Looking Back on Electroconvulsive Treatment

Posted on February 25, 2026

The history of ECT as psychiatrists and neurologists evaluated its use and effectiveness since the early 1900s.

By Peter J. Koehler

Last year, I received an antique electroconvulsive treatment (ECT) device for placement in the museum of the Dutch Trefpunt Medische Geschiedenis Nederland [Meeting Point Medical History, the Netherlands]. It was probably produced in the 1950s by a Dutch company called Elther, likely a contraction of “electric therapy.”

Looking at the small but heavy device, I wondered when and how neuropsychiatrists began working with it. What happened in the 1970s? Is it still used today? This article will examine the possible answers to those questions.

Shock Therapies

Electric shock apparatus with control panel, built in the Netherlands, probably in the 1950s (9 kg, dimensions 21x23x36 cm).

In previous issues, we covered several so-called somatic therapies applied by neuropsychiatrists, including malaria fever therapy and insulin coma therapy (ICT). Both of these therapies were introduced in the 1920s, but there were more to come.

Medical historian Edward Shorter mentions them in his book, “A Short History of Psychiatry.” Sleep therapy was among the first somatic therapies, and it was soon followed by various shock and coma treatments, and then lobotomy.1 ICT had been introduced by Austrian Manfred Sakel (1900-1957) soon after the discovery of insulin in 1922. He published a monograph in 1934.2,3

About that time, another shock therapy was introduced by the Hungarian neuropathologist and neuropsychiatrist Ladislas Meduna (1896-1964), who worked at the Brain Research Institute in Budapest, which was founded by Károly Schaffer (1864-1939). It was a chemically induced shock therapy. It used Metrazol/Cardiazol (pentylenetetrazol), which produced convulsions without coma.

Both types of shock therapies, insulin and Metrazol, soon disappeared and were replaced by ECT. In the meantime, the first publications on prefrontal leucotomy by António Egas Moniz (1874-1955) appeared in 1936.4

Top row, left to right: Manfred Sakel (© National Library of Medicine). Ladislav Meduna (public domain). Elizabeth Garrett Anderson (1836-1917) (© Wellcome Collection).
Bottom: Ugo Cerletti (public domain). Lothar B. Kalinowsky (© University Hospital Charité, Berlin).

Electrotherapy of the Central Nervous System

Today, when talking about the use of electricity in the treatment of conditions affecting the central nervous system, most neurologists will think of deep brain stimulation (DBS) for Parkinson’s disease. Its history was discussed in the article, Brain Stimulation for Psychiatric Indications Preceded Movement Disorders, in the May/June 2016 issue of World Neurology.

Electricity, however, has been applied as therapeutic option for several centuries. It had been applied for paralysis5 and headache6, but also for migraine. Elizabeth Garrett Anderson (1836-1917), England’s first female physician, advised it in her doctoral thesis, Sur la Migraine.7,8 Conditions that today we would call functional neurological disorders were also treated by electrotherapy.9

In psychiatry, cranial electrotherapy was already applied for melancholy in the 18th century. (Franklin and Ingenhousz on Cranial Electrotherapy, World Neurology, March 2016.)  In the late 19th century, however, the German neuropsychiatrist Paul Julius Möbius (1853-1907) pioneered the idea that curative effects of electrotherapy, in which he also wrote about its peripheral use, were based on suggestion.10

Prototype of the Cerletti-Bini electroshock device (©Museo di Storia della Medicina della Sapienza, Rome).

Convulsions Elicited by Electricity

If you have the opportunity to visit Rome, you might want to include a tour of the Museo di Storia della Medicina della Sapienza at the University of Rome. There you will find the Cerletti-Bini device for ECT. The Italian neuropsychiatrist Ugo Cerletti (1867-1963) and his student Lucio Bini (1908-1964) introduced ECT in 1938.

Cerletti had studied under neurologist Giovanni Mingazzini (1859-1929), whom we know from the Mingazzini test,11 and worked with Nobel Laureate Camillo Golgi (1843-1926).12 As a medical student, Cerletti also worked with Franz Nissl (1860-1919) in Heidelberg and as a postgraduate student with Emil Kraepelin (1856-1926) in Munich.

During his research on epilepsy in Genoa, where he had become director of the Neuropsychiatric Clinic in the early 1930s, Cerletti applied electricity to dogs to elicit seizures. After moving to Rome in 1935, he and his residents compared insulin coma, Metrazol shock, and electric shock, continuing his Genoa research.

