ECT in the Ozarks

In July the Springfield (Missouri, USA) newspaper the News-Leader published a story entitled “Mystery artist from the Ozarks is recognized”.

Forty years ago, the story goes, a book of drawings that had been done on pages of an old ledger from “State Hospital No. 3” in Nevada, Missouri, was found on a rubbish dump in Springfield. Years later the drawings were advertised on ebay and eventually became the property of New York sculptor Harris Diamant, who set out to discover the identity of the artist. A relative came forward and the artist was identified as James Edward Deeds who had spent many years in the Nevada asylum and undergone electroconvulsive therapy (ECT).

“During early treatments, which is when Edward would have received it, high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects, according to information from the Mayo Clinic”.

The Mayo Clinic does indeed say this:

“Much of the stigma attached to electroconvulsive therapy is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.”

In fact, the current and the voltage in ECT have not changed much since the early days and the duration of the shock has got much longer, not shorter. A switch from sine-wave to brief-pulse current may have done something to reduce the risk of severe memory loss but only in a relatively minor way – witness the fact that at the last survey a few hospitals in the United States were still using sine-wave. This may explain why, far from being a thing of the past, memory loss still is experienced by people undergoing ECT today.

James Edward Deeds, who was admitted to the asylum in 1925, would have already been there for well over a decade before ECT was used. ECT was invented in Italy in 1937 but it took a few years to spread to other countries and start replacing cardiazol/metrazol convulsive therapy (a similar therapy in which the seizures are caused by drugs and not electric shocks). In 1948 a survey of hospitals in the United States regarding the use of what in those days were called shock treatments – insulin coma therapy, metrazol convulsion therapy and electroshock – was carried out.  A questionnaire was sent to 487 hospitals; 359 replied and the results were as follows, showing ECT to be the most widely used treatment:

Electroshock 278

Insulin 176

Metrazol 62

Combinations 162

Other 7

No answer 1

(More than one answer was chosen by some respondents).

In answer to the question “Is physiological shock treatment for psychiatric disorders used in your hospital?” the answers were as follows showing that not all hospitals were using the new therapies – a few had experimented with them and discarded them:

Yes 302

No (never) 53

No (discontinued) 4

(From G.L. Jones Pychiatric shock therapy: current views and practices, circa 1948, pages 17 and 3)

The News-Leader interviewed local historian and retired professor Lyndon Irwin, who has a website about the hospital (you can see a selection of the drawings his website here):

In a 100-year report of the asylum, the former director wrote a few paragraphs on ECT. “He made the remark that for the average patient it was used twice a week,” said Irwin. “They were not ashamed of the fact. This was just a treatment they were using.”

It was not just in the United States that ECT was used in such a way. A study of Netherne Hospital (a former County Asylum at Coulsden, Surrey, the United Kingdom) by a PhD student in the 1950s looked at the use of ECT on one ward with 50 patients, about one-third of whom had undergone leuctomies:

“Until the end of 1954 an average of 20 patients received Electrical Treatment once or twice weekly as a form of ‘maintenance treatment’, in the belief that this helped many of them and prevented them from becoming aggressive. As this practice had been in operation for a considerable period of time, some of the patients had received a large number of treatments…. forty-seven out of the fifty patients on the ward had between them received 5,590 Treatments, and twenty-two of them had received more than 100 Treatments each. As already mentioned, from the beginning of 1955, this form of ‘maintenance treatment’ was stopped completely, and from then onwards it was only used when specially indicated in particular cases”. (M.S. Folkard 1957 A sociological contribution to the understanding of aggression and its treatment, pages 93-4).

But the routine (as opposed to the ‘when specially indicated in particular cases’) use of ECT did not die out completely in the 1950s. Writing in the 11 April 2011 edition of the British Medical Journal about a stay in one of the old county asylums in the early 1970s, Jackie Hopson described how “Treatment was electroconvulsive therapy twice a week for everyone on my ward” (BMJ 2011;342:d93).

Neither is the use of ECT to control aggression, as it was used at Netherne Hospital in the 1950s, entirely a thing of the past. A letter from two psychiatrists in the United States in The journal of neuropsychiatry and clinical neurosciences (Spring 2010) described the use of maintenance ECT on two elderly people with dementia whose behaviour was causing problems at the nursing homes where they were resident. And at the other end of the age range, in an article in the March 2011 issue of European Child and Adolescent Psychiatry, three psychiatrists from Baltimore, USA, write about a similar use of ECT in an 11 year old child with autism.






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