The behavior of patients after the seizure could be problematic as well. Some became unpredictable, irrational, and—in rare cases— even suicidal. These factors, combined with a paucity of evidence to suggest that Cardiazol actually was having an effect that was specific to schizophrenia it actually seemed that Cardiazol could jolt almost any patient out of a stuporous state —whether they suffered from schizophrenia, depression, mania or something else , caused Cerletti to tenaciously seek other treatments.
After all, everyone knew that large doses of electricity could cause convulsions. Maybe, then, electricity could also be used to induce the type of convulsions that were thought to have potential in treating schizophrenia.
When Cerletti began testing this idea on dogs, however, he realized how dangerous the approach might be: about half of the animals subjected to electrical shock died of cardiac arrest. They soon learned that the original placement of the electrodes one in the mouth and one in the anus was a large reason dogs were dying after electrical stimulation.
This configuration caused the current to cross the heart, which not surprisingly sometimes caused cardiac arrest. When the electrodes were moved to the head, pulses of electricity produced convulsions—but rarely death.
After many tests on canine and porcine subjects, Cerletti was confident that electrical stimulation to the head was not a fatal procedure.
It was time for the ultimate test: a human. Which brings us back to the morning of April 11th, Cerletti was surrounded by a small group of other physicians, a nurse, and an assistant.
They had sequestered themselves in a laboratory that had a bed in it, originally installed so the director of the laboratory could rest between experiments. But now on the bed was a homeless schizophrenic patient with a circular metal apparatus placed on his head. Wires ran from the apparatus to a device on a table nearby.
Everyone else stared intently at the patient, eagerly but apprehensively waiting for something to happen. Then, his body just as suddenly fell back down—limp, but alive. That was the first proof a human could tolerate this type of controlled electrical stimulation to the head.
He wanted to see convulsions reminiscent of a seizure, not just one spasm. He ordered another shock be given—this time at 90 volts.
The patient stopped breathing—his diaphragm remained contracted—and he began to turn pale. The asphyxia continued for a few seemingly interminable seconds, but then the patient suddenly let out a deep breath. He lay silent for about a minute, then abruptly sat up in bed and began to sing a bawdy song that was popular at the time. Centre for Addiction and Mental Health. Please select a newsletter. Please complete the following:.
CAMH Foundation - provides updates on the mental health movement and ways you can get involved. First Name Please input a first name. Last Name Please input a last name. Email Please input an email address. I agree to the Terms of Use for privacy and use of my personal data. Please agree to the Terms of Use. However, since Sakel's method is the gentler and less deleterious of all somatic techniques, it was still in use in many countries until recently.
In , in the same year that Sakel announced officially his results with the insulin coma therapy, a young Hungarian physician named Ladislaus von Meduna, working at the Interacademic Institute of Psychiatric Research, in Budapest, started what would become an entirely new approach to physiological shock in the treatment of mental disease. Unaware of Sakel's investigations, Meduna studied the brains and the mental health histories of schizophrenics and epileptics and noted that there seemed to exist a "biological antagonism" between these two diseases of the brain.
Meduna reasoned, then, that "pure" artificially induced epileptic convulsions could be able to "cure" schizophrenia. He then began testing several kinds of convulsant drugs on animals and then on patients.
His goal was to achieve completely controllable and reproducible convulsions. The first substance he tested, in , was camphor, but the results were not reliable. He tested also strychnine, thebain, pilocarpin and pentilenetetrazol also known as metrazol, or cardiazol , always injecting them intramuscularly.
Sakel had used many of these drugs together with insulin, in order to enhance the convulsions, but never alone. However, Meduna's aims were achieved only when he experimented with intravenous injections of metrazol.
Convulsions ensued quickly and violently, and were dose-dependent. From this point on, two camps were firmly established in relation to physiological shock therapy: those who defended insulin coma therapy and those who sided with metrazol-induced convulsions. Metrazol was cheaper, much easier to use and more reliable to induce convulsions.
Insulin coma required five to nine hours of hospitalization and close follow-up, but it was easily controlled and stopped with injections of glucose or adrenalin, when needed.
Metrazol was stronger and more difficult to control. Meduna was also forced to immigrate to Chicago, in the USA, in , and from there he continued his research on metrazol convulsions. Eventually, psychiatry recognized that his theory of biological incompatibility between epilepsy and schizophrenia was unfounded, but that artificially-induced convulsions were useful to reduce schizophrenia.
In , A. Bennett, a psychiatrist, combined metrazol injections with curare to neutralize the strong muscle contractions which were responsible for this and other incidents. Curare is a muscle paralyzing agent which is extracted from South American plants used by Indians to make poison darts and arrows. It occupies the nerve receptors in muscles, blocking the normal action of acetylcholine neurotransmitter released by motor cells at that point.
Later, scopolamine was also used in conjunction with metrazol and curare, to sedate the patient and to avoid the terror of being subjected to violent convulsions while conscient this was an advantage of insulin. However, in controlled trials, metrazol seemed to be far less efficient than insulin in the treatment of schizophrenia, particularly chronic disease. Due to the appearance of many other methods to treat mental disease, including neuroleptics and electroconvulsive therapy, metrazol was gradually discontinued in the late 40's and is no longer in use.
It's importance is only historical. In , an Italian neurologist named Ugo Cerletti was convinced that metrazol-induced convulsions were useful for the treatment of schizophrenia, but far too dangerous and uncontrollable to be applied there was no antidote to stop the convulsions at the time, as it happened with insulin.
Furthermore, they were highly feared by the patients. Cerletti knew that an electric shock across the head produced convulsions, because as an specialist in epilepsy, he had done experiments with animals on the neuropathological consequences of repeated epilepsy attacks.
In Genoa, and later in Rome, he used a electroshock apparatus to provoke repeatable, reliable epileptic fits in dogs and other animals. Ironically, given that ECT would become iconic as a frightening treatment, the Italian researchers who proposed using electricity instead were searching for a safer, more humane and less fearsome method of inducing the seizures.
Their colleagues, internationally, believed they had succeeded. Within only a few years of its invention, ECT was widely used in mental hospitals all over the world. Many depictions of ECT in film and television have portrayed the therapy as an abusive form of control. There is probably no fictional story that so haunts our consciousness of a medical treatment. There is no question that ECT was benefiting patients then, but there is also a lot of evidence from that period showing that ECT, and the threat of it, were used in mental hospitals to control difficult patients and to maintain order on wards.
ECT was also physically dangerous when first developed. Now there are ways to mitigate those dangers. Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anesthesia to avoid pain from the electricity. These modifications were learned early, but it took a while for them to become standard practice. He would have been able to witness all of this. This was not a major part of ECT practice, but this is not a comfort to gay people who received the treatment, for whom it could be traumatizing.
But it survived in the social memory of the therapy. By the s, the evidence that ECT was very effective for treating depression was robust.
But there were also good reasons for patients to fear ECT. These reasons, combined with widespread revolts against authority and conformity that flourished in the s, also gave rise to a revolt against medical authority — the anti-psychiatry movement. In its most extreme versions, the anti-psychiatry movement rejected the very idea of mental illness.
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