Yesterday, someone asked about the origins of ECT as a treatment for
depression. I was too busy and tired to respond. Today, I'm not tired
(still busy, though), so I thought I would investigate this more while
giving my abnormal-psychology students an examination.
Alexander & Selesnick (1966) stated that a set of observations and an
inference made by Ladislaus von Meduna in the late 1920s were the
initial influences on a chain of investigations that led to ECT. Meduna
was the superintendent of a mental hospital in Budapest, who:
"observed that the glial tissue [in the cortex]...had thickened in
epileptic patients. When he compared their brains with those of deceased
schizophrenic patients he noted that the latter showed a deficiency of
glial structure. On the basis of these findings (which have not been
subsequently confirmed) Meduna became convinced that schizophrenia and
epilepsy were incompatible diseases and that a convulsive agent
adminsitered to schizophrenics would therefore cure them. " (p. 281)
In a footnote to this passage, Alexander & Selesnick mention that, soon
after making this initial set of observations, "Meduna had read of
statistical clinical studies purporting that schizophrenia and epilepsy
rarely, if ever, occur in the same patient. These reports claimed that
should a schizophrenic develop epilepsy, his psychosis could be cured"
(p. 281). Shorter (1997) stated that these reports claimed that
"epileptic patients who developed schizophrenia seemed to experience
less epilepsy" (p. 215). Perhaps both sets of claims were made (I
haven't read the original reports). Because of these claims and his own
observations, Meduna "accepted the concept of a biological antagonism
between the two diseases" (from Meduna's autobiography; quoted in
Shorter, p. 215).
Meduna first used camphor in 1934 to induce convulsions in a
schizophrenic patient. The patient was given six injections over a
two-week period and improved dramatically. This drug had been used as
far back as the 1700s to induce convulsions in psychotic patients (with
apparently good results), but Meduna seemed to be unaware of this
history (although I know I read about this somewhere else several years
ago, I now no longer remember why camphor had been used in those earlier
times as a treatment for psychotic disorders). Meduna had some success
with camphor in other patients. He switched to a synthetic substitute,
Metrazol, because it had fewer side effects and was faster acting. He
had some success with this as well. It now seems that the most success
came with patients who had recently become psychotic, which suggests
that the improvement was due to spontaneous remission of symptoms. As
far as I can tell from what I have read, no control groups were used. [I
also asked about this on TIPS a month or two ago.]
Patients did not like camphor or Metrazol, and neither drug produced
convulsions as reliably as practitioners would have liked. Thus, Ugo
Cerletti--a psychiatrist in Genoa and, later, Rome--and his assistants
began to experiment on dogs with electrical stimulation to induce
convulsions. A few years before Meduna's report, Cerletti had used
electrical stimulation on dogs to study the cause of a hardening in a
certain area of the brains of epileptic patients. He had wondered if the
convulsions occurring during seizures might be the cause of this
hardening. He induced convulsions in dogs by stimulating them through
electrodes placed in the mouth and anus, but ended up killing half of
them. When he heard about Meduna's results with Metrazol a couple years
later, he decided to find a safer method of delivering electrical
stimulation so that it might be used to induce convulsions in humans. He
assigned his assistant, Lucio Bini, this task. Bini discovered that
placing electrodes on the dog's temples allowed a relatively safe
induction of convulsions. Later, Cerletti learned that animals at a
slaughterhouse in Rome were rendered unconscious by electrical
stimulation. Bini and another of Cerletti's assistants spent a year
performing more experiments at the slaughterhouse to make certain that
the procedure was safe.
Cerletti's assistants now wanted to try the procedure on a human
patient, but Cerletti hesitated since it would severely hurt his
reputation if a patient were killed by the procedure. In the meantime,
an apparatus was built. Finally, in 1939, a 39-year-old psychotic
patient was referred to Cerletti's clinic. Cerletti agreed to try the
procedure on this patient (with an assistant stationed in the corridor
as a lookout). They first tried a low dose of 80 V. Afterwards, the
patient had no memory of this shock, but he seemed unharmed. They
increased the current to 90 V. According to Shorter (1997), the "patient
lay motionless for a minute, then began to sing" (p. 220). Cerletti
decided on one more shock at a higher voltage. When this shock was
delivered, the patient went into convulsions and his breathing stopped.
After 48 seconds, he recovered. Then the patient sat up and, according
to Cerletti, was "calm and smiling" (quoted in Shorter, p. 220). The
patient improved and was discharged after a month in the clinic. ECT
spread quickly after this point. At some point during this spread, it
became apparent that ECT improved depression in schizophrenic patients.
Thus, it eventually began to be used in patients suffering from
depressive episodes.
There's much more facinating detail that I'm skipping over. But I have
to go. I recommend the books from which I quoted as well as one by Eliot
Valenstein (1986) for more information (at least, I THINK that
Valenstein talked about the history of ECT, but I read this several
years ago). As always, sorry about the length!!!!!!
Jeff
References:
Alexander, F. G., & Selesnick, S. T. (1966). _The history of psychiatry:
An evaluation of psychiatric thought and practice from prehistoric times
to the present_. New York: Harper & Row.
Shorter, E. (1997). _A history of psychiatry: From the era of the asylum
to the age of Prozac_. New York: John Wiley & Sons.
Valenstein, E. S. (1986). _Great and desperate cures: The rise and
decline of psychosurgery and other radical treatments for mental
illness_. New York: Basic.
--
Jeffry P. Ricker, Ph.D. Office Phone: (480) 423-6213
9000 E. Chaparral Rd. FAX Number: (480) 423-6298
Psychology Department [EMAIL PROTECTED]
Scottsdale Community College
Scottsdale, AZ 85256-2626
"The truth is rare and never simple."
Oscar Wilde
"Instead of having 'answers' on a test, they should just call
them 'impressions'. And, if you got a different 'impression',
so what? Can't we all be brothers?"
Jack Handey
