Shock therapy
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- This article is about the medical term. For other meanings of "shock therapy" or "shock treatment", see shock therapy (disambiguation). For the 1981 film, see Shock Treatment. For information on the song "Gimmie Gimmie Shock Treatment", see The Ramones.
Shock therapy is the deliberate and controlled induction of some form or state of shock for the purpose of psychiatric treatment. Shock therapy attempts to produce this state artificially and under controlled conditions, on the premise that states of shock can induce improvement in the patient's mental state once the patient recovers.
Various types of shock 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. Electroconvulsive therapy is the only type of shock therapy still practiced in the 21st century, though highly controversial and intended to be mainly restricted to severe cases of depression and bipolar disorder which have not responded to other kinds of therapies.
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[edit] History
Physicians have noticed for thousands of years that a person's mental state sometimes changes dramatically following recovery from physiopathological shock or brain seizures, whether induced by a head injury, an intense febrile illness such as malaria, or chemically induced loss of consciousness or convulsions. 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.
Other instances of medical use of shock 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".
The rationale which supported the shock 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.
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 shock-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 shock 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 (who shot himself after undergoing ECT treatment at the Mayo Clinic) and Janet Frame, poets Sylvia Plath (who also later committed suicide) 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 and politician Thomas Eagleton.
Though popular in the first half of the 20th century, most shock therapies are now considered ineffective or too risky for general use. Only electroconvulsive therapy is still used today, and is intended to be reserved for particularly severe, chronic or life-threatening mental illness that hasn't responded to other treatments.
[edit] Forms of shock therapy
- Malarial fever therapy involves the inocculation of malarial protozoa into the bloodstream of patients, in order to provoke episodes of intense fever and unconsciousness, which are sometimes followed by convulsions. The method was discovered by an Austrian physician Julius Wagner-Jauregg (1857-1940) in the 1910s, who got the Nobel Prize for his discovery. For a while, it was used for treating the general paresis of the insane, caused by tertiary syphilis. It is no longer used.
- Insulin shock therapy involves injecting a patient with a large amount of insulin, which causes convulsions and coma by provoking brain hypoglycemia. It was discovered by Polish physician and researcher Manfred Sakel (1900-1957) in 1933 and was used well until the 1950s for the treatment of depression and psychosis. It is also rarely used.
- Metrazol shock therapy involves injecting a patient with Metrazol (cardiazol), a drug that quickly induces powerful brain seizures. It was discovered by Hungarian physician and researcher Ladislas J. Meduna (1896-1964) in 1934. It was soon superseded by electroconvulsive therapy, because it was difficult to control and had many adverse effects.
- Electroconvulsive therapy involves inducing a grand mal seizure in a patient by passing an electrical current through the brain. It was discovered by Italian researchers Ugo Cerletti (1877-1963) and Lucio Bini (1908-1964). It is still in use today, albeit with restricted indications, such as usually untreatable depression or bipolar affective disorder and obsessive-compulsive disorder or anxiety disorders. In these cases, it is considered a safe and effective procedure, when carried out under a clinical protocol which involves EEG monitoring, application of muscle blocking agents and general anesthesia or sedation.
[edit] Mechanisms of action
The mechanism of action by which shock therapies might exert any lasting effect is unknown. A generic defense mechanism might be at work following a state of shock. Alternatively a post-traumatic stress reaction might be induced. Long-standing neural networks or cognitive-behavioural patterns, associated with psychopathology, could potentially be disrupted.
When shock therapies were most used, science had no effective tools to study their effects. Studies about the underlying mechanism of electroconvulsive therapy, though, still continue. Many hypotheses have been proposed, including potential effects on neurotransmitters, and a possibliity that transcranial electroshock induces neoneurogenesis (i.e., the growth of new neurons) in some areas of the brain which are involved with the control of emotions and memory.[citation needed] Since chronic depression is associated to a neuron loss in the same areas, this might explain a therapeutic effect. However, the long-term efficacy of ECT is unclear and relatively unstudied, and the procedure is actually associated with memory loss and other adverse effects.
[edit] See also
[edit] External links
- The History of Shock Therapy in Psychiatry. Brain & Mind Magazine, 1997. A historical review by Dr. Renato M.E. Sabbatini. Text partially used as source for this article, by permission of the author.
- A History of Somatic Therapies. by Joel T. Braslow, M.D., Ph.D, Spring 2000.
- Milner, G. The present status of electroconvulsive therapy: a systematic review. MJA 1999; 171: 687sr:Шок терапија
