History of Electroconvulsive Therapy (ECT)

Description

What is the actual eponymous medical sign/syndrome/repair/classification…

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History of ECT

1933 – Manfred Sakel (1900–1957) introduced insulin coma therapy as a somatic treatment for psychosis, particularly schizophrenia, based on the belief that shock states could recalibrate mental function. Sakel began trials in Vienna before migrating to Berlin. His method became globally influential by the late 1930s despite lacking a clear physiological rationale.

The coma itself seems to break through the pathological processes of schizophrenia… the patient awakens with a changed state of consciousness, in many cases with striking improvement

Sakel originally tested insulin therapy for opioid withdrawal before observing calming effects in psychotic patients. His theory aligned with a broader somatogenic trend in psychiatry: “biological shocks” (fever, insulin, seizures) were seen as catalysts for mental reset. The mortality rate (0.5–2%) and prolonged hospitalisation needs were major drawbacks. While now obsolete, Sakel’s work paved the way for the concept of biological psychiatry and helped legitimize further convulsive therapies.

1934 – In the early 1930s, Ladislas J. Meduna (1896–1964) observed the histological distinction between patients with epilepsy and those with schizophrenia. Through autopsy studies, he noted increased glial cell counts in epileptics, and decreased glial cell counts in the brains of schizophrenic patients. Meduna hypothesised a biological antagonism between the two conditions and proposed that generating epileptic seizures in patients with schizophrenia might alleviate their symptoms.

…if I can stimulate epileptic seizures in schizophrenics then these… will alter the chemical and humoral processes in the body in a way… that the suppression of the disease will be made physiologically possible. The two diseases are pathophysiologically antagonistic…inducing epileptic seizures might therefore cure schizophrenia.

Meduna, 1934

Meduna used camphor oil injections, and later Metrazol (pentylenetetrazol), to provoke seizures in experimental animals. On January 23, 1934, he administered the first seizure-inducing injection to a man (Zoltán L.) with catatonic schizophrenia. The treatment produced dramatic effects and after a course of nine seizures, the patient regained speech and mobility.

By 1937, Meduna had treated over 100 patients and published “Die Konvulsionstherapie der Schizophrenie,” his seminal work on convulsive therapy.

1934 – At the Brain Research Institute in Budapest, Ladislas J. Meduna (1896–1964) introduced chemically-induced convulsive therapy using camphor (and later, cardiazol/metrazol) to treat schizophrenia. He hypothesised a biological antagonism between epilepsy and schizophrenia, based on neuropathological findings and epidemiological studies. His systematic method, grounded in histology, marks the true beginning of convulsive therapy in psychiatry.

The epileptic convulsion is the therapeutic agent… I believed that this antagonism should be utilised to cure not epilepsy, but schizophrenia.

Context:

• Meduna observed glial proliferation in epileptic brains, but not in those of schizophrenics.
• After safe induction trials, he administered camphor intramuscularly to catatonic patients.
• Switched to cardiazol for reliability and faster onset.
• Reported early remission in 10 of his first 26 patients.
• ECT would later render cardiazol obsolete, but Meduna’s work laid the experimental foundation for all convulsive therapies.

On April 11, 1938, at the University of Rome, Ugo Cerletti and Lucio Bini conducted the first electroconvulsive therapy (ECT) on a human. After extensive animal studies and practical experimentation in abattoirs using electrical stunning equipment, they applied a controlled current to a patient with paranoid schizophrenia. The induced seizure resulted in significant improvement after repeated sessions.

Cerletti sought a simpler, non-toxic method to provoke epileptic convulsions… Electroshock, unlike cardiazol, induced immediate and absolute unconsciousness… without the distressing latency period… The attack was fundamentally identical to that obtained with cardiazol and should achieve the same beneficial effects—if not more

Cerletti and Bini, 1938

1939 – At the Third International Neurological Congress in Copenhagen, Bini introduced electroconvulsive therapy (ECT) to a global audience for the first time. Bini delivered a detailed presentation titled “Seizures triggered through electrical current (electroshock)” in German, describing the technical, physiological, and clinical aspects of the newly developed therapy.

This method permits controlled, repeatable seizures without the adverse psychic effects caused by cardiazol… The psychotic symptoms receded gradually with successive treatments.

Bini 1939

His lecture outlined extensive preclinical animal trials, the physiological parameters of induced seizures, and the design of the ECT apparatus. Bini discussed the optimal settings for voltage (130–145 V), current frequency (approx. 45 Hz AC), electrode placement on the temples, and seizure classification (complete vs. incomplete). He emphasised the treatment’s safety, reporting no complications in over 3,000 cases

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Associated Persons

• Manfred Sakel (1900–1957)
• Ladislas J. Meduna (1896–1964)
• Ugo Cerletti (1877–1963)
• Lucio Bini (1908–1964)
• Friedrich Meggendorfer (1880–1953)
• Lothar Kalinowsky (1899–1992)
• Max Fink (1923–)

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Alternative names

• Name
• Name

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Controversies

Did they first describe or popularise or plagiarise?

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References

Historical references

• Sakel M. Neue Behandlungsmethoden der Schizophrenie. Wiener klinische Wochenschrift. 1933; 46: 1258–1262.
• Sakel M. Schizophreniebehandlung mittels Insulin-Hypoglykamie sowie hypoglykamischer Shocks, Wiener Medizinische Wochenschrift 1934; 84: 1326-1327
• Meduna L. Versuche über die biologische Beeinflussung des Ablaufes der Schizophrenia. I: Campher- und Cardiazolkrämpfe. Zeitschrift für die gesamte Neurologie und Psychiatrie. 1935; 152: 235–262
• Meduna L. Die Konvulsionstherapie der Schizophrenie. 1937
• Cerletti U, Bini L. L’Elettroshock. Archivio Generale di Neurologia, Psichiatria e Psicoanalisi 1938; 19: 266-268
• Bini L. Der Durch Elektrischen Strom Erzeugte Krampfanfall (Elektroschock). III Congres Neurologique International. Einar Munksgaard-Copenhague, 1939; 121: 706–708.

Eponymous term review

• Endler NS, Persad E. Electroconvulsive Therapy: The Myths and the Realities. 1988
• Endler NS. The Origins of Electroconvulsive Therapy (ECT). Convuls Ther. 1988;4(1):5-23.
• Shorter E, Healy D. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. 2007
• Faedda GL, Becker I, Baroni A, Tondo L, Aspland E, Koukopoulos A. The origins of electroconvulsive therapy: Prof. Bini’s first report on ECT. J Affect Disord. 2010 Jan;120(1-3):12-5. 
• Aruta A. Shocking waves at the museum: the Bini-Cerletti electro-shock apparatus. Med Hist. 2011 Jul;55(3):407-12.
• Rzesnitzek L, Lang S. A Material History of Electroshock Therapy. N.T.M. 2016; 24, 251–277
• Sirgiovanni E, Aruta A. The electroshock triangle: disputes about the ECT apparatus prototype and its display in the 1960s. Hist Psychiatry. 2020 Sep;31(3):311-324.