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Tuesday, 20.08.2019

Max Fink’s comment on Jay Amsterdam’s comment on Edward Shorter’s comment
Barry Blackwell: The Baby and The Bath Water

(Dear Jay,)

 

ICT was developed on the same philosophical grounds of ECT, the fever-neurosyphilis spirochaete-antagonism theory that dominated WWI thinking and enabled the 1927 Nobel in Medicine for Wagner Jauregg.  

I came to ICT and ECT on January 2, 1952, on the first day of my fifth year of neurology/psychiatry residency at age 29. On day one I was introduced to ECT and to a 22-bed-ICT unit for service during the next three months. After the residency I accepted a position to manage this unit and went on to organize the hospital’s Department of Experimental Psychiatry in 1954. 

ICT was the main Rx for “schizophrenia.”   Treatments were daily for up to 50 comas.  The treatments were difficult, seizures frequent, prolonged coma a threatening risk, death on two occasions. Spontaneous hypoglycemic induced seizures were frequent, estimated as 20% of comas. If patients were not improving, we often added an ECT seizure 3x/week.

CPZ appeared in 1954 and in 1956 we established a proper RCT of ICT vs high dose CPZ.  Our articlein JAMA(Fink et al.1958) reported an equivalent efficacy with less toxicity, less morbidity, less cost for CPZ.  Late in 1958 we closed the ICT unit and the air-conditioned space became the site for the Department of Experimental Psychiatry. Don Klein joined the unit and we collaborated on the CPZ-IMI-Placebo RCT studies. 

ICT was an inefficient method of seizure therapy. Induced seizures are a most remarkable method to relieve melancholia (not MDD or BAD), catatonia (not schizophrenia), delirious mania.  It is the seizure, not any aspect of the electricity, that elicits the benefits of the Rx.  The best explanation is the neuroendocrine one outlined in 1980.

 

The Nobelist John Nash was treated with ICT at Trenton State Hospital in 1961. The book and film “A Beautiful Mind” portrayed the treatment and illness poetically and correctly.  Thinking about this experience led me to see the seizures considered side-effects of ICT as the main agent of the benefits, the same outcomes as ECT.  ICT is best seen as an inefficient form of induced seizure therapy (Fink 2003).

            In the march of medical history, induced seizures are an unheralded, stigmatized, poorly studied but extremely effective relief used increasingly worldwide.  It is the most effective treatment for the severely ill, those in catatonic stupor, delirious mania, life-threatening melancholia, and malignant catatonia.

 

(All the best.

Max)

 

Fink M, Shaw RG, Gross G and Coleman FS.  Comparative study of Chlorpromazine and insulin coma in the therapy of psychosis. J. Amer. Med. Ass., 1958; 166: 1846-1850.

Fink M. A Beautiful Mind and insulin coma: social constraints on psychiatric diagnosis and treatment. Harvard Review of Psychiatry 2003; 11: 284-290.

 

May 31, 2018