In the popular imagination, electroconvulsive therapy (ECT) is a violent affair. Many people immediately think of One Flew Over the Cuckoo's Nest, in which Jack Nicholson's character violently convulses on a gurney while nurses attempt to hold him down after an electric current passes between electrodes strapped to the sides of his head. Though advancements have now made ECT an effective and painless treatment for mental illnesses, that wasn't always the case. ECT often induced bone-breaking convulsions before sedatives were widely used, for example.
In one particularly dark period of its history, the technique was used not as a treatment for the mentally ill, but as a form of torture. A paper published this week in History of Psychiatry documents a case in which ECT was embraced by at least one Nazi doctor as a tool to murder unsuspecting mentally ill patients.
ECT was invented in 1938 by two Italian researchers, Ugo Cerletti and Lucio Bini. By then, scientists already knew that inducing seizures could alleviate some symptoms of mental illness, but the drugs that doctors used to bring on seizures also gave patients a strong feeling of terror before the seizure set in. Cerletti and Bini were looking for a more humane treatment, and so they experimented with an electric current to induce seizures in a schizophrenic man; after nine treatments, the man was improved enough to reunite with his wife and return to work. It quickly spread throughout Europe and the United States as a new and effective therapy for mental illness.
The practice of killing off "incurable" patients continued until Germany was defeated in 1945.
Shortly thereafter, in October of 1939, Adolf Hitler signed a decree that authorized German doctors to euthanize psychiatric patients deemed incurable. Between 1939 and 1941, tens of thousands of patients were killed at psychiatric hospitals. Though the program officially ended in 1941 thanks to public outcry, the practice of killing off "incurable" patients continued until Germany was defeated in 1945.
At first, ECT was primarily considered purely a weapon of treatment in Nazi Germany. "The Nazi political and medical establishment regarded ECT favourably, as the early, overoptimistic reports promised a very effective treatment," the authors write. "ECT was expected to help to empty psychiatric institutions, thereby relieving the state of the burden of looking after psychiatric patients and freeing up hospital beds for wounded soldiers." But many psychiatrists actively participated in the extermination of treatment-resistant patients, and "none with more murderous enthusiasm than Dr. Emil Gelny," the authors note.
When Gelny took control of psychiatric hospitals in Gugging and Mauer-Öhling, Austria, in 1943 and 1944, he used lethal doses of drugs like morphine, hyoscine, and barbiturates to kill incurable patients at first. But with those drugs becoming increasingly scarce, Gelny added four extra electrodes to existing ECT machines, which were attached to patients' wrists and ankles to deliver the lethal shocks after patients were knocked unconscious by the initial current applied to the head. "Besides its easy availability and cost-effectiveness, a further important factor was that ECT could be camouflaged as a medical procedure to reduce patients' suspicion, at a time when many correctly feared that drugs were used to kill them," the authors write.
It's unclear exactly how many people Gelney murdered with ECT at Gugging and Mauer-Öhling. The death tolls at the two hospitals topped 2,100 and 2,700 respectively, though most patients still likely died from overdoses or neglect and malnutrition. "Yet Gelny's horrific abuse has cast a long shadow on ECT," the researchers write. Indeed, ECT's violent past fueled the anti-psychiatry movement in the late 20th century. "In this way," the authors write, "Gelny's crime continues to have a negative impact on patients' lives today."