Convulsive therapy

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Convulsive therapy is the deliberate and controlled induction of a seizure or other disturbance of brain function for the purpose of psychiatric treatment.[1] Convulsive therapy attempts to produce this state artificially and under controlled conditions, on the premise that seizures can induce improvement in the patient's mental state once the patient recovers.

History

Physicians have noticed for thousands of years that a person's mental state sometimes changes dramatically following recovery from a seizure whether induced by a head injury, an intense febrile illness such as malaria, or chemically induced loss of consciousness or convulsions.[citation needed] In the time of the Roman Empire, for instance, electric fish were used to provide electric shocks to ill patients. For example, Scribonius Largus used it in AD 47 for treating persistent headaches. It is said that the Emperor Claudius himself was one of his patients.[citation needed]

Other instances of medical use of convulsive therapy were Paracelsus, who used seizures induced by camphor to treat psychosis in the 16th century; Drs. Jean LeRoy (France, 1745), Robert Whytt (London, 1751) and Leonard Yealland (London, 1917), all of whom used weak (non-convulsive) faradic electrical shocks to treat various "nervous, hypochondriac, or hysteric" cases as well as men suffering "shell-shock."[citation needed]

The rationale which supported the convulsive treatment strategy may also have been partly related to the 18th century rational in medicine which saw the 'breaking of the will' of the patient as necessary to cure insane persons.[citation needed]

With the rise of more biological explanations for mental disease at the end of the 19th century, the search for biological treatments also increased. In a short decade between the 1920s and the 1930s, several methods were developed by scientists who started to experiment with seizure-inducing techniques. Due to the absence of any effective therapeutic approaches to mental disease, and because it sometimes lead to remarkable immediately observable changes in patients, in the next two or three decades convulsive therapy became one of the most widely used tools of psychiatry. Hundreds of thousands of patients were subjected to it, including many important personalities, such as writers Ernest Hemingway and Janet Frame, poets Sylvia Plath and Robert Lowell, performer Paul Robeson, rock star Lou Reed, film actresses Frances Farmer, Vivien Leigh, Clara Bow and Gene Tierney, pianists Vladimir Horowitz and Oscar Levant, talk show host Dick Cavett, mathematician John Forbes Nash, author and philosopher Robert Pirsig and politician Thomas Eagleton.

Though popular in the first half of the 20th century, most convulsive therapies are now considered ineffective or too risky for general use. Only electroconvulsive therapy- also referred to as ECT- is still used today. It is reserved for particularly severe, treatment-resistant and life-threatening mental illness.

Methods

Various types of convulsive therapy were common until the mid or late 20th century. However, doubts over long-term benefits, ethical concerns, and advances in psychiatric drugs, psychotherapies and supportive services led to decreased use. Under this definition of convulsive therapy, which excludes similar treatments involving the passage of current through the body for therapeutic ends such as cardioversion and defibrillation, electroconvulsive therapy is the only type of convulsive therapy still practiced in the 21st century, though controversial and intended to be mainly restricted to severe cases of depression and bipolar disorder which have not responded to other kinds of therapies.

Mechanisms of action

The mechanism of action by which convulsive therapies might exert any lasting effect is unknown. A generic defense mechanism might be at work following a seizure.[citation needed] Alternatively a post-traumatic stress reaction might be induced.[citation needed] Long-standing neural networks or cognitive-behavioural patterns, associated with psychopathology, could potentially be disrupted.

When convulsive therapies were most used, science had no effective tools to study their effects. Studies about the underlying mechanism of electroconvulsive therapy, commonly known as ECT, still continue. Many hypotheses have been proposed, including potential effects on neurotransmitters, but the precise mechanism remains elusive.

See also

References

Notes

  1. Centre for Cancer Education. (Unknown last update). convulsive therapy. Retrieved August 19, 2007, from http://cancerweb.ncl.ac.uk/cgi-bin/omd?convulsive+therapy
  2. Board of Control for England & Wales (1939) The Twenty-fifth Annual Report of the Board of Control 1938 (London: HMSO)
  3. Reitmann, F. (1939) Cardiazol therapy of schizophrenia: some statistical data. The Lancet 233(6026): 439–40.
  4. McCrae, N. (2006) ‘A violent thunderstorm’: Cardiazol treatment in British mental hospitals. History of Psychiatry 17: 67–90.
  5. Ross, J.R.; Rossman, I.M.; Cline, W.B.; Schwoerer, O.J. & Malzberg, B. (1941) The pharmacological shock treatment of schizophrenia: a two-year follow-up study from the New York State Hospitals with some recommendations for the future. American Journal of Psychiatry 97: 1007-1023.
  6. McCrae, ibid. p.68.
  7. Dax, E. C. (1940) Convulsion therapy by ammonium chloride. Journal of Mental Science 86: 660–667

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