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PSYCHOTHERAPY: THEORY, RESEARCH AND PRACTICE

VOLUME 8, #1, SPRING, 1971

FROM THE SLAUGHTERHOUSE TO THE MADHOUSE


THOMAS S. SZASZ
State University of New York
Syracuse, N. Y.

I the psychiatric "therapeutics" of "mental ill-


Like all widely-shared beliefs with impor- ness."
tant social consequences, the belief in "mental This brief note is intended to review the or-
illness" as a medical disorder is embedded in igin of one such discovery-that of electric
our language, supported and reflected by it. shock treatment; and to suggest that this pro-
Thus, we call problems in living "mental ill- cedure is paradigmatic of the interventions of
nesses"; individuals who consult psychiatrists Institutional Psychiatry: based on force and
or are compelled to submit to them by force or fraud,. and justified by "medical necessity,"
fraud are "mental patients," their complaints the prime purpose of psychiatric treatments-
or the complaints of others about them are whether utilizing drugs, electricity, surgery, or
"mental symptoms," and the conditions im- confinement, especially if imposed on uncon-
puted to them that allegedly "cause" and "ex- senting clients-is to authenticate the subject
plain" their conduct are "mental diseases" as a "patient," the psychiatrist as a "doctor "
( among these, "schizophrenia" occupies an es- and the intervention as a form of "treatment'."
pecially important position); we call psychiat- The cost of this fictionalization runs high: it
ric inquiries, whether invited by consenting requires the sacrifice of the patient as a per-
clients or imposed on them against their will, son; of the psychiatrist as a critical thinker
"diagnoses," and psychiatric interventions and moral agent; and of the legal system as a
"treatments"; finally, we call the setting in protector of the citizen from the abuse of state
which psychiatric encounters take place "med- power, (Szasz, 1963).
ical offices," "clinics," and "hospitals." And
since we even have a National Institute of II
Mental Health it is easy to see why the right- The Italian psychiatrist Ugo Cerletti is
thinking person considers it unthinkable that credited with the introduction of electroshock
there might be no such thing as mental health therapy into psychiatry. In an essay on the
or mental illness. If that were so, we would be discovery of this treatment, he described the
the victims of our own folly, (Szasz, 1961). work that led to its development as follows:
No! It is better that we maintain, and if nee- "Vanni informed me that at the slaughterhouse in
essary, fortify our fictions. Rome hogs were killed by electric current. Such infor-
Many illustrious physicians have labored, mation seemed to confirm my doubts regarding the
and continue to labor, on strengthening the danger of electric applications to man. I went to the
medical fiction of mental illness: the result is slaughterhouse to observe this so-called electric
slaughtering, and I saw that the hogs were clamped at
the very real fortress that is Institutional Psy- the temples with big metallic tongs which were
chiatry, (Szasz, 1970). As I showed in The hooked up to an electric current (125 volts). As soon
Manufacture of Madness, (Szasz, 1963), the as the hogs were clamped by the tongs, they fell un-
most highly esteemed psychiatrists are those conscious, stiffened, then after a few seconds they
were shaken by convulsions in the same way as our
who have forged the best weapons for defend- experimental dogs. During this period of unconscious~
ing and broadening the justifications for the ness ( epileptic coma), the butcher stabbed and bled
medical claims and pretensions of their profes- the animals without difficulty. Therefore, it was not
sion. Their "discoveries"-from unchaining true that the animals were killed by the electric cur-
rent: the latter was used, at the suggestion of the So-
t b e m~~11;anht~ shockin~, lobohtomhi~ing, and ciety for the Prevention of Cruelty to Animals, so
tranqm 11zmg 1m-const1tute t e 1story of that the hogs might be killed painlessly.
64
FROM THE SLAUGHTERHOUSE TO THE MADHOUSE 65
It occurred to me that the hogs of the slaughter- too low voltage. It was proposed that we should al-
house could furnish the most valuable material for low the patient to have some rest and repeat the ex-
my experiments. And I conceived, moreover, the idea periment the next day. All at once, the patient, who
of reversing the former experimental procedure : while evidently had been following our conversation, said
on dogs my aim had been the use of minimal quantity clearly and solemnly, without his usual gibberish:
of current capable of inducing a seizure without harm 'Not another one! It's deadly!'
to the animal, I now decided to establish the time I confess that such explicit admonition under such
duration, voltage, and the method of application that circumstances, and so emphatic and commanding,
would be necessary to produce the death of the ani- coming from a person whose enigmatic jargon had
mal. Electric current would therefore be applied until then been very difficult to understand, shook my
through the skull, in different directions, and through determination to carry on with the experiment. But it
the trunk for several minutes. My first observation was just this fear of yielding to a superstitious notion
was that the animals rarely died, and then only when that caused me to make up my mind. The electrodes
the duration of electric current flowed through the were applied again, and a 110-volt discharge was ap-
body and not through the head. The animals that re- plied for 0.2 seconds'' (Cerletti, 1956).
ceived the severest treatment remained rigid during
the flow of the electric current, then after a violent III
convulsive seizure they would lie on their sides for a
while, sometimes for several minutes, and finally they Like all honest self-disclosures, Cerletti's
would attempt to rise. After many attempts of in- account of his discovery of electric shock
creasing efficiency, they would succeed in standing up treatment is perhaps more revealing than he
and making a few hesitant steps until they were able
to run away. These observations gave me convincing
realized or would have wished. I shall list cer-
evidence of the harmlessness of a few tenths of a sec- tain facts mentioned by Cerletti, and some in-
ond of application through the head of a 125-volt ferences based on them, which seem to me
electric current, which was more than sufficient to in- particularly significant.
sure a complete convulsive seizure. 1. Electroshocking of hogs was an empiri-
At this point I felt we could venture to experiment
on man, and I instructed my assistants to be on the cally discovered method for tranquilizing and
alert for the selection of a suitable subject. subduing the animals, so that they could be
On April 15, 1938, the Police Commissioner of butchered without the excitement and squeal-
Rome sent a man to our Institute with the following ing which they normally exhibit.
