Mental Health Care

The beginning of electro-convulsive therapy was made in April 1938. It was in the ancient city of Rome that Ugo Cerletti and Lucio Bini administered the first electro-convulsive treatment. Using two electrodes placed over the temples, they passed current through the head of a patient with schizophrenia. The passage of the current caused an immediate induction of convulsive seizure, and this benefited the patient by an unknown mechanism. At that time, they gave it the name of electro shock therapy.

This brave attempt by Cerletti and Bini was inspired primarily by the work of Laszlo von Meduna of Budapest. Von Meduna had begun what can now be called the chemical shock therapy, using intra-muscular shots of camphor suspended in oil. He later switched to another chemical, pentylenetetrazol, that had to be given into the veins. He found the treatment worked successfully in people with catatonia and other acute schizophrenic symptoms. The first reports of this pharmacologically induced seizure treatment were published in 1934, and the treatment remained in vogue for the next four years until Cereletti and Bini decided to use the constant electric current to shock the disturbed brain.

Just as in many other spheres of science, the concept of shock therapy was a gift of serendipity. It had been observed that in people with schizophrenia, an accidental seizure due to any cause often resulted in a decrease of symptoms and an unexpected clinical improvement. There was also an incorrect belief held by the physicians of that time that schizophrenia and epileptic convulsions never occurred together in the same patient. They reasoned, therefore, that the induction of convulsions might rid the person of the schizophrenic symptoms. And the hunch worked, even if for all the wrong reasons!

The first few years of chemical shock therapy were extremely distressing to the people who were compelled to take the treatment. The intra-muscular injection of camphor suspended in oil caused severe discomfort and suffering to the patient for at least two to six hours, before producing a seizure. The introduction of penty­lenetetrazol brought about a major change by inducing convulsion rather quickly, yet any patient who had been through the experience once, almost never ever agreed to take the treatment again. Sent out to empty their urinary bladder before the treatment, most patients simply shut themselves in, in the bathroom, and refused to stir out.

The introduction of electric current signaled a major change in the treatment, but the technique was still unsafe. It could lead to dislocation of the jaw, and sometimes, the shoulder; fracture the bones, and in certain instances cripple the patient by causing fractures in the spine and spinal cord. Still, since it was the only therapy that worked against severe depression and schizophrenia, it was used widely until the 1950s when the first major antipsychotic medications were introduced.

Over the years, the technique acquired a considerable sophistication. General anaesthetics and muscle relaxants have lessened the discomfort and patients now hardly feel anything. This has also eliminated the risk of dislocations and fractures, making it a safe and relatively painless technique. In more recent years, the treatment has seen further refinement. The most troubling side effect of electro-convulsive therapy was the loss of memory. To avoid that, most physicians now roUtinely apply electric current to the non-dominant side of the brain only. This unilateral electro-convulsive therapy, however, does not always work as well as the bilateral technique, and if a physician does not get the desired effect even after five or six treatments, he switches over to the conventional bilateral placement of electrodes.

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