Today, "Classics in ECT" brings you a paper that ECT pioneer, Lothar Kalinowsky, delivered to the New York Academy of Medicine on March 3, 1949:
Present status of electric shock therapy.
Bull N Y Acad Med. 1949 Sep;25(9):541-53.PMID: 18138472
The pdf is here.
There are many clinical "pearls" here, that still ring true today. There are also many anachronistic ideas and terms that are no longer acceptable. On the whole, however, this is a remarkable essay, worth reading in its entirety.
Here are Dr. Kalinowsky's concluding words: of
The reluctance on the
part of some psychiatrists
to apply ECT even in
those cases where a favorable result is clearly predictable, is based primarily on theoretical objections. It is true that the shock treatments
have no foundation in psychological theories; on the other hand, those thinking
in organic terms, are as much at a loss to understand their action. As treating
physicians we cannot wait for satisfactory theories. As psychiatry begins to
enlarge its therapeutic armentarium, we psychiatrists like other physicians
will learn to select the right therapeutic techniques for the right type of
patient. If this is done, ECT applied with discrimination, will be helpful in
many psychiatric patients.
The below comment is from Max Fink:
ReplyDeleteThe Kalinowsky essay is a classic. I knew him well and his opinions were based on his experience. He was limited (as are we) by our poor identification of abnormal behaviors. His positions on indications, the complexities of “schizophrenia”, the failure of ECT in psychoneuroses are all on the mark. He was accepted at APA as a voice of ECT.
When Richard Abrams, a resident at NYMC in 1968 asked to re-examine BT vs RUL and MMECT, we had no site for ECT. I called on Lothar who was the head of the Medical Board at Gracie Square Hospital. He approved our research use and attended our NIMH site visits.
In the decade ending in 1949, the treatment had been in use for a decade, yet Lothar could describe a plethora of electric currents, dosages, electrode placements, frequencies, that concluded with AC currents, BT placements, 6 to 12 seizures in a course, augmenting insulin comas by ECT, and a short list of risks (fractures, tardive seizures, cognitive deficits) that in the succeeding decades were relieved by sedation, succinylcholine, and oxygenation that became the "modified ECT" that is today's standard for effective treatment. He was a strong advocate of office treatment and block courses. He readily re-treated patients who relapsed.
His wife was a loyal support, always at his side in lectures in Berlin and other European centers, and at the APA. In his retirement, I often joined him for lunch at his reserved table at the Carlyle Hotel. His portrait by Richard Avedon is on exhibit at the MOMA.
Max Fink