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Shock Therapy in Danish Psychiatry

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1 German E Berrios, ‘The scientific origins of electroconvulsive therapy: a conceptual history’, Hist. Psychiatry, 1997, 8: 105–19; Roberta Passione, ‘Italian psychiatry in an international context: Ugo Cerletti and the case of electroshock’, Hist. Psychiatry, 2004, 15: 83–104; Max Fink, Electroshock: healing mental illness, 2nd ed., Oxford University Press, 2002.

2 Timothy W Kneeland and Carol A B Warren, Pushbutton psychiatry: a history of electroshock in America, Westport, Praeger, 2002; Jonathan Sadowsky, ‘Beyond the metaphor of the pendulum: electroconvulsive therapy, psychoanalysis and the styles of American psychiatry’, J. Hist. Med. Allied Sci., 2006, 61 (1): 1–25. See also Zigmond M Lebensohn, ‘The history of electroconvulsive therapy in the United States and its place in American psychiatry: a personal memoir’, Compr. Psychiatry, 1999, 40: 170–81.

3 Edward Shorter and David Healy, Shock therapy: a history of electroconvulsive treatment in mental illness, New Brunswick, Rutgers University Press, 2008.

4 Andrew McDonald and Garry Walter, ‘The portrayal of ECT in American movies’, J. ECT, 2001, 17: 264–74; Laura Hirshbein and Sharmalie Sarvananda, ‘History, power, and electricity: American popular magazine accounts of electroconvulsive therapy, 1940–2005’, J. Hist. Behav. Sci., 2008, 44: 1–18; Claire Hilton, ‘Changes between the 1959 and 1983 Mental Health Acts (England & Wales), with particular reference to consent to treatment for electroconvulsive therapy’, Hist. Psychiatry, 2007, 18: 217–29. See also Moacyr Alexandro Rosa, ‘Pacheco e Siva and the origins of electroconvulsive therapy in Brazil’, J. ECT, 2007, 23: 224–8; Paola Bertucci and Giuliano Pancaldi (eds), Electric bodies: episodes in the history of medical electricity, Bologna, CIS, University of Bologna, 2001.

5 Shorter and Healy, op. cit., note 3 above, p. 3.

6 Kitty Dukakis and Larry Tye, Shock: the healing power of electroconvulsive therapy, New York, Avery, 2006; Jan-Otto Ottosson and Max Fink, Ethics in electroconvulsive therapy, New York, Brunner-Routledge, 2004; Richard D Weiner, The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging, 2nd ed., Washington, DC, American Psychiatric Association, 2001.

7 Peter R Breggin, Brain disabling treatments in psychiatry: drugs, electroshock, and the psycho-pharmaceutical complex, 2nd ed., New York, Springer, 2007; Thomas Szasz, Coercion as a cure: a critical history of psychiatry, New Brunswick, Transaction Publishers, 2007, pp. 117–50. See also Robert Whitaker, Mad in America: bad science, bad medicine, and the enduring mistreatment of the mentally ill, New York, Basic Books, 2002, pp. 96–106; Phil Fennell, Treatment without consent: law, psychiatry, and the treatment of the mentally disordered people since 1845, London, Routledge, 1996, pp. 126–47. For older critical studies, see John Friedberg, Shock treatment is not good for your brain, San Francisco, Glide, 1976; Leonard Roy Frank (ed.), The history of shock treatment, San Francisco, L R Frank, 1978; Peter Roger Breggin, Electroshock: its brain-disabling effects, New York, Springer, 1979.

8 Joel Braslow, Mental ills and bodily cures: psychiatric treatment in the first half of the twentieth century, Berkeley, University of California Press, 1997, pp. 95–124. This is, in fact, the only study of ECT where patient records are used in the analysis. Braslow has analysed fifty-nine records of ECT patients from Stockton State Hospital. Braslow's book also contains studies of malaria fever therapy and lobotomy. For other studies of these somatic treatments, see Magda Whitrow, Julius Wagner-Jauregg (1857–1940), London, Smith-Gordon, 1993; Edward M Brown, ‘Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for general paresis of the insane’, Hist. Psychiatry, 2000, 9: 371–82; Lucy Jane King, ‘The best possible means of benefiting the incurable: Walter Bruetsch and the malaria treatment of paresis’, Ann. Clin. Psychiatry, 2000, 12: 197–203; Elliot S Valenstein, Great and desperate cures: the rise and decline of psychosurgery and other radical treatments for mental illness, New York, Basic Books, 1986; Jack D Pressman, Last resort: psychosurgery and the limits of medicine, New York, Cambridge University Press, 1998; Marietta Meir, “‘Soziale Heilung” als Ziel psychochirurgischer Eingriffe. Leukotomie im Spannungsfeld von Individuum, Anstalt und Gesellschaft’, Schweizerische Zeitschrift für Geschichte, 2004, 54: 410–25; Kenneth Ögren and Mikael Sandlund, ‘Psychosurgery in Sweden 1944–1964’, J. Hist. Neurosci., 2005, 14: 353–67; Mical Raz, ‘Between the ego and the icepick: psychosurgery, psychoanalysis, and psychiatric discourse’, Bull. Hist. Med., 2008, 82: 387–420; Zbigniew Kotowicz, ‘Psychosurgery in Italy, 1936–39’, Hist. Psychiatry, 2008, 19: 476–89.

