SEVEN YEARS OF EXPERIENCE WITH MODIFIED INSULIN TREATMENT IN NEUROSES AND EARLY PSYCHOSES

This brief résumé ends with one warning. Weir Mitchell developed a very successful treatment of neurosis in the American Civil War after he had observed that "those who had fought gallantly with Sheridan and Grant" could become "as hysterically emotional as the veriest girl" under continued loss of weight and wounds. Patients were greatly helped by his régime of rest, moral talks, heavy massage to the point of sweating, and enormous food intake (the same sort of effects that we now get with modified insulin techniques—but more easily). He stressed that every part of the régime was dependent on other parts for its success. He laid down strict limitations of its use. It was so successful a treatment that for 25 years it enjoyed a world-wide vogue in peacetime practice—even greater than modified insulin today. But doctors gradually began to use isolated parts of the treatment for all types of psychiatric patients. They ceased to pick their cases carefully. Too much was expected of the treatment, and people saw inevitable relapses and failures. By 1925 the treatment was dead and buried, partly due to the increasing theoretical importance attached to the psychodynamic aspects of neurotic illnesses.

World War II showed us again the importance of attempting to treat, wherever possible, both the physiological and the psychological aspects of neurotic illnesses. A study of Weir Mitchell's indications for his treatment proved very similar to ours for modified insulin. But I fear that today history may repeat itself. Modified insulin has enormously increased in popularity because of some of its successes, and it is now too often used as a mere placebo for many unsuitable patients without reference to its precise indications and its many limitations seen in actual bedside practice. We shall have only ourselves to blame if it falls into total disrepute in a few years' time. Then in a third future war somebody else will have to rediscover Weir Mitchell's principles afresh, and try to emphasize again that good psychiatric treatment may often have to be multidimensional in approach, but must also be extremely selective in the methods and combinations of methods employed for different groups of patients.