Physical Methods of Treatment in Psychiatry
Authors: W. Sargant, E. Slater
Journal: BMJ (1951)

No general practitioner can afford to regard psychiatry as a remote specialty of which he need know nothing. Psychiatric illness is far too common for that. It has been estimated that nearly half of the hospital beds in the country are occupied by psychiatric patients ; and about one-third of all the patients going to their doctors for help have symptoms which are caused or compli cated by psychological factors. Even if these patients are referred to hospitals or clinics they are likely to be handed back to their own doctors again. The family doctor is likely to be the last as well as the first court of appeal, especially when the patient has been seen by specialists of rival schools who have tendered mutually conflicting advice. The bewildered patient will then go to his own doctor, who, he trusts, will decide these com plicated questions for him on a basis of common sense. Furthermore, psychiatry depends on the general body of medical knowledge and opinion for guidance in making its advances. The family doctor knows which of his patients have benefited from one or another method of treatment. If in fact some theory of psychi atry proves of little practical use, its adherents, how ever fanatical their faith, will eventually be brought into touch with reality by a dwindling clientele. In the conference rooms of learned societies abstruse theories will continue to be debated in magniloquent terms. The wise practitioner will eschew theory but pay the closest attention to clinical facts, and judge from them alone. In this article methods of treatment are discussed which have no adequate theoretical basis. Their dis coverers were often led by theoretical notions which now no longer gain much credence. The reason why these methods are still used is because they are actually found to work. The lack of theoretical foundation cannot be claimed as a merit. But it mus? be remem bered that many of the most effective methods of treat ment in general medicine were discovered in the same accidental way?the use of liver extract to treat perni cious anaemia, for example. Much of our medical knowledge has been gained the wrong way round, and a discovery in therapy has compelled reconsideration of pathogenesis. Psychiatry to-day is in a stage of develop ment in many ways equivalent to that of general medi cine a hundred years ago, and we can expect advances to occur in the same way. The three methods of treatment discussed in this article have altered the face of clinical psychiatry. Before their advent the hospital psychiatrist had to watch the progress of his patients uphill or down almost with folded hands. Only in the case of the general paretic was he able to take active remedial measures. Since the discovery of insulin coma treatment, electric convulsion therapy, and leucotomy the outlook for the great bulk of his patients has been altered immeasur ably. This change has not occurred without putting new responsibilities on the general practitioner. It is now his duty to see that no one of his patients slips into a state of dangerous depression or mental alienation without being put in touch with the sources of aid. The several indi cations of these treatments are of immediate interest to all doctors who are directly in touch with and are directly consulted by the general public.