9 Therese Walther, Die Insulin-Koma-Behandlung. Erfindung und Einführung des ersten modernen psychiatrischen Schockverfarhrens in Deutschland, Berlin, Lehmann, 2004; F E James, ‘Insulin treatment in psychiatry’, Hist. Psychiatry, 1992, 3: 221–35; Max Fink, ‘A beautiful mind and insulin coma: social constraints on psychiatric diagnosis and treatment’, Harv. Rev. Psychiatry, 2004, 11: 284–90; Deborah Blythe Doroshow, ‘Performing a cure for schizophrenia: insulin coma therapy on the wards’, J. Hist. Med. Allied Sci., 2007, 62 (2): 213–43.

10 Doroshow, op. cit., note 9 above, p. 223.

11 Ibid., p. 243.

12 David Healy, The creation of psychopharmacology, Cambridge, MA, Harvard University Press, 2002: “It worked in the sense that it had neurological effects. It worked in terms of generating enthusiasm in the staff. And it probably also worked for some ‘psychotic’ conditions by providing some relief of anxiety and some opening and mobilization of personal resources” (p. 55). As evidence of a positive effect of ICT, historians have referred to Max Fink's randomly controlled trial of insulin treatment and chlorpromazine published in 1958. Max Fink, Robert Shaw, George E Gross, and Frederick S Coleman, ‘Comparative study of chlorpromazine and insulin coma therapy in psychosis’, J. Am. Med. Assoc., 1958, 166 (15): 1846–50. For example, Doroshow, op. cit., note 9 above, p. 217. Yet Fink's study was rather small with only twenty-six patients in each set. In the 1950s, the effect of insulin treatment was questioned by Harold Bourne, ‘The insulin myth’, Lancet, 1953, ii: 964–8; Brian Ackner, Arthur Harris and A J Oldham, ‘Insulin treatment of schizophrenia’, Lancet, 1957, i: 607–11; Brian Ackner and A J Oldham, ‘The insulin treatment of schizophrenia. A three-year follow up of a controlled study’, Lancet, 1962, i: 504–6. See also Kingsley Jones, ‘Insulin coma therapy in schizophrenia’, J. R. Soc. Med., 2000, 93: 147–9.

13 Valenstein, op. cit., note 8 above, pp. 48–50; Max Fink, ‘Meduna and the origins of convulsive therapy’, Am. J. Psychiatry, 1984, 141 (9): 1034–41; idem, ‘Induced seizures as psychiatric therapy. Ladislas Meduna's contribution in modern neuroscience’, J. ECT, 2004, 20: 133–6; idem, ‘Once upon a time in Hungary—The story of LászlóMeduna’, Neuropsychopharmacologia Hungarica, 2006, 8: 75–80. See also Shorter and Healy, op. cit., note 3 above, pp. 21–30, 60–6. Two new interesting articles have been published by a team of Hungarian psychiatrists: Gabór Gazdag, Brigitta Baran, Miklós Kárpáti and Zoltán Nagy, ‘The history of Lipótmezö, the site of the first convulsive therapy’, J. ECT, 2007, 23: 221–3; Brigitta Baran, István Bitter, Gabor S Ungvari, Zoltán Nagy and Gábor Gazdag, ‘The beginnings of modern psychiatric treatment in Europe. Lessons from an early account of convulsive therapy’, Eur. Arch. Psychiatry Clin. Neurosci., published online: 27 May 2008, The Hungarian studies reveal that Meduna's often cited account of the outcome of the first shock treatment is incorrect. About this, see the following pages in this article.

14 Niall McCrae, “‘A violent thunderstorm”: Cardiazol treatment in British mental hospitals’, Hist. Psychiatry, 2006, 17: 67–90.

