Classics in ECT: Swartz LTE-"Programmed Seizures"
"Classics in ECT" brings you this LTE from the Green Journal in 1993:
ECT will stand on its own merits, and the name is but a minor part of the stigma problem.
Early Use of the Name "ECT"- Sacklers in 1949
"Classics in ECT" brings you this study from Creedmore State Hospital in 1949: Nonconvulsive biochemotherapy with histamine and electric convulsive therapy; a comparative study on hospitalized psychotics with a control ECT series. SACKLER AM, SACKLER MD, SACKLER RR. J Nerv Ment Dis. 1949 Sep;110(3):185-97. doi: 10.1097/00005053-194911030-00001. PMID: 18138865 The pdf is here . I originally choose this article as the earliest in PubMed to use the name, "ECT," although it also uses "electric [sic] convulsive therapy." The very first PubMed "ECT" citation is from 1947, but it is written "E.C.T." and also reports a complication, so we prefer this one. Nomenclature aside, this turns out to be an interesting read, with what would now be considered a somewhat bizarre study comparing histamine therapy with ECT. Among the interesting details are the inclusion of a couple of patients with postpartum psychosis and the observation that longer
The below comment is from Dr. Max Fink:
ReplyDeleteProgrammed Seizures Jan 24, 2021
"A rose by any other name would smell as sweet."
The tragedy in our history of induced seizures as therapy was the ease of seizure induction by electricity. While the early therapists recognized the core benefits to come from the seizure -- its effects on the ictal and interseizure EEG, the changes in systemic hormones -- they knew that electricity was a switch, not essential or necessary to the behavioral outcome. They had experience with chemical (Metrazole, PM-1090) and inhalant (flurothyl) induced seizures. They recognized that memory effects were transient. "Seizure therapy", "convulsive therapy" were common professional terms.
When I published my review of 40 years research in seizures, I chose "Convulsive Therapy" for its title.1 In 1985 I launched the new journal "Convulsive Therapy". A year later the IPAAE changed its name to "Association for Convulsive Therapy."
A decade later, the psychologists' cries of "memory loss, memory loss", their attempts to reduce such effects (though recognized as transient and irrelevant to benefits) by fiddling with electricity, and the industry creation of TMS, tDCS, VNS as "forms of ECT without its memory effects" took over the Journal's name, the ACT name, the focus of interest from the EEG and endocrines to electricity.
So degenerated is the name for Meduna's treatment that the JECT just published an article from the Mideast that listed various names for the treatment, omitting "convulsive therapy" alltogether.2 (My puzzlement is how this article was favorably reviewed by JECT reviewers.)
The treatment has weathered the Covid epidemic, the denigration of clinical psychiatry by psychology, and is more accepted worldwide as an effective instrument in patient care, regardless of its name. I assume that ECT is as good a label as any, provided we recognized that the "E" is just the light switch, energizing the brain seizure/convulsion that is evidence of the neuroendocrine effects that alter patients' behavior.
Max Fink
1. Convulsive Therapy, Theory and Practice. NY: Raven Press, 1979
2. Sidhom E, Omar M. Nomenclature of Electroconvulsive Therapy. JECT (in press).