Posts Tagged ‘ ECT ’

Book announcement – Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy

9781138696969

Jonathan Sadowsky, the Theodore J. Castele Professor of Medical History at Case Western Reserve University, has published a new book entitled “Electroconvulsive Therapy in America
The Anatomy of a Medical Controversy”. The cover blurb reads:

Electroconvulsive Therapy is widely demonized or idealized. Some detractors consider its very use to be a human rights violation, while some promoters depict it as a miracle, the “penicillin of psychiatry.” This book traces the American history of one of the most controversial procedures in medicine, and seeks to provide an explanation of why ECT has been so controversial, juxtaposing evidence from clinical science, personal memoir, and popular culture. Contextualizing the controversies about ECT, instead of simply engaging in them, makes the history of ECT more richly revealing of wider changes in culture and medicine. It shows that the application of electricity to the brain to treat illness is not only a physiological event, but also one embedded in culturally patterned beliefs about the human body, the meaning of sickness, and medical authority.

For more information, click here.

Dissertations – Electroconvulsive Therapy and Its Devices

Max Gawlich: “Electroconvulsive Therapy and Its Devices”

In 1939 a wave of enthusiasm swept through the asylums of Europe. Machines and circuit diagrams originating from Italy, but often only the idea of electrically induced convulsions seized the imagination of psychiatrists. In this dissertation project I study the years of 1938 to 1950 as the period of early adoption and beginning routinization of electroconvulsive therapy (ECT). The history of somatic therapy in mid-century psychiatry remains under-studied, often undervalued as mere precursor of psychopharmacological therapies since the development of Chlorpromazine in the 1950s. On the other hand, next to Lobotomy ECT continues to be the infamous therapy of a disciplining and punishing psychiatric regime, dominating as such the critical discourse about psychiatry since the 1970s. The historical question what ECT was, how the machines were built, what those devices did and how they were adopted in the contexts of asylums remained unanswered.

The study compares three large asylums in Europe which were among the earliest to adopt therapeutic innovations in general and ECT in particular: Eglfing-Haar, south-east of Munich in the German Reich; Münsingen near Bern, Switzerland; and Warlingham Park Hospital in South-London, England. Eglfing-Haar was one of the largest asylums in Europe at the time, infamously known for both its function as relay-station for the transfer of patients into asylums where they would be killed as well as its establishment of so-called starvation units in which patients were murdered through neglect and overdoses of opiates. Münsingen was an internationally acclaimed centre for the so-called somatic therapies like insulin-coma therapy or sleeping-therapy and served as a hub for medically trained refugees fleeing the persecution in the German Reich or Italy. Warlingham-Park Hospital was the first British asylum to adopt ECT besides the Burden Neurological Institute. Its Super-Intendent Thomas P. Rees was famous for his reformist zeal opening the gates of his clinic in 1936.

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Siemens Konvulsator II – booklet

The source-material of my project is structured mainly by two institutional contexts. First there is the archival material from asylums, meaning mostly patient-files and therapy-registers. The second group are files, correspondence, brochures, and circuit-diagrams created in the development-process either at the Ediswan Co. in Britain or the Siemens-Reiniger-Werke in Erlangen. The opportunity as well as challenge was to develop a framework in which both kind of source materials complement each other and enable new questions and perspectives on clinical therapy with machines in asylums. To achieve this, I focus on 1) records and inscriptions of ECT, 2) the technical evolution of ECT-Devices in the period from 1938 to 1950, and 3) the therapeutic practices utilizing those devices. I further argue that with somatic therapies also the evaluation of those therapies was introduced. Contrary to previous research, my dissertation will show how psychiatrists involved in somatic therapies developed methods to record therapy, add up data and present statistical evidence supporting their claim of clinical success. Not only were the development and utilization of devices deeply entangled, but also questions of dosage, security, or wanted and unwanted effects were technically as well as practically addressed. Institutional settings, personal preferences and the design of ECT –devices produced specific adaptations of ECT in the local spaces of each asylum. The Second World War hindered the exchange of ideas and concepts of ECT, and rather strengthened the position of Swiss psychiatrists as intermediaries in the international transfer of knowledge. The War created a situation of largely isolated developments, producing specific technical and therapeutic solutions, which demands a comparative perspective and explicative approach.

