The use of electroconvulsive therapy in Quebec - INESSS

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possible. In this light, electroshock therapy quickly
replaced insulin therapy and pharmacological
convulsive therapy.
Prior to the introduction of neuroleptics in the
mid-1950s, ECT and psychosurgery were the only
forms of biological therapy offering the hope of any
form of relief from the symptoms of mental illness. In
this context, it is not surprising that only three years
after electroshock therapy was first used by Cerletti in
Italy, 42% of psychiatric institutions in the United
States used this form of therapy [Braslow, 1999].
This ECT craze was such that certain psychiatrists
even offered ECT treatments in patients’ homes
[Lebensohn, 1999, p. 177].
When several ECT treatments were administered
per day, the symptoms of schizophrenia
seemed to disappear more quickly. This form of ECT,
which became known as “annihilation therapy” in
1942, was developed by Bini, a close collaborator of
Cerletti [Cerletti, 1950]. In the following decade and
up to the 1970s, a more standardized form, known
as “regressive treatment,” was used. D.E. Cameron
provided the following description of this method:
“In its original form, the method consisted
essentially of the administration of two to four
electroconvulsive therapies daily to the point
where the patient developed an organic brain
syndrome with acute confusion, disorientation
and interference with his learned habits of
eating and bladder and bowel control. While
in this condition, his schizophrenic symptoms
disappeared. On cessation of electroconvulsive
therapy – usually after the patient has been
given about thirty treatments – reorganization
would set in. The organic symptoms would
recede quite rapidly and, in favorable cases,
the schizophrenic symptomatology would not
reappear.” [Cameron et al., 1962, p. 65]
THE USE OF ELECTROCONVULSIVE THERAPY IN QUÉBEC
In the 1940s and 1950s, ECT and psychosurgery
were even combined to physically treat a
brain considered sick. ECT not only replaced anaesthesia,
in a transorbital frontal lobotomy, but also was
supposed to act in synergy with psychosurgery to
obtain the therapeutic effects:
“The question of ‘anesthesia’ is under debate.
I prefer three electro-convulsive shocks given at
intervals of two to three minutes. Stated succinctly
and much too simply, I believe that shock
treatment disorganizes the cortical patterns
that underlie the psychotic behavior, and the
lobotomy, by severing the connections between
the thalamus and the frontal lobe, prevents the
pattern from reforming. When a comparable
series of cases is done under local or general
anesthesia, if the results also turn out to be
similar, I shall drop this hypothesis and still
prefer electroshock because of its simplicity,
swiftness, safety and general availability to
the psychiatrist.” [Freeman and Watts, 1950,
p. 56]
In his contribution to the National Institutes of
Health Consensus Development Conference of 1985
[National Institutes of Health (U.S.) and Office of
Medical Applications of Research, 1985], the
medical historian David Rothman wrote:
“Judged by the history of other medical therapies,
the administration of ECT has an atypical
history of significant misuse. […]The annual
reports of state hospitals through the early
1950’s are replete with statements about the
use of ECT for purposes of control, not therapy.
Reports candidly noted that ECT was being
applied to make patients ‘more amiable [sic] to
hospital care’ and ‘more tractable’. ECT makes
patients ‘more docile and relieves employees of
the necessity of feeding or tube feeding’.”
[Rothman, 1986]