Convulsive therapy

Convulsive therapy emerged because a Hungarian neuropathologist noticed something strange in post-mortem brains: patients with epilepsy had abundant glial cells, while patients with schizophrenia had far fewer. Ladislas Meduna wondered if inducing seizures might somehow correct whatever was wrong in schizophrenia.

The reasoning was speculative, but Meduna was also responding to clinical observations. Reports suggested that the incidence of epilepsy in hospitalized schizophrenia patients was extremely low, and that some schizophrenic patients who developed seizures after infection or head trauma seemed to recover from their psychosis. The biological mechanism was unknown, but the pattern suggested a therapeutic possibility.

Meduna experimented with alkaloids that could induce seizures: strychnine, thebaine, coramine, caffeine, brucin. He settled on camphor dissolved in oil as effective and reliable. On January 23, 1934, in Budapest, he administered the first seizure-inducing injection to a 33-year-old man named Zoltan L. who had catatonic schizophrenia. The patient had been mute and immobile for four years.

The treatment produced dramatic effects. After a course of nine seizures, Zoltan regained speech and mobility. Meduna soon substituted intravenous Metrazol (cardiazol) for camphor, which was more predictable. In 1935, he published his first results: 'An attempt to influence the course of schizophrenia by biologic means.'

Of his first 110 patients, roughly half recovered. Results were much better for patients who had been ill less than a year compared to those who had suffered for many years. Other centers quickly replicated his results, and convulsive therapy became recognized as the first effective treatment for schizophrenia.

In 1938, Italian doctors Ugo Cerletti and Lucio Bini discovered that electrical current could induce seizures more controllably than drugs. Electroconvulsive therapy (ECT) supplanted Metrazol within a decade. Meduna emigrated to Chicago in 1939 as Nazism spread across Europe. He became president of the Society of Biological Psychiatry in 1953 and died in 1964, leaving behind the legacy of convulsive therapy—still among the most effective treatments for severe mental illness.