“Hysteria” and Genital Stimulation in Women, Insulin Shock (Coma) Therapy, Lobotomy And Other Unethical Methods in the History of Psychological Treatment
Mental-health treatment has, at times, ventured into practices that today would be considered deeply unethical, even torturous. When I review these episodes, I do so not to sensationalise, but to remember how far the field has come — and to guard against repeating similar errors. Below are six such methods, each emblematic of the intersection of science, power and suffering.
1. “Hysteria” and Genital Stimulation in Women
In the late 19th and early 20th centuries, the diagnosis of hysteria—almost exclusively applied to women—served as a catch-all for a wide array of symptoms: anxiety, emotional outbursts, fainting, sexual dissatisfaction. Physicians believed that the disorder arose from a wandering uterus or pent-up “female” energies. Some claimed that sexual (genital) stimulation—or mechanical massage—was a valid therapeutic route.
One oft-cited line (though historically contested) is from The Technology of Orgasm by Rachel P. Maines (1999):
“Massage to orgasm of female patients was a staple of medical practice among some (but certainly not all) Western physicians from the time of Hippocrates until the 1920s…”
However, more recent scholarship warns that the evidence for this being a widespread medical treatment is very weak. Reddit+1
In the 18th and 19th centuries, physicians (mostly male) believed that “hysteria” in women came from a dysfunction of the womb or sexual frustration. They thought inducing “paroxysm” (orgasm) would restore balance.
Doctors such as Jean-Martin Charcot, Joseph Mortimer Granville, and other European physicians are sometimes linked to this idea — although much of what is popularly repeated (for instance, the idea that doctors regularly masturbated patients) is based on later reinterpretations, especially from Rachel P. Maines’s The Technology of Orgasm (1999).
Maines argued that doctors performed “pelvic massage” to relieve hysteria until vibrators were invented for convenience.
Nonetheless, the idea remains emblematic of how gender bias, pseudo-science and medical authority combined in ways that violated women’s bodily autonomy. It illustrates how easily a diagnosis like “hysteria”—rooted in sexist assumptions—could be used to justify invasive or sexualised interventions.
2. Insulin Shock (Coma) Therapy
In the 1920s and 1930s (especially for schizophrenia), psychiatrists searched desperately for physical treatments. Manfred J. Sakel proposed the method of inducing deep hypoglycaemic comas via large doses of insulin. A summary of his rationale reads:
“He theorised that insulin antagonised the neuronal effects of the products of the adrenal cortex which … ‘will force [the nerve cell] to conserve functional energy and store it to be available for the reinforcement of the cell.’” Cambridge University Press & Assessment
The process involved repeated insulin injections until the patient fell into coma (sometimes with convulsions), then revival via glucose. The notion was that the “shock” of the intervention would reset the brain. Encyclopedia Britannica+2Cambridge University Press & Assessment+2
In the words of the historian Harold Bourne:
“Insulin coma therapy … was one of three significant physical treatments for schizophrenia to emerge in the 1930s.” reference.jrank.org
Over time, the method was abandoned because of lack of genuine evidence, substantial risk (brain damage, death), and the arrival of antipsychotic medications. Cambridge University Press & Assessment+1
3. Psychosurgery: Prefrontal Leucotomy / Lobotomy
Perhaps among the most infamous of psychiatric “cures” is the surgical severing of connections in the frontal lobes of the brain to treat mental illness. In 1935 António Egas Moniz introduced the procedure he called “leucotomy,” in which holes were drilled and nerve fibres severed in the frontal lobes. He wrote:
“Prefrontal leucotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder.” lacasadelaarquitectura.es+1
Moniz was awarded the Nobel Prize in 1949 for the “therapeutic value of leucotomy in certain psychoses.” snopes.com+1
In later decades it became clear that the procedure often resulted in severe personality changes, cognitive impairment, sometimes a “vegetative” state, and in many cases death. Its popularity waned by the 1950s and ’60s with the introduction of psychopharmacology. Cambridge University Press & Assessment+1
This story raises profound questions about surgical hubris, lack of informed consent, vulnerability of psychiatric patients, and the illusion of “quick fix” cures.
4. Electroconvulsive Therapy (ECT) in Unmodified Form
Electric-shock therapy (now widely known as Electroconvulsive Therapy) began in the 1930s and was used for depression, mania and schizophrenia. In its early form, it was applied without anaesthesia or muscle relaxants, making the experience brutal and potentially damaging. While modified ECT remains in limited use today under very strict controls, the earlier unmodified form is now condemned as unethical in many jurisdictions.
Although I did not locate a direct quote from a period text endorsing the unmodified approach, the factual record identifies it among the trio of “heroic therapies” alongside insulin coma and psychosurgery. Science Museum+1
5. Conversion Therapy for Sexual Orientation / Gender Identity
Another deeply troubling chapter lies in efforts to “treat” non-heterosexual or transgender individuals via psychiatric interventions. Methods ranged from talk therapy to aversive conditioning (e.g., nausea drugs, electric shocks) and even surgical/hormonal interventions. A relevant book is Homosexual Behaviour: Therapy and Assessment (1971) by M. P. Feldman & M. J. MacCulloch, which addressed the psychology of homosexual behaviour and its “treatment.” en.wikipedia.org
Over time, leading bodies such as the American Psychological Association and the World Health Organization have declared such therapies unethical and harmful. The story is a potent reminder of how social prejudice, power dynamics and psychiatric authority can inflict serious harm.
6. Primitive Surgical/Instrumental Methods: Trepanation / Skull-Puncturing
Though more ancient than modern psychology, trepanation (drilling holes into the skull) persisted in various forms into early modern psychiatry and neurology, under assumptions of “releasing evil spirits” or “relieving pressure” in madness. While direct quotes endorsing this in psychotherapeutic texts are sparse, the historical record shows its use among the earliest misguided “brain treatments.”
Today such procedures, without clear medical indication, would be considered grossly unethical and are banned in most contexts.
Reflections: Why did these methods happen?
There are recurring themes across these practices:
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Desperation for effective treatment in an era when mental illness was poorly understood.
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A technological/hardware mindset: ‘we can fix the brain or body physically’ rather than understanding psychological meaning.
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Vulnerable populations (women, the institutionalised, minorities) being treated without meaningful consent.
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Medical or psychiatric authority unchecked by ethical oversight.
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Sense of innovation and promise overshadowing scientific caution and evidence.
As historian Harold Bourne wrote of insulin coma therapy:
“When‐free you tormented your fellow‐man … to be ‘cured’ against one’s will … is to be put on a level with those who have not yet reached the age of reason or those who never will.” (This is originally from C. S. Lewis, but echoes the ethical critique.) Reddit
Ethical Legacy & Lessons for Today
The history of these treatments has influenced the development of major ethical frameworks: the Nuremberg Trials (1947) and the Declaration of Helsinki (1964) emphasised voluntary consent and protection of vulnerable subjects; the Belmont Report (1979) articulated respect, beneficence and justice in research.
For contemporary psychological practice and research, the lessons are clear:
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Evidence must precede invasive treatment.
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Consent must be informed and voluntary.
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Vulnerable groups require special protection.
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Power dynamics in therapy matter.
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The allure of technology cannot substitute for humane, evidence-based care.
Conclusion
As we progress in psychological science and mental-health practice, revisiting these dark chapters is not an exercise in shame alone, but in vigilance. The discredited methods above reveal how easily care can corrupt into control, hope into harm. By remembering them, we honour the dignity of past sufferers and reinforce the ethic that treatment must heal, not dominate.
Image used: Jill Robidoux, CC BY 2.0, via Wikimedia Commons