15 Gerald N Grob, The mad among us: a history of the care of America's mentally ill, New York, Free Press, 1994, p. 184.

16 In 1937, a total of 9,985 beds for psychiatric patients existed, 6,940 in the state hospitals; in 1950, 10,638 beds, 7,445 in the state hospitals. Medicinalberetning for Kongeriget Danmark i året 1937, Copenhagen, Hagegrup, 1940, pp. 138–9; Medicinalberetning for Kongeriget Danmark i året 1950, Copenhagen, Hagegrup, 1952, pp. 124–5. On Danish psychiatry, see Jesper Vaczy Kragh (ed.), Psykiatriens historie i Danmark, Copenhagen, Hans Reitzels Forlag, 2008; Jette Møllerhøj, ‘On unsafe ground: the practices and institutionalization of Danish psychiatry, 1850–1920’, Hist. Psychiatry, 2008, 19: 321–37; Mogens Mellergaard, Epoker i dansk psykiatri, Copenhagen, Munksgaard, 2000.

17 The State Mental Hospital in Middelfart (Fuen), Nykøbing Sjælland (Zealand) and Vordinborg (Zealand).

18 The hospital received patients from the capital Copenhagen, the countryside of Zealand and the island of Bornholm. In addition, the hospital had a special ward for wealthy patients.

19 Braslow, op. cit., note 8 above, p. 8. The use of patient records as a source for historians is usually dated back to the article by Erwin Ackerknecht, ‘A plea for a “behaviourist” approach in writing the history of medicine’, J. Hist. Med. Allied. Sci., 1967, 22: 211–14. Since then, a substantial literature on medical history and patient records has been produced: Guenter B Risse and John Harley Warner, ‘Reconstructing clinical activities: patient records in medical history’, Soc. Hist. Med., 1992, 5: 183–205; Steven Noll, ‘Patient records as historical stories: the case of Caswell Training School’, Bull. Hist. Med., 1994, 68: 411–28; Jonathan Edwards, ‘Case notes, case histories, and the patient's experience of insanity at Gartnavel Royal Asylum, Glasgow, in the nineteenth century’, Soc. Hist. Med., 1998, 11: 255–81; Jonathan Gillis, ‘The history of the patient history since 1850’, Bull. Hist. Med., 2006, 80: 490–512.

20 Ladislaus von Meduna, Die Konvulsions- therapie der Schizophrenie, Halle, Carl Marhold, 1937, p. 7. “Zwischen der Epilepsie und der Schizophrenie besteht ein biologischer Antagonismus.” As noted by Berrios, op. cit., note 1 above, p. 108, the idea of an antagonism has not been supported by later research. All translations from German and Danish are by the author.

21 Ladislaus von Meduna, ‘Versuche über die biologische Beeinflussung des Ablaufes der Schizophrenie: Campher- und Cardiazolkrämpfe’, Zeitschrift für die gesamte Neurologie und Psychiatrie, 1935, 152: 235–62.

22 For other examples, see Richard Adams, ‘The treatment that will not die: electroconvulsive therapy’, Psychiatr. Clin. N. Am., 1994, 17: 525–30, pp. 526–7; Max Fink, ‘Convulsive therapy: a review of the first 55 years’, J. Affec. Disord., 2000, 63: 1–15, pp. 1–3; Edward Shorter, A history of psychiatry: from the era of the asylum to the age of Prozac, New York, John Wiley, 1997, pp. 215–16. This story is even referred to in the critical study by Whitaker, op. cit., note 7 above, p. 92.

23 Shorter and Healy, op. cit., note 3 above, p. 27.

24 Ibid., pp. 26–8.

25 Meduna's autobiography is in the Meduna Papers at the University of Illinois Archives. A condensed version in English was published by Max Fink, ‘Autobiography of L. J. Meduna’, Convulsive Ther., 1985, 1: 43–57, and 121–35.

26 Baran, et al., op. cit., note 13 above.

27 Gábor Gazdag, István Bitter, Gábor S Ungvari, Brigitta Baron and Max Fink, ‘LászlóMeduna's pilot studies with camphor inductions of seizures: the first 11 patients’, J. ECT, 2009, 25: 3–11.

28 Personal communication, Gábor Gazdag, 2 July 2008.

29 Baran, et al., op. cit., note 13 above; Gazdag, et al., op. cit., note 27 above. Gazdag has found other discrepancies in Meduna's reports. Four of the first-treated patients were not included in Meduna's 1935 article. In their study of the case notes of the first eleven patients, Gazdag and his co-workers conclude that only three of these patients improved with the treatment.

30 Pressman, op. cit., note 8 above, pp. 96–101.

31 Shorter and Healy, op. cit., note 3 above, p. 43.

32 Valenstein, op. cit., note 8 above, pp. 53–4, and Shorter and Healy, op. cit., note 3 above, pp. 11–21. See also Edward Shorter, ‘Sakel versus Meduna: different strokes, different styles of scientific discovery’ J. ECT, 2009, 25: 12–14.

