New therapeutic compounds often changed the
wild, reckless, abusive, or confused behavior of patients to such an extent
that they could be given considerable liberty. Some psychotics, especially the
more recently admitted, improved so rapidly that they could leave the hospital
in a few weeks. It is now apparent that a brief course of treatment with
tranquilizers is seldom enough for permanent cure, but the medicines are of
tremendous value in making many psychotic patients, previously unreachable,
amenable to psychotherapy. And continued maintenance doses of them allow
thousands of patients to function in the community.
Similarly, severely depressed patients may be
treated with another type of compound-a central nervous system stimulating or
mood- elevating agent. There is a whole family of such agents which have helped
to cut short what could otherwise be long-drawn-out and even permanent
depressive states. As yet, exactly how the "mind medicines"
accomplish their work is not understood. It may be, as some physicians suggest,
that in effect they help much as do antibiotics. As we have seen earlier, when
the body is injured, it tends to heal itself, unless a wound or infection is
overwhelming.
An antibiotic helps not by curing the
disease but by changing the odds, helping to control the infectious organisms,
giving the body a chance to muster its defenses and then to heal. In mental
illness, the mind medicines probably produce no cures on their own, but by
reducing the intensity of fears, wild ideas, and hallucinations, they may give
the mind an opportunity to heal itself. That same type of effect may explain
the value of other methods of treatment. Shock treatment, for example, can be
considered to produce a temporary respite which may allow self-healing to take
place. Electric shock and insulin coma are the most frequently employed forms
of shock therapy. The patient is .rendered unconscious by a carefully
controlled electric shock or dose of insulin. Shock therapy, especially when
followed by psychotherapy, has been successful in severe depression,
particularly involutionmelancholia, and in schizophrenia.
Despite the ability
of mind medicines to make psychoses recede, they are of only limited value in
the treatment of neuroses. With the medicines, the neurotic patient remains
what he is but doesn't feel as bad -until the medicines wear off. Psychosurgery
may be employed, usually only in otherwise unyielding cases of mental illness.
Psychosurgery stems from observations that soldiers and others who had suffered
head injuries of a kind that severed the connection between the two parts of
the brain, without injuring either part, sometimes underwent marked improvement
in personality and experienced significant lessening of tension.
This is what the surgeon does-carefully
sever the connections between the two parts of the brain -when he performs an
operation called lobotomy. Social Treatment For social treatment, the patient
is placed in a sheltered environment, such as a mental hospital, where there is
a deliberate effort to provide him with many reassuring, and friendly, useful
experiences. He is drawn into games, work, and other daily activities. The idea
is that through many encouraging human contacts he can be rescued from his private
night- mare and brought back, bit by bit, to a real world, one that, in the
sheltered environment at least, is friendly, interesting, not as alarming as
the one from which he fled. Like medicines, social treatment gives him some
relief from the noxious thoughts that have ruled his life, helps him to rebuild
himself, and helps him to visualize himself again as a person relating to other
people.
