1. Biomedical Approaches to Treatment

2. The Extraction of the Stone of Madness
Iron age skull
Bosch c. 1494
The Extraction of the Stone of Madness
Trepanning: drilling holes into the skull to relieve intracranial problems and mental disorders; evidence of this practice dates back to the Neolithic period (9500 BC).

3. Lobotomy Moniz (1935) Walter Freeman (1936)

4. Severing connection between frontal lobes and deeper underlying structures
Tens of thousands were given lobotomies up until70s for range of disorders: mood, anxiety, personality, psychoses etc.
Particularly used in schizophrenia for which there were no effective drug treatments at the time
Cheap, effective (brought about calm behaviour!)
Long term ineffective in treating precise symptoms
1976 review by National Commission in USA said it is effective in treating some conditions such as severe depression that is resistant to all other treatments
Today only used for severe depression and OCD

5. Insulin Coma therapy introduced 1930s, mainly for schizophrenia
used extensively through the 40s and 50s
coma induced by injecting large amounts of insulin
Seizures sometimes occurred before or during the coma
patients would toss and turn, moan, twitch and spasm
No detailed theory ever proposed regarding how this helped, though success rates of up to 80% were claimed
some claimed that the process “jolted” patients out of their mental illness!
minute clip of a man who was treated using this little understood procedure.
16 second clip of a person undergoing treatment

6. Electro-Convulsive Therapy
8 minute clip about a woman with severe depression and ECT.
Short 2-3 minute clip about ECT and depression
Less risky and more controlled than insulin coma therapy
originally pioneered by Cerletti and Bini (1938) as a treatment for schizophrenia.
now used as a last-resort for treatment resistant, severe depression/suicide risk;
Electrodes on temples shock the brain with approx. 100 volts (can be unilateral or bilateral).

7. ECT cont’d... Results in seizure.
Early days process was painful/distressing-nowadays anaesthetics and muscle relaxants are used to make the process more humane.
Patients remember nothing of the procedure
60-80% achieve relief from symptoms
side effect of severe memory loss (robs a person of their sense of self)

8. More on ECT 6 treatments in the space of 3-4 weeks.
Mortality rate= 3 in 10,000 (fairly acceptable given the risk of suicide without treatment?)
Discuss: If ECT can save lives of depressed patients should practitioners be allowed to administer the procedure without patient consent? 

9. How does it work? Nobody sure how it works
shocks destroy neuronal circuits linked to emotion
Shocks affect neurotransmitter levels in brain regions associated with emotion
treatment is negative reinforcement of recovery behaviour (avoidance of unpleasant stimulus (shocks) or punishment for depressive behaviour
memory loss aspect allows restructuring of thinking patterns.
Discuss: When doctors don't know how and why a treatment works, should they be allowed to use it?