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Online Forum

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I am so anxious to understand the link between mental illness and insulin. As a diabetic, I have experienced many insulin shocks, and in the movie, it is gruesome to watch. I can understand some of the thought behind the treatment, when I have insulin shock, I feel an emotional collapse, afterward. Sort of like going to the foundation of one's soul. How, was this treatment justified, and what, if any, realistic outcomes were experienced?

Rick Phillips
Noblesville, Indiana

Answered by John Hsiao, M.D.:
Shortly after insulin was introduced in the 1920s, Manfred Sakel, an Austrian psychiatrist, attempted to use insulin to manage morphine withdrawal. He noted that it was possible to "safely" induce hypoglycemia, and decided to try insulin therapy in patients with schizophrenia. Many patients with schizophrenia appeared to improve dramatically after a course of insulin coma therapy and the practice spread widely and quickly to other hospitals around the world. It continued to be widely used until displaced by the introduction of chlorpromazine (the first antipsychotic drug) in the 1950s. There was never any a priori justification for trying insulin coma therapy in schizophrenia, aside from the fact that nothing else worked. The treatments were associated with considerable morbidity and mortality. The long term benefits and safety of insulin coma therapy are unknown.

John Hsiao, M.D.

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