Invented in Italy in 1938 and making its way over to the UK in 1939; Electro-convulsive therapy was invented as an alternative to Metrazol. Its role was to create a new form of therapy to induce seizures in patients suffering from a variety of mental illnesses. Unfortunately, Metrazol had strong and often uncontrollable effects. In fact, the convulsions it induced were so strong that 42% of patients would experience spinal fracture and even Ladislas J. Meduna, the founder of Metrazol which has formed the basis of modern convulsive therapy, admitted his treatment, ‘made brutal inroads into the organism’. However, it was not only the physical effects of the treatment that called for the invention of a new convulsion-inducing therapy but the psychological impacts that many patients would experience. It was a highly feared treatment in psychiatric institutions, most describing an overwhelming sense of, ‘terror’ after the injection of Metrazol and awaiting the convulsions to begin. A psychiatrist writing in the American Journal of Psychiatry recounted how one patient described their experience using Metrazol as, ‘being roasted alive in a white-hot furnace’. Ugh Cerletti, an Italian psychiatrist, recognised both the need for an improvement to Metrazol Therapy but the, perhaps, vital usage of convulsions in treatment for mental disorders and hence came about the invention of electro-shock therapy. As many depictions in films such as, ‘Over the Cuckoo’s Nest’ and in Sylthia Plath’s, ‘The Bell Jar’ in which we are prevented with the brutal use of ECTs it seems questionable as to whether ECT has in any way, as it intended to, steered away from its predecessor. ECT itself is also a highly-feared and stigmatised treatment and despite Cerletti’s intention to steer away from the fear-inducing Metrazol it can be argued that has not happened.
In order to understand ECTs it is important to first consider the treatments that came before it and their impacts on the world of psychiatry which ultimately led to Cerletti’s discovery. Insulin-Coma therapy was said to have opened, ‘new horizons’ in psychiatry and depictions in the media described it as a, ‘bedside miracle’. Viennesse psychiatrist Manfred Sakel, in the late 1920s, was using small doses of insulin to help morphine addicts with their withdrawal symptoms. However, the use of insulin often to lead to patients falling into hypoglycaemic comas and, in order to bring patients back to consciousness Sakel would have to inject a rapid dose of glucose to bring them back to consciousness. Sakel observed that when patients awoke from their comas their behaviours were often radically changed. Before the coma, patients would be resistant to treatment and often irritated but would seem tranquil and responsive afterwards. Sakel observed these behaviour changes and considered the possibility of being being able to deliberately induce comas in psychotic or schizophrenic patients and hopefully observe similar positive changes. In 1933, Sakel began to test his ideas and found that in order to get a profound and prolonged improvement patients would require up to 60 comas in 2 months. The results proved positive, not only in Sakel’s investigations, but across Europe and in America. Psychiatrists such as Alexander Gralnick described this new treatment as opening ‘new horizons’ for psychiatry and Benjamin Malzberg claimed that, “Every institution that has given it a fair trial has found it to be effective”. The world of psychiatry rejoiced in this new and revolutionary treatment that could alter patients’ behaviour significantly for the better. Despite this storm of positive coverage of ‘Insulin Coma Therapy’ there were disturbing facts often left unreported by the various media stories covering its success. Manfred Sakel himself could not explain why this treatment worked but proposed that the comas selectively killed diseased cells and replaced with healthy ones describing it as a ‘rebirth’ of the patient. The treatment was definitely selective in the cells that it would kill but this was far from a ‘rebirth’. In fact, the brain would become so starved of glucose, levels would reach dangerously close to the cusp of death that the brain would begin to shut down. This dangerous process would begin with the areas of the brain which would have been developed most recently, those concerned with higher intellectual functions. This meant that after the coma patients would behave in infantile and childish ways which Sakel described as, ‘a regression to an ontogenetically earlier stage’. Physicians with Freudian backgrounds proposed that in a state of being ‘mentally sick’ patients will look for anyone to be a ‘tender, loving mother figure’ in the patients’ state of vulnerability and that the physician becomes this. After a while it proved that patients would return to their normal behaviours but through repeated treatments it would take longer and longer for patients to recover – which Sakel saw as a success as patients would become more friendly and sociable. However, investigations showed that these changes were in fact the result of severe irreversible damage to the brain and nervous system.