note: 'S.E., 39 years old, engineer, resident of Milan,
was arrested at the railroad station while wandering 2. The first human being on whom elec-
about without a ticket on trains ready for departure. troshock was tried was a man, identified only
He does not appear to be in full possession of his by his initials, "S.E.," by his occupation, "en-
mental faculties, and I am sending him to your hospi- gineer," by the city of his residence, "Milan,"
tal to be kept there under observation .... ' The con- and, significantly, by the psychiatric diagnosis
dition of the patient on April 18 was as follows: lu-
cid, well-oriented. He describes with neologisms deliri- attached to him, "schizophrenia."
ant ideas of being telepathically influenced with re- 3. S.E. was a complete stranger to Cerletti,
lated sensorial disturbances; his mimicry is correlated whose help he did not seek (and whose inter-
to the meaning of his words; mood indifferent to en- vention he later rejected). In actuality, S.E.
vironment, low affective reserves; physical and neuro-
logic examination negative; presents conspicuous hy- was a prisoner: he had been "arrested" by the
pacusic and cataract in L.E. A diagnosis of schizo- police for "wandering about," and instead of
phrenic syndrome was made based on his passive be- being tried for his offense, he was sent to Cer-
havior, incoherence, low affective reserves, hallucina- letti.
tions, deliriant ideas of being influenced, neologisms. 4. Although sent to the hospital expressly
This subject was chosen for the first experiment of
induced electric convulsions in man. Two large elec- "for observation," Cerletti flagrantly dis-
trodes were applied to the frontoparietal regions, and obeyed the instructions of the Police Commis-
I decided to start cautiously with a low-intensity cur- sioner of Rome: instead of observing S.E., he
rent of 80 volts for 0.2 seconds. As soon as the cur- used him as an experimental subject for elec-
rent was introduced, the patient reacted with a jolt
and his body muscles stiffened; then he fell back on troshock.
the bed without loss of consciousness. He started to 5. Cerletti does not mention having ob-
sing abruptly at the top of his voice, then he quieted tained permission for his experiment from
down. anyone. It would appear that having received
Naturally, we, who were conducting the experiment
were under great emotional strain and felt that we
the prisoner from the police, Cerletti immedi-
had already taken quite a risk. Nevertheless, it was ately regarded him as his "patient" and him-
quite evident to all of us that we have been using a self as the sole judge of the sort of "treat-
66 THOMAS s. SZASZ
ment" his "patient" should have. Thus Cer- they administered the first electric convulsion
letti writes that "we, who were conducting the to man, described above.
experiment, were under great emotional strain In Cerletti's obituary, Ferrucio di Cori
and felt that we had already taken quite a ( 1963) appraised the significance of electro-
risk"; but he says nothing about the risk to shock treatment as follows: "[Cerletti's] new
which S.E. had been subjected without his method was widely investigated and univer-
consent. sally accepted throughout the world....
6. Throughout the experiment, S.E. was Countless lives, suffering, and tragedies had
treated as a thing or an animal. He had no been spared."
control whatever over his fate. When, after Cerletti continued to work on electroshock
the first shock, he announced "clearly and sol- until he died. "He formulated a theory that
emnly: 'Not another one! It's deadly!'" his the humoral and hormonal changes provoked
seemingly entirely rational communication in the brain by the epileptic attack lead to the
had no effect on those who were experimenting formation of substances which he called
on him. 'acroagonines'-substances of extreme de-
7. In short, the .first person on whom elec- fense. These substances, when injected into
troshock therapy was tried was neither a hu- the patient, would have therapeutic effects
man volunteer; nor a regular (voluntary or similar to those resulting from electroshock"
committed) mental patient, with whose his- ( di Cori, 1963) .
tory, personality, and family the psychiatrists Ayd ( 1963) has recorded another interest-
were familiar; nor a prisoner convicted of ing aspect of history's first electroshock treat-
crime subsequently declared mentally ill and ment. Cerletti was apparently in the habit of
under the jurisdication of a court. These facts recalling that memorable experience. "As he
are important because, as a professor of psy- described what transpired," writes Ayd, "he
chiatry at the University of Rome, Cerletti remarked, 'When I saw the patient's reaction,
must have had access to many "schizophrenic" I thought to myself: This ought to be abol-
patients who might have been potential candi- ished! Ever since I have looked forward to the
dates for his experimental treatment. time when another treatment would replace
electroshock.' " But if Cerletti had thought
IV this, why did he say it only to himself? Nei-
Although the circumstances surrounding the ther Cerletti, nor other advocates of electro-
discovery of electroshock therapy are reveal- shock, ever spoke or wrote publicly about abol-
ing, they may be placed in fuller perspective ishing this "treatment."
by noting a few facts about the discoverer,
Ugo Cerletti. V
Cerletti was born in Cornigliano, Italy, on As the history of Anna 0. and Breuer,
September 26, 1877, and died in Rome, on (Szasz, 1963) is paradigmatic of a truly per-
July 25, 1963. He studied medicine in Turin sonal encounter between patient and doctor,
and Rome, and received his medical degree in so the history of S.E. and Cerletti is paradig-
Rome in 1901. First, he did special work in matic of a truly impersonal contact between
histopathology and neuropathology. Then, he dehumanized subject and medical experi-
studied clinical psychiatry under Kraepelin menter. As the former exemplifies the volun-
and was captivated by him. In 1933, he be- tary relationship between "neurotic" and
came interested in Meduna's work on schizo- "psychotherapist," so the latter exemplifies
phrenia, and became an enthusiastic advocate the involuntary relationship between "psy-
of the hypothesis of the incompatibility of chotic" and "institutional psychiatrist." It is a
schizophrenia and epilepsy. In 1935, following measure of the moral decline of the psychiat-
his appointment as Professor of Psychiatry at ric profession that these fundamental distinc-
the University of Rome, Cerletti began his ex- tions-between person and object, physician
periments on induced convulsions. In collabo- and alienist, voluntary and involuntary psy-
ration with Professor Bini, he devised the first chiatric interventions---,were better appreci-
electroshock apparatus, and, in April 1938, ated, in practice if not in theory, during the
FROM THE SLAUGHTERHOUSE TO THE MADHOUSE 67

