The nursing role in the use of insulin coma therapy for schizophrenia in Britain, 1936-1965

Aim. To explore the nursing role in the use of insulin coma therapy for schizophrenia in Britain, 1936-1965. Background. The only history of mental health nursing in Britain published to date gives a minor role to insulin coma therapy and emphasizes nursing opposition to it. Design. An historical study using documentary and oral history sources obtained in 2003-2008 and supplemented by material drawn from interviews in 2010. Method. Historical method was used involving the collection and analysis of primary documentary and oral history material, together with relevant secondary sources. Findings. A range of contemporary sources suggest that nurses in Britain were generally supportive of this treatment regime. The scope for using physical nursing skills was particularly attractive, while the emphasis on close interaction with patients also laid the foundation for later developments in social therapy. The debates surrounding its evidence base are also examined. Faced with a lack of rigorous research findings, clinicians preferred to rely on their clinical judgement. The issue of whether the treatment was abandoned as worthless or merely superseded by still more effective regimes is also explored. Conclusion. A nuanced account of the rise and fall of insulin coma therapy provides a lens through which to examine the development of mental health nursing and a case study of the challenges involved in implementing care based on the best evidence.