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Profile: Dr Bourne's identity –credit where credit's due

  • Jonathan Pimm (a1)
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Abstract

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

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1 Sargant, W, Slater, E. An Introduction to Physical Methods of Treatment in Psychiatry (3rd edn). Livingstone, 1954.
2 Bourne, H. The insulin myth. Lancet 1953; ii: 9648.
3 Jones, K. Insulin coma therapy in schizophrenia. J R Soc Med 2000; 93: 147–9.
4 Mayer-Gross, W, Roth, M, Slater, E. Clinical Psychiatry (1st edn). Cassell & Co, 1954.
5 Bourne, H. Insulin coma in decline. Am J Psychiatry 1958; 114: 1015–17.
6 Ackner, B, Harris, A, Oldham, AJ. Insulin treatment of schizophrenia, a controlled study. Lancet 1957; i: 607–11.
7 Baumann, P, Gaillard, JM. Insulin coma therapy: decrease of plasma tryptophan in man. J Neural Transm 1976; 39: 309–13.
8 Kalinowsky, LB. The discoveries of somatic treatments in psychiatry: facts and myths. Compr Psychiatry 1980; 21: 428–35.
9 Bourne, H. The saga of Freud's dinner jacket. Br J Psychother 2008; 24: 91–7.
10 Bourne, H. Rationing (letter). BMJ 1992; 304: 718.

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Profile: Dr Bourne's identity –credit where credit's due

  • Jonathan Pimm (a1)
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eLetters

Insulin coma therapy

Alan Gibson, Retired Consultant Psychiatrist, Bournemouth and East Dorset Hospitals.
24 April 2014

Anyone working in an insulin unit in the fifties would not recognize Dr Pimm's account of the results of their treatment (1), or detailsof what it involved. The patients received daily and increasing doses of insulin, rising to many hundreds of units, for a six week period. The depth of the resulting hypoglycaemic coma was determined by the patient demonstrating a Babinski response over a period of fifteen minutes. He was then revived by ingesting glucose.

I worked in the insulin unit at Newcastle General Hospital from 1956 to 1959, when I was senior registrar to Sir Martin Roth. Insulin treatmentwas reserved for people suffering their first attack of schizophrenia, andfrom memory I would say half made a complete remission, and another 25% improved. Nobody thought that we were effecting a cure, but remissions lasted about two years. One woman relapsed nine years after hertreatment. Of course there were dangers, but in those days the alternative was incarceration in a locked ward in a Victorian asylum, withlittle hope of rehabilitation or discharge.

Martin Roth was an intellectual giant, but also a man who was perspicacious and compassionate, and who would not have contemplated usingsuch a treatment if he did not think it effective. The depth of the coma seemed to me to be critical in terms of remission. A few patients did notregain consciousness when given glucose, but usually 'came out of it' after some hours, although there was the occasional death. Very occasionally a patient who was clearly psychotic who had an 'irreversible coma,' on recovery was greatly mentally improved. These days, people findthis difficult to believe, but I witnessed it on one occasion. I find it inconceivable that a multitude of psychiatrists, working in Europe and North America, over 25 years, would not have noticed that the treatment they were giving was having no effect, when it clearly was, if only for a limited period. The real question was not whether insulin worked but how did insulin work.

I have no wish to minimise the success of Dr Bourne's crusade, but what made insulin units redundant was the realisation that the new antipsychotic drugs actually worked, and at last, we had an effective, cheap, and long lasting method of managing a seemingly incurable disease. This was generally accepted by 1960.

References: 1. Pimm J. Dr Bourne's identity - credit where credit's due.Psychiatric Bulletin 2014; 38: 83-85.

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Conflict of interest: None declared

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