Beyond the Metaphor of the Pendulum: Electroconvulsive Therapy, Psychoanalysis, and the Styles of American Psychiatry

It is common to represent the history of American psychiatry by comparing it to a pendulum. In this metaphorical rendering, psychiatry has swung back and forth between extremes of emphasis on psyche (life events and inner conflict ruling etiological thinking, talk therapy dominating treatment) and soma (biochemical sources dominating etiological thinking, somatic treatments dominating treatment). This article argues that, while this metaphor is suited to capturing certain aspects of American psychiatric history, it distorts others by, for example, exaggerating the extent of dogmatism on either side and obscuring continuities in psychiatry's history. The article looks specifically at the reception by psychoanalysts to the introduction of electroconvulsive therapy. It shows that psychoanalytic views of ECT were diverse and more receptive to ECT than the pendulum metaphor might lead us to believe.