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Electroconvulsive therapy or ECT as it commonly referred to is defined as a "medical procedure in which a brief stimulant is used to induce a cerebral seizure under controlled conditions."(Webster's, 146.) This type of therapy has evolved over many, many years. It was actually first noticed by Hippocrates, that malaria-induced convulsions seemed to calm insane patients and give them a little relief. In A.D. 47 Scribonius Largus treated the headaches of the Roman Emperor with electric eels; this is the first known case of using any form of electric therapy to treat an ailment. Even though it didn't cause convulsions it's still important to the finding that electrical current is a useful treatment. In the sixteenth century a Jesuit missionary found that the people of Ethiopia believed that using an electric catfish was good to expel devils out of the human body, they found that it tormented the spirits as well as the subjects that these acts were performed on. This is relevant because people in those times believed that you were being occupied by demons or evil spirits, they didn't believe that there was something medically wrong with the person. Also during the middle ages physicians in Europe noted that high fevers that resulted from epidemics, occurring in patients in asylums, seemed to cause them to have a reduction in the psychological symptoms.

The first form of modern convulsive therapy was used by Dr. Manfred Sakel in 17. He introduced the insulin-induced coma, which produced convulsions. This was used to treat schizophrenic clients. There were several things wrong with Sakel's therapy. First and foremost, for the maximum effect of the therapy, at least thirty to fifty hours of coma had to be produced. This required these patients to have to have continuous nursing care as well as physicians very knowledgeable in administration of insulin in order to avoid irreversible coma, respiratory failure, and then finally circulatory failure; all of which cause death. Secondly, if and when the patient comes out of the coma they are said to have psychologically regressed as well as physically regressed. They are dependent on nurses for their nourishment, which they receive from feeding tubes that go directly to their stomachs. Finally, there was no antidote to stop bring the patient out of the coma once the treatments began. So this therapy was deemed too uncontrollable for this and the other major reasons that have been mentioned.

The next form of therapy that became popular was the use of Metrazol. This therapy was developed by Dr. Ladislaus von Meduna. He was the head of the Royal state mental hospital in Budapest Hungry. He observed that glial tissue which connects the cells of the cerebral cortex had thickened in patients with epilepsy. He then examined the brain of a person who had had schizophrenia and noticed that they had no glial structure. He then concluded that these conditions must be totally unrelated, and that the patient with epilepsy could not get schizophrenia. We now know that is false. He also concluded that if schizophrenic patients experienced convulsions they would be cured. He tested out his theory with the drug Metrazol, which is a synthetic form of camphor, but much less toxic. The drug two main faults; there was an extended period of time between the injection and the beginning of the convulsion and these convulsions once they begun were so severe that they often caused bone fractures. So this treatment eventually disappeared just as its predecessor had.

We finally come to Ugo Cerletti, who is the founder of Modern ECT. He noticed when autopsying patients who had died from epilepsy that there was a hardening of Ammons horn. He decided to find out if this was because of the epilepsy or the drugs that the patient was taking to control their symptoms. He unlike the other two doctors took that into consideration, which makes his theory even more reliable. He collaborated with another doctor Lucio Bini; they learned that hogs that were killed in the slaughter houses of Rome received a small amount of electrical shock before being slaughtered. They used a variety of animals to establish safe dosages of electricity that they would later use on patients. And on April 15, 18 the first electroshock therapy was performed on a schizophrenic client. It was seen as being very simplistic as well as less dangerous than the two previously mentioned therapies.

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L. B. Kalinowski was a young German doctor that had collaborated with Cerletti and Bini on developing ECT. In 1 he began to travel all over the world promoting and advertising "shock therapy". The researchers that adopted the methods saw that it had more of an effect on affective disorders. They saw that 0% of the patients they used the ECT on experienced very minimal or no more symptoms. Soon doctors who had adopted the treatment found that giving light anesthetics and muscle relaxants decreased the incidence of convulsion related injuries such as bone fractures.

