Introduction to Electroconvulsive Therapy: History and Legal Aspects

1. A Self-guided,
Learning activity, about
Electro-Convulsive Therapy: author: Johagen
Descartes Li, M.D.
Health Sciences Clinical Professor
University of California, San Francisco
descartes.li@ucsf.edu
History and legal
issues

2. Objectives
• Know that Meduna, Cerletti, and
Kalinowsky developed ECT and led its
introduction to the U.S. in 1940.
• Realize that ECT is specifically regulated
by California Law, AB1032.
• Understand that ECT requires
documentation by two Board-certified
psychiatrists or neurologists.
• Know that a detailed explanation of ECT
must occur 24 hours before consent form
can be signed
By the end of this independent learning
activity, the learner will:

3. History of ECT
1932: Ladislas Meduna
observed cell over- and under-
growth in brains of patients with
epilepsy and schizophrenia, resp.
1933: Animal trials to
find medication that
could reliably induce
seizures
1934: First trial of
camphor induced
seizures in humans
Ladislas J. Meduna (1896–
1964), Hungarian neurologist
and neuropathologist,
http://en.wikipedia.org/wiki/Ladislas_J._Meduna

4. History of ECT
1934: Camphor
replaced by
pentylenetetrazol
(Metrazol)
1938: Ugo Cerletti
and Lucio Bini use
electricity to
stimulate seizures.
Ugo Cerletti (1877-1963) Italian neurologist
http://en.wikipedia.org/wiki/Ugo_Cerletti

5. History of ECT
1940: Kalinowsky introduces ECT to
the U.S.
Lothar B. Kalinowsky (1899 –1992)
In my opinion, these
first ECT practitioners
were rather freaky
looking.

6. Current practice of ECT
We have an elective in ECT!

7. Current practice of ECT
UCSF Ambulatory Surgery Center

8. Electro-Convulsive Therapy
About 50,000 people receive ECT
each year.
The number of ECT procedures
performed in the U.S. exceeds
coronary bypass, appendectomy or
hernia repair.
American Psychiatric Association Committee on Electroconvulsive Therapy. The
Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training,
and Privileging. 2nd ed. Washington, DC: American Psychiatric Association; 2001.

9. ASC Reception and Waiting
Room

10. Legal Issues: California
1977 – Assembly Bill 4481,
severely restricts use of ECT in
California
[Legal challenge by Association for
Convulsive Therapy, led to
replacement by less restrictive
AB1032]

11. Legal Issues: California
1982 – Berkeley, California passes
referendum:
administration of ECT punishable by a fine of
$500 or 6m in prison.
[Later reversed by Alameda County Superior
Court]
1991 – San Francisco Board of Supervisors
passes a resolution against the use or
financing of ECT
[this resolution has little practical effect]

12. Legal Issues:
ECT in California
•Regulated by State law
•Requires documentation by two BC
psychiatrists [or neurologists] every 30 days
• Detailed explanation of procedure must
occur 24 hours before consent form can be
signed

13. Legal Issues:
ECT in California
• Family must be notified, or notification of
family must be specifically rejected by the
patient
• Banned for minors less than 12

14. Summary
• Meduna developed seizure treatments for
schizophrenia
• Cerletti developed ECT
• ECT is specifically regulated by California
Law, AB1032.
• ECT requires documentation by two
Board-certified psychiatrists or
neurologists.
• Detailed explanation of ECT must occur 24
hours before consent form can be signed

15. Sherwin Nuland, M.D., on ECT