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                    <text>January 12, 1997
Dear Jack,
It was good to hear from you again; I also received a card from Sophie and
her family on holiday. All is well here. Martha has just returned from a short visit to our
two grandchildren in Phoenix. The are growing well and the reports were glowing. My
son, as a Department chairman, is in that phase of his life that he is dealing with ‘movers
and shakers’ -- deans, university presidents, and corporate executives. He likes the power.
At the same time, he is at a pinnacle of his research career, with much research money
and many students, and has to decide which effort -- the academic or the political -- to
follow. Martha reminds me that I was in the same phase when I was in Missouri as the
head of an institute. I am glad I chose the research.
On the topic of research, a few years ago I urged some leaders in ECT to
organize a study comparing the efﬁcacy of continuation ECT to that of continuation
medications [lithium and a tricyclic]. After three years of bargaining, the Government has
awarded grants to four hospitals in a collaborative effort. Unfortunately, the federal funds
are inadequate to do the study properly. In the past, universities were willing to support
the research effort, seeing such work as part of their academic responsibility. No longer.
The issue now is wholly -— how much money do you bring in as a clinician; how much
are we paying you; and if we cannot make a proﬁt, maybe it is time to go. So, I am in the
process of returning the money to NIMH.
The process has become ugly. The Dean has asked whether I am willing to
retire now. After all, he says, he can hire two psychiatrists for my salary. When I noted
that I have been accorded all sorts of honors as a teacher and as a leader in research, he
smiled and said that the school had paid me for such efforts in the past, but for me to ‘get
with it’ -- the times have changed. Martha and I have begun the necessary dialogue to
retire later this year, after I have completed my present assignments. These end in June
and after some months of terminal leave, I should be free.
My book ELECTROSHOCK is coming along nicely. I have written a
for
the laity. I have a good publisher [Oxford University Press]. All the main
description
chapters are written; I am busy with the end-notes and appendices. While it will not lead
many to this useful treatment, it will serve to answer some questions.

�As with my university, a similar immediate return seems to have affected
old
your
company. Earlier in the year, when mirtazepine [ORG 3770] was about to be
marketed, I reached the research director at Organon USA and suggested that we
undertake a clinical trial of mirtazepine in delusional depressed patients, with an eye to
deﬁning its efﬁcacy in hospitalized patients. I noted that the ﬁling data in the US. [which
he had sent me] was limited to out—patients. In return, he said that they were not at all
interested in testing mirtazepine in in—patients. [I do miss the days when it was possible to
talk directly to Organon’s leaders]
I replied that I ran a clinic of depressed patients and I offered to examine
mirtazepine in either our depressed patients after a course of ECT [was it as effective as a
tricyclic in continuation treatrnent?] or in those who were not so ill, and for whom we
could deﬁne the clinical efﬁcacy at the same time as its effects on adrenal functions.

Again, he wrote to say that they were not interested. Too bad. The competition for
attention in modern psychopharmacology is based wholly on hiring ‘names’ to give
‘talks’ about new drugs and to ‘testify’ as to their effects. Most of my peers are already
on the do g-leash for other compounds [of which there are about eight]. I fear that
mirtazepine will have no better fate than mianserin in this country.

Martha continues her supervision of student teachers; our daughter Rachel
in Massachusetts has adopted a lovely, bright, and intelligent Chinese girl whom we love.
And Linda has convinced her husband to take a position in Virginia -- they are building
their home on almost 200 acres of mountain-top nearby to her college.
I continue to give courses in ECT and lecture on my new-found interest,
the syndrome of catatonia. Martha and I are off to Melbourne in late February. That will
be our ﬁrst trip to Australia.
So, we move on from one phase to another. When I step down, it should
be possible to travel more freely. We will see. Meanwhile, Martha joins me in thanking
you for your kind note, and we wish you and your family continuing health in 1997.

�</text>
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                    <text>Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
1 6 1 32
GENOA,
ITALY

February 4, 1997

Dear Walter,
Thanks for your recent notes. I worked on the IPEG Artiles of Association and enclose
my pencilled comments. I think that some members would be shocked to think that the residual
money -- even if there will not be any -- was committed to the German EEG Society. Better to
have the ofﬁcers decide what to do at the end. It is usual to give a party and spend all the money
when a society dissolves. Good times and good memories should be had by all.
As for Dr. Valducci, it is a tragedy. But, electroshock is a surgical procedure and even if
someone has given more than one-million treatments, the same care must be given to the one—
millionth-and-one. The patient’s death, as described, is the result of a doctor’s error. It happens,
but that does not excuse the physician. The family deserves recompense. The reason is simple —if there is a question about eating before ECT, the treatment is either passed over; or if the
treatment is compelled by the state of the patient, it can be given, provided that the patient is
intubated. [Hence, our insistence in the US. on an anesthesiologist for every treatment]
Tell Dr. Valducci we are sympathetic, but he seems to have erred.
I am off to Astralia for two weeks. It seems that they want an American ‘course’ in ECT

and Martha agreed to go with me.
My best regards to Titty.

Sincerely yours,
Max Fink, M.D.

