A Brief History of Convulsive Therapies
Electroconvulsive therapy (ECT) is a topic that guarantees lively classroom debate. Some background on the development of convulsive techniques will enrich your discussion.
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Julius Wagner-Jauregg (1857-1940) noticed that improvements in mental illness often followed a severe fever. Beginning in 1886 he induced fevers in the mentally ill, using at turns tuberculin, typhus vaccine, and tertian malaria. In 1917 nine patients with general paresis were treated by injecting blood from patients experiencing active malaria; three recovered, three showed temporary relief, and three showed no improvement. In 1927 Wagner-Jauregg won the Nobel Prize for Medicine based on this type of work.
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Manfred Sakel (1900-1957) in 1933 reported success using insulin coma and insulin subcoma therapy to treat schizophrenia. Sakel concluded that the repeated induction of hypoglycemia, typically accompanied by coma and convulsions, produced beneficial effects. With the advent of chlorpromazine in the early 1950s and subsequent clinical comparisons, insulin coma therapy quickly fell from favor.
Laszlo Meduna (1896-1964), a Hungarian psychiatrist, is credited as the founder of modern convulsive therapy. A somewhat popular notion in Meduna's time was that schizophrenic processes were helpful in treating epilepsy, leading some researchers to unsuccessfully transfuse the blood of schizophrenics to treat those with epilepsy. Meduna sought to demonstrate the reverse, believing that there was a fundamental antagonism between epileptic processes and schizophrenic processes. Accordingly, he tried camphor, pentylenetetrazol, and carbon dioxide to induce seizures in his patients.
Ugo Cerletti's (1877-1963) contribution to this sequence of events was to advocate the use of electroshock. In 1938, after a series of studies using nonhuman animals, Cerletti applied electroshock to a 19-year-old man found wandering the streets of Rome in a psychotic state. The patient received 11 electroshock applications, and was reported to be "cured" after 1 year and able to return to his former job. Electroshock methods were introduced to the United States in 1939, although the Journal of the American Medical Association published editorials warning of the possibility of electrocution.
After World War II interest in convulsive therapies increased, although concern was growing over complications associated with the techniques. For example, both pentylenetetrazol and electrical inductions produced death, panic, fear, fractures, memory loss, postseizure delirium, spontaneous seizures, and cardiovascular disorders. By 1950, then, muscle paralysis and anesthesia were commonly used when inducing seizures. More recent developments include localizing the placement of electrodes to one side of the head, and modifying the amount of electricity or frequency of treatments.
Fink, M. (1979). Convulsive therapy: Theory and practice (pp. 5-17). New York: Raven Press.
