The Influence of a Biological Therapy on Physicians' Narratives and Interrogations: The Case of General Paralysis of the Insane and Malaria Fever Therapy, 1910-1950

Over the last two decades, biological psychiatry—“biological” in terms of both models of causation and therapeutic practice—has gained increasing numbers of adherents from the psychiatric profession as well as from society at large. Representative of this movement, President Bush and the U.S. Congress in 1989 declared the 1990s to be the “Decade of the Brain.” Psychiatry’s current biological bent is not new. Throughout the 150 years that they have been an identifiable set of medical practitioners, psychiatrists have proposed biological models and treatments for psychiatric disorders. Most would argue that biological psychiatry has succeeded in recent years simply because biological treatments are efficacious. However, since the history of psychiatry is strewn with onetime successful somatic treatments that investigators later showed to be of dubious value, it would be reasonable to assume that biological remedies might have effects, quite distinct from their biological effects, that could account for their perceived efficacy. Indeed, these failed forays into somatic therapeutics can provide insight into the “nonbiological” effects of biological treatments. ¹

This essay examines the effect of a once wildly successful and subsequently abandoned biological therapy on physicians’ perceptions of disease, as well as on their relationships with their patients. In particular, I look at the treatment of general paralysis of the insane by malaria fever therapy, a remedy that psychiatrists throughout the world used extensively between the 1920s and 1940s. My central aim is to explore the ways in which this new technology transformed physicians’ narratives and interrogations of their neurosyphilitic patients. To this end, I have based much of this essay upon patient medical records from Patton State Hospital, in the foothills of southern California’s San Bernardino mountain range. ² These records provide a particularly rich source for studying medical practices; they contain, among other items, verbatim transcripts of patient interviews conducted upon admission, discharge, and the initiation of a new therapy, which furnish a vivid view of the way in which physicians saw patients and remedies. As the records illustrate, the introduction of malaria fever therapy led to a dramatic change in physicians’ descriptions and interrogations of patients, leading them to see their patients in a more positive light than they had before this remedy was available. This finding underscores the fact that therapies do more than simply address disease processes.

Three aspects of this episode in psychiatric history make it a fruitful area of study. First, unlike any previous or even subsequent psychiatric disorder, general paralysis of the insane conformed to the ideals of scientific medicine by having a known biological cause—namely, syphilis. Second, malaria fever therapy gave psychiatrists of the 1920s their first widely successful and scientifically acknowledged somatic treatment. Third, since psychiatrists had largely abandoned malaria by the 1950s and general paralysis is now a rarity, we have the anthropologic distance that helps us to avoid inserting our own perceptions of the disease and its treatment.

Paresis: Its Nature and Cause

General paralysis of the insane, or more simply paresis, is a tertiary form of syphilis that appears ten to twenty years after initial infection. The disorder has both neurologic and psychiatric manifestations; before the advent of penicillin, it led to psychosis and an agonizing death. Although it was unrecognized as a distinct illness before the nineteenth century, patients with symptoms similar to those of general paresis were described by Thomas Willis in the late seventeenth century and by John Haslam in the late eighteenth century. However, Anton Bayle has consistently been credited as the “discoverer” of the disease because of his observation in 1822 that the particular constellation of psychic, physical, and neuropathological features constituted a single disease entity. ³

While they described a disease with protean and unpredictable manifestations, nineteenth-century physicians believed that paresis often led from a subtle “perversion” of the patient’s disposition to a manic-like insanity marked by extravagant “delusions”; ⁴ the final psychological manifestation was dementia with “rapid and complete mental decay.” ⁵ Simultaneously, subtle...