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Against the backdrop of European fascism, an Italian physician pioneered a new treatment.
Looking Back to Look Forward
This Day in History
Eighty years ago, a mute man with paranoid schizophrenia, exhibiting delusions, hallucinations, and mannerisms, was found wandering the streets of Naples. On April 21, 1938, on the first floor of Rome Royal University Clinic for Nervous and Mental Illnesses, he became the first individual to be given what became known as electroshock treatment (electroconvulsive therapy or ECT) with complete resolution of his symptoms.1 A turning point in psychiatric treatment, the psychiatrist who performed the treatment was Ugo Cerletti, MD, assisted by Lucio Bini, MD.
Ugo Cerletti (1877-1963) trained in psychiatry and neurology at leading European centers before becoming head of the Institute for Neuropsychiatry in Rome in 1935.
During a lengthy career, Cerletti distinguished himself with research in many areas. He conducted neuropathological studies on perivascular corpuscles (now known as corpuscles of Cerletti), general paresis, and had a special interest in goitres—cretinism was prevalent in some parts of Italy—which he was still studying in his 80s. A creative and questioning mind, his interests extended beyond medicine; for example, he introduced white uniforms for Alpine troops and designed an advanced artillery missile.
Ideas about using electricity on the nervous system go back to suggestions from the Greeks 2000 years ago. Cerletti was interested in the electrical provocation of seizures, which had already been used for 60 years. His electroshock machine, built by his associate Bini, was originally intended for research on epilepsy.
Giving live patients electric shocks could potentially stop their hearts, leading to death. Cerletti visited the Rome abattoirs and learned that the animals were first stunned by a current delivered across the temples, thus sparing the heart.
Of the biological therapies in the 1930s ECT was the most successful and lasting treatment. It had started with a serendipitous misconception that epilepsy and schizophrenia were mutually antagonistic. This led to the cardiazol therapy of Ladislas Meduna, MD, preceded by prefrontal leucotomy and insulin coma.2 Some saw coma therapy as a progression from Julius Wagner-Jauregg, MD’s fever shock treatment for what was then called general paralysis of the insane. But cardiazol, although effective, had unpleasant side effects, including a terrible premonition of death before the seizure.1 Inducing the convulsion by electricity was cleaner, cheaper, and less cumbersome.
In his account of the first ECT treatment, Cerletti created a self-exalting myth. There were 3 failed attempts on the patient, each with a higher voltage, before getting a seizure. The hapless patient shouted “Another time is murderous ”before having his fit. It took a fortnight before Cerletti publicized his endeavor, suggesting some doubts still remained in his own mind.3
Cerletti believed that the therapeutic effect of ECT was produced by acroaginine (ECT in a bottle, according to Edward Shorter, MD) during the seizures and did extensive research on animals to isolate the substance, although without success.4
ECT was used to treat schizophrenia, but by the 1940s physicians realized that it was more effective for affective disorders, and the epilepsy/schizophrenia antagonism hypothesis was finally discarded.5 Thus was born a new treatment in psychiatry that has saved countless lives despite the continuing stigma, myths, and fear regarding its use.6
Cerletti’s venture into electroshock was done when fascism was at its height. Italian psychiatry, although heavily influenced by German psychiatry, had its own character. From the start it regarded neurology as an equal partner with a strong focus on neuropsychiatry.7 It did not follow the German model of killing psychiatric patients, which presaged the horrors of the Holocaust.8 To his credit Cerletti did not support the fascist party, although it is reported that he read the literature.
It is ironic that the most life-saving treatment in psychiatry was discovered by someone who saw himself as primarily a neurologist—an indictment of the chasm that has grown between the 2 disciplines.9
Despite all of his successes, Cerletti, “the most renowned representative of Italian neuropsychiatry in the mid-twentieth century,” can be considered unlucky. Despite being twice nominated, he never won the Nobel Prize; it would have been well deserved.10
Dr Kaplan is Clinical Associate Professor at the Graduate School of Medicine, Wollongong University, Australia.
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