75 years of electroconvulsive therapy

Last month saw the 75th anniversary of the first use of electroconvulsive therapy (ECT). On 18 April 1938, in Rome, Lucio Bini and Ugo Cerletti, who had been using electricity to produce experimental seizures in dogs, gave the first treatment to a human. That, at least, is what Cerletti said and what has been retold many times since, although it may not be factually accurate (I believe Edward Shorter discovered some discrepancies in the dates, although I haven’t read his work so can’t be sure). Here, for what it is worth, is what Cerletti recalled:*

“At this point [after seeing pigs rendered unconscious with 125 volt electric shocks prior to slaughter at an abbatoir in Rome] I felt we could venture to experiment on man, and I instructed my assistants to be on the alert for the selection of a suitable subject. On April 15, 1938, the Police Commissioner of Rome sent a man to our Institute with the following note ‘S.E., 39 years old, resident of Milan, was arrested at the railroad station while wandering about without a ticket on trains ready for departure. He does not appear to be in full possession of his mental faculties, and I am sending him to your hospital to be kept there under observation…’ The condition of the patient on April 18 was as follows: Lucid, well-orientated. He describes with neologisms deliriant ideas of being telepathically influenced with related sensorial disturbances… A diagnosis of schizophrenic syndrome was made… This subject was chosen for the first experiment of induced electric convulsions in man. Two large electrodes were applied to the frontoparietal regions, and I decided to start cautiously with a low-intensity current of 80 volts for 0.2 seconds…. The electrodes were applied again, and a 110-volt discharge was applied for 0.2 seconds. We observed the same instantaneous, brief, generalized spasm, and soon after, the onset of the classic epileptic convulsion.”

Although Cerletti and his colleagues were the first to use electricity to induce seizures in patients, there was nothing new about convulsive therapy. It had been in use for several years, but with the convulsion induced by drugs, and was developed by a Hungarian doctor, Laszlo Meduna. He was inspired by the work of another Hungarian doctor, Julius Nyirӧ, who had a theory that schizophrenia and epilepsy were in some way antagonistic and had treated epilepsy with blood transfusions from patients who had schizophrenia. Meduna explained his reasoning for trying to treat schizophrenia with convulsions:

“ My conclusions from Nyirӧ’s observations were the reverse of his. The epileptic process, I assumed, might have, probably through its stimulating effect upon the torpid glia system in schizophrenia, a beneficial effect upon the process of schizophrenia itself.”

Although these theories about schizophrenia and epilepsy didn’t gain much credence, convulsive therapy became widely used as a psychiatric treatment. Cerletti’s first patient, found in Rome station, had in fact undergone cardiazol convulsive treatment a few months previously.

A lot has changed in seventy-five years as far as science and technology is concerned. Then there were Bakelite plugs; now there are computers and MRI scans. Has ECT metamorphosed into a sophisticated medical treatment 75 years on from those early crude experiments?  No, ECT remains now exactly what it was then: someone is given an electric shock and they have a seizure. Of course, in a lot of places (and this includes most western countries) ECT is nowadays given with a general anaesthetic and a muscle relaxant.  This means that the psychiatrists who administer ECT are no longer confronted with the visual evidence (being knocked unconscious and then convulsing) that their patient has had a powerful electric shock, and so they are able to talk about small currents and mild seizures, although the amount of electricity used and its impact on the brain is not significantly different to what it was 75 years ago.

*The accounts by Cerletti and Meduna come from a book called The Great Physiodynamic Therapies in Psychiatry: An Historical Reappraisal, edited by A.M. Sackler et al and published in 1956.

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3 Responses to 75 years of electroconvulsive therapy

  1. Melinda James says:

    The drug they give to avoid bones breaking is NOT a muscle relaxant. It is a muscle paralyzer. It paralyzes all the muscles. You cannot blink your eyes, you cannot breathe. I know because one time or maybe more (i only remember one) they did not give me enough of the anaesthetic, and I was not asleep. I could not tell them I was fully conscious — could not move, could not blink my eyes. I saw the doctor leaning over me with the electrodes. Then I was knocked out by the shock. Fully conscious, but paralyzed. It felt like someone had bashed my head in with a hammer.

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