An Individual Point of View on Shock Therapy

One who is accustomed to a purely psycho-analytical approach to borderline disorders may be expected to find shock therapy as applied to the psychotic by the psychiatrist a somewhat revolutionary procedure. I was at first rather sceptical as to what it could accomplish, fearing that it might prove to be nothing more than a reversion to the old 'kick in the pants' therapy—but in a more subtle guise. I confess to being now somewhat disabused of this idea and impressed with what the psychiatrist has been able to demonstrate by his shock tactics in certain psychotic cases. Only a few cases, however, appear to sustain their improvement. Many relapse sooner or later, some while in the institution, and others on returning to a psycho-traumatic environment, to be re-admitted later for a further course of treatment. The main beneficial effects therapeutically of shock treatment appear to be a shortening of the psychotic attack—in itself an advance upon past methods. It would be helpful if the tendency to relapse could be overcome. I have wondered whether the psychiatrist might not get nearer to achieving this goal, were he to make more use of the transference situation. It seems doubtful if he always makes as much use as he could of the parental rôle in which he stands towards his patients.

The importance of the transference in psychotic cases (whether undergoing shock treatment or not) cannot be over-estimated. I suspect that some psychiatrists who use shock therapy tend to place too much reliance on their insulin or machine and too little on their own personality. The Robot parent needs to be reinforced by the Human one. I have observed how important too is a gradual weaning process from the person of the physician—subsequent to the cessation of the actual treatment. In shock therapy a violent transference appears to be thrust upon the patient which persists when the actual treatment as such is ended. The administration of any form of shock therapy is bound tem