Electroconvulsive therapy

Electroconvulsive therapy emerged in 1938 Rome from an unlikely source: the city's Testaccio slaughterhouse. There, Ugo Cerletti observed something that contradicted medical assumptions—pigs stunned with electrical current across their temples did not die, even after prolonged application. They simply lost consciousness and then recovered. This observation would transform psychiatric treatment.

The adjacent possible for ECT had been building through the 1930s. Ladislas Meduna had demonstrated that chemically-induced seizures could relieve symptoms of schizophrenia, using metrazol (a cardiac stimulant) to trigger convulsions. But metrazol therapy was terrifying for patients, who experienced intense fear during the minutes between injection and seizure. The treatment also produced unpredictable, violent convulsions that sometimes broke bones. Psychiatrists sought a more controllable method.

Cerletti and his assistant Lucio Bini reasoned that if seizures themselves were therapeutic, electricity might offer a safer, more precise way to induce them. At the slaughterhouse, Cerletti learned that the key was electrode placement—current delivered across the temples affected only the brain, not the heart. Back at the Clinic for Nervous and Mental Disorders at the University of Rome, Bini designed an apparatus that could deliver precisely calibrated electrical pulses.

On April 21, 1938, they treated their first patient: a mute man with paranoid schizophrenia found wandering the streets of Naples. The treatment was controversial from the start—after the first shock, the patient reportedly said "Not another one! It's deadly!" But after eleven sessions, his symptoms resolved completely.

ECT spread with remarkable speed through the psychiatric world, demonstrating competitive exclusion in medical practice. Within two years, it had reached Britain and the United States, almost entirely displacing metrazol therapy because it was cheaper, less frightening, and more controllable. Bini patented the apparatus in October 1938, and the original prototype is now displayed at the Sapienza Museum of the History of Medicine in Rome.

The therapy's subsequent history illustrates the complexity of medical path dependence. ECT became associated with psychiatric abuse in the mid-20th century, depicted negatively in films like "One Flew Over the Cuckoo's Nest." Yet research consistently showed its effectiveness for severe depression, and modified versions with anesthesia and muscle relaxants eliminated the dramatic physical convulsions. Today, ECT remains the most effective treatment for treatment-resistant depression, a direct descendant of what Cerletti observed in the Rome slaughterhouse.

Cerletti and Bini were nominated for the Nobel Prize but never received it. Their invention remains the only somatic therapy from the 1930s still in clinical use—insulin coma therapy and lobotomy have been abandoned, while ECT continues to evolve.