I did an episode last year around Halloween time about spooky social psychology experiments and what they say about humanity. I figured I’d keep the trend going and do an episode all about creepy treatments from the origin of psychological health care. Before listening any further, just know that some of these are cruel and gross. We’ve come a long way since the different treatments that I will talk about, but they are important in that they are the predecessors to the treatments that we have now. In some cases they were mean and cruel. In others they were well intentioned, but limited by the lack of knowledge that we have today. Either way, if you are sensitive to topics like this, feel free to skip this one.
Just like any medical field, the origins of psychology have had some missteps along the way. This is partially why psychology and mental health treatment has gotten a bad rap in movies and popular culture. Until relatively recently, it was still common to see psychological treatment depicted in the typical spooky asylum type setting. It’s for good reason. There really were some types of treatment that were horribly misguided or just plain cruel. In the last year’s social psychology episode, we talked about how it’s so easy for something terrible to go on for a long time without anyone stepping in to do anything about it. That is certainly the case here and it’s due to a number of individuals speaking up and taking a stand against inhumane treatment that we have been able to progress beyond the types of treatments that I’ll describe here.
So you know how when you go to the dentist and they have to drill into your teeth to fill a cavity? There terrible sound and sensation? Well imagine that on your skull. That’s trepanation. It is basically when you drill a small hole into the skull until you expose the outer covering of the brain called the Dura Mater. Typically you are not going through that and actually messing with the brain itself. It’s believed that in ancient times, trepanning was used because they assumed that evil spirits were inhabiting the person who was behaving abnormally. There is actually fossil evidence of trepanning all the way back to the Neolithic period. Cave paintings and such indicate that they used the technique to try to treat things like seizures or mental disorders. Apparently the bone from the hole was also kept and scholars believe it was used as a sort of charm to ward away evil spirits.
In some cases, trepanning actually served as a legitimate medical treatment. Back in those days, it was common to have blows to the head by blunt objects such as clubs or rocks, which left nasty dents and shards of bone. There is some evidence to suggest that trepanning was used to clear out the shards and get rid of the excess blood that sometimes pools in the space between the skull and brain. Interestingly, this version of the technique is still used today. When someone has a head injury that causes a subdural or epidural hematoma, which is when blood pools outside the brain, something often needs to be done to relieve the pressure on the brain caused by the excess blood. If not, you can have serious permanent damage. In modern times we typically aren’t just drilling a hole straight in, but rather taking out a portion of bone to be replaced later, which is called a craniotomy. Another modern use of trepanning is to clear access to the brain for other procedures.
In general, trepanning is not used to treat mental disorders unless the brain is actually being operated on in some way and it’s clearing the way for that. It is mainly used to prevent damage from bleeding like we had talked about. In that way, the misguided attempts to release bad spirits and such actually lead the way to an absolutely vital medical technique that we still use today. I should also mention that there are some people who claim that trepanning is still has some other valid uses. Let me be clear that these are not substantiated by research, but there are people out there drilling holes in their head to achieve higher levels of consciousness, increase blood flow to the brain, and for other pseudosciencey reasons. As I said, there is not research to support these applications, but who knows. Maybe our current understanding will be totally different in a few hundred years.
Next one you are probably a bit familiar with already. Let’s talk about lobotomies. Lobotomy is when you severe the nerves in the brain that connect the prefrontal cortex from the rest of the brain. In early times, the procedure was sometimes less specific and there were various types of brain surgery that involved removing parts of the cortex. Lobotomies represent a shift in view from mental illness being something that is more spiritual in nature to the understanding that there may be some organic, or physical, basis to what is going on.
Why would you want to lobotomize someone? Well the it’s not actually that wild of an idea. The frontal lobe of the brain is thought to be involved in many psychological disorders. OCD and Schizophrenia are two in particular that involve the functioning of the frontal lobe. This part of the brain plays a huge role in our personality and behavior. When someone has damage to the frontal lobe due to a brain injury or degenerative disease, they often have radical changes. Someone might shift in their personality or have trouble controlling their behavior. It can even cause symptoms of psychosis or compulsiveness. So it makes a sort of logical sense why disconnecting or destroying this part of the brain might help for things like severe OCD, psychosis, or treatment resistant depression. And the interesting thing is it worked! Kind of… sometimes.
Some estimates indicate that up to 2/3 of people saw improvement in symptoms. The thing is, there were also some pretty horrific side effects. There have been quite a few high profile individuals including Rosemary Kennedy, who was JFK’s sister, who suffered severe side effects from lobotomy, which incapacitated them for the rest of their life. Lobotomies can have pretty intense side effects such as seizures, lethargy, changes in personality, and incontinence. In many cases the person will not only lose their symptoms, but lose their personality entirely and become vacant and docile. This is the source of some criticism that lobotomies were used more as a control measure than as a real treatment. Early on, the method for achieving lobotomy was to go through the skull using a burr hole, just like in trepanning. Later, they realized that you can go through the orbit of the eye, which is gnarly, but actually a more accurate and less invasive procedure. The more primitive the technique, the more likely the side effects, so in addition the the side effects we talked about, early on you also frequently had infections and other physical ailments that would ruin the person’s life.
