Table Of ContentA PSYCHOLOGICAL EVALUATION OF CERTAIN ASPECTS OP
ELECTRO—CONVULSIVE THERAPY
Dissertation
Prsssntsd in Partial Fulfillment of the Requirements
for the Degree Doctor of Philosophy in the
Graduate School of The Ohio State
Unlversity
BP
H. Robert Albrecht, B. A.
The Ohio State University
1951
a eraowiaqmrs
The writer le grateful to the administrative officials and to
the medical staff of the Chlllicothe Veterans Administration
Hospital. He is especially indebted to Dr. H.A. Rock and to the
Shock Team headed by Dr. CI.W. Mockbee for their excellent cooper
ation in the selection and; handling of patients employed in this
1 mr estimation.
The writer is especially grateful to Dr. Ranald M. Wolfe,
Chief of the Clinical Psychology Service in the Veterans
Administration Hospital for his kind assistance In both the admin
istrative and academic aspects of this study. Dr. M.H. Cordon's
contributions toward the statistical analysis of the data cannot
be given sufficient praise.
Acknowledgments are also given to Miss Smith and to Hiss
Henderson of the Clinical Psychology Service for their efforts
in making this manuscript presentable in its final form.
My fellow trainees, William N. Bowen and Charles T. Baker,
who acted as raters must be thanked for their heln and understanding.
Sepeclal acknowledgment is given to Dr. II. A. Durea, Professor
of Psychology, at The Ohio State University, for his kind and
thoughtful assistance throughout the investigation. Without his
direction, this research undoubtedly would not have been oosslble.
(i)
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TABLE OF CONTENTS
PAGE
INTRODUCTION............................ 1
HISTORY AND PRESENT STATUS OF EST . . . 9
Historical Developments . . . . . . . . 9
Modem Shock Methods . . . . . . . . . . 11
Recent Practices • • • ................. 13
Theories Concerning the Operation of EST 19
Organic Theories ........... 20
Psychoanalytic Theories ........... 21
Psychological Theories ........... 22
STATHJENTS CONCERNING THE PROBLEM . . . 25
METHOD AND PROCEDURE ................... 30
Description of the Scoring System • • • 30
Reliability of the Scoring System . . . 37
Subjects « • • # # • * • • • • • • • # • U3
Experimental Groups . . . . . . . . . . U+
Preparation of Subjects . . . . . . . . U9
Equipment............................. U9
Interview Procedure ................... U9
Experimental Sample • 50
STATISTICAL METHODS ................... 52
RESULTS ................................ 55
DISCUSSION .............................. 66
(ID
CHAPTER PA(Z
VIII. SUMNARY AND CONCLUSIONS............................ 73
BIBLIOGRAPHY.......................................79
AFPTSNDIX........................................... 83
(iii)
TABLES AND FIGURES
TITLE DESCRIPTION PAGE
Table I* Agreement Between Raters for Identification
of Thought Units 39
Table II• Agreement Between Raters for Efficiency
Index Determination • • • • . • • • • • • • • LO
Table III* Distribution of Global Ratings by Judges . • • 1*1
Table IV. Agreement Between Judges in Assigning
Global Ratings • • • • • • . * • • • • • • . . l»2
Table V. Agreement of Judges' Global Ratings Com
pared with Chance Expectancy • • • • • • • . *1*2
Table VI. Graphic Representation of Experimental
Conditions 1|7
Table VII. Ages and Diagnoses of Subjects . . . . . . . .U8
Table VIII. Slope Values Representing Trends of Scores
for Each Experimental G r o u p .......... . . . 56
Table IX. Trends Occurring Within Each Interview
Series............................. . . . . 57
Table X. Statistical Tests of the Significance of
Differences Between Scores From Each Ex
perimental Situation ..................53
Fig. 1. Average Number of Thought Units Produced
During Each Interview . . • • • • • • • • • • 5 9
Fig. 2. Efficiency Index Values for Each Interview • • 60
Fig. 3» Global Rating Scores for Each Interview • • * 61
(iv)
Although this investigation was conducted with the permission
and assistance of the Veterans Administration, the methods employ-’
ed and results expressed do not necessarily represent the policies
or attitudes of that organisation.
( )
t
CH1PTHR I
IMTEODPCTlOy
I. IWTROIXrCTOBT RBMABE8
The literature dealing with behavior disorder* and conditions of
maladjustment contains many references to a group of therapeutic methods
i
which are desettbed as "shock treatments". Of these various, but re
lated techniques, electroshock therapy* has received the most attention
from Investigators and theorists In the field of psychology and
psychiatry.
Prior to the advent of the surgical techniques such as the ore-
frontal lobotomy, X5T was one of the more recent of the "shock
therapies"• The recency of the development of this method, together
with the relative ease of Its administration, are factors which have
influenced Its popularity.
The basic technique of X5T was first utilised with human subjects
by Cerlettl in 1933* However, as will be pointed out, there vers numer
ous antecedent methods which paralleled Cerlettl's technique. The
introduction of 2ST was well received and was ranldly followed by
numerous Investigations dealing with its nature and practical application.
