Thoughts on ECT – Part III 1960-1980


Ken Kesey’s 1962 novel, loosely based on his own experience working in a state mental hospital, expressed for many the outrage of the antipsychiatry movement that peaked in the 1960s. 

ECT was already in decline in the 1960s,  due to the rise of psychopharmacology.  New drug treatments in the form of chlorpromazine, MAOIs, tricylcics, and lithium allowed patients to be removed from mental hospitals;  some psychiatrists suggested that ECT was over-used by physicians and mental health professionals.   ECT was also attacked by a coalition of interests who opposed psychiatry in any form.  

In the twenty year period between 1960 and 1980, patient accounts of ECT  reflected the  cultural changes. Instead of ECT as a miracle worker, many saw it as analogous to crucifixion. 


When the morning came, all the chief priests and the elders of the people took counsel against Jesus to put him to death; and they bound him and delivered him to Pilate the governor[1]…. Then the soldiers of the governor took Jesus into the praetorian and they gathered the whole battalion before him. And they stripped him and put a scarlet robe upon him, and plaiting a crown of thorns they put it on his head and put a reed in his right hand.

The ritual qualities of ECT often brought to mind crucifixion.  In many cases  ECT was scheduled in the morning, much like a ritual execution.  When brought to the treatment room, patient’s  limbs were extended – attached to electrodes, and an apparatus (or crown) was  applied to their heads. They then receive between 100-170 volts of electricity, resulting in a kind of coma. 

Literary accounts of the often invoked the imagery of crucifixion.     Sylvia Plath recreated her experience own shock treatments in several places, including the Bell Jar[2]:

The nurse started swabbing my temples with smelly grease…. Doctor Gordon was fitting two metal plates on either side of my head.  He buckled them with a strap that dented my forehead, and gave me a wire to bite.  I shut my eyes.  There was a brief silence, like an indrawn breath, Then something bent down and took hold of me and shook me like the end of the world.

In a post-ECT conference with Doctor Gordon, she recalls moving a lamp with a frayed cord that electrocuted he creating “A small hole, blackened as if with pencil lead, pitted the center of my right palm.” [3] The stigmata associated with Christ’s crucifixion.

Plath reworked the theme in “Johnny Panic and the Bible of Dreams”[4] Like Christ, her character has been seized and brought before a group of high priests:

I see Johnny Panic’s top priests staring at me, … I lift my hand to reassure them, holding up my notebook, my voice loud as Johnny panics; with all stops out,  “Peace, I bring you…” The Book.  … The white cot is ready.  With a terrible gentleness Miss Milleraverage takes the watch from my wrist, the rings from my fingers, the hairpins from my hair.  She begins to undress.  When I am bare, I am anointed on the temples and robed in sheets virginal as the first snow.  Then, from four corners of the room and from the door behind me come five false priests in white surgical gowns and masks whose one lifework is to unseat Johnny panic from his own throne.  They extend me full-length on my back on the cot; the crown of wire is placed on my head, the wafer of forgetfulness on my tongue.  The masked priests move to their posts and take hold: one on my left leg, one on my right, one on my right arm, one on my left.[5]

Ken Kesey who was a  hospital orderly, envisioned ECT as crucifixion.  Although the film version of the novel One Flew Over the Cuckoo’s Nest[6] has been the American vision of ECT since 1975, in many ways it was Kesey’s  1962 book that brokers the change from the age of miracles to the time of crucifixion.  In an early exchange from the novel, Randall McMurphy first hears about ECT: 

HARDING: “The shock shop Mr. McMurphy, is jargon for the EST machine, the Electro Shock Therapy.”

McMURPHY: “what’s this thing do?”

