions.
In 1927, the Polish neurophysiologist-neuropsychiatrist Manfred Sakel, working in Vienna, was using insulin to relieve the anxiety and agitation of patients undergoing narcotic withdrawal. When, on occasion, an inadvertently excessive insulin dose was given, the patients experienced coma and convulsions. Sakel reasoned that by blocking a weakened nerve cell by inducing a coma with insulin, the nerve would conserve energy and restore its normal function, thus enabling the schizophrenic patient to recover. It was later understood that the benefits of insulin shock therapy (also referred to as insulin coma therapy) resulted from the coma and not the “shock.”
Sakal’s report that up to 88 percent of his schizophrenic patients improved was particularly impressive, considering the other potentially dangerous treatment options available in the mid-1930s. These included electroconvulsive shock therapy, Metrazol-induced convulsions, and psychosurgery (usually a frontal lobotomy).
The worldwide psychiatric community enthusiastically embraced the “Sakel technique.” Typical courses of therapy in specialized facilities entailed up to sixty coma episodes. As with many drug discoveries, the initial excitement was tempered by later reports showing far less favorable results, a high incidence of remissions to the schizophrenic state, adverse effects, and even deaths in 1–10 percent of patients. The appearance of the antischizophrenic drugs Thorazine and Haldol in the 1950s contributed to the virtual demise of insulin coma therapy by the 1970s.
SEE ALSO Insulin (1921), Chlorpromazine (1952), Haldol (1958), Clozapine (1989).
Vaslav Nijinsky (1890–1950), photographed here during a 1912 performance of Scheherazade, was a Russian-born ballet dancer celebrated for his spectacular leaps and sensitive interpretations as a choreographer. When, at the age of twenty-nine, he was diagnosed with schizophrenia, his career essentially ended. He spent the rest of his life in psychiatric hospitals and asylums being treated with insulin shock therapy, among other antipsychotic modalities.