Its theoretical foundations and empirical considerations have
been discussed widely, but as yet there has been no general agreement
as to either the theoretical or the practical basis for this method of
treatment. Although there have been several systematic and searching
reviews of the literature dealing with BBT, disagreement persists.
•Hereinafter, electroshock therapy, or as it Is often referred to,
electroconvulslve therapy, will be aborevlated BBT to conform to general
practice employed by writers in the field.
(1)
(22, UO, U3). It appears that one of the outstanding conclusions derived
from such reviews of the literature is that t|he general area of EST
research still has many unsettled problems.
O'Kelly (20) suanarlses these general conclusions when he states,
"Modern shock therapies have been empirical in nature, and there is no
acceptable theoretical explanation to account for their effect"• This
opinion Is wide-spread. (5, 21, 23, Uo). "uch of the seemingly dis
ordered structure surrounding EST can be attributed to the development
and growth of the technique itself, which was a startling new method
that was received enthusiastically by workers representing diverse
theoretical viewpoints. Many of these workers regarded EST as a "cure"
for behavior disorders, and, as such, it was subjected to investigations
which represented various theoretical viewpoihts. The conclusions of
these investigations, of course, have been equally diverse.
Despite the Initial hope that EST would be a "cure", it became
evident that shock therapy in itself was a "pflychosiSMnodifying agent"
(1*0). This realisation led to the investigation of relationships between
EST and other factors, proximate and remote. Among these relationships
was that of the correlation between EST and psychotherapy*
As is true within the general field of 3$T, investigators have
expressed various theories and attitudes concsming the relationship
between EST and psychotherapy. On some points there is relative agree
ment. On others, the viewpoints are etartlingly disparate. The point
on which there seems to be the legist disagreentent is that of the merits
of EST as an agent with which to augment, or render possible, the under
taking of some form of psychotherapy. However, disagreement exists as
to the psychotherapy which should be provided and, more importantly,
(2)
there art even more opinions as to when psychotherapy should bs eon-
‘ductsd. Kailnowsky (21)., for example, reviews soae of the opinions
expressed by others and summarises then Into several rather specific
attitude-categoriesi vis, psychotherapy should not be undertaken con
currently with BBT; pemissive, reassuring psychotherapy should be
given; deep-level psychotherapy should be administered upon temin-
atlon of 2ST; psychotherapy aust be a concomitant of 1STI Krainee (23)
feels that psychotherapy should be concomitant with 1ST and that whenever
possible contacts with the nomal environment should be maintained.
Bennett (3) feels that therapy should accompany 1ST because of the In
crease In accessibility during treatment. Myereon (2?) , however,
found that B T alone achieved results comparable with combined BT-
psychotherapy for certain ambulatory patients.
Wilcox (IQ) believes that the amnesias which accompany 1ST obviate
the possibilities for deep psychotherapy. This point of view has been
taken by others but the foundations for such belief rest on the nature
and the functioning of the "amnesias'', the nature of which has been
challenged by the work of Janls (20) , Bub in (34), and others (23, 43)
who have shown that memory Is not a unidimensional factor during 1ST
but that selective elements are important.
Krai nee (23) and Wilcox (43) are among the writers who have sug
gested that some of the benefits observed from B T may be attributable to
concomitant factors. These authors suggest that the attitudes of the
physician and his staff may be of importance. Wilcox describes how
these attitudes may help to reorder perceptual relationships so as to
(3)
Influence remission rates. He says, "Patients who have responded to
any intensive therapy become interesting peoole to the Psychiatrists,
and. If they subsequently relanse, they are given renewpd special
attention". Thus, the patients are Perceived as treatable, the method
as a Tjositlve one vhlch permits approach to a problem situation which
was previously regarded as essentially Insoluble. This point should
not be dismissed too lightly. It seems possible for research workers
to be enthusiastic about new techniques and to noseess attitudes which
influence interpersonal relationships. This point is hinted by
Hathaway (1?) who expresses the possibility that much of the benefits
of therapy may be ascribed to the personality of the therapist. Thus,
it may be that psychotherapy, broadly conceived, Is basic In the attain
ing of benefits from JEST. Bowen (4), in discussing material drawn
from Interviews with patients undergoing 1ST, cites examples of sub
jective feelings emphasising the importance of the ascribed feeling-
tone of the melieu in which the Patient finds himself and the Influences
of the personnel administering EST,
Briefly then, there are differing opinions as to when Psychotherapy
should be held and as to its merits. Kalinovsky, after summarising the
views of others, states that in his opinion psychotherapy should depend
upon individual factors* "In some eases psychotherapy should follow
shock treatments; in other? , it would be superfluous; and, in still
others, it may be contraindicated."
Many of the statements are subjective in nature although some of
the authors attempt to "explain" them on theoretical or analogical bases.
Therefore, the proolem which is herein undertaken is an attempt to
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