Electrotherapy, Shock Therapy & Electroconvulsive Therapy
Synopsis of the use of electricity to treat mental illness.
First known case 47 A.D.– Scribonius Largus treated the Roman Emperor for headaches with an electric eel.
First electroconvulsive administered by J.B. LeRoy 1755 treatment for psychogenic blindness. No follow-up study was conducted.
In 1800’s electrotherapy was the leading treatment of nervous diseases.
Wilhelm Erb (1840-1921) known for clinically describing neurological diseases connected with muscular dystrophy.
He did work on pathology of peripheral nerves, spinal cord, and brain stem.
He developed treatment procedure of applying low-grade galvanic and faradic currents to patients’ muscles.
He published Handbuch der Elektrotherapie 1881– translated to English 1883, French 1884. It is 336 pages long, containing detailed descriptions of methods of electrotherapy. Some, such as Thomas Szazs claim that electrotherapy is nothing more than pure fakery. He cites the following passage by ERB:
“Of the diseases of the nervous system in the strictest sense it now remains to discus a large group of frequent, severe, and important affections. These morbid processes vary greatly in character, but a feature common to all is that they must be regarded as so-called “functional neuroses” i.e., diseases in which a gross anatomical lesion is not demonstrable by our present means of investigation. Not even the exact location of these affections in the nervous system – whether in the peripheral nerves, spinal cord, brain or sympathetic system – is always known, or several localizations must be assumed at the same time. Indeed, in certain forms of the neuroses, a general diffuse affection of the entire nervous system is assumed, and they are called “general neuroses”
In other words- the guy sez he’s sick, he’s sick.
In reference to Nervous Exhaustion (Neurasthenia) ERB remarked
“this is the most fashionable neurosis at the present time.” Furthermore, he stated, ” Electricity often produces admirable results in this neurosis”
Since neurasthenic patients were often described as impaired sexually, treatments involving the direct application of electricity to their genitals were prescribed.
Sigmund Freud utilized these therapies early on in his career, but found them grossly ineffective.
Between 1893-95,a case involving a woman known as Fraulein Elizabeth von R. was referred to Freud.
The woman complained of great pain in walking and of being quickly overtaken by fatigue both in walking and standing. The patient had no demonstrable bodily illness. She had been referred to Freud as a case of hysteria.
Treatment consisted of kneading the leg muscles regardless of resulting pain, plus treatment of the legs with high-tension electric currents. Quote from Freud:
“In the meantime, my colleague was preparing the ground for psychical treatment, and when, after four weeks of my pretense treatment…”
Freud realized that these treatments were only a form of covert suggestion with no lasting therapeutic effect. The failure of this treatment led to his experimentation with hypnosis.
In 1920 Julius Wagner-Jauregg was director of the Psychiatric division of the Vienna General Hospital.
An investigation was launched to look into allegations that shock therapy was being used in the abuse of war neurotics from WW1.
Sigmund Freud was called as a defense witness:
“This painful form of treatment, introduced in the German Army for therapeutic purposes could no doubt also be employed in more moderate fashion. If it was used in the Vienna clinics, I am personally convinced that it was never intensified to a cruel pitch by the initiative of Professor Wagner-Jauregg. I cannot vouch for other physicians whom I did not know.”
But in his autobiography Wagner-Jauregg writes:
“If all the malingerers I treated at the clinic, often by harsh enough measures, had appeared as my accusers, it would have been an impressive trial.”
The implication is that Electro therapy was a great hoax played out in the world of psychotherapy.
Electro-shock, or Electroconvulsive therapy was born in Italy 1938.
In the late 1920’s the director of the Royal State Mental Hospital in Budapest, Ladislaus Joseph von Meduna observed that epileptic patients’ brains had a thickening of glial tissue. Schizophrenics showed a deficiency of glial tissue.
Meduna concluded that schizophrenia and epilepsy were incompatible diseases.
Further concluded that if epileptic seizures could be induced, schizophrenia could be cured.
1932- Ugo Cerletti was doing autopsies on epileptic patients at the Neropsychiatric Clinic in Genoa.
He noticed a hardening of a sector of the brain and wondered if it caused or was a result of epileptic attacks.
He assumed that drugs used to produce experimental convulsions might have done it and decided to use electricity to produce convulsions.
1935- electric shock used as averse stimulus in treating a patient who displayed homosexual behavior after exposure to fetishistic stimulus.
1935- Cerletti was in Rome collaborating with L. Bini and after experimenting with pigs from a local slaughterhouse; on April 15, 1938 they gave the first electroshock treatment of a schizophrenic patient.
Electro-shock proved more reliable, cheaper, and less dangerous than drug therapy like Metrazol or insulin shock.
Even though the treatments seemed quite painful, the risk of a torn ligament or a fracture was much more acceptable than the risk of coma by an incorrect dosage of insulin.
Problem- nobody knows why it works.
Theory 1- the patient is so scared that they would rather be healthy than go through that again.
Theory 2- that like Fraulein von R., they like the treatment. Possibly a need to be punished is fulfilled.
If that were true then beating or torturing patients would be enough. Psychiatry would not have to have moved beyond the middle ages.
Theory 3-the patient regards the shock as a threat to his/her life, thus mobilizing the body’s total defenses.
If that were true then any time a psychotic patient was in a life-threatening situation, he would show signs of remission.
Theory 4- the shock produces slight brain damage, which erases the memory of events leading up to the symptoms, and so puts the patient back into a predepression psychological state.
By 1940’s Electroshock was the most widely used treatment for mental disorders.
Almost all evidence of worth was anecdotal.
Major scientific study undertaken in 1960’s
ECT vs. Tricyclic Antidepressants and monoamine oxidase inhibitors.
After studies ECT used as gold standard by which to judge new drugs.
Further studies done in 1980’s.
Double blind conditions almost impossible to apply. Clinical evaluations were videotaped, references to side effects edited out & tapes shown to reviewers.
Standards of drug dosages higher now than then. Questions have been raised as to actual level of superiority. If dosages of drugs were inadequate, then ECT may not be so great after all.
Generally more study is needed. While ECT is widely regarded as an acceptable treatment for mania, depression, and a host of other mental problems, nobody is quite sure why it works. Common practice today is a combination of drug and shock therapy used with analysis.
While the most common application is for depression, shock therapy has been used in all sorts of treatments from homosexuality to quitting smoking.
Consumer’s Guide to Mental Health
Brian L. Mishra Ph.D/Robert D. Patterson M.D.New York Times Books New York, NY. 1977
History of Psychiatry
Franz G. Alexander M.D./Sheldon T. Selesnick M.D.
Arper & Row 49 E. 33rd St. New York, NY. 10016 1966
The Myth of Psychotherapy
Doubleday Anchor Press Garden City, NY. 1978
Edited by Gary E. Stollak/Bernard G. Guerney, Jr./Myer Rothberg
Rand McNally 1966
Originally written for SBCC Physiological Psych course around 1990.
I’m sure a lot more has been discovered since then…