early decades of this century than they are at 1877-1963, Psychosomatics, 4, A-6-A-7, Nov.-
present, (Szasz, 1970). Dec., 1963.
CERLETTI, U. "Electroshock Therapy," in, A. M. Sack-
The invention of electroshock is modern ler, M. D. Sackler, R. R. Sackler, and Marti-Iba-
therapeutic totalitarianism in statu nascendi: nez F. (Editors) : The Great Physiodynamic Thera-
the mental patient, a non-person, is handed pies in Psychiatry: An Historical Reappraisal, Chap-
over to psychiatrists by the police, and is ter 4, pp. 91-120, New York, Hoeber-Harper, 1956,
pp. 92-94.
"treated" by them without his consent. The DI CORI,FERRUCIO, In Memoriam (Cerletti), Journal
social circumstances in which electroshock of Neuropsychiatry, 5, 1-2, Sept.-Oct., 1963.
treatment was developed are consistent with SzAsz, T. S. The Myth of Mental Illness, New York:
its "therapeutic" action. If a man wishes to Hoeber-Harper, 1961.
punish and subdue another, he does not ask SzAsz,T. S. Law, Liberty, and Psychiatry, New York:
Macmillan, 1963.
his permission. Nor can the public, in a soci- SZAsz, T. S. The concept of transference, lnternat.
ety that permits and even encourages this J. Psycho-Anal., 44, 432-443, 1963.
type of human relationship because it is "ther- SzAsz,T. S. The Manufacture of Madness, New York:
apeutic," expect the law to protect the victim. Harper & Row, 1970, p. xvii.
SzAsz, T. S. Law, Liberty, and Psychiatry,· Psychiat-
ric Justice, New York: Macmillan, 1965; and
REFERENCES Ideology and Insanity, Garden City, N.Y.: Double-
Avo, F. T. JR., Guest editorial: Ugo Cerletti, M.D. day Anchor, 1970.