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Shock Therapy

Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness

Copyright Date: 2007
Published by: Rutgers University Press
Pages: 398
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  • Book Info
    Shock Therapy
    Book Description:

    Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classicOne Flew over the Cuckoo's Nest,where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives.In this book, Edward Shorter and David Healy trace the controversial history of ECT and other "shock" therapies. Drawing on case studies, public debates, extensive interviews, and archival research, the authors expose the myths about ECT that have proliferated over the years. By showing ECT's often life-saving results, Shorter and Healy endorse a point of view that is hotly contested in professional circles and in public debates, but for the nearly half of all clinically depressed patients who do not respond to drugs, this book brings much needed hope.

    eISBN: 978-0-8135-6052-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Illustrations
    (pp. ix-x)
  4. Acknowledgments
    (pp. xi-xiv)
    Edward Shorter and David Healy
  5. CHAPTER ONE The Penicillin of Psychiatry?
    (pp. 1-8)

    It is 1947. X, a thirty-eight-year-old New York physician and veteran of World War II, has just dropped out of training in internal medicine. He has been diagnosed with lung tuberculosis and has become depressed. He develops feelings of guilt, particularly about his income tax, “complaining that he did not file properly after he sold his house.”¹ He confesses to his wife that he has had extramarital affairs “and that he has committed so many crimes that he will never be able to do penance for it.” He is fearful of starting up practice on his own, that patients will...

  6. CHAPTER TWO “Some Experiments on the Biological Influencing of the Course of Schizophrenia”
    (pp. 9-30)

    The whole idea of a “convulsive” therapy is dissonant to many doctors and patients. By training, physicians are resistant to the notion that convulsions can be curative and their induction desirable, because they typically associate fits with brain illness or damage. Deliberately causing a patient to have an epileptic seizure, many doctors feel, means opening Pandora’s box. Patients, too, instinctively shun the notion that fits can be therapeutic and imagine themselves unconscious and convulsing on a laboratory table as they have seen in films such asOne Flew over the Cuckoo’s Nest. But this image is a misconception. Convulsive therapy...

  7. CHAPTER THREE “Madness Cured with Electricity”
    (pp. 31-48)

    In early April 1938, the Police Commissariat of Rome brought to Ugo Cerletti’s psychiatric clinic a mechanic from Milan named Enrico X. A man in his forties, Enrico had been picked up at the Rome railway station trying to board various trains without a ticket. “The subject does not appear to be in full possession of his mental faculties,” the conveyance slip noted. Three days later, as Enrico was examined at the clinic, he seemed “lucid and oriented,” meaning that he knew where he was. But he “expresses in neologisms delusional ideas about being influenced.” In fact, the patient spoke...

  8. CHAPTER FOUR From the University Clinic to the Psychiatric Institute: Shock Therapy Goes Global
    (pp. 49-82)

    On November 30, 1937, a female schoolteacher in her early twenties was admitted to Hillside Hospital in Hastings-on-Hudson, New York (its original location, before it moved to Queens). Mae X’s problems started when she was working at a summer camp. “While there, a man kissed her, according to the patient for the first time in her life.”¹ She became panicky and imagined that everybody at camp knew about it and was talking about her. She experienced auditory hallucinations, believed that everyone had turned against her, and failed to return to the classroom that fall. She came to Hillside with a...

  9. CHAPTER FIVE The Couch or the Treatment Table?
    (pp. 83-102)

    Back in the 1960s, Joe Schildkraut was a resident physician at the Massachusetts Mental Health Center in Boston. It was a fortress of psychoanalysis where Elvin Semrad, the charismatic chief psychiatrist, referred disparagingly to drugs as “taking a patient to a cocktail party.” But it had an ECT service, and Schildkraut, as a first-year resident, was obliged to serve a couple of months on this rotation. At Mass Mental, as it is commonly known, there were many agitated and depressed patients who would pace the halls wringing their hands, saying: “Oh my God. Oh my God. Oh my God. What...

  10. CHAPTER SIX “ECT Does Not Create Zombies”
    (pp. 103-141)

    In 1965, a practicing psychiatrist in England, depressed and psychotic for some time, received a series of ECT treatments on an outpatient basis. “The way in which memory returns is very interesting,” he said. “I have always had a good topographical sense and have been able to memorize maps and, for example, find my way with ease around the Underground system of London.” After his ECT he found that he had “forgotten completely the patterns that previously have been almost second nature to me. It is with considerable effort that I am learning again.” He discovered his office filing system...

