This article emphasizes the psychotherapeutic aspect of insulin treatment, paying high tribute to Manfred Sakel who considered his method 'not only as a medicine but also as an instrument' the success of which depends 'on the skill of the guiding hand'. The author refers to various cases treated at Central Islip State Hospital which became accessible after lengthy explanatory and reassuring interviews despite their initial resistance. The insulin treatment itself, although very often not even carried to the point of coma,