Illustration: SRW Erlangen Technische Entwicklung, Konvulsator II für die Elektrokrampfbehandlung von Psychosen. 1949, in: Veröffentlichungen a.d. Technischen Entwicklung Bd. 4. SRW 1948-1961 p54, Siemens MedArchiv Erlangen, Nr. 71. (Reproduced with the kind permission of the Siemens MedArchiv, Erlangen)

Max Gawlich is a PhD Candidate at the Historical Institute in Heidelberg, were he also studied history and Jewish studies.

Contact: @MaxGawlich on Twitter or max.gawlich@googlemail.com

Some Reflections on Electroconvulsive Therapy, Past and Present

The online magazine Psychiatric Times features an exchange between two respected psychiatrists on the history and status of electroconvulsive therapy (ECT).  In a piece entitled “Electroconvulsive Rx: A Memoir and Essay (Part 1),” Dr. Alan Stone (Touroff-Glueck Professor of Law and Psychiatry in the Faculty of Law and the Faculty of Medicine at Harvard University) discusses his experience after reporting for  military service at Fitzsimmons Army Hospital outside Denver, Colorado in 1959:

The Colonel in charge of the psychiatric unit prescribed a course of 20 to 25 unmodified ECT’s for virtually every soldier requiring admission to the inpatient unit. When I questioned this rigid regimen and expressed my unwillingness to participate, the Colonel informed me that I was not being asked I was being ordered and would either take my turn administering the full course of unmodified ECT or be court martialed.  As I look back on my military service, I have always regretted that I did not risk being court martialed. In any event, under the Colonel’s threat, I learned what a course of 20 -25 unmodified bilateral ECT could do to a sample of approximately 100 young physically healthy men of various diagnoses.

Stone goes on to reflect on what he considers to be the unethical and careless manner in which ECT was employed at the time.

In his response, “ECT Today: The Good It Can Do,” Dr. Charles Kellner (Professor of Psychiatry and Chief of the Division of Geriatric Psychiatry at the Mount Sinai School of Medicine in New York City) insists that any abuses of ECT committed some fifty years ago should not be taken to impugn ECT today, which, in his view, is “practiced to high standards of medical care and with fully informed consent.”  Kellner sums up the benefits of ECT this way:

ECT is the only “somatic” treatment from the early 20th century that has survived. It has done so because of its unparalleled efficacy and safety. ECT is the most effective antidepressant treatment we have; response rates are typically in the 60% to 90% range.   Because ECT is rarely given as a first line treatment, most ECT patients have already proven refractory to multiple trials of antidepressant and other psychotropic medications. Severely suicidal or catatonic patients often improve dramatically within 1 to 3 weeks of starting an ECT course. Interestingly, the most severely ill patients respond best to ECT; high severity of depressive symptoms, presence of melancholic and catatonic features, and psychosis all predict better outcomes with ECT.  Where else in medicine is severity of illness a predictor of good outcome?

You can follow this exchange and all subsequent reader comments at Psychiatric Times. Keep in mind, you must register in order to read articles at the site, but registration is free.

ECT and LSD

Two items of interest appeared in the news today, concerning two very different approaches to mental illness and its treatment. First, the musical “Next to Normal”, about a woman suffering from manic depression who undergoes electro-convulsive therapy, won this year’s Pulitzer Prize for drama. Here is a review:

http://theater.nytimes.com/2009/04/16/theater/reviews/16norm.html

Second, reporting on a gathering being held this week in San Jose, CA that is described as the “largest conference on psychedelic science held in the United States in four decades,” the New York Times ran an article about the growing interest in using hallucinogens to treat depression:

http://www.nytimes.com/2010/04/12/science/12psychedelics.html

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