Bini showed that electricity delivered on a dog’s temples was safe. He also experimented on pigs in a slaughterhouse and found that there was a wide margin between lethal and convulsive doses. After some hesitation, Cerletti and his residents began applying it to patients. Following several unsuccessful previous attempts, they were able to induce an epileptic seizure in a schizophrenic patient with good results, at least temporarily with respect to his psychotic episodes.13,1 Although side effects were observed, including muscle tears, jaw luxation, vertebral fractures, and memory loss, they decreased with the use of muscle relaxants and the use of shorter current pulses.14

Diffusion From Italy: Forced Emigration

Interestingly, the spread of pharmacological shock (insulin and Metrazol) and electroshock therapies was accompanied by the forced emigration of Jewish physicians and scientists by National Socialism.15 Sakel left Vienna to go to New York in 1936; Meduna left Budapest and emigrated to Chicago in 1939.

Neurologist Lothar B. Kalinowsky (1899-1992), working at Charité hospital in Berlin, had to leave Berlin and went to Rome, where he got an unpaid job at Cerletti’s clinic to study ECT (1935).16 He was able to provide some income through a partnership in Bini’s patents. However, when the Pact of Friendship and Alliance (Pact of Steel) between Nazi Germany and Fascist Italy was signed in 1939, Kalinowsky also had to leave Rome. Via France, the Netherlands, and England, he finally arrived in New York. Along the way, he presented his experience to colleagues.

In the Netherlands, for example, he helped introduce ECT to neuropsychiatrist Johannes Barnhoorn (1899-1975), who wrote: “Through his kind mediation, on behalf of Prof. Bini, I received from the Arcioni company in Milan full details of the equipment, while Prof. Cerletti requested one of his assistants, who happened to be in our country, to provide me with all the information I required. The latter, Dr. Kalinowski [sic], informed us of various technical details and of the results achieved up to that time.”

Kalinowsky told Barnhoorn that approximately 1,500 ECT procedures had been performed in Rome without complications. Even one year after treatment, no adverse effects had been observed. Pathological examination of dogs treated with ECT had shown no microscopic changes.

Barnhoorn started with ECT in July 1939 and reported on 23 patients in January 1940. “The therapeutic results cannot yet be judged of,” he wrote. However, he was able to mention a number of advantages above pharmacologic convulsion treatment. “Apparently the method is innocuous.”15,17 Kalinowsky presented his experiences in January 1940 at a meeting of the Royal Society of Medicine in London. He later moved to Columbia University in New York.

ECT in the Antipsychiatry Period

Film still showing ECT application in the early 1900s. The full films are: Convulsive Shock Therapy in Affective Psychoses: Digital Collections, National Library of Medicine. Recent Modifications of Convulsive Shock Therapy: Digital Collections, National Library of Medicine.

The term “antipsychiatry” usually refers to a movement in the 1960s and 1970s in which there was both professional and public criticism of psychiatric diagnoses and treatments. It was part of a broader social protest against forms of authority that threatened individual development. Although it also began after the introduction of antipsychotics in the 1950s, it led to continued deinstitutionalization of patients.

The 1960s saw the publication of several books that had a significant impact on the academic and public imagination of psychiatry. These include:

  • “The Divided Self” by British psychiatrist Ronald D. Laing (1927-1989)
  • “Madness and Civilization” by French philosopher Michel Foucault (1926-1984)
  • “The Myth of Mental Illness” by the Hungarian Thomas Szasz (1920-2012)
  • “Asylums” by Canadian sociologist Erving Goffman (1922-1982)

Perhaps the most important book was the novel “One Flew Over the Cuckoo’s Nest” by the American author Ken Kesey (1935-2001). It was made into a movie directed by Miloš Forman (1932-2018) in 1975, with Jack Nicholson playing the role of antihero Randle P. McMurphy. The movie won five Oscars.1 Although the film was released 50 years ago, a digital reissue appeared more recently, receiving a positive critical response: “A thrilling acting duel, a great ensemble: As an actors’ film, ‘One Flew Over the Cuckoo’s Nest’ remains a timeless masterpiece.”18

The antipsychiatry movement had a significant effect that led to a temporary decrease in ECT. “The antipsychiatrists charged that ECT damaged the brain, that it was used as a form of discipline rather than therapy, and that it was therapeutically useless in any event.”1 Indeed, in the film mentioned above, ECT is portrayed as a punishment for deviant behavior. The protest by lay groups against the use of ECT led to legislation in some U.S. states. In California, for instance, it was practically banned in 1974. In the Netherlands, the public commotion about ECT led to Parliamentary questions in the late 1970s about the abolition of treatment.14

