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  • I'd like to do pretty much what I did the first time,

  • which is to choose a light-hearted theme.

  • Last time, I talked about death and dying.

  • This time, I'm going to talk about mental illness.

  • But it has to be technological,

  • so I'll talk about electroshock therapy. (Laughter)

  • You know, ever since man had any notion

  • that some of his other people, his colleagues,

  • could be different, could be strange, could be severely depressed

  • or what we now recognize as schizophrenia,

  • he was certain that this kind of illness

  • had to come from evil spirits getting into the body.

  • So, the way of treating these diseases

  • in early times was to, in some way or other,

  • exorcise those evil spirits, and this is still going on, as you know.

  • But it wasn't enough to use the priests.

  • When medicine became somewhat scientific, in about 450 BC,

  • with Hippocrates and those boys,

  • they tried to look for herbs, plants

  • that would literally shake the bad spirits out.

  • So, they found certain plants that could cause convulsions.

  • And the herbals, the botanical books of up to the late Middle Ages,

  • the Renaissance are filled with prescriptions

  • for causing convulsions to shake the evil spirits out.

  • Finally, in about the sixteenth century,

  • a physician whose name was Theophrastus Bombastus Aureolus von Hohenheim,

  • called Paracelsus, a name probably familiar to some people here --

  • (Laughter) -- good, old Paracelsus

  • found that he could predict the degree of convulsion

  • by using a measured amount of camphor to produce the convulsion.

  • Can you imagine going to your closet, pulling out a mothball, and

  • chewing on it if you're feeling depressed?

  • It's better than Prozac, but I wouldn't recommend it.

  • So what we see in the seventeenth, eighteenth century

  • is the continued search for medications other than camphor that'll do the trick.

  • Well, along comes Benjamin Franklin,

  • and he comes close to convulsing himself

  • with a bolt of electricity off the end of his kite.

  • And so people begin thinking in terms of electricity to produce convulsions.

  • And then, we fast-forward to about 1932,

  • when three Italian psychiatrists, who were largely treating depression,

  • began to notice among their patients, who were also epileptics,

  • that if they had an epileptic -- a series of epileptic fits,

  • a lot of them in a row -- the depression would very frequently lift.

  • Not only would it lift, but it might never return.

  • So they got very interested in producing convulsions,

  • measured types of convulsions.

  • And they thought, "Well, we've got electricity, we'll plug somebody into the wall.

  • That always makes hair stand up and people shake a lot."

  • So, they tried it on a few pigs, and none of the pigs were killed.

  • So, they went to the police and they said,

  • "We know that at the Rome railroad station,

  • there are all these lost souls wandering around,

  • muttering gibberish. Can you bring one of them to us?"

  • Someone who is, as the Italians say, "cagoots."

  • So they found this "cagoots" guy,

  • a 39-year-old man who was really hopelessly schizophrenic,

  • who was known, had been known for months,

  • to be literally defecating on himself,

  • talking nothing that made any sense,

  • and they brought him into the hospital.

  • So these three psychiatrists, after about two or three weeks of observation,

  • laid him down on a table,

  • connected his temples to a very small source of current.

  • They thought, "Well, we'll try 55 volts, two-tenths of a second.

  • That's not going to do anything terrible to him."

  • So they did that.

  • Well, I have the following from a firsthand observer,

  • who told me this about 35 years ago,

  • when I was thinking about these things

  • for some research project of mine.

  • He said, "This fellow" -- remember, he wasn't even put to sleep --

  • "after this major grand mal convulsion,

  • sat right up, looked at these three fellas and said,

  • 'What the fuck are you assholes trying to do?' "

  • (Laughter)

  • If I could only say that in Italian.

  • Well, they were happy as could be, because he

  • hadn't said a rational word in the weeks of observation.

  • So they plugged him in again,

  • and this time they used 110 volts for half a second.

  • And to their amazement, after it was over,

  • he began speaking like he was perfectly well.

  • He relapsed a little bit, they gave him a series of treatments,

  • and he was essentially cured.

  • But of course, having schizophrenia,

  • within a few months, it returned.

  • But they wrote a paper about this,

  • and everybody in the Western world began using electricity

  • to convulse people who were either schizophrenic or severely depressed.

  • It didn't work very well on the schizophrenics,

  • but it was pretty clear in the '30s and by the middle of the '40s

  • that electroconvulsive therapy was very, very effective

  • in the treatment of depression.

  • And of course, in those days, there were no antidepressant drugs,

  • and it became very, very popular.

  • They would anesthetize people,

  • convulse them, but the real difficulty was

  • that there was no way to paralyze muscles.

  • So people would have a real grand mal seizure.

  • Bones were broken. Especially in old, fragile people,

  • you couldn't use it.

  • And then in the 1950s, late 1950s, the so-called muscle relaxants

  • were developed by pharmacologists,

  • and it got so that you could induce a complete convulsion,

  • an electroencephalographic convulsion -- you could see it on the brain waves --

  • without causing any convulsion in the body except a little bit of twitching of the toes.

  • So again, it was very, very popular and very, very useful.

  • Well, you know, in the middle '60s,

  • the first antidepressants came out. Tofranil was the first.

  • In the late '70s, early '80s, there were others,

  • and they were very effective.

  • And patients' rights groups seemed to get very upset

  • about the kinds of things that they would witness.

  • And so the whole idea of electroconvulsive, electroshock therapy disappeared,

  • but has had a renaissance in the last 10 years.

  • And the reason that it has had a renaissance

  • is that probably about 10 percent of the people, severe depressives,

  • do not respond, regardless of what is done for them.