HARDING: “You are strapped to a table shaped ironically like a cross, with a crown of electric sparks in place of thorns.  You are touched on each side of the head with wires. Zap! Five Cents worth of electricity through the brain and you are jointly administered therapy and punishment for your hostile go-to-hell behavior, on top of being put out of everyone’s way for six hours to three days, depending on the individual.” (64-65)

Studies of patients show that many thought they were receiving ECT as punishment for their sins[7], one patient stated ‘They’re going to electrocute me for my sins…'”[8] Another patient described his experience “A jolt of power jars you into the darkness of temporary death.”  One patient asked another if he died in the shock treatment room.[9] Another suggested that every ECT ” was (like) going through the crucifixion again.”[10]

Curiously, in the absence of a therapeutic paradigm to explain how ECT actually worked, some  practitioners suggested that making patients feel a little death was the reason  WHY ECT worked!   Ugo Cerletti, the inventor of ECT,  formulated a theory that convulsions bring the organism to a state, which is close to death, thereby arousing a reaction of extreme biologic defense in producing a substance he called agonine, which created the therapeutic effect. [11]  

Psychologist Thelma Alper[12]  thought “that the treatment threatened the patient with death and offers him an opportunity of rebirth cleansed of previous fear anxieties.”  Other practitioners recognized that the oft reported and sometimes profound memory loss associated with ECT could be a means of death followed by the feeling of rebirth.  And the co-founder of ECT, Lucio Bini went so far as to advocate blitz therapy.  Give a patient thousands of Electroshocks until their old personality is destroyed.  This fits the thesis proposed by psychoanalysts Otto Fenichel,[13] who wrote

The author of this book has no personal experience with shock treatments.  He has, however, personally experience in analyzing doctors who apply shock treatment.  The (conscious or unconscious) attitude of the doctors toward the treatment was regularly that of ‘killing and bringing back alive again,” which idea, of course, provoked different emotions in different personality.  It may be some that the impression the treatment gives to the doctors corresponds to the impression it gives to the patients.  It seems they too, experience a kind of death and rebirth. Killing the sick person and creating the patient anew as a healthy person as an ancient form of magic treatment.

[1] Mathew 27: 1-2; 27-29 The Holy Bible Revised Standard Version New York; American Bible Society  1952

[2] Sylvia Plath, The Journals of Sylvia Plath, 1950-1962 forward by Ted Hughes, edited by Frances McCullough, New York: Dial Press, 1982.

[3] Sylvia Plath The Bell Jar 162

[4] Thomas Szasz, The Age of Madness 315-

[5] ibid. 316

[6] Ken Kesey, One Flew Over the Cuckoo’s Nest New York Signet 1962

[7] Millet and Moses found that patients treated by electric shock the treatment is desired because it felt to be a fitting punishment (341)

[8]Jack Kerkhouff, How thin the view A newspaper mans story or his own mental crackup and recoveryGreenbergNY 1952, 10

[9] Cyril Kolocotrnis,  “The Truth About Electro-Shock Treatments” Madness Network News Reader (San Francisco: Glide Publications, May 1973) reprinted in Freidberg 166

[10]Quoted in  Friedberg, 108-

[11] Lothar Kalinowsky  and Paul Hoch , Somatic Treatments in Psychiatry: pharmacotherapy; convulsive, insulin, surgical, other methods New York Grune & Stratton 2nd edition 1952

[12] Thelma Alper, “An Electric Shock Patient Tells His Story” journal OF Abnormal and Social Psychology 43 (1948) 201-210

[13] Otto Fenichel, The Psychoanalytic Theory of Neurosis New York Norton 1945, quoted in Friedberg Shock Treatment, 138


Thoughts on Electroshock-Part II

  1. Image  to the left is Lothar Kalinowsky, one of the first men to bring ECT to the U.S. He was with Cerletti in Rome when the treatment was invented.  

One metaphor that is sustained throughout the history of ECT is the utilization of religious metaphors, especially a discursive model employing Christian imagery.  This paper attempts to recapture this subset of symbolic and literary visions of ECT  which sequentially envisioned ECT as a miraclemaker, crucifier and resurrector.

