Insulin coma therapy

Domain XVI · Historical, discredited & harmful · Manfred Sakel · 1933 · Vienna

What it is

Insulin coma therapy (also called insulin shock therapy) was a physical treatment for schizophrenia, and sometimes other psychoses. Patients were deliberately and repeatedly put into hypoglycaemic coma. The Austrian psychiatrist Manfred Sakel reported his results to the Medical Society of Vienna in…

Format

• Origin (late 1920s to 1933). Sakel first used insulin in morphine withdrawal and then in schizophrenia in Vienna. He claimed that 70% of his first series fully recovered and 88% improved well. Later commentators noted that his patients were recent-onset outpatients, "an earlier and more recoverable…
• Rapid spread (1934 to the 1940s). Government public-health bodies were promoting the treatment by 1939, and the press reported it favourably. By the late 1930s most psychiatric hospitals in England and the USA had dedicated insulin units. The Retreat in York began using it in October 1938. A…

Evidence status, as the guide reports it

• Challenge and decline (1953 to the mid-1960s). Bourne's 1953 critique, the 1957 randomised trial, and the arrival of chlorpromazine led to decline. Freudenthal and Moncrieff argue the treatment was "quietly forgotten" rather than formally rejected. Some textbooks still called it "a landmark in…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Defensiveness. Working well: changes in practice follow outcome data.
• Disengagement from needed care. Working well: the client attends and feels able to speak up.
• Exposure the client did not anticipate. Working well: the client feels the testimony is theirs.
• Fatigue and cognitive limits (4.5). Working well: the client describes themselves as more than a former patient.
• Covert self-harm, and online communities promoting such methods. Working well: the client engages with safe options.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.