A Shocking Discovery (Part Two)

Continued from Part 1.

If Italy's fascist government played a role in the invention of electroshock therapy (also called electroconvulsive therapy or ECT for short), it may very well have been the Nazis who played a greater role in its spread around the world. Three clinicians who had trained under Ugo Cerletti left Europe to escape Nazi persecution and brought ECT with them.

Lothar Kalinowsky had originally trained in Berlin before fleeing the Nazis and earning his second MD degree in Rome under Cerletti. As the Nazis advanced, Kalinowsky fled to France and then to England and introduced ECT to both countries.  Immigrating to the United States in 1940, he helped launch ECT at the New York State Psychiatric Institute while Renato Amansi (Cerletti-trained refugee number two) did the same at the Columbus Hospital in New York. Victor Gonda (refugee number three) introduced ECT in Chicago at the same time and there continues to be some controversy over who was the original "godparent" of electroconvulsive therapy in the United States.

While asylum psychiatrists were enthusiastic about the potential for the use of ECT, psychoanalysts were far more skeptical. Washington psychoanalyst, Harry Stack Sullivan, was an early critic of ECT and the biological model of mental illness which ECT supported. Despite this resistance, by 1946 when Kalinowsky and Paul Hoch published Shock Treatments, Psychosurgery and Other Somatic Treatments, ECT had become widely used across North America.

While there were warnings as early as 1947 by the Group for the Advancement of Psychiatry about the "promiscous and indiscriminate use of" electroshock treatment, psychiatrists were eager for new treatments to deal with the chronic overcrowding in psychiatric hospitals. The end of World War II and its aftermath led to thousands of psychiatric casualties (including returning veterans) and drastic reductions in hospital staff. A 1942 survey of 305 state psychiatric hospitals found that 93 percent of them had adopted some form of ECT (although medical standards varied widely). An estimated 7000 patients were treated within the first two years of ECT;s introduction.

The first machines tended to be "in-house" creations made by local technical staff or hired electricians following directions provided by Cerletti and his assistants. As different designs and innovations began to proliferate, manufacturers offered their products to hospitals and the familiar ECT machine started sporting brand names such as Offner, MedKraft, Rahm, and Lektra. There were active marketing campaigns with ads in psychiatry journals and psychiatrists began favouring some manufacturers and brands over others.

The use of ECT replaced all other forms of somatic treatment (except for the continuing use of lobotomies but that's another story). Patients suffering from any form of psychosis, depression, dementia, personality disorder, psychopathy, or even homosexuality (it was still considered a mental illness at the time) were considered for the new treatment. New organizations sprang up including the Electroshock Research Association in 1944 and the Society for Biological Psychiatry in 1945.

Clinical literature was filled with post-treatment validity studies testing ECT in different psychiatric populations. A typical research study in 1945 reported a 67-70 per cent remission rate for first-episode schizophrenics compared to a 25-30 spontaneous remission rate. Studies of longer-term improvements tended to be far less optimistic though and it was increasingly recognized that ECT was a treatment rather than a cure. ECT even entered the popular culture with a prominent appearance in the 1948 classic film The Snake Pit (based on Mary Jane Ward's semi-autobiographical book). The sight of Olivia de Havilland being subjected to ECT in the movie helped shape popular attitudes of the time.

Despite the eagerness associated with ECT use there was one important stumbling block: nobody knew exactly why it worked. Ugo Cerletti proposed that ECT caused the brain to produce beneficial chemicals which he termed "acro-amines" although his arguments were unconvincing. Other critics suggested that ECT produced selective brain damage due to trauma (and pointed out the short and long-term memory impairments that often resulted from its use) which affected emotional responsiveness. ECT advocates suggested that ECT stimulated neurotransmitter production but experimental studies were (and still are) inconclusive.

With research came more innovations to deal with the serious dangers associated with ECT use. Patients receiving electroshock often developed broken bones due to their thrashing about on the table. Nerve blockers and general anesthetics made ECT less risky although patients still complained of memory loss afterward.

Although he was nominated, Ugo Cerletti died in 1963 without ever receiving his long-cherished Nobel prize in medicine. Given that the only other Nobel prize ever awarded to a psychiatrist was for the invention of the lobotomy, you do have the sense that the Nobel Committee shied away from recognizing another potentially controversial breakthrough. Cerletti was lucky enough to miss the backlash against ECT that would come later but he lived long enough to see a marked decline in ECT use during the 1950s and early 1960s. The availability of antidepressant and antipsychotic medications that were safer and more effective made ECT less popular with therapists and patients.

While ECT still continued to be used for bipolar disorder and depression, things were about to change...

Continue to Part Three.

Comments

[Encefalus]

Your articles are excellent! Keep going with the history of psychiatry. I offered you a link at my homepage to support you.

[Romeo Vitelli]

Thank you for your words of praise. There is one more in the series coming next Sunday.