ECT & The Age of Miracles, 1940-1960

When Jesus stepped ashore, a demon-possessed man from the town met him. “For a long time this man had not worn any clothes or lived in a house, but had lived in the tombs.  When he saw Jesus, he cried out and fell at his feet shouting at the top of his voice, “what do you want with me Jesus, son of the Most High God?  I beg you do not torture me!”… (Later the townspeople would find the man) sitting at Jesus feet, dressed and in his right mind.[1]

Historians have traced the history of mental illness in the West as it developed from concepts of possession and sin.[2] The function of a psychiatrist often resembles that of a high priest of old.[3]  Or, as seen above, Jesus going throughout Galilee delivering people from demons.  We can find  this trope in a patient’s literary description of his treatment in a mental hospital circa 1933.[4] Committed to asylum for alcoholism in winter 1933, William Seabrook wrote:

An excellent candidate for the mourner’s bench … a more hopeful candidate than most for the different brand of salvation purveyed by the doctors and psychiatrists.[5] In the comparatively short seven months I stayed, I saw some of them [the patients] come out of it as demon-ridded men came out of it in the miracles of Galilee[6]

Early newspaper accounts drew a miraculous image of ECT as a healer that delivered patients from a “hopeless” mental illness into society.  They are brought back from the “living death of mental disease.” ECT did seem like a miracle to a generation that believed mental disease was untreatable.  Furthermore, the number of patients seemed to be rising out of control and leading news publications including the New York Times and Newsweek claimed mental illness was the number one health problem in the 1940s.

Ugo Cerletti, who invented ECT and used it for the first time in Rome in 1938, emphasized the treatment led to the complete restoration to sanity. Several early newspaper accounts indicated that with just one shock a patient would be up “walking around cheerful.”[7]  Even the social critic Albert Deutsche, who indicted mental health care in a series of exposes in PM magazine echoed the description of madness provided in his exposes, suggested that ECT would be helpful in delivering patients from their “damp, bed-bug ridden basements.” His description of patients echoes that of the demon-possessed young man,  Removing them from hospitals where they were naked, filthy,   and shackled.[8]  It was not uncommon in the golden age of ECT in the years falling between 1940 and 1960 for patients to testify that: “A miracle happened at Herrick to me – within a week after starting, the shock treatment had me out of the worst of my depressions.”[9]

Indeed, the behavior of medical practitioners in its first twenty years of use evinces a belief in its curative powers over all mental illness.  ECT was used on neuroses and psychosis, on toddlers, children, pregnant women, and senile cases.  It was used to treat homosexuality, cross dressing and other behaviors that were deemed as both psychological and moral illnesses!  It was used by psychiatrists, psychoanalysts, and general practitioners.  It was used in large state mental institutions, private hospitals, at the doctor’s office, and some physicians even made house calls with their portable ECT machine.

One patient, remarked of his physician:

The doctor was shock happy  — I mean he shocked everybody.  There were about thirty-two people on the ward and only about four were not getting shock treatment.  Or hadn’t got shock treatments.  He thought shock was a miracle treatment.[10]

As with any miracle there was an absence of a specific explanation for its use.  One physician noted that there were dozens of explanations for why ECT worked:

The practice was spectacular and awful to watch: Patients would flail about the table, some breaking their bones, biting their tongues; they would turn bright blue from apnea, and might involuntarily urinate, defecate or ejaculate.  The power wrought on the body and the seemingly complete cure were such that one critic of ECT put it:

Indeed shock therapy is looked upon by many as little short of miraculous, and this modern interest recalls that of medieval minds in results for miracle healing…. The marvelous reports of shock therapy have never been more carefully checked than the marvelous reports of miracles and patent medicines.[11]

The age of miracles was abandoned by 1970 when one optimistic psychiatrist titled his book The Miracle of Shock Treatment, because after One Flew Over the Cuckoo’s Nest (1962) ECT became conceptualized in in terms of punishment, torture, execution and crucifixion.

[1] Luke 8:27-35,

[2] George Rosen, Madness in Society: Chapters in the Historical Sociology of Mental Illness (Chicago: University of Chicago Press, 1968)

[3] Albert Duetsch, The Shame of the States (New York: Harper and Brothers,1948)

[4] William Seabrook, Asylum (New York: Harper & Brothers, 1938 )

[5] Ibid., 147, 209

[6] Ibid. 167-168

[7] “Insanity Treated by Electric Shock,” New York Times July 6, 1940 , 17; Marjorie Van De Water “Electric Shock: A New Treatment,” Science News, 20 July, 1940

[8] Deutsch, ”Mentally Ill in America, p. 449.