Rehabilitation of ECT in the 1980s

A committee set up by the Dutch Health Council in 1983 concluded that ECT should be maintained. The committee ruled it was a safe and effective treatment, but it should only be used as an ultimum refugium in cases of severe depression or severe catatonia.14  Likewise, the British Royal College of Psychiatrists published guidelines concluding that ECT was an effective treatment for endogenous depression.19

One of the advocates of rehabilitation of ECT in the U.S. was neuropsychiatrist Max Fink (1923-2025) who believed in the superiority of this treatment over antidepressants. The American Psychiatric Association reported in favor of the use of ECT in 1990.1

In 2018, the U.S. Food and Drug Administration (FDA) considered all of the scientific data, along with more than 3,400 submissions and concluded that ECT is “safe and effective.” Moreover, they said that further trials were not needed to confirm this for patients with severe depression and catatonia.

A recent article concluded: “It is astonishing that, after more than 80 years, no other treatment for depression has been developed that is the equivalent of ECT” and that “the precise mechanism of ECT is not yet fully unraveled.”20

References

  1. Shorter E. A history of psychiatry. From the era of the asylum to the age of Prozac. New York, Wiley, 1997.
  2. Sakel M. Schizophreniebehandlung mittels Insulin-Hypoglykämie sowie hypoglykämischer Shocks. Wiener medizinische Wochenschrift 1934; 84: 1211-4.
  3. Sakel M. Neue Behandlungsmethode der Schizophrenie [A New Method of Treating Schizophrenia]. Wien, Perles, 1935.
  4. Kotowicz Z. Gottlieb Burckhardt and Egas Moniz–two beginnings of psychosurgery. Gesnerus. 2005;62(1-2):77-101
  5. Finger S. Benjamin Franklin, electricity, and the palsies: on the 300th anniversary of his birth. Neurology. 2006 May 23;66(10):1559-63.
  6. Lutters B, Koehler PJ. De elektrische behandeling van hoofdpijn [Electrotherapy for headaches]. Ned Tijdschr Geneeskd. 2016;160: D191.
  7. Koehler PJ, Boes CJ. A history of nondrug treatment in headache, particularly migraine. Brain. 2010 Aug;133(Pt 8):2489-500.
  8. Garrett E. Sur la migraine. Thèse. Paris: Faculté de la médicine; 1870.
  9. McWhirter L, Carson A, Stone J. The body electric: a long view of electrical therapy for functional neurological disorders. Brain. 2015 Apr;138(Pt 4):1113-20.
  10. Steinberg H. Electrotherapeutic disputes: the ‘Frankfurt Council’ of 1891. Brain. 2011 Apr;134(Pt 4):1229-43.
  11. Koehler PJ. The Barré and Mingazzini tests. In: Koehler PJ, Bruyn GW, Pearce JMS. Neurological Eponyms. New York, Oxford University Press, 2000, pp. 119-26.
  12. Golgi C. The impossible interview with the man of the hidden biological structures. Interview by Paolo Mazzarello. J Hist Neurosci. 2006 Dec;15(4):318-25.
  13. Aruta A. Shocking waves at the museum: the Bini-Cerletti electro-shock apparatus. Med Hist. 2011 Jul;55(3):407-12.
  14. Verschoor ME, Lutters BTH. Psychiatrie onder hoogspanning [The history of electroconvulsive therapy in the Netherlands]. Ned Tijdschr Geneeskd. 2023 Nov 8;167: D7758
  15. Rzesnitzek L, Lang S. A Material History of Electroshock Therapy: Electroshock Technology in Europe until 1945. NTM. 2016 Sep;24(3):251-277
  16. Rzesnitzek L. ‘A Berlin psychiatrist with an American passport’: Lothar Kalinowsky, electroconvulsive therapy and international exchange in the mid-twentieth century. Hist Psychiatry. 2015 Dec;26(4):433-51.
  17. Barnhoorn JAJ. Mededeelingen over de toepassing van de convulsietherapie door middel van electroshock. Nederlands tijdschrift voor geneeskunde 1940; 84:290–300.
  18. ‘One Flew over the Cuckoo’s Nest’ is 50: een slijtvast acteerduel in de psychiatrische kliniek – NRC
  19. The Royal College of Psychiatrists’ Memorandum on the use of Electroconvulsive Therapy. Part 1-Effectiveness of ECT-a review of the evidence. Br J Psychiatry. 1977 Sep; 131:261-8.
  20. Kirov G, Jauhar S, Sienaert P, Kellner CH, McLoughlin DM. Electroconvulsive therapy for depression: 80 years of progress. Br J Psychiatry. 2021 Nov;219(5):594-597.