Shock Therapy: The History of Electroconvulsive Treatment in Mental Illness (review)

Historians of modern medicine tout the rise of scientific medicine, especially noting its remarkable and recent successes in treating disease. Examinations of these studies also reveal the scarcity of attention paid to mental illness. Edward Shorter and David Healy suggest a possible reason for this oversight in their recent book, Shock Therapy. ‘We still know neither what causes mental illness nor how to cure it.’ Their fascinating depiction of the history of electroconvulsive treatment (ect) and its role in the development of mental therapies addresses the unknown history of ect and, at the same time, marks a welcome contribution to the history of mental illness.

Part of the problem confronting mental illness is its inherent and two-fold intractability. First, unlike therapies tied to the biomedical model of disease, medical therapies for the mind are plagued by the unknown causal etiology of mental illness. Neuroscience may reveal how the brain works, but the source of disease is more problematic. Second, mental illness is rife with terms notoriously resistant to precise and localized explanations. For example, melancholic depression, manic behaviour, catatonia, schizophrenia, and anxiety are difficult to demarcate or to define with certainty.

Nevertheless, mental illness afflicts many people and, thus, has always been a target of medical practitioners. Not surprisingly, and absent precise theoretical models for disease, physicians have adopted empirical treatments assessed primarily by their efficacy. Convulsive treatment, ‘an important, responsible, and reliable therapy that deserves to be more widely used’ is one such approach. Shorter and Healy trace its development from Constance Pascal who, in 1926, suggested that mental illness resulted from a ‘mental anaphylactic reaction,’ an early claim to its somatic nature and severity. Manfred Sakel provided the first strategy to counter the reaction through the use of an insulin-induced coma in 1934, with considerable success. At the same time, Laislaus Meduna created the notion of ‘shock therapy’ as a therapeutic convulsive state, eventually selecting Metrazol as his causal drug of choice. In 1935, he published Metrazol’s startling results for treating schizophrenia. Then Ugo Cerletti, when confronted with a recalcitrant schizophrenic patient in 1938, resorted to the use of electroshock, and ect was born. Picked up almost immediately by equipment manufacturers, ect therapy quickly replaced insulin and Metrazol, spread throughout Europe, and crossed the Atlantic just as the Second World War broke out. It then became the major therapy in hospitals and psychiatric clinics to treat a wide range of mental illnesses. Even psychoanalysts, reluctant initially to embrace ect, soon accepted the treatment, which then became the ‘secret love of psychoanalysis.’

Similar to many medical therapies, there were problems along the way. The induced seizures sometimes caused bone fractures among patients. Others complained of memory loss. While these problems were soon remedied, ect found itself competing with the rise of psychopharmacology in the early 1950s, it was greeted with hostility by skeptical psychologists in the 1960s, and it was attacked by an anti-psychiatric movement associated with the cultural upheavals of the 1960s and 1970s. Eventually, ect disappeared from teaching hospitals, mental institutions, and psychiatric centres, becoming a treatment of last resort by the 1980s. The real story here, however, is the rise of the drug industry, with well-financed companies, a host of specific drugs, and a public that associates modern medicine with modern drug therapy. Shorter and Healy conclude the narrative with ect‘s recent renaissance due to the increasing awareness of ‘treatment-resistant’ mental diseases and the rise of neurological syndromes associated with drug therapies. As they state, ect thus remains a highly effective treatment.

The history of ect needs to be told, and this is a good read. But the authors’ advocacy sometimes gets in the way of historical fidelity. For example, they provide a startling claim that ‘the intellectual class decided that ect was really a bad idea,’ using evidence from movies, selected writers, and the media that led to ect‘s demise. But the argument is more...