[9] Quoted in John Freidberg, Shock Treatment Is Not Good For Your Brain,San Francisco: Glide Publications, 1975,  174

[10]Quoted in Friedberg, 102

[11] John Maurice Grimes,  When Minds Go Wrong ; A Simple Story of The Mentally Ill – Past, Present and Future,    Chicago:  John Maurice Grimes,  n.d 135-141

Thoughts on Electroshock- Part I





Having written the first history of electroshock not written by a practitioner or patient, Push Button Psychiatry ( 2002),  I continue to be fascinated by the media’s re-discovery of this psychiatric tool.    Simon Winchester has written an account of his  treatment of Electro-Convulsive-Therapy in the 1960s see,  and the book review in the Wall Street Journal  led me back to a paper, which I initially wrote in 1995; since  it is unlikely I will ever get around to publishing it I decided to  share excerpts in  this blog.

Part I


Christian Imagery and ECT 1940-Present

In submitting to the shock, the patient is laid on a bed with his arms and legs fastened and held by four attendants; an adhesive covered tongue depressor is placed between the patient’s teeth to prevent biting of the tongue. At the push of a button … the patient instantaneously becomes unconscious, undergoes convulsions and lapses into what resembles a profound sleep 1

Dr. Deutsch has smeared a thick yellowish jelly on his temples. Now he is dripping the padded ends of the forceps into a big bowl of saltwater and the white folds of the gauze over the rubber pads are soaking it up. The dripping forceps are clamped over Bevan’s head, a pad on each temple. A gag is slipped between his teeth; the five attendants bear down on ankles, knees, hands, and shoulders. Dr Deutsch reaches out to the box…. He throws the switch. It happens, what would happen when you throw 110 volts of electricity into a living body. It seems as though it would burst. For fifty Seconds it seems as though it would burst.2

These descriptions provide a glimpse into the psychiatric practice of Electroconvulsive Therapy (ECT), also known as electroshock or shock treatment. The history of this treatment, used on over a million individuals suffering mental disease since its introduction in the United States in 1940, has been
most often written from the perspective of the practitioner and the ex-patient.3 However, these histories tend to overlook the cultural significance of the symbolism evident in descriptions of the treatment. Indeed, literary, medical, and patient narratives contain a number of competing metaphors to describe ECT, including the idea that ECT is a torture or an execution; ECT as an assembly line of psychiatry, or ECT as a procedure equivalent to rebooting the human computer.4

Winchester, himself reaches for this metaphor in his own text.

1 H. Warren Dunham and S. Kirson Weinberg, The Culture of the State Mental Hospital Detroit: Wayne State University Press, 1960, 170.

2M B Ray Doctors of the Mind: What Psychiatry Can Do (Boston: Little Brown & CO 1946), 229

3 Zigmond Lebensohn, “Electroconvulsive Therapy: Psychiatry’s Villain or Hero?” The American Journal of Social Psychiatry IV , 4 Fall 1984, 39-43; but see Timothy Kneeland and Carol Warren, Pushbutton Psychiatry: A History of Electroshock in America (Westport CT: Praeger,2002)

4 ECT as a torture machine see Jack Kerkhouff How Thin the Veil: A Newspaperman’s Story of His Own Mental Crack Up and Recovery (New York: Greenberg, 1952), 10; for ECT as assembly line see Ray Doctors of the Mind, 229 and J Batz “A Kinder Gentler Shock” The Riverfront Times, 21 October, 1996, pp. 9, 15. For the computer metaphor see Patricia Cornwall, Body of Evidence (New York: Avon Books, 1991), 284.

A Landmark for Same-Sex Marriage: Supreme Court update June 26, 2013 -first published on blogspot

This blog reviews the SCOTUS decisions in US v Windsor (DOMA) and Hollingsworth v Perry (Prop 8)- June 26, 2013 and contains a brief review of what happened, why it happened, and what it means for the future.

