A Brief History of Electroshock

A Brief History of Electroshock
(Electroconvulsive Therapy)

Electroconvulsive therapy (ECT) apparatus previously used at mental patients at the Eg Asyl mental hospital, in Kristiansand, Norway. The apparatus was in use in the 1970s and 1980s. Exhibit at the Technical Museum of Norway, Oslo.
Creative Commons Licence: Photograph by Bjoertvedt

Hippocrates was the first to observe that malaria-induced convulsions in insane patients were able to bring a reduction in their symptoms.

Middle ages. Physicians note that high fevers occurring with infection epidemics in asylums appear to have a calming effect on the insane.

During these times, several physicians noted that few epileptics suffered from schizophrenia (actually the correlation is very high) leading to a common theory that the two conditions are incompatible.

In 1917, Julius Wagner-Jauregg introduces the malaria-induced fever to treat neurosyphilitic paresis.

In 1927, Manfred Sakel introduces the insulin-induced coma and convulsions to treat

1934 Meduna introduces the cerebral agitating agent Metrazol to chemically induce convulsions for schizophrenia.

The belief that epilepsy is incompatible with schizophrenia is a curious one. We now know this belief to be utterly false and curious some people with manifest schizophrenia will calm down when administering anti-convulsant drugs such as carbamazepine. Just for the record, father of transactional analysis, Eric Berne also noted a correlation between schizophrenia and an absence of asthma. Maybe we could try inducing asthma…

“Sakels Technique” of inducing convulsions using insulin were received worldwide by 1933.

“Insulin Shock” was brought about by giving an unfed patient a large injection of insulin thereby inducing a hypoglycemia reaction resulting in hypoglycemic convulsions. The patient would be revived by passing a tube via the nose into the stomach and passing glucose fluid into the stomach to raise blood sugars. The “procedure” is portrayed in the film “A Beautiful Mind” and in Paulo Coelho’s book, “Veronika Decides to Die”. According to a 1939 American Psychiatric Association study, of 1757 recipients of insulin shock, 11 % were said to have had a prompt and total recovery, 26.5 % were “greatly improved” and 26 % had some improvement. Since an adult human brain normally extracts about 60 to 80 milligrams of glucose per minute from circulating blood depriving it of essential glucose is not necessarily a good thing.

Extensive brain damage can occur, particularly to the sensitive area of the hippocampus (involved with memory) and the cerebellum (balance, coordination). Diabetics are usually very keen to avoid dangerous situations such as insulin shock whilst psychiatry induced them in a manner suggesting that the damage was the cure.

The story of Ugo Cerletti and the abattoir are well known by now. Convulsions were already being introduced into patients, primarily via insulin shock and the use of the cerebral agitation agent, metrazol. Glucose could be used to abort insulin induced convulsions, however metrazol had no ‘antidote’ and was most feared by patients, not all of whom ever actually consented to being given this dreadful “treatment”. Cerletti observed pigs being stunned with electric prods to their heads prior to slaughter to render the animal more manageable for the slaughterhouse staff. Not surprising then that this method should quickly transfer across to the overcrowded psychiatric units of the time (don’t be mistaken – if you think that it isn’t done any more, or that it is a rarity, you are
mistaken. It is not banned and is still a very common ‘treatment’, especially
for ‘agitated’ little old ladies in nursing homes who want to “go home”.)

Cerletti and colleagues practiced shocking animals (mostly dogs) until they came up with what they considered a safe and reliable procedure. On administration of shocks to people (at the time without muscle relaxant nor anaesthetic) recipients were often found to have retrograde amnesia.

This means that they often did not remember receiving electroshock, nor the period of time immediately prior to the procedure. Thus the patients carried no negative perception of the electroshock itself. Used primarily on schizophrenics, Cerletti and teams found the results “remarkable”. Strange, since these days ECT is said to have no role in the treatment of chronic schizophrenia and is generally considered to be of most value in the treatment of depression.

ECT grew in popularity with only a few modifications (including the introduction of light
anaesthetic and muscle relaxant to try and reduce the number of bone fractures occurring during the convulsion) and today approximately 150,000 patients receive electroshock per year.

In one of the most authoritative psychiatric texts, Kaplan (1997) writes: “Because ECT
requires the use of electricity and the production of a seizure, many laypeople, patients and patients’ families are understandably frightened by the procedure. Many inaccurate reports have appeared in both professional and lay literature about alleged permanent brain damage resulting from ECT. Although these reports have largely been disproved, the spectre of ECT-induced brain damage remains.”

This is strange. Maybe the numerous people that have contacted me with varying neurological syndromes that they attribute directly to their ECT “treatments” including epilepsy, tics, dystonias, parkinsonism, memory disorders, lack of concentration etc are all being “inaccurate”.

Despite all modern research, patients charters, improved civil rights, etc, David J. Rothman stated in an NIH Consensus Conference on ECT in 1985: “ECT stands practically alone among the medical/surgical interventions in that misuse was not the goal of curing but of controlling the patients for the benefits of the hospital staff.”