33 Gretchen J Diefenbach, Donald Diefenbach, Alan Baumeister and Mark West, ‘Portrayal of lobotomy in popular press: 1935–1960’, J. Hist. Neurosci., 1999, 8: 60–9; Hirshbein and Sarvananda, op. cit., note 4, above.

34 Andrew Scull, ‘Somatic treatments and the historiography of psychiatry’, Hist. Psychiatry, 1994, 5: 1–12, p. 2.

35 Charles Rosenberg, ‘The therapeutic revolution: medicine, meaning, and social change in nineteenth-century America’, Perspect. Biol. Med., 1977, 20: 485–506; John Harley Warner, The therapeutic perspective: medical practice, knowledge, and identity in America, 1820–1885, Cambridge, MA, Harvard University Press, 1986.

36 Valenstein, op. cit., note 8 above, p. 50.

37 Katherine Angel, Edgar Jones and Michael Neve (eds), European psychiatry on the eve of war: Aubrey Lewis, the Maudsley Hospital, and the Rockefeller Foundation in the 1930s, Med. Hist., Suppl. No. 22, London, Wellcome Trust Centre for the History of Medicine at UCL, 2003, p. 142.

38 Victor Hahnemann, ‘Kliniske Erfaringer efter 1 Aars Behandling af Psykoser med S. K. Cardiazolchok’, Ugeskrift for Læger, 1939, 101: 771–9, p. 779: “et værdifuldt Middel til Behandling ikke blot af Skizofreni, men ogsaa af Stemningspsykoserne”.

39 Manfred Sakel, Neue Behandlungsmethode der Schizophrenie, Vienna, Moritz Perles, 1935, p. 111. See also, Doroshow, op. cit., note 9 above, pp. 2–3; James, op. cit., note 9 above, p. 221.

40 Otto Jul Nielsen, ‘Hypoglykæmien i Neurologien og Psykiatrien’, Hospitalstidende, 1937, 80: 47–53.

41 Otto Jul Nielsen, ‘Insulin- og Cardiazolbehandlingen ved Schizofreni’, Ugeskrift for Læger, 1938, 109: 80–5; Gudmund Magnussen, ‘Om Insulinbehandlingen, dens Grundlag og fysiologiske Virkemaade’, Ugeskrift for Læger, 1939, 110: 1467–75.

42 Kolonien Filadelfias, Dianalund, Museum og Arkiv (Museum and Archive of the Hospital Kolonien Filadelfia in Dianalund), ‘H. I. Schous dagbog 1921–1946’, 31 Dec. 1938: “Sindssygebehandlingen har gjort det store Fremskridt, at vi for første Gang har faaet en effektiv Behandling nemlig Chokbehandling med Insulin og Cardiazol. Selvom vi ikke kender de blivende Resultater, er dog dette, at vi kan fremkalde et totalt Omslag i Psykosen i gunstig Retning noget saa overraskende og glædeligt, at det giver et helt nyt Perspektiv påvor Gerning. Hvor vi før kun registrerede og behandlede symptomatisk, er det nu, som om vi rammer ætiologien og kan kurere. Det er som et Mirakel!”

43 Villars Lunn, ‘Dansk Psykiatrisk Selskab 1908–1983’, Nordisk Psykiatrisk Tidsskrift, supplement 1985, 39: 7–103.

44 Psykiatrisk Historisk Museum, Risskov (Psychiatric History Museum in Risskov), Dansk Psykiatrisk Selskab, Journalsager, No. 94, ‘Medlemsmøder 1936–1957’.

45 ‘Report on the seventh congress of Scandinavian psychiatrists held in Oslo, Norway, 1938’, Acta Psych. Neurol., Scand., 1938, 13. The fear patients had of Cardiazol shock therapy was not recognized in the Danish peer review literature of the late 1930s. In the 1940s, however, it was mentioned in some of the psychiatric textbooks. Erik Strömgren, Psykiatriske Behandlingsmetoder, Copenhagen, Ejnar Munksgaard, 1941, p. 10.

46 Oringe Arkiv, Vordingborg (Archives of the Hospital Oringe in Vordingborg) (hereafter OAV), Patientjournaler, Mænd (patient records, males), No. 9,446: “I den sidste Tid har jeg faaet ca. 5-7 Indsprøjtninger med noget der hedder Cardiazol. Det bliver indsprøjtet i en Vene … inden i højre Albueled. Det er noget nyt siger Dr. Hahnemann. Det har en meget stærk Virkning, helt forskellig fra alt Andet, hvad jeg hidtil har været indsprøjtet med. Ca. 10 Sekunder efter man har faaet Injektionen, bliver man med ét ligesom rykket ud af sig selv ind i en anden Verden, men dog ser man de omkringstaaende ligesom i en vandklar Taage. Der er aldeles ulideligt og fuldkommen umuligt at komme ud af. Sommetider er Virkningen stærkere, sommetider svagere; naar den er stærk, bliver man hallucineret (ser syner). Stuen man ligger i kommer til at ligne Helvede og man ligesom brændes af en usynlig Ild. Det er meget uhyggeligt. Men nu er det heldigvis forbi”.

