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Notwithstanding the fact that many therapists regard repeated convulsions as the most effective treatment for psychosis, there has been no satisfactory theoretical understanding of the mode of action of this therapy. The many theories that have been proposed fall into either psychogenic or biologic classes. The psychogenic theories have been found by many to be speculative and unconvincing. Those theories that base the effect of ECT on memory changes are contradicted by therapeutic results following a newer technique which avoids memory loss. The somatogenic approach has made it possible to eliminate many of the factors which previously had been thought determinative: anoxia, muscular exertion, adrenal effect, catecholamine response, and other stress factors. It is now thought that the activity responsible for clinical change is inherent in the convulsions.
The neurophysiologic adaptive view of convulsive therapy, developed by Fink, takes into account the fact that changes in cerebral function, measured by increased EEG slow wave recordings, are essential for change in behavior. In addition, he notes that patterns of change are also influenced by individual personality qualities and by environmental reaction which has the effect of rewarding certain behaviors and discouraging others. Fink implies that convulsive treatment exaggerates behavior already present in the pretreatment character of improved patients, including increased verbal denial, euphoria, displacement, and a tendency to minimize.