Unconscious constellations

In a previous post I touched upon the subject of variation in electroconvulsive therapy (ECT) use and how little the reasons for this variation have been studied. Whilst looking for statistics about ECT use in the United Kingdom in the 1950s I came across an article by psychiatrist G. de M. Rudolf, The treatment of depression with methylamphetamine, published in The Journal of Mental Science in 1956. In the article he compared the results of treating people with ECT and with amphetamines and concluded that the “more prudent course” was to use drugs first and only use ECT if they didn’t work. (The article provides a reminder that psychiatrists used drugs to treat depression before the introduction of tricyclic antidepressants.) The author commented on “the great differences amongst therapists regarding the necessity for the use of E.C.T., the frequency and total number of treatments”  and on the fact that the “unconscious constellations” as well as the “conscious preferences” of psychiatrists influenced their choice of treatment. He listed 8 examples of the physicians’ unconscious relationships with ECT. He attributes the list to G.G. Wayne, writing in the Psychoanalytic Review, which explains why some of the examples sound slightly Freudian. So, here is Wayne’s list of unconscious motivations for giving ECT:

  • “deep-seated inadequacy resulting in a secret desire to eliminate sick people
  • over-compensation for this inferiority with the need to impress colleagues, or to have apparent power of life or death over patients
  • punishment of the patient for his failure to improve rapidly
  • assaulting the patient to neutralize tension in the physician who may feel assaulted or disturbed by his own lack of understanding
  • unresolved rivalry feelings towards fathers or brothers may lead to desire to annihilate patients though of as rivals
  • revenge towards older women for archaic frustration at the mother’s breast
  • proof of strong masculinity towards younger women
  • anxiety about his own sexual and aggressive impulses so that the physician uses a treatment in which he can remain psychologically aloof or can even withhold it entirely”

 On a conscious level, the author suggests that the “more timid, the more humane and the less dramatic” psychiatrists would favour drug treatment, whilst the “less humane, the lover of the dramatic and the reckless” would favour ECT.

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