47 Villars Lunn, Afsind: påsporet af en uvirkelighed, Copenhagen, Gyldendal, 1987, p. 107: “Det hændte, at vi, tit fire mand høj, bogstavelig talt med magt måtte nedkæmpe patientens modstand—for de efterfølgende minutter at bivåne hendes pinefulde angst, før krampeanfaldet udløstes”.

48 OAV, Patientjournaler, Kvinder (patient records, females), No. 18,834, 14,918 and 18,945: “saa angst for Muligheden for at hun igen skulle have Chok, at hun har raabt højt fra tidligt i morges, tømt Sengen og truet med at rive Haaret af Afdelingslægen”.

49 C Fürstner, ‘Über delirium acutum’, Archiv für Psychiatrie und Nervenkrankheiten, 1881, 5: 505–43. Delirium acutum was also called Bell's mania. S H Kraines, ‘Bell's mania’, Am. J. Psych., 1934, 91: 29–40. See also Dimitros Adams, Adrian Treloar, Finbarr C Martin and Alastair J D Macdonald, ‘A brief review of the history of delirium as a mental disorder’, Hist. Psychiatry, 2007, 18: 459–69.

50 Erik Strömgren, Psykiatriske Behandlingsmetoder, 2nd ed., Copenhagen, Ejnar Munksgaard, 1944, p. 26.

51 OAV, Patientjournaler, Kvinder, No. 18,834: “overvældende Angst for Cardiazolbehandling”. “love at opføre sig behersket”.

52 OAV, Patientjournaler, Kvinder, No. 12,312: “Man aftalte ved sidste Chok, at hun skulle opgive sin Ceremoni ved Maaltider, og at hun efter at have været paa Toilettet skulle tørre sig med Toiletpapir”. “nogen som helst Fremgang hverken med paaklædning, spisning eller toilette”.

53 OAV, Patientjournaler, Mænd, No. 11,609: “han var meget ked af at have Chok, og man foreholdt ham saa i gaar, at hvis han ville arbejde på Værkstedet, skulle han ikke have flere Chok. Dette gjorde sin Virkning, og han har i gaar og i dag arbejdet flinkt påVærkstedet”.

54 OAV, Patientjournaler, Kvinder, No. 13,731: “havde i Dag påtænkt Cardiazol Chok, men hun er meget bange for Behandlingen, beder om at blive fri. Man afstaar da fra Behandlingen paa den Betingelse, at hun i Eftermiddag skriver et Julekort til sine Forældre”.

55 For a detailed Danish study of psychogenic psychoses, see August Wimmer, Psychogenic psychoses, Adelaide, Adelaide Academic Press, 2003.

56 Jens Christian Smith, Psykiatriske Forelæsninger, Copenhagen, Ejnar Munksgaard, 1939, pp. 222–5; Paul Reiter, Om Psykopather, Copenhagen, Ejnar Munksgaard, 1946, p. 143.

57 OAV, Patientjournaler, Kvinder, No. 14,406, 15,297, 15,565.

58 OAV, Patientjournaler, Kvinder, No. 15,297. “Vredladen, truende. Forsøgsvis: Cardiazol Shock”. The woman had previously had malaria fever therapy but did not obtain full remission.

59 The main categories in Danish psychiatry were: schizophrenia, manic-depressive psychosis, pre-senile and senile psychosis, cerebrovascular disease, neurosyphilis, epilepsy, psychogenic psychosis, neurosis, psychopathia, mental deficiency, alcoholism, and drug addiction. In his study of ECT, Joel Braslow has pointed to a similar procedure at Stockton State Hospital. Braslow, op. cit., note 8 above, pp. 102–3.

60 OAV, Patientjournaler, Kvinder, 28,803 and 30,152. “paa grund af hendes Epilepsi maa Chokbehandling formentlig anses for kontraindiceret (28,803). “De sidste par Dage noget urolig, vredladen og aggressiv. Chok-behandling” (30,152).

