An up-to-date review of theories of shock therapies: are convulsive shock therapies "moral treatments"?

About four decades ago, empirically developed shock therapies were introduced as treatments for mental disorders. However, there still remains today a wide disagreement as to why these procedures are effective. It has long been known that the behavior in lower animals can be altered by the use of planned psychologcal methods. Likewise psychological procedures (employing such factors as suggestion and fear) had been used by preliterate man all through the ages in the treatment of mental illness. During the past century various types of pre-modern shock therapies using suggestion, fear or excitation were used in different forms. Electricity was the most common form used and favorable effects from its use were reported. These treatments were often referred to as "moral treatment" (as having psychological rather than physical effects). Employing the hypothesis that pharmacologic shock therapies could be categorized mainly as forms of central stimulation or excitation and sedation, the writer used Faradic electric stimulation (similar to currents frequently used in the past century) plus a rapidly acting intravenous drug for sedation. This procedure was used by the writer before he had learned that Cerletti and Bini had advocated the use of electric stimulation to produce immediate convulsions as a substitute for metrazol. The fact that definite improvement was observed with the Faradic stimulation and sedation led the writer to believe that the use of fear and suggestion were likewise the paramount therapeutic factors of modern shock therapy. One should discriminate the fear and anxiety which are frequent symptoms in mental disorders from the fear and anxiety a patient usually shows as he anticipates the treatment as an imminent danger or as a punishment. The purpose of this paper is not to attempt to prove which form ofhock treatment i is best,t rabuher to demonstrate the similarity of the modus peranodi in all forms of shock therapies.