The Development of Electroconvulsive Therapy (original) (raw)

Deborah Sevigny-Resetco Electroconvulsive therapy (ECT), otherwise referred to as electroshock therapy, was first utilized as a treatment for schizophrenia in 1938 and its use has been surrounded by controversy ever since [1]. From the time this somatic therapy was introduced, it has been continually commended and criticized by both the scientific community and society as a whole. This paper will trace ECT from its origins in Rome to its integration in the United States; evaluating its development, as well as the contributions and the conflicts that accompanied it [2]. The brief history of ECT is as riveting as is it disconcerting; it is filled times of both rapid progress and stagnation. The effectiveness of ECT is evident in its success as a viable medical treatment however; simultaneously the implications of its misuse cannot be ignored. In an attempt to reconcile the ramifications of ECT with the benefits it has produced both in the past and to this day, this paper will juxtapose its successes and shortcomings throughout history. In 1926, twelve years prior to the invention of ECT, Constance Pascal, a woman Parisian psychiatrist in France, introduced the term 'shock' into psychiatry. The meaning of this term for her arose from the idea that mental illnesses were caused by what she referred to as "mental anaphylactic reactions" and that shock could restore the brain and the autonomic nervous system [1]. Subsequently in 1933, a physician named Manfred Sakel was working with schizophrenic patients and developed what he referred to as "shock therapy" [1]. This idea echoed Pascal, but utilized insulin as the shocking agent to induce comas to restore the brain [1, 3]. After treating one patient with insulin shock therapy for three weeks with no improvement, one more injection of insulin induced an epileptic seizure so severe it had to be stopped by the administration of glucose. After the episode, when the patient's memory returned and the confusion diminished, it appeared his symptoms of schizophrenia had subsided. After four more weeks of treatment, the man was released and deemed normal [1]. With this new tie between epilepsy and schizophrenia, electroshock therapy was underway. In Genoa, Ugo Cerletti who had been studying the role of the hippocampus as a function of epilepsy (starting in 1931) learned of Sakel's discovery, began connecting it to his own research, and was inspired by a colleague Gaetano Vaile to use electricity to stimulate seizures. With the assistance of Lucio Bini, Ferdinando Accornero, and Mario Felici: Cerletti was able to refine his experiments of electroshock in dogs and by 1938 the team was prepared to treat their first human [3].In April, a device built by the Acroni Company administered 80 volts for .25 seconds to the patient, however after three tries the man still retained consciousness. A week later, the experiment was retested on the same man, this time with 92 volts for .5 seconds: the patient lost consciousness. After eight minutes the patient regained full consciousness, was responsive, and had no memory of the treatment that had occur; the experiment had been a success [1]. From that point on, electroconvulsive therapy spread rapidly. ECT was introduced into the United States by one of Cerletti's follower's Renato Almansi [3]. In the U.S alone, within two years 7000 individuals had received ECT and by 1941 fortytwo percent of U.S mental institutions had ECT machines [2, 3]. ECT began to evolve almost immediately after its introduction. There were four machines that developed; the classic alternating current, the controlled amperage alternating current, the unidirectional pulsating current, and the "brief stimuli" apparatus [3]. The diagnoses that