61 OAV, Patientjournaler, Kvinder, 8,562: “8:20 første Cardiazol Injection 50 ctgr. Efter 13 Sekunder toniske og kloniske Kramper, der varer 62 Sekunder, dyb bevidstløshed”. “8:02, anden Cardiazol Injection, 50 ctgr., efter 10 Sekunder toniske og kloniske Kramper, 60 Sekunder”. “Rolig siden Cardiazolkuren. Oppe hele Dagen, strikker flittigt, maa dog endnu mades”. “Rolig, kan være oppe, beskæftiges med strikning”. “larmende, vredladen, aggressiv”.

62 OAV, Patientjournaler, Mænd, 10,733: “rolig, renlig, spiser godt, læser Avis”. “De første 14 Dage efter Cardiazolkuren havde Patienten det godt”, “blev derpaa urolig”.

63 OAV, Patientjournaler, Mænd, 12,050: “Paa Grund af en kolossal Trang til iturivning af Tøjet, Chokbehandling”.

64 OAV, Patientjournaler, Mænd, 33,563: “kniber saa meget med at samle Tankerne”. “ønsker meget at blive Cardiazolbehandlet”. “lidt bedre”, “lidt ængstelig”.

65 OAV, Patientjournaler, Kvinder, No. 11,048: “det hjælper at faa Indsprøjtninger hver anden Dag. Det klarer Tankerne saa godt”.

66 OAV, Patientjournaler, Mænd, No. 12,696: “jeg blev klar over, at noget skulde hjælpe mig til at blive rask… jeg var saa glad”.

67 OAV, Patientjournaler, Mænd, No. 14,902: “den gode Behandling, jeg har modtaget paa Vordingborg Hospital”. “baade legemligt og sjæleligt”.

68 Hahnemann, op. cit., note 38 above, p. 771.

69 Beretninger om Sct. Hans Hospital og Statens Sindssygehospitaler i 1938, Copenhagen, Centraltrykkeriet, 1939, p. 1. Rigsarkivet (Danish State Archives) (hereafter RA). Direktoratet for Statshospitalerne (hereafter DS), Journalsager, I4, 1941/42, G 304.

70 Jette Møllerhøj, ‘Sindssygdom, dårevæsen og videnskab. Asyltiden 1850–1920’, in Kragh (ed.), op. cit., note 16 above, pp. 88–119.

71 Betænkning afgivet af kommissionen af 29. marts 1952 vedrørende Statens sindssygevæsen, Copenhagen, Centraltrykkeriet, 1956, p. 148.

72 Frode Krarup and Aage Tune Jacobsen, Vejledning i Sindssygepleje, Copenhagen, H Hagerup, 1920; Alexander Friedenreich, Kortfattet, speciel Psykiatri, Copenhagen, H Hagerup, 1921; Marie Anchersen, Forelæsninger over Sindssygdom og Sindssygepleje, Viborg, F V Backhausen, 1924.

73 Strömgren, op. cit., note 50 above, p. 13. Futhermore, many Danish psychiatrists had reservations about Freud's work. See Finn Korsaa, ‘Psykoanalysen i Danmark’, Psyke og Logos, 1989, 10: 182–222; R Jensen and H Paikin, ‘On psychoanalysis in Denmark’, Scand. Psychoanal. Rev., 1980, 3: 103–16.

74 A Wimmer, Speciel klinisk Psykiatri, Copenhagen, Ejnar Munksgaard, 1936, p. 361; Smith, op. cit., note 56 above, p. 137; Erik Strömgren, ‘Status pået psykiatrisk hospital’, Ugeskrift for Læger, 1955, 117: 221–5. A census of 1957 reported that 62.2 per cent of the inmates in the state hospitals had schizophrenia. K Arentsen and E Strömgren, ‘Patients in Danish psychiatric hospitals: results of a census in 1957, Acta Jutlandica, 1959, 31: appendix tables 1a and 1b.

75 On schizophrenia and Danish psychiatry, see Lise østergaard, En psykologisk analyse af de formelle schizofrene tankeforstyrrelser, Copenhagen, Munksgaard, 1962. The notion of schizophrenia has also been noted by Richard Warner, Recovery from schizophrenia, 2nd ed., London, Routledge, 1994: “Scandinavian psychiatrists have tended to use a rather narrow definition of schizophrenia in an attempt to adhere to Kraepelin's emphasis on poor outcome” (p. 11).

76 Beretning til Indenrigsministeren om Statens Sindssygehospitaler afgiven af Direktøren for Statens Sindssygehospitaler 1936/37, Copenhagen, Centraltrykkeriet, 1938, pp. 274–5. In this report, a 1937 survey of the state hospitals shows that 2,568 of 5,569 beds were placed in disturbed wards.

77 Arild Faurbye and Ruth Poort, ‘Columfraktur ved Krampebehandling af Psychoser’, Ugeskrift for Læger, 1942, 104: 1019–22. Higher rates of fractures of up to 40 per cent were reported in American and Dutch articles. McCrae, op. cit., note 14 above, p. 77.