What Happened


The Defense of Marriage Act  (DOMA) was passed by Congress and signed into law by Bill Clinton in September of 1996.   The act stated that for federal purposes marriage was defined as that between a man and a woman effectively upholding traditional marriage customs, laws and practices.

What propelled this decision were seismic cultural changes that were beginning to make themselves felt by the early 1990s.   To understand the context you would have to recall that as late as the 1970s the American Psychiatric Association declared that homosexuality a mental illness, and that in 1986 the Supreme Court ruled in Bowers v Hardwick that the state of Georgia had a right to uphold sodomy laws which effectively criminalized the intimate relations of same sex couples.   Perhaps the ultimate rejection of a same sex lifestyle came in 1992 the state of Colorado passed amendment 2 which forbid any political subdivision of that state from recognizing gay and lesbian individuals as a protected class.   Arguing that such action violated Equal Protection the case made its way to the Supreme Court as Romer v Evans,  the decision was written by Anthony Kennedy (who also penned US v Windsor) struck down the amendment as not only a violation of Equal Protection it lacked any rationale:  “Its sheer breadth is so discontinuous with the reasons offered for it that the amendment seems inexplicable by anything but animus toward the class that it affects; it lacks a rational relationship to legitimate state interests,” wrote Kennedy.

Fearing, that the decision in Romer would set a precedent for gay rights (which it did)  Congress and the president enacted DOMA.   Romer did indeed set a precedent and led the Supreme Court in Lawrence v Texas (2003) to overturn Bowers which effectively cleared the way for same sex marriage legislation.   This in turn has led to the decision today.

Why it Happened


Ten years after Lawrence, DOMA was held to be unconstitutional in US v Windsor (2013) because it violated the Equal Protection and Due Process guarantees in the Fifth Amendment.  It was also a question of federalism as States have always had the right to regulate, as they saw fit, marriage and marital relations.    Kennedy wrote that “DOMA rejects this long-established precept. The State’s decision to give this class of persons the right to marry conferred upon them a dignity and status of immense import. But the Federal Government uses the state-defined class for the opposite purpose—to impose restrictions and disabilities”  Kennedy explained that “DOMA’s avowed purpose and practical effect are to impose a disadvantage, a separate status, and so a stigma upon all who enter into same-sex marriages made lawful by the unquestioned authority of the States.”  

Dissenters in the case focused more on the question of whether the petitioners had standing in the Court.   However Scalia’s blistering dissent is worth reading for his trenchant criticism of judicial activism.

What it Means for Now the future

In a blistering dissent, Justice Scalia rightly pointed out that the precedent established here, and the language used will lead to challenges in every state that attempts to maintain a traditional marriage.

By formally declaring anyone opposed to same-sex marriage an enemy of human decency, the majority arms well every challenger to a state law restricting marriage to its traditional definition. Henceforth those challengers will lead with this Court’s declaration that there is “no legitimate purpose” served by such a law, and will claim that the traditional definition has “the purpose and effect to disparage and to injure” the “personhood and dignity” of same-sex couples, see ante, at 25, 26.

Updated August 12, 2013

As expected judges across the United States have over the last eight weeks been  applying the ruling to strike  at same-sex marriage laws.  In Cincinnati, a judge suggested that Ohio’s 2004 law banning the recognition of same-sex marriages is likely unconstitutional.

In Michigan, in two separate cases, judges cited the decision in Windsor to strike down laws denying domestic benefits to same-sex couples and to challenge the state’s ban on gay marriage.

At least nine other legal challenges against same-sex marriage have been filed since  the Windsor decision and these could have the effect that justice Scalia keenly perceived.

Meanwhile Minnesota and Rhode Island have passed laws making same-sex marriage legal in their states and more states, including Illinois, New Jersey, and Hawaii may be next.

Thoughts on the Future of Small Museums #mobile-apps #public history

One of my LinkedIn network members, a marketing expert,  shared a story today on how Google Maps is creating new ties to social mobile marketing.  The story led  me to think about the future of smaller, roadside museums.  Especially those that developed at a time when the family road trip was the norm.  Small  museums could always expect to bring in summer-time traffic by catchy billboards or kitschy icons along a state route or interstate.   The days of people loading up the station wagon for the family outing are gone:  families are smaller, gas is higher. and individuals  are more likely to be tied into an adult supervised structured event  in the summer(sports, educational, arts, etc).

