History of Psychiatry
Here, I interview Jonathan Sadowsky, PhD, about his book Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy, published late last year by Routledge. Dr. Sadowsky is the Theodore Castele Professor of Medical History at Case Western Reserve University, where he is also Associate Director of the Master’s Program in Medicine, Society, and Culture. His interests include the history of colonial psychiatry, convulsive therapy and other somatic treatments in psychiatry, race and psychiatry, and the history of psychoanalysis. He is the author of Imperial Bedlam: Institutions of Madness and Colonialism in Southwest Nigeria (University of California Press, 1999) and, more recently, his book on ECT.
Greg Eghigian, PhD (GE): As you point out in your book Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy, ECT has had—and continues to have—both its champions and detractors. And historians who have written on the subject have largely fallen into the same pattern, seeing it either as a technology of social control or as an instance of unmitigated progress. How does your book differ from these?
Jonathan Sadowsky, PhD (JS): There is nothing wrong with historians’ advocating for a point of view. And it would be disingenuous of me to claim that after years of study, I have no opinions of my own about ECT. But I thought we might be better served now by an inquiry into how views of this treatment became so polarized. There is no single answer to this. But one point I can make here is that ECT has been pressed into service as a proxy in wider struggles over the authority of medicine, what kind of psychiatry we should have (“biological” or “talk,” for example), or even if we should have psychiatry at all, since ECT was a main target of the antipsychiatry movement. These debates not only have practical clinical significance, but touch deeply held but often implicit beliefs about the meaning of illness and wellness—and even what a person is.
GE: You acknowledge that throughout the history of ECT, “Patients have both attested to damage it has done and expressed gratitude for the relief and hope it can provide.” How do you explain this seemingly paradoxical disparity in the experiences and opinions of patients?
JS: The human body is not a mass-produced machine, where given inputs such as therapies produce automatic and predictable results. Most clinicians and lay people know this but often act as if they don’t. One result of this mechanistic conception is resistance to the variability of bodily experience. But this variability is easy to show. Any psychiatrist who reads this knows it is not completely random—a psychiatrist might hesitate to prescribe bupropion to treat depression comorbid with extreme anxiety, for example—but there is a lot of mystery involved.
In the case of ECT, there has been a reluctance by many partisans to recognize that the experience they have had or observed may not be universal or typical. We will have more productive discussions if we are more sensitive to variability.
Dr. Eghigian is Associate Professor of Modern History and former Director of the Science, Technology, and Society Program at Penn State University, University Park, PA, and Section Editor for Psychiatric Times History of Psychiatry.
1. Hirshbein L. Electroconvulsive therapy, memory, and self in America. J Hist Neurosci. 2012;21:147-169.