Sadly during the 160's and 170's the use of ECT decreased. It was primarily due to pharmacologic advancements in the psychiatry world, as well as reports that it was being misused by healthcare professionals. Ken Kesey wrote a very controversial book on the treatment of patients who were committed in Psychiatric hospitals. The book was called "One Flew Over the Cuckoos Nest". It was later made into a movie starring Jack Nicholson. He depicts the brutality and ignorance in asylums during a very dark period of psychiatric medicine. The main reference to Shock Therapy comes when the patients broke quite a few major rules one night. They broke into the nurses' station, took cigarettes, smuggled in two women, and were out of their rooms when they were not supposed to be. They were punished with the administration of shock therapy. This is the major reason that the use of shock therapy decreased. The people we trusted to take care of our loved ones were abusing a very dangerous and sometimes fatal treatment. This movie opened up people's eyes and people began to come out and say that they had experienced the same thing as the characters in the book, punishment by shock therapy. There were a series of legal actions involving the abuses of shock therapy in the years following the release of the movie.

There are several psychological theories to why electricity works well as a treatment for some mental illnesses; one theory states that the patient is so fearful of the treatment that he/she "escapes into health" rather than face another treatment. Another proposes that the treatment satisfies the patients need for punishment. But if this were true, the beatings and torture that those in the Middle Ages endured would have cured their illnesses. Finally the last major theory states that the patient releases all of his/her pent up aggression and hostility through the violent muscular convulsions; but if this were true than exercising to the point of exhaustion would have the same effect.

There are also several other recent theories that attempt to explain how ECT works. The Neurotransmitter theory suggests that ECT works like anti-depressant medication that changes the way receptors receive mood related chemicals like serotonin. The Anti-convulsant theory proposes that the induced seizures teach the brain to resist seizures. This effort to inhibit seizures dampens abnormally active brain circuits, stabilizing mood. The Neuroendocrine theory hypothesizes that the seizure causes the hypothalamus, part of the brain that regulates water balance and body temperature, to release chemicals that cause changes throughout the body. Brain scans have shown that ECT affects the brain by increasing metabolism and blood flow to certain parts of the brain; however, it is not known how this increased blood flow alleviates depression. Another theory suggests that this therapy damages the brain, causing memory loss and disorientation that creates a temporary illusion that problems are gone. (Electroconvulsive therapy, 156.)

The modern day procedure is usually performed in an operating room in a hospital. The patient is sedated and given muscle relaxants to reduce the risk of injuries from the convulsions. The actual treatment consists of passing seventy to one hundred and thirty volts through electrodes attached to the patients head. This is done for a very short period of time, only one tenth to five tenths of a second. The usually treatment regime consists of three treatments a week; and anywhere from five treatments to thirty five treatments is considered adequate. The production of bilaterally generalized seizures that lasts a minimum of twenty five seconds is the goal for one treatment session. And even if the patient has a seizure for the minimum amount of time, it does not guarantee a good response.

There is a degree of amnesia for each patient that undergoes the treatment. This is good because they do not remember the treatment, so therefore they do not fear it, but this is also bad because some patients develop anxiety from the loss of memory. Immediately following the procedure there is a period of confusion. It can take up to ten minutes for the patient to remember who he or she is and what day it is. After the initial confusion, there is a period of retrograde amnesia, or forgetting events that happened days, weeks, or months before the treatment. This memory loss can last for up to several weeks after the last treatment. For this reason doctors advise patients to avoid driving or doing any form of business during this "convalescence time". There is also a period of anterograde amnesia, or forgetting post seizure events. Less than one percent of patients experience severe memory loss. Studies show that ECT does not permanently affect the Whatever brain changes do occur is reversible, and everlasting brain damage is very rare.

It needs to be understood that ECT is not a cure for depressive disorders, but a treatment that has the means to control the symptoms to where they are almost unseen. The benefits of the treatment are clearly beneficial; they outweigh the potential risk of permanent brain damage as well as the amnesia that follows. ECT is the only somatic therapy from the 10's that is still around today.

Works Cited

Abrams, Richard. Electroconvulsive Therapy. Oakland New Harbinger Press, 00.

Alexander, Franz G. and Sheldon T. Selesnick, M.D.. The History of Psychiatry. New York Harper & Row Publishers, 166. 7-85.

Hamburg, David A. and H. Keith H. Brodie. American Handbook of Modern Psychiatry, nd Edition, New York Basic Books, Inc., 175. 514-516.

Kesey, Ken. One Flew Over the Cuckoos Nest. New York Viking Press, 16.

Sullivan, Henry Stack. Concepts of Modern Psychiatry. New York W.W. Norton & Company, 15. 1-0.

Webster's College Dictionary. Springfield, MA Merriam Webster, 000.146.

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