78 RA, DS, Journalsager, K1, 1941/42, G 304.

79 H Christiansen, J C Smith, G Magnussen, et. al., ‘Report on insulin and Cardiazol shock therapy from the Danish Psychiatric Society’, Acta Psychiatrica et Neurologica, 1942, 17: 217–97, pp. 290–3. In studies from other countries the mortality associated with Cardiazol therapy varied from 0.3,per cent to 1.6 per cent. McCrae, op. cit., note 14 above, p. 77.

80 RA, DS, Journalsager, S8, 1952/54, G 530. The hospital in Vordingborg to the Directorate, 24 Aug. 1951.

81 Complaints were settled by the Directorate of the State Mental Hospitals. Only one case in 1949, a complaint about Cardiazol therapy, was taken to court, but this did not lead to regulations regarding the therapy.

82 RA, DS, Overlægemøder 1926–47, K4, Meeting 14 July 1938.

83 Ibid. “den billigste og mest praktiske Løsning for Hospitalet i Vordingborg”.

84 RA, DS, Journalsager, I4, 1942/43, G 322, ‘Udgifter til specialundersøgelser af patienter med hjertelidelser der underkastes insulin-eller Cardiazolbehandling’.

85 RA, DS, Journalsager, O8, 1943/44, G 351, Meeting 27 Jan. 1941. At the meeting, the chief physicians reported on the use of electrocardiography. Yet three of the hospitals did not examine all patients before ICT and Cardiazol therapy, testing only those who were more than forty-five years old.

86 RA, DS, Journalsager, I4, 1942/43, G 322, ‘Insulin’ 1939/40, nr. 2a.

87 Christiansen, et al., op. cit., note 79 above, p. 219.

88 Ibid., p. 222.

89 In 1938–39, Benjamin Malzberg and later Horatio M Pollock carried out large studies of Cardizol therapy and ICT using control groups. See Gerald N Grob, Mental illness and American society, 1875–1940, Princeton University Press, 1983, pp. 301–2.

90 Lunn, op. cit., note 47 above, pp. 105–6: “Vi husker vist alle spændingen … Og så sprang bomben: komplet symptomfrihed mere end fire måneder efter behandlingens afslutning var iagttaget hos fire skizofrene patienter”. “Et antiklimaks, en iskold douche”.

91 Christiansen, et al., op. cit., note 79, above, p. 261.

92 Ibid., p. 290.

93 McCrae, op. cit., note 14 above, p. 78.

94 E Gothen, ‘Erfaringer med curare præmedication og efterkur ved shockterapi’, Ugeskrift for Læger, 1950, 112: 1243–6.

95 J Heshe, ‘Elektrochokbehandling’, Nordisk Psykiatrisk Tidsskrift, 1965, 19: 490–9. About “sux”, see G Holmberg and S Thesleff, ‘Succinyl-choline-iodide as a muscular relaxant in electroshock therapy’, Am. J. Psychiatry, 1952, 108 (11): 842–6, and Shorter and Healy, op. cit., note 3 above, pp. 128–30.

96 Strömgren, op. cit., note 45 above, p. 17: “medføre midlertidige Forandringer”, ”men næppe kan ændre Forløbet pålængere Sigt”.

97 Jesper Vaczy Kragh, ‘Elektrochok, psykiatri og historie’, Ugeskrift for Læger, 2005, 167: 4750–2; idem, ‘Sidste udvej? Træk af psykokirurgiens historie’, Dansk Medicinhistorisk årbog, 2007, 35: 9–36. Lobotomy was introduced in Denmark in 1939, ECT in 1940. The state hospitals began using ECT in 1943.

98 Betænkning 1. Afgivet af Udvalget af 26. november 1943. Betimeligheden af Opførelse af nye Sindssygehospitaler i Nordjylland og paa Sjælland, Copenhagen, Centraltrykkeriet, 1944; Betænkning 2 afg. af Udvalget af 26. Nov. 1943 ang. Betimeligheden af Opførelse af nye Sindssygehospitaler i Nordjylland og paa Sjælland, Copenhagen, Centraltrykkeriet, 1945.

99 Betænkning afgivet af Udvalget af 23. November 1945 ang. Hospitalisering af Sindssyge på Fyn og i det sydlige Jylland, Copenhagen, Centraltrykkeriet, 1948, p. 30: “erstatte fortidens golde forvaringsprincipper med moderne behandlingsmåder og omskabe hospitalerne til det, de bør være: virkelige helbredelses-anstalter”.

