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The 1930s was a turbulent decade for Italian psychiatry, largely due to widespread interest in "physical therapies" for treating asylum inmates. Use of Insulin coma, barbituate narcosis, and other medical interventions represented an exciting alternative to the psychoanalytic movement of the time in treating the untreatable. Given the widespread perception that mental patients represented an economic burden on society, Italy's Fascist government (likely inspired by the Erbkrank movement in Nazi Germany), began funding different research projects investigating somatic therapies for mental illness. At the forefront of this research was the medical team led by Ugo Cerletti.
Born in 1877, Ugo Cerletti had studied with the most eminent neurologists of his time before graduating with twin specialties in neurology and neuropsychiatry. By 1935, he had become the Chair of the Department of Mental and Neurological Diseases at Universita Di Roma 'La Sapienza". After visiting Vienna to study insulin coma therapy under Manfred Sakel, Cerletti formed his own research program into chemical convulsion treatments. After observing the use of electrical stunning on hogs being prepared for slaughter however, Cerletti was struck by an inspiration. Since epileptic-type seizures induced by insulin and metrazol were already being used to treat schizophrenics in many countries, could electrically induced convulsions be used as well?
As part of his long-term research project, Cerletti used dogs as test subjects to induce seizures electrically. Although half of the animals died as a result of shock stopping the heart, Cerletti and his research assistant Lucio Bini discovered that electric current could be safely administered if the electrodes were applied to the dog's temples. The dog experiments continued (with the dog catcher's wagon making weekly stops at the clinic) and the bodies were autopsied to examine the effect of electric shock on their brains.
Despite perfecting the technique on dogs, testing the procedure on a human subject was very different. Cerletti was extremely hesitant about taking this next step for obvious reasons. As primary researcher, he would bear full responsibility for any death or serious injury that resulted. Still, his research team (Bini, Ferdinando Accornero, and Lamberto Longhi) developed an experimental device that would develop 80 to 100 volts of electricity for a fraction of a second.
On April 15, 1938, a 39-year old engineer from Milan was arrested while wandering about the railroad station in Rome. The patient (identified only as "S.E") was found to be actively hallucinating and complaining about being "telepathically influenced". Diagnosed with schizophrenia, S.E. became the first test subject for the new treatment (which Cerletti named electroshock). Exactly who provided the informed consent for the use of this experimental procedure on a human patient isn't recorded.
There are different versions of what happened during that first session (the actual date is disputed although it occurred in April, 1938). In addition to Cerletti and his team, there was also medical observers and a male nurse to tend to the patient. S.E. was reportedly very docile as he lay on the examining table while the electrodes were attached to his temples. The first trial was at 80 volts for a tenth of a second and all that happened was that the patient contracted suddenly and then relaxed. His vital signs were carefully monitored with no apparent problems.
After a second trial with the voltage raised to 90 volts with no apparent reaction (although the patient did start singing), the team debated whether to try again. It was at this point when the patient stated in a calm voice, "Careful, the first is pestiferous, the second mortiferous". Although the researchers were puzzled by what he meant, they continued on to the next stage.
On the third trial, with the apparatus turned up to the maximum voltage, S.E. had a classic grand mal epileptic seizure. He became pale, turned blue, and then stopped breathing. The doctors found that his heart was racing and, after forty-eight seconds, S.E. began breathing again on his own (so did the doctors). The patient then sat up calmly and asked what they wanted from him. According to Cerletti's account, S.E. denied any memory of what had just happened. And so ended the first electroshock treatment session.
After ten additional electroshock sessions, S.E. was considered well enough to be discharged from the hospital on June 17, 1938. Cerletti later reported that the patient was "in good condition and well oriented" and could return to his engineering job in Milan. A follow-up assessment a year later found the patient reporting that he was "very well". His wife added her own concerns about her husband's condition, however. She reported that her husband became increasingly paranoid and jealous just a few months after his release. She also mentioned that "sometimes during the night he would speak as though in answer to voices”. While electroshock was no cure for schizophrenia, Cerletti continued to use it with countless other patients and his discovery would soon be adopted around the world.
For better or worse, a new era had begun in psychiatry.
Continue to Part Two.
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