Now, much like the trepanning, lobotomies paved the way for modern medical practices that are still used today. In some rare cases, lobotomy will still be performed on people who have extreme OCD and cannot live life despite other attempts at treatment. There may be other uses that we circle back around to again as technology allows us to be more precise. The major way that lobotomies have contributed to modern medical treatment is that they paved the way for deep brain stimulation. Deep brain stimulation is a method in which holes are drilled in the brain and electrodes are implanted. They are then given an electrical current in a controlled fashion, which provides a variety of benefits. The main population that uses deep brain stimulators are people with movement disorders, such as Parkinson’s disease. We don’t know exactly why it works, but it does for many people. It’s also FDA approved for treatment of severe OCD and studies are being done for people with mood disorders like depression.
Insulin is a hormone that is mainly used in the treatment of diabetes to lower blood sugar. In the 1920s, low dose insulin had been used to treat people with drug addiction or various personality issues and a doctor noticed that one of his patients accidentally slipped into a coma with the use of insulin and subsequently had a huge improvement in his psychiatric symptoms, so it was reasoned that other people may have a similar benefit. The technique was super shady because there were not standards of practice. It was very labor intensive and required specific hospital units for it. Basically they would administer repeated doses of insulin to the patient, increasing in strength until eventually they fell into a coma. They would then cut off the coma after about an hour by administering glucose (or other methods). The course could take a very long time and an entire treatment might consist of over 50 comas. Seizures would sometimes occur during or after the coma.
It’s really unclear as to how effective the treatment was. It’s no longer used today, but actually got really popular in the 30s and 40s for treatment of schizophrenia and other significant psychiatric issues, with entire wings of hospitals devoted to it. Back when it was popular, there were some insane estimates like 80% of patients seeing remission of their symptoms, but looking back a lot of researchers think that the results are inflated and coincidental. There does seem to be some sort of significant effect when the brain is “reset” in some way be that by seizure, coma, psychedelic drugs, electrical shock etc. I can’t fault anyone who used this treatment because for many treatments that do work well, we still can’t exactly explain why. As far as we have come, the field of mental health is still pretty mysterious.
Insulin shock fell out of use because of the crazy side effects. Obviously, messing with people’s blood sugar repeatedly like that isn’t going to be easy on the body. Most people had severe hypoglycemia (low blood glucose), which caused them to be restless, sweaty, and also often lead to obesity. In some cases, more severe effects like irreversible coma or death happened. Despite the intensive nature of the treatment and the scary side effects, it remained popular until about the 1970s in the USA.
The last one that I want to talk about is a modern example. The reason I want to talk about this is to show the cyclical nature of medical and mental health treatment, and to highlight how far we still have to come. Conversion therapy is the practice of trying to change an individual’s sexual orientation from being homosexual or bisexual into heterosexual by using psychological techniques. There is virtually no reliable scientific evidence that sexual orientation that can be changed and throughout the years, many harmful practices have been used in attempts to do so. Conversion therapy operates under the assumption that sexual orientations other than being heterosexual are representative of a mental disorder. Obviously some of the biggest advocates of conversion therapy are fundamentalist religious organizations that believe homosexuality is a disease.
There have been many different horrific tools used to try to convert someone’s sexual orientation including lobotomies, chemical castration, and aversive treatments in which negative stimuli such as electrical shock or nausea-inducing drugs paired with erotic homosexual stimuli. Very much like what you see the movie A Clockwork Orange. These aversive techniques are not supposed to be used anymore, but you still hear reports of it well into the 1990s. Currently, the techniques are made to look like more typical psychotherapy techniques and involve group therapy, visualization, social skills training, and spiritual interventions.
This is another topic that gives psychology a bad image for good reason. Many old psychoanalysts such as Sigmund and his Daughter Anna Freud, claimed that they could treat homosexuality. There were even surgical approaches used such as transplanting testicles from heterosexual men into homosexual men. Time and time again throughout the years, it has been shown in the research that conversion therapies are not effective and that homosexuality does not constitute a mental disorder.
Despite this, it’s a practice that has continued into modern times. Even within the past year there have been political battles around the banning of conversion therapy, specifically with children. The reason that I’m including it in this episode is that even though in most cases the extreme medical interventions are no longer used, going through conversion therapy attempts can have some serious negative effects. What does it say about someone when they are told that a fundamental part of themselves is morally wrong and despite their best attempts, they can’t seem to do anything about it? This can lead to depression, anxiety, and even suicide.
The majority of mental and medical health organizations, including the American Psychiatric Association have come out saying that conversion therapy is inappropriate and in many cases dangerous. There is of course some debate about self-determination and an individual’s right to change what they want to change about themselves, but it should not be the goal of the mental health provider to change the person’s sexual orientation and aversive techniques should not be used.
All of these psychological treatments are interesting in their own way. They are part of our history. As with any field, the field of mental health has many blunders and terrible injustices that have paved the way for more accurate and appropriate treatments. Although we have come a long way, I feel that the field of mental health is still in its infancy and in the future, we will look back on some of our current practices as barbaric and nonsensical. I personally am encouraged by the trends. I wish that things like overuse of lobotomy and conversion therapy did not happen, but seeing the world move from isolation, torture, and killing of people with mental health issues, to attempts to treat and attempts to understand that diversity in mental health exist, is encouraging. We still have some ways to go, but it’s important to keep in mind that the speed of change has been massively accelerated by the advent of the internet and social media.
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