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02_04PT_p79-102.qxd 1/15/04 11:42 AM Page 93 CONVULSIVE THERAPY
that it, rather than medication, should be the treatment of choice in major depres-sion. The real question today is: Why isit not? Why does the idea of applying The History of ECT:Some Unsolved Mysteries
ECT still cause a chill among manypsychiatrists and patients, who consider illnesses as well. It was in this context erable efficacy in the treatment of major Cardiazol in Europe and Metrazol in theUnited States. Psychiatrist Ladislas von Meduna, M.D., hypothesizing an antag-onism between epilepsy and schizo-phrenia, reasoned that chemicallyinducing convulsions might somehowmeliorate the psychotic symptoms ofschizophrenia. He first tried camphor,then pentylenetetrazol, which was moresoluble and acted faster (Fink, 1985). Infact, he achieved considerable results,and treatment units sprang up before PROOFING
World War II at a number of centers inEurope. In the United States, suchdisparate institutions as the Georgia stateasylum at Milledgeville and theSheppard-Pratt private clinic inBaltimore installed Metrazol units.
PURPOSES
ECT, initiated in 1938. In one of the fewItalian contributions to modern psychi- Y atry,psychiatry professor Ugo Cerletti,
M.D., inspired by the successful treat-ment of a rapidly accumulating list of ONL physical disorders (including fever,deep
sleep and insulin coma) resolved toinduce convulsions by applying elec-tricity directly to the brain. Like Meduna, ISLAND 4/C
he and his assistant Lucio Bini selectedpatients with schizophrenia for theirtrials and enjoyed a record of success(Cerletti, 1950). Their publicationscreated a major stir in psychiatry, andin May of 1940, Cincinnati psychiatristDouglas Goldman, M.D., demonstratedECT at the annual meeting of theAmerican Psychiatric Association(Shorter, 1997). quickly in popularity, and handbookswere not long in appearing. In 1941,Lucie Jessner, M.D., at MassachusettsGeneral Hospital and V. Gerard Ryan,M.D., at Harvard University publishedShock Treatment in Psychiatry: AManual, the introduction written byHarry Solomon, M.D., chief of researchat the then Boston Psychopathic Hospital(later Massachusetts Mental HealthCenter). In 1944,William Sargant, M.D.,and Eliot Slater, M.D., at The MaudsleyHospital in London, themselves notedfigures in English psychiatry, broughtout An Introduction to Physical Methodsof Treatment in Psychiatry. In 1946,Lothar Kalinowsky, who was instru-mental in bringing ECT to the United (Please see History of ECT, page 95) 02_04PT_p79-102.qxd 1/15/04 11:42 AM Page 95 History of ECT
antipsychiatry novel One Flew Over the Cuckoo’s Nest, published in 1962. There influential book Shock Treatment and is no doubt that the generation of flower Other Somatic Procedures in Psychiatry. executives and scientists often had a kind tial work Asylums, published in 1961, endorsement of the practice, but it at least bore a scanting reference to “shock treat- was also the first in the history of psychi- literature was written largely for intel- accepted as a matter of course in U.S.
patients.) After long years of silence, the discipline’s professional association had now uttered a rather feeble imprimatur.
of the discipline’s great success stories.
The technique became steadily modi-fied. In 1940, curare was introduced tomoderate the vertebrae-cracking force does not explain the bizarre initial vanish- if one fell into the clutches of psychia- try. The movie was United Artists’biggest PURPOSES
the ECT unit at Hillside Hospital in Glen early 1950s, plenty of analysts were ready Practice, which marshaled data show- talized for depression stood an excellent ing in a 1974 la Y
better chance of benefiting from it.
California. In retrospect, it is actually What seems to have ONL
published in JAMA in October 1985, (Please see History of ECT, page 96) REMUDA RANCH
PSYCHLINK 2
02_04PT_p79-102.qxd 1/15/04 11:42 AM Page 96 ment’s progress for a bit. Yet, to put the ECT, just as many still fear vaccination.
of Toronto. He has written numerous books on History of ECT
medical history, including A History of Psychiatry: From the Era of the Asylum to the noted, “Not a single controlled study has Age of Prozac (John Wiley & Sons, 1997). Christian Science, then experienced diffi- References
culty struggling back from the precipice, Abrams R, Taylor MA (1976), Diencephalic stimula- tion and the effects of ECT in endogenous depres- sion. Br J Psychiatry 129(5):482-485.
APA (1978), Electroconvulsive Therapy. Washington, D.C.: American Psychiatric Publishing Inc.
itself as having rejoined scientific medi- Cerletti U (1950), Old and new information about elec- and reliability is within reach for them.
troshock. Am J Psychiatry 107:87-94.
remains infused with the kinds of cultural It is madness not to use the full resources Fink M (1985), Historical Article: Autobiography of L.J. Meduna. Convulsive Ther 1(1):43-57.
represented a definitive turn in the revival Healy D (1998), The Psychopharmacologists II.
ties are able to insulate with the firewall London: Lippincott Williams & Wilkins Publishers.
Shorter E (1997), A History of Psychiatry: From the Dr. Shorter is professor of the history of medi- Era of the Asylum to the Age of Prozac. New York: ity is that the culture we inhabit still fears cine in the faculty of medicine at the University wrote the first ECT textbook for thegeneration that had sat on the sidelines.
In 1988, Richard Abrams, M.D.,published Electroconvulsive Therapy, awork that entered its 4th edition in 2002.
In 1994, the APA offered Laurence B.
Guttmacher, M.D.’s, Concise Guide toPsychopharmacology and Electro-convulsive Therapy.
able to run a front-page article on thetreatment of depression without a singlemention of ECT? Indeed, commenting of general hospital inpatients with majordepression receive ECT, an editorial byHarvard’s Carl Salzman, M.D., in theJanuary 1998 issue of the AmericanJournal of Psychiatry expressed bewil-derment that it was not more widelyadopted. changed from being a first-line treat-PURPOSES
ADDERALL XR
1950s to merely an approach to treat-ment-resistant depression in the 1990s.
ISLAND 4/C
depression” as a euphemism: It shouldbe called, in his words, “inadequately treated” depression.) An article in theMay 22, 2001, issue of The MedicalPost noted that the competence of youngpsychiatrists in ECT was falling. Thelikely reason: Few of their teachers,trained in the fallow period of 1960 to1980, felt comfortable with it.
resolution of industry not to include ECTin drug trials, satellite symposia andindustry-sponsored meetings. The logicseems clear to me: ECT would showsuperior efficacy to whatever they haveto offer, and they prefer to keep it out ofscientific discussion. I once, rather puck-ishly, asked a drug company to supporta conference on ECT and received ascrawled handwritten reply from thehead of psychopharmacology sayingbasically, “Are you kidding?” Requestsfrom senior psychiatrists to includepapers on ECT at industry-financedmeetings are routinely refused.
medical history of an important treat-ment suddenly disappearing for culturalreasons? Possibly the vaccination riotsof the 19th century held back that treat-

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