  • Now, why am I telling you this story at this meeting?

  • I'm telling you this story, because actually ever since

  • Richard called me and asked me to talk about

  • -- as he asked all of his speakers --

  • to talk about something that would be new to this audience,

  • that we had never talked about, never written about,

  • I've been planning this moment.

  • This reason really is that I am a man who, almost 30 years ago,

  • had his life saved by two long courses of electroshock therapy.

  • And let me tell you this story.

  • I was, in the 1960s, in a marriage. To use the word bad

  • would be perhaps the understatement of the year.

  • It was dreadful.

  • There are, I'm sure, enough divorced people in this room

  • to know about the hostility, the anger, who knows what.

  • Being someone who had had a very difficult childhood,

  • a very difficult adolescence --

  • it had to do with not quite poverty but close.

  • It had to do with being brought up in a family where no one spoke English,

  • no one could read or write English.

  • It had to do with death and disease and lots of other things.

  • I was a little prone to depression.

  • So, as things got worse, as we really began to hate each other,

  • I became progressively depressed over a period of a couple of years,

  • trying to save this marriage,

  • which was inevitably not to be saved.

  • Finally, I would schedule -- all my major surgical cases,

  • I was scheduling them for 12, one o'clock in the afternoon,

  • because I couldn't get out of bed before about 11 o'clock.

  • And anybody who's been depressed here knows what that's like.

  • I couldn't even pull the covers off myself.

  • Well, you're in a university medical center,

  • where everybody knows everybody, and it's perfectly clear to my colleagues,

  • so my referrals began to decrease.

  • As my referrals began to decrease,

  • I clearly became increasingly depressed

  • until I thought, my God, I can't work anymore.

  • And, in fact, it didn't make any difference

  • because I didn't have any patients anymore.

  • So, with the advice of my physician,

  • I had myself admitted to the acute care psychiatric unit of our university hospital.

  • And my colleagues, who had known me since medical school

  • in that place, said, "Don't worry, chap. Six weeks,

  • you're back in the operating room. Everything's going to be great."

  • Well, you know what bovine stercus is?

  • That proved to be a lot of bovine stercus.

  • I know some people who got tenure in that place with lies like that.

  • (Laughter)

  • So I was one of their failures.

  • But it wasn't that simple. Because by the time

  • I got out of that unit, I was not functional at all.

  • I could hardly see five feet in front of myself.

  • I shuffled when I walked. I was bowed over.

  • I rarely bathed. I sometimes didn't shave. It was dreadful.

  • And it was clear -- not to me,

  • because nothing was clear to me at that time anymore --

  • that I would need long-term hospitalization

  • in that awful place called a mental hospital.

  • So I was admitted, in 1973, in the spring of 1973,

  • to the Institute of Living, which used to be called the Hartford Retreat.

  • It was founded in the eighteenth century,

  • the largest psychiatric hospital in the state of

  • Connecticut, other than the huge public hospitals

  • that existed at that time.

  • And they tried everything they had.

  • They tried the usual psychotherapy.

  • They tried every medication available in those days.

  • And they did have Tofranil and other things -- Mellaril, who knows what.

  • Nothing happened except that I got jaundiced from one of these things.

  • And finally, because I was well known in Connecticut,

  • they decided they better have a meeting of the senior staff.

  • All the senior staff got together, and I later found out what happened.

  • They put all their heads together and they decided

  • that there was nothing that could be done

  • for this surgeon who had essentially separated himself from the world,

  • who by that time had become so overwhelmed,

  • not just with depression and feelings

  • of worthlessness and inadequacy,

  • but with obsessional thinking,

  • obsessional thinking about coincidences.

  • And there were particular numbers that every time I saw them,

  • just got me dreadfully upset -- all kinds of ritualistic observances,

  • just awful, awful stuff.

  • Remember when you were a kid, and you had to step on every line?

  • Well, I was a grown man who had all of these rituals,

  • and it got so there was a throbbing, there was a ferocious fear in my head.

  • You've seen this painting by Edvard Munch,

  • The Scream. Every moment was a scream.

  • It was impossible. So they decided there was no therapy,

  • there was no treatment. But there was one treatment,

  • which actually had been pioneered at the Hartford hospital in the early 1940s,

  • and you can imagine what it was. It was pre-frontal lobotomy.

  • So they decided -- I didn't know this, again,

  • I found this out later --

  • that the only thing that could be done was

  • for this 43-year-old man to have a pre-frontal

  • lobotomy.

  • Well, as in all hospitals, there was a resident

  • assigned to my case. He was 27 years old,

  • and he would meet with me two or three times a week.

  • And of course, I had been there, what, three or four months at the time.

  • And he asked to meet with the senior staff, and they agreed to meet with him

  • because he was very well thought of in that place.

  • They thought he had a really extraordinary future.

  • And he dug in his heels and said,

  • "No. I know this man better than any of you. I have met with him over and over again.

  • You've just seen him from time to time. You've read reports and so forth.

  • I really honestly believe that the basic problem here is pure depression,

  • and all of the obsessional thinking comes out of it.

  • And you know, of course, what'll happen if you do a pre-frontal lobotomy.

  • Any of the results along the spectrum,

  • from pretty bad to terrible, terrible, terrible

  • is going to happen. If he does the best he can,

  • he will have no further obsessions,

  • probably no depression, but his affect will be dulled,

  • he will never go back to surgery,

  • he will never be the loving father that he was to his two children,

  • his life will be changed. If he has the usual result,

  • he will end up like 'One Flew Over the Cuckoo's Nest.'