What then might the future of commemorative sites, museums, and even roadside historical markers be in an age when few people go to AAA for a trip-ticket that includes guidebooks and physical maps?  Now the traveler is more apt to  check their computer, tablet, android, gps  or smart phone.   Running today, I reflected directly on a specific  small museum in LeRoy, New York called the Jello  Gallery.   Run by the LeRoy Historical Society,  the Jello Gallery, as the name suggests, is  a museum dedicated to preserving the history of Jello, which was invented in Le Roy.   The museum website is useful as it includes a history of Jello, recipes, and links to local lodging.   Taking it a step further, googling  “Jello Museum”  shows that the museum has a presence on  websites such as Trip Advisor, Roadside America, etc .which is a a good start,  but what about other ways to connect with audience?  Why not a mobile app?    Under my role as director of the Center for Public History at Nazareth College, I recently shared on Twitter and LinkedIn the app Historical Mobility which came out of an NEH funded study of best practices on historical sites.  Another good app  is Next Exit History, a mobile App that might  fit with the museum’s existing website.  Such apps could be a push for content and possible draw from visitors.

However, I imagine the best app  would provide content such as historical images, specific histories, and links to social or cultural references that tie into Jello (caveat:  I am thinking Jello shots is a non-starter for a family museum), but also games and activities.   The apps might not even have to be about the food.  For example, there is a strong tie in  between Jello and  Old Time Radio fans, as  the “J-E-L-L-O” jingle was synonymous with the Jack Benny radio program.  Jack Benny owned Sunday nights from the the ’30s through the 1950s.  People who are fans of OTR might find an app that provides them with interesting trivia questions or games .   There is also a strong tie in between the entertainer Bill Cosby and Jello, as Cosby was the Spokesperson for Jello for two decades.      How about a tie in that includes a  trivia game on Cosby’s career?   Even more exciting would be a  Jell0-based strategy  game  —  one of the top free apps is Candy Crush Saga.   How about apps that tie into Food History?  Cookbooks, etc?   How about an app  that ties in the history of jello molds, which once adorned nearly every middle class house in America. How about direct marketing between Kraft Foods, the apps, and the museum?    I think you see the possibilities as much as I do, so I will not belabor them.

Obviously, these are not things that would happen overnight.  Small museums have small budgets, rely on volunteers, and most would not have the human resource personnel to keep the apps up to date across different mobile devices.   However younger volunteers, with a handle on the technology, might well provided the necessary skills to monitor these.    An internship program drawing on the model of  AmeriCorps  could enhance both the museum and the professional skills of post-high school and college graduates  and would be another form of community service.      Worth thinking about anyway…

Reflections on NCPH 2013

The annual NCPH meeting in Ottawa, Ont. Canada was an opportunity for scholars across Europe and the United States to engage in dialogue and to find both commonalities and differences.  CPH was delighted with the chance to discuss Public History with other North Americans and Europeans.  Ottawa was a delightful destination.  The people were friendly, the government buildings accessible, the museums rich and thick.  CPH will have to make more forays into Canada’s capital region to further explore the tremendous cultural resources.

At the NCPH 2013 the Naz_CPH tried an experimental form of public history which seemed to fall short of its mark.  Bringing together non-historian undergraduates students to find what  level of engagement might exist with graduate students and the broader array of “public historians.”    CPH at Naz is still assessing whether we bridged the gap between these communities.  Indeed, since the theme was audience, CPH slyly was wondering at how the non-historian audience would respond to the community which is engaged with a segment of the public, but a “public ” that only constitutes a fraction of the whole.  CPH was disappointed with the results.  Further work needs to be done, but the overall response was that the non-historian participant observers nor the public historians knew what to make of each other.   There is much to consider and unpack but it is clear we still need to define what we mean by “public” when talking about public history.