Medical and general reports and accounts for the year ended 31st December, 1944 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1945?]
Catalogue details

Licence: In copyright

Credit: Medical and general reports and accounts for the year ended 31st December, 1944 : Present Address: Ash Hall, Bucknall, Stoke-on-Trent (from Swaylands, Penshurst, Kent) / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

    7/22 (page 3)
    preliminary investigations and a subsequent period of psychotherapy, which we consider essential. The average number of treatments administered for each patient in the whole group was 7.8. Nature of Control Group In contrasting these results with those which were obtained in cases of depression before shock therapy was instituted, it is necessary to bear in mind that the Cassel Hospital has not been in a position to TABLE 2 or inaccessible to treatment, or suicidal. Many cases of depression had therefore formerly to be discharged unimproved because they were not considered suitable for retention in the hospital. Some of these were referred to mental hospital, others returned home. The 75 patients in the control group represent the cases of mild depressive psychoses which were actually retained for treatment during the years 1938 and 1939. These are a more carefully selected, more favourable group than the shock therapy series. Results are shown in Table 2. 75 Selected Cases of Depression Treated Without Shock Therapy Much Improved Improved Not Improved Total 40 19 16 75 Percentage 53.3% 25.3% 21.4% 100% Mean duration of stay in hospital—26 weeks (approx.) CONCLUSION The conclusion which appears inescapable is that the use of electric shock therapy has rendered depressive psychosis a much less devastating disorder than formerly. It now responds to active treatment rather than to custodial care, with all the difference in outlook which that change implies. It appears equally obvious that unless there is a definite incidence of serious complications, the question must be not whether the treatment should be administered but whether in a given case there is any legitimate reason for withholding it. COMMENT The rapid recovery rate in states of depression treated by electric shock treatment is so high that the few complete or partial failures occurring become rather conspicuous. A survey of these cases (18 in all) shows that definite factors played a part in the unsatisfactory response to the treatment. In six patients the selective influence of electric shock treatment on the depressive element in the illness was clearly shown. It was equally clear that other underlying difficulties were but little influenced. Three of the six showed a life-long background of maladjustment in a psychopathic direction (alcoholism, homosexuality) and three an admixture of schizoid reactions. Two of these patients were later admitted to mental hospitals with a diagnosis of schizophrenia. On admission the depression was the most outstanding element and had overshadowed the underlying grave personality disorder. It is not surprising that shock treatment did not have a permanent or complete effect. In a group of six patients the treatment had to be prematurely interrupted. On four occasions this was due to the development of confusional states which will be further discussed under the heading of “Complications.” One patient refused further treat¬ ment after she had had three and in one case rising blood pressure prevented further treatment. Three patients showed a very satisfactory response to treatment—the depression disappeared—but these three patients had to leave for domestic reasons immediately after the treatment was completed and before a proper psychological approach had been possible; we therefore did not feel justified in classifying these patients as much improved. In the remaining three patients there were none of these factors—no serious underlying personality disorder, no premature interruption of treatment, no premature discharge from hospital—and yet no response to the treatment. It is interesting to note that two out of these three were true manic de- pressives who had had in the past a number of both depressive and manic episodes. Both had once benefited by shock treatment—but failed to benefit by it a second time. The last of these presented a typical recurrent depression without manic episodes. Personality, between attacks was well preserved and no explana¬ tion can be offered for the failure of treatment in this case. 3