  11. CHAPTER SEVEN “They’re Going to Fry Your Brains!”
    (pp. 142-163)

    In October 1983, an internationally renowned scientist at a prominent East Coast campus was in Copenhagen on sabbatical. There, he started to feel ill. He was depressed, fearful that he could not keep up with his students. New symptoms began to develop, as researcher Michele Greenwald, who had access to the family’s notes of the illness, tells the story.¹ The scientist experienced what seemed like permanent insomnia, feelings of guilt, decreased energy, and thoughts of death. Then at an international scholarly meeting in Copenhagen he flipped into mania, jumping up and “animatedly explaining exactly what the speaker had really intended...

  12. CHAPTER EIGHT The End of “Bedlam” and the Age of Psychopharmacology
    (pp. 164-180)

    Stigma alone would not have sufficed to marginalize electroconvulsive therapy. Physicians have a kind of gut-wrenching responsibility for patients with serious illnesses and, generally speaking, do not lightly discard a useful therapy. For years, shock had been virtually the only effective treatment of depression and psychosis. Clinicians would not have let the cinematic image of Jack Nicholson as “McMurphy” deter them from prescribing a remedy of benefit to their patients. But they could easily discard a treatment if an apparently superior one came along. This is essentially what happened within medicine to ECT: it was put aside in favor of...

  13. CHAPTER NINE The Swinging Pendulum: The Effects of Politics, Law, and Changes in Medical Culture on ECT
    (pp. 181-218)

    Reform movements have punctuated the history of psychiatry. From the celebrated loosening of the chains of the inmates of the Bicêtre Asylum in Paris by Philippe Pinel in the 1790s, to the policies of nonrestraint in the mid nineteenth century, and to the revisions of the committal laws during the twentieth century, practices and theories of mental illness have responded to broader contexts of social change. These reforms are often lumped together with the upheaval in psychiatry during the 1960s that has been termedantipsychiatry, but 1960s antipsychiatry was fundamentally different from anything that had gone before.¹

    Previous reforms focused...

  14. CHAPTER TEN Electrogirl and the New ECT
    (pp. 219-252)

    In 1965, a patient identified in the court records as “W.S.” was hospitalized in 1965 at the Veterans Administration Hospital in Lyons, New Jersey, as dangerous to himself and others. Twelve years later, he experienced a severe exacerbation of his psychosis but did not respond to aggressive courses of antipsychotic drugs, and in fact, he became worse under chemical treatment. W.S. agreed to ECT to “chase the voices away,” but the hospital administration deemed him incompetent to give consent, and on May 12, 1977, requested a hearing on his behalf. By then, the patient was on round-the-clock, one-to-one supervision and...

  15. CHAPTER ELEVEN Magnets and Implants: New Therapies for a New Century?
    (pp. 253-289)

    On May 1, 2000, a further chapter in the history of the shock therapies opened. Katherine X, a twenty-year-old depressed woman, was wheeled into a specially prepared room in the university psychiatric clinic in Berne, Switzerland, where she was put to sleep in the way patients have been put to sleep for ECT for decades. But instead of being given ECT, she had a magnetic paddle placed in close proximity to her skull, and with the stimulus delivered in this way she went on to have a seizure. The team looking after her, Thomas Schlaepfer and Sarah H. (Holly) Lisanby,...

  16. CHAPTER TWELVE Epilogue: Irrational Science
    (pp. 290-298)

    In 1944, John Whitehorn was asked to review the therapeutic scene within psychiatry for the American Psychiatric Association’s one hundredth anniversary. ECT had just exploded onto the scene, and shock treatments dominated the sessions on therapy at the APA meetings. Nevertheless, Whitehorn had difficulties writing his review. ECT was not derived from a theoretical framework; it simply worked, and no one knew exactly why. “The shock treatments remain essentially empirical,” he wrote. “We are without adequate rational understanding of their mode of helpfulness: the empiricists have posed a formidable problem for rational research. In addition the shock therapies have stimulated...

  17. Notes
    (pp. 299-362)
  18. Index
    (pp. 363-382)
  19. Back Matter
    (pp. 383-384)