Shock therapy (psychiatry)

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In psychiatry, shock therapy is understood as a relatively unprepared and sudden physical treatment with unusually strong physical or chemical stimuli, which triggers a "shock" in the form of intense mental, vegetative, hormonal or humoral (or immune) reactions. The hormonal response is z. B. to look at the release of adrenaline as a reaction to sudden and overwhelming terrible experiences ( psychotraumas ).

Psychiatry history

Jean-Baptiste Denis (1643–1704) was the first to carry out a successful blood transfusion on June 15, 1667 in a feverish 15-year-old boy and first successfully injected large amounts of arterial lamb blood into the veins of the mentally ill. These initial successes were doubtfully due to a shock effect. In the history of psychiatry from the 18th to the middle of the 20th century, shock treatments were carried out as specific somatic treatment procedures with very different chemical or physical methods. They are therefore to be related to very different medical facts. In terms of medical history, they are ultimately accompanied by sterile disputes between psychics and somatics , because both sides defended claims to absoluteness in their own way . This led to an increasing use of coercive measures on both sides . A distinction must be made between the older shock treatments of the 18th century with immersion, fall baths, drugs and the newer ones in the 20th century with insulin , pentetrazole (cardiazole), electricity in the form of electroconvulsive therapy and, more rarely, with camphor and amphetamine . Higher doses of insulin induced hypoglycemic shock . The more recent methods have in common that they either deliberately provoke epileptic seizures or accept the dangers of such attacks. In addition to terms such as cardiazole shock therapy (1934), insulin shock therapy and electroshock therapy, names such as cardiazole cramp treatment, insulin cramp treatment and electroconvulsive treatment are also used. The shock therapy with cardiazol first described by Ladislas J. von Meduna (1896–1964) was first replaced by insulin shock treatment and then by electroconvulsive therapy. Even today in the era of psychotropic drugs, this is still regarded as an unavoidable form of treatment in some cases. Uwe Henrik Peters summarizes the shock treatments as "attack-like disturbance of the humoral and neuro-vegetative balance for the treatment of mental disorders". Also Otfried K. Linde describes the sudden and unexpected nature of such treatments on the example of the old Übergießungs- and camber bathrooms.

psychotherapy

As part of a psychotherapy , especially for behavioral methods which plays exposure therapy a significant role in the treatment of anxiety. However, in a professionally performed therapy, the patient is under no circumstances "shocked", i.e. confronted with objects of fear, surprisingly or without his consent. The term “shock therapy” is therefore incorrect for serious psychotherapeutic methods of confrontation.

Colloquial use of terms

Colloquially, a shock experience and its processing is also referred to as a massive confrontation with a rather fearful stimulus, which should prove to be beneficial, i.e. contribute to reducing fear. However, it must be assumed that the fear-inducing event itself is objectively harmless. However, whether the underlying subjective assumptions and fears are appropriate, exaggerated or even wrong is controversial and has to be assessed differently on a case-by-case basis. So feels like For example, touching a snake is often disgusting, but the associated risk has to be assessed differently from case to case. The definition of shock given by Karl Jaspers (1883–1969) as the suspension of function without destruction caused by injuries of all kinds or even violent stimuli on the nervous system is derived from this colloquial definition . Normally, the parts damaged by shock will return to normal function after a while. However, there are exceptions to this basic rule.

Mode of action

Klaus Dörner (* 1933) regards the healing effects of the shock effect as unknown. One speaks more out of embarrassment z. B. of "central vegetative change of mood". From him, however, the amateur conviction: "I want to shake Mr. X from the ground up, so that he can finally come back to himself!" Is not denied any justification. It corresponds to one of the oldest psychiatric experiences of all. Organic brain or other physical diseases could u. U. cause a weakening or interruption of psychotic modes of experience. According to Walter Ritter von Baeyer, they would remove the ground from them, such as the fear, the attention and the drive. Fear of life or physical fear can make psychotic fears superfluous. This effect is also called symptom change in psychiatry . Play psycho-economic moments (and the energy priority vegetative-physical processes involved layers doctrine , abaissement du niveau mental by Pierre Janet ). Aristotle already pointed to the healing moment of catharsis . Horror experiences call u. U. Primitive reactions and conversion reactions emerge.

Assessment of shock therapy

The French doctor Jean-Étienne Esquirol (1772-1840), director of the insane asylum in Charenton, gave instructions for the use of water in mental illnesses in his book "The mental illnesses in relation to medicine and state medicine" (1838). He proposed milder applications than his teacher Philippe Pinel (1745–1826). Pinel then distanced himself from these procedures he had used himself by saying that "one must blush before this medical madness, which is far more dangerous than the madness of the insane whose confused mind one wants to heal."

Individual evidence

  1. ↑ shock . In: Norbert Boss (Ed.): Roche Lexicon Medicine . 2nd Edition. Hoffmann-La Roche AG and Urban & Schwarzenberg, Munich 1987, ISBN 3-541-13191-8 , p. 1541, Gesundheit.de/roche
  2. ^ Thure von Uexküll : Basic questions of psychosomatic medicine. Rowohlt, Reinbek 1963, chap. V The wisdom of the body and its limits, pp. 166–169
  3. ↑ a b Erwin H. Ackerknecht : Brief history of psychiatry . 3. Edition. Enke, Stuttgart 1985, ISBN 3-432-80043-6 ; (a) Re. “Questionable shock effect”: page 33; (b) Re. “Early and later shock therapies”: pp. 38, 101–103
  4. ^ Rudolf Degkwitz et al. (Ed.): Mentally ill. Introduction to Psychiatry for Clinical Study . Urban & Schwarzenberg, Munich 1982, ISBN 3-541-09911-9 , p. 319
  5. ^ Klaus Dörner : Citizens and Irre. On the social history and sociology of science in psychiatry. [1969] Fischer Taschenbuch, Bücher des Wissens, Frankfurt / M 1975, ISBN 3-436-02101-6 , p. 287
  6. ↑ Shock treatment . In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . 3. Edition. Urban & Schwarzenberg, Munich 1984, p. 503 f. GoogleBooks 6th edition, Elsevier-Verlag, Munich 2007
  7. ^ A b Otfried K. Linde : Pharmacopsychiatry in the course of time. Experiences and results. Tilia, Klingenmünster 1988, p. 4 f.
  8. ↑ Karl Jaspers : General Psychopathology . 9th edition. Springer, Berlin 1973, ISBN 3-540-03340-8 , Part 1: The individual facts of the soul, Chapter 2: The objective achievements of the soul (achievement psychology ), b) The basic neurological scheme of the reflex arc and the basic psychological scheme of task and performance, p. 132.
  9. ↑ fright . In: Hans W Gruhle: Understanding Psychology. Experiential theory . 2nd Edition. Georg Thieme, Stuttgart 1956, pp. 56, 81, 515, 566.
  10. ↑ Klaus Dörner , Ursula Plog: To err is human or textbook of psychiatry / psychotherapy . 7th edition. Psychiatrie-Verlag, Rehburg-Loccum 1983, ISBN 3-88414-001-9 , p. 377 f.
  11. ^ Walter Ritter von Baeyer : The modern psychiatric shock treatment . Thieme, Stuttgart 1951, 160 pages
  12. ^ Theodor Spoerri : Compendium of Psychiatry . 5th edition. Academic Publishing Company, Frankfurt a. M. 1969, p. 142