Am J Psychiatry 1995; 152:660-665
Copyright © 1995 by American Psychiatric Association
Effect of therapeutic innovation on perception of disease and the doctor-patient relationship: a history of general paralysis of the insane and malaria fever therapy, 1910-1950
JT Braslow
VA Robert Wood Johnson Clinical Scholars Program, Sepulveda, CA 91343, USA.
OBJECTIVE: The purpose of this study was to examine the effect of
therapeutic innovation on the interpersonal style of physicians by using
the historical example of the treatment of general paralysis of the insane
by malaria fever therapy. METHOD: The study employed historical qualitative
and descriptive methods to analyze medical and popular literature and
medical records. These medical records were from a single institution and
contained verbatim transcripts of patient interviews and doctors'
conferences. The author examined records of patients diagnosed with
neurosyphilis from the periods before (1910- 1928) and after (1928-1950)
the introduction of malaria fever therapy. RESULTS: Before the introduction
of malaria fever therapy, physicians saw their neurosyphilitic patients as
"hopeless," "immoral," and "stupid" paretics--objects to be acted upon, a
view consistent with the cultural belief that syphilitic patients were
sinful and depraved. After the introduction of malaria fever therapy,
doctors wrote more positively and empathically about their neurosyphilitic
patients, allowing patients to become active participants in their
therapeutic regimens. Patients with neurosyphilis voluntarily sought
admission specifically for fever therapy, seeing the asylum as a place of
cure rather than as an institution of confinement. CONCLUSIONS: This
history illustrates that biological therapies can powerfully affect
physicians' perceptions of patients and need not remove them from patients'
subjective experiences. Instead, biological treatments may enhance
physicians' ability to empathize with their patients' suffering.
