Pushbutton Psychiatry: A History of Electroshock in America (review)

It is not surprising that in our current era of ascendant biological psychiatry, there has been a growing interest among historians of psychiatry in somatic treatments for mental disorder. Of the major somatic treatments developed in the first half of the twentieth century, electro-convulsive therapy is the only one still in wide use, and its use has actually been increasing in recent decades. There is also abundant evidence that ECT is highly effective in relieving the symptoms of a number of psychiatric disorders. What is surprising, then, is that this is the first book-length study devoted to the history of this therapy. Timothy Kneeland and Carol Warren place ECT's history in several overlapping contexts: the history of electricity, especially its uses in medicine; gender history; and the history of the structures of medical reimbursement. But Pushbutton Psychiatry argues most emphatically for the case that ECT has been a tool of patriarchal social control over women.

Kneeland and Warren note that most psychiatrists who have used ECT have been male, but this is historically true of such a wide array of medical practices that what is distinctively revealing about it with regard to ECT is not clear. Most ECT recipients have been women, but the reasons for this raise perennially challenging questions of historical epidemiology: Were women getting certain illnesses at higher rates than men? Were they getting them at similar rates, but being diagnosed and treated more? Were diagnosis and treatment rates similar, but ECT used more readily on women with the same diagnosis as the men? Each of these explanations is potentially revealing about gender politics, but none of these alternatives is addressed in Pushbutton Psychiatry. Instead, Kneeland and Warren argue that the gendering of ECT was metaphorical, "reflecting the place of women in Western society" (p. 58). They argue that in the 1950s, clinicians valued ECT for its ability to return people (mostly white and apparently middle-class, though there are not extended examinations of class, race, or ethnicity) to their expected social role—for men, the workplace, and for women, management of the home.

The authors write that "any protestations about a women's [sic] traditional role might be silenced at the push of a button" on an ECT machine (p. 59). They follow this claim with an example of a woman who became depressed and careless in her appearance, and gave up her "outside interests"; after her shock treatments, she resumed the management of her household, as well as a number of clubs and civic organizations with which she had previously been involved. There may have been protest in this woman's example, but there is no evidence presented to show it: the only evidence of protest is the woman's illness itself, which one can be sure is protest only if one assumes that any housewife who becomes depressed does so as a protest against being a housewife. The most interesting part of this vignette, to me, is that the woman became a virtual ECT evangelist, seeking out other potential patients who she thought might benefit from the treatment; Kneeland and Warren's only comment on this is that "not all mad housewives were as sanguine about electroshock as this woman" (p. 60).

The limitations on women's roles in American history, and the way those limitations have been reflected in mental illness, have been shown by a number of historians, but this does not mean that none of those women needed, or benefited from, psychiatric treatment. Mental illness has multiple causes and aspects, including the genetic and biochemical, as well as the social and political. There may be instances where madness can be shown to suggest inchoate political protest, but in many cases, Kneeland and Warren simply assume it to be so.

Early in...