100 Aalborg Stifttidende, 14 Nov. 1946: “sindssygdommenes behandling i de sidste ti år har undergået en gennemgribende forvandling”.

101 Folketingets Forhandlinger, no. 3. 1946–47, p. 261: “store fremskridt”, “fordringerne til de moderne behandlinger”.

102 RA, DS, Journalsager, D1, 1945/46, G 390, ‘Forslag til lov om ombygning af Sindssygehospitalet i Viborg, Opførelse af et nyt Sindssygehospital i Brønderslev og udvidelse af Sindssygehospitalet ved Aarhus’.

103 Beretninger til Indenrigsministeren om Statens Sindssygehospitaler 1942/43, Copenhagen, Centraltrykkeriet, 1943, p. 4. RA, DS, Journalsager, I4, 1943/44, G 322. Expenses for electricians and ECT machines were covered by the Ministry of the Interior as well as the cost of lobotomy operations carried out by neurosurgical departments in Copenhagen and Aarhus.

104 See papers by Møllerhøj, notes 16 and 70 above.

105 Anon., ‘Apropos somatisk behandling af psykiske lidelser’, Ugeskrift for Læger, 1949, 111: 1001: “det er uomtvisteligt, at psykiatrien i øjeblikket er den mest ekspansive af de medicinske discipliner”. “klinisk psykiatri har gjort store fremskridt”. “betydningsfulde bidrag”.

106 Vagn Askgaard, et. al., ‘Det nye sindssygehospital’, Ugeskrift for Læger, 1949, 111: 1431: “har nødvendiggjort et stadigt nærmere samarbejde mellem psykiatrien og de øvrige lægevidenskabelige specialer”.

107 Anon., ‘Betænkning vedrørende undervisningen i psykiatri ved de lægevidenskabelige fakulteter i København og århus’, Ugeskrift for Læger, 1949, 111: 789–92, p. 790. As in many other countries, neurosis was a widely discussed topic in Denmark, and demands for special institutions for these patients were put forward in the press and in medical journals. Bjørn Hamre, ‘Pulter-kammerdiagnoser, rentehysteri og kristen sjælesorg’, in Edith Mandrup Rønn and Inger Hartby (eds), Det forrykte menneske. Den psykisk syge i historien ca. 1830–1980, Ebeltoft, Skipperhoved, 2006, pp. 153–84. See also Petteri Pietikainen, Neurosis and modernity: the age of nervousness in Sweden, Leiden, Brill, 2007. On the mental health movement in Denmark, see T Hansen, A Christensen, and P Triantafillou, ‘Da selvudvikling blev en del af den psykiatriske behandlingspraksis i Danmark’, Bibliotek for Læger, 2006, 198: 216–42.

108 årbog for Københavns Universitet indeholdende meddelelser for de akademiske år 1953–58, Copenhagen, 1961, pp. 372–3.

109 Betænkning, op. cit., note 71 above, p. 115.

110 Merete Bjerrum, ‘Fra stat til amt. Dansk hospitalspsykiatri 1930–1976’, in Kragh (ed.), op. cit., note 16 above, pp. 223–62.

111 Cardiazol Shock therapy was still used in some hospitals in the 1950s, mostly on patients who refused to have or did not respond to ECT. In the sample of medical records in Vordingborg a female patient was, for instance, treated with Cardiazol in August 1951. OAV, Patientjournaler, kvinder, 16,735.

112 Pressman, op. cit., note 8 above, p. 183.

113 Shorter and Healy, op. cit., note 3 above, pp. 60–76.

114 Edgar Jones, Shahina Rahman and Robin Woolven, ‘The Maudsley Hospital: design and strategic direction, 1923–1939’, Med. Hist., 2007, 51: 357–78, p. 378; Edgar Jones and Shahina Rahman, ‘Framing mental illness, 1923–1939: the Maudsley Hospital and its patients’, Soc. Hist. Med., 2008, 21: 107–25, pp. 120–1; Richard C Keller, ‘Taking science to the colonies: psychiatric innovation in France and North Africa’, in Sloan Mahone and Megan Vaughan (eds), Psychiatry and empire, London, Palgrave Macmillan, 2007, pp. 41–66, p. 28; Shorter, op. cit., note 22 above, p. 216. See also Angel, et al. (eds), op. cit., note 37 above, p. 13.

115 Shorter and Healy, op. cit., note 3 above, p. 65.

116 McCrae, op. cit., note 14 above, p. 77.

117 Faurbye and Poort, op. cit., note 77 above; Christiansen, et al., op. cit., note 79 above; Poul Hedegaard and Niels Hjerrild, ‘Some cerebral complications in shock therapy’, Acta Psychiatrica et Neurologica, 1945, 20: 167–84.

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Medical History
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