"In the eyes of many of the psychiatrists, the new methods of treatment failed to live up to initial proclamations of a major breakthrough. Several identified problems with the experiments, e.g. uncertain diagnoses and spontaneous remission, which might potentially skew the results. The question of a control group with the same diagnosis was also raised. During his experiments with manganese in 1927, Reiter had in fact used such a group—“control material of 50 patients whose conditions were similar to the ones treated with metal salt, and who – without treatment of any sort – were followed for a similar period.” However, this approach did not carry over to subsequent experiments, and neither Helweg, Ravn nor Schroeder used control groups in their studies.
The spate of sensational announcements of imminent revolutions in psychiatric therapy began to peter out in the mid-1930s, and predictions of breakthroughs became more guarded. In July 1936, August Wimmer, professor of psychiatry at Rigshospitalet in Copenhagen, published his major textbook Speciel klinisk Psykiatri (“Special Clinical Psychiatry”). In it, he stated that while there had been no shortage of experiments with the treatment of schizophrenia, none of the proposed methods had been convincing. There had “over time” been experiments with many different fever treatments, including “in recent years malaria fever therapy and sulfosin therapy (Schroeder),” but “the results are questionable, including with regard to schizophrenics’ susceptibility to spontaneous remissions […] Nor does metal-salt treatment (Reiter) seem to have triumphed.” Wimmer went on to conclude that “a causal treatment for schizophrenia has not yet been found.”
In the late 1930s, Hjalmar Helweg was similarly lacking in optimism about the methods that he had tested at Vordingborg. In September 1937, after 19 years as chief physician at the hospital, Helweg was appointed to succeed Wimmer in the prestigious position of professor and chief psychiatrist at Rigshospitalet. Just before he left Vordingborg, he was interviewed by the newspaper Berlingske Tidende, who wanted to paint a portrait of the new face of Danish psychiatry and hear his thoughts on the latest advances in “the fight against mental illness.”
“We psychiatrists […] have never been spoiled by luck or stunning victories, and now that I am asked directly, I must admit that no breakthrough has been made in the treatment of mental illness in my time. There have been no breakthroughs, no progress on a scale equivalent to the discovery of insulin […] and its application in the treatment of diabetes. Therefore, it is today equally miserable for a human being to be mentally ill as it was 30 years ago.” Nor did he hold out high hopes for the near future. “The truth is that, as things stand now, we might as well try tap water and beer rather than some chemical preparation,” Helweg concluded.
Several psychiatrists also expressed concern about the direction in which the discipline was heading. Like Helweg, some thought that psychiatry was the poor relation compared to other specialisations and unable to point at the same kind of progress as other forms of medicine. Nor was psychiatry at the front of the queue when it came to medical training. It was not even an exam subject at the University of Copenhagen. Medical students only had 36 hours of teaching and a month of fieldwork in psychiatry. The situation was far from satisfactory. Many psychiatrists thought the discipline deserved better, but changes in the curriculum were still a long way off.
Nor did psychiatry enjoy the best of reputations among the general public. Doctors at the hospitals often encountered “wrong-headed notions” about psychiatry and “a fairly widespread reluctance” among families to allow their relatives to be treated in mental hospitals. In 1934, Carl Clemmensen, chief physician at Bispebjerg Hospital’s Psychiatric Department, conducted a small study aimed at gauging relatives’ animosity towards mental hospitals. He asked 100 relatives what they felt about a family member being admitted to St. Hans and found that 55% were critical and had raised objections
- Jesper Vaczy Kragh, Lobotomy Nation: The History of Psychosurgery and Psychiatry in Denmark (Springer: 2021) p. 60-61.