The era of 'heroic' medicine and the quest to cure the mind

Science · Published 19 October 2026 Swipe more like this →

In short: In the early 20th century, psychiatry faced a crisis of efficacy. To move beyond mere custodial care, doctors turned to 'heroic' physical therapies. Among the most extreme was insulin coma therapy, a grueling procedure that plunged patients into deliberate comas to treat schizophrenia, fueled by a desperate need for medical legitimacy.

During the early 1900s, 'heroic' treatments developed because clinicians suspected that brain-based physical causes underpinned mental disorders, following a time of static psychiatric practice. Following World War I, the need to treat 'war neuroses' spurred an interventionist shift. In 1927, Polish neurologist Manfred Sakel introduced insulin coma therapy in Vienna after observing a patient with improved mental clarity following an accidental coma. By 1936, Sakel moved to New York, where the practice rapidly spread; by the late 1940s, the majority of American psychiatric hospitals were utilizing the treatment.

The procedure was physically grueling and dangerous. Patients were injected with increasing doses of insulin—sometimes reaching 450 units—to induce comas that lasted up to an hour. These were often accompanied by violent seizures, where patients would toss, roll, and thrash. Doctors would then revive them with glucose solutions. The treatment was labor-intensive, requiring specialized units and constant supervision to prevent 'hypoglycemic aftershocks' or brain damage from prolonged comas. Despite these risks, including heart failure and death, the therapy was widely adopted because it allowed psychiatrists to feel like 'real doctors' rather than mere institutional attendants.

The decline of insulin coma therapy in the 1950s and 60s marked a pivotal shift toward evidence-based medicine. Randomized controlled trials, notably one comparing insulin to barbiturate-induced comas, found no significant difference in outcomes. While often dismissed today as 'furor therapeuticus'—a period of indiscriminate medical enthusiasm—the therapy remains a significant historical marker. It represents a time when the psychiatric profession struggled to establish its credibility as a medical specialty, often prioritizing high-intensity, visible interventions over proven results.

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