�</text>
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                    <text>February 5, 1997
Henry Pechstein, MD.
145 Cathedral avenue
Hempstead, New York 11550-1125
Dear Henry,
What a lovely surprise! It was a pleasure to look through that Newsletter
of 1959 and to realize that it was almost 40 years ago. The names alone -- Lenzner, Nord,
Shapiro, Zuger, Bauer, Whittier, and the speakers Nate Klein and Harvey Tompkins-brought back images. I remember almost all of them. It was a much freer time in
psychiatry; our battles with the psychologists seem like the battles of Neanderthals today.
archives.

I am delighted that you are sending the old numbers to the Society

I am still teaching at Stony Brook. I have maintained an active research
interest, and seem to have made a name in keeping electroshock alive. My book in 1979
was useful; my student Richard Abrams took it over in 1988 and is now issuing his third
edition. Not to compete with him, I decided that a ‘popular’ book on electroshock was
needed and I have just signed a contract with Oxford University Press for a ‘trade’ [read=
popular] book which I hope to have done by June.

All in all, life has been good to me. I trust the same for you. My thanks for

thinking of me.

Sincerely yours,
Max Fink, M.D.

�</text>
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                    <text>February 6, 1997
Lee C. Miller, MD.
Northwood Ofﬁce Center, Suite 9
2201 Forest Hills Drive
Harrisburg PA 17112
Dear Dr. Miller,
You inquire about a 39-year old man with a ‘life-long’ depression who has
been sensitive to the side-effects of medications and is considered a treatment failure to
psychotherapy and medications. He began ECT on September 6, 1996, showing
improvement after 6-8 treatments ‘and then curiously the gains seemed to recede.’
Treatments continued and then ‘switched over to maintenance treatments.’ Treatments
have had to be given weekly, and any attempts at lengthening the interval between
treatments is followed ‘by a drop in mood’ [and presumably a request to continue].
The beneﬁts of ECT usually persist alter the course has ended. But
some patient’s beneﬁts are limited to a few days after each treatment and it was for such
patients that continuation therapy, either medication or ECT, has been recommended.
1.

How to explain it? The beneﬁts of ECT arise from our ability to stimulate
the hypothalamic-pituitary axis to liberate, in greater quantities over a persistent period,
of those hormones [labeled by me as ‘antidepressin’] which regulate mood. In some
patients, ECT ‘j ump-starts’ the process and further stimulation is not required. In others,
the change is transient and repeated stimulation is required. The best analogy is our
experience with insulin -- in some patients, diabetes can be controlled by diet; in others,
oral agents; and yet others, daily and mullti-daily dosing of insulin is necessary.
To get around it -- treat more intensively and hope to get the system
working again. At times, we have re-admitted patients to hospital and given a new course.
2. ‘Indeﬁnite’ courses of treatment are occasionally required. At UH we
have records of patients with 40, 140, and 180 treatments over periods as long as 10
years. In some, the period between treatments was lengthened by concurrent treatments -lithium and then lorazepam in one case, clozapine in another.

�Given these facts, I have no concern about continuation treatment. I
would, however, do the following.
a. Assess by careful inquiry to the family whether unprescribed
medications are being taken out of your ken. Speciﬁcally, alcohol, benzodiazepines, or
even barbiturates muck up a treatment series. I would surely enquire what is meant by ‘a
small dose ofXanax at bedtime ’. Self-restraint is not a feature in benzodiazepine use.

b. I would next entertain a series of treatment trials —- lithium at levels of
0.4-0.6 mEq/l; lorazepam at 0.5mg bid; and if well tolerated, lorazepam at 1mg tid.
c. Perhaps, an independent consultation as to diagnosis is warranted. If the
underlying pathology is that of a dysthymic disorder [a lifelong atypical depression] or an
Axis 11 character pathology, perhaps the best course is to forego ECT before any damage
is done. Prolonged courses of ECT are the basis for legal suits, the plaintiffs arguing that
the treatments incapacited their ability to survive and work in society and their claims for
damages achieve credibility with insurers and juries.

Your question is interesting. I will be out of the country until February 26.

If you want to discuss this ﬁn'ther, try me late afternoons at the numbers above.
Sincerely yours,
Max Fink, M.D.

�</text>
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                    <text>Date: March 11, 1997

T0:

Dr. Athanasios P. Zis

FAX #

604.822.7922

Total Pages (including this sheet)

-5-

Dear Athanasios,
Sorry for the delay in answering your FAX but I have been on holiday.
A search of the ECT Database ﬁnds only a few studies of parkinson’s disease
and ECT. I attach the citations from the ﬁle.
I know of no studies in progress on PD and ECT. A few years ago I was told
that Dr. Melvin Yahr at the Mount Sinai Hospital in New York was managing such a
study but I have yet to hear or read an abstract. Richard Abrams had such a study in
progress in Chicago but the intake must have been slow because he retired and I have
heard nothing more of it.
Ray Faber at the VA in San Antonio, Texas told me of his program in ECT in
PD and that he was doing maintenance treatment. Ray was the one who explained our
cases of delirium and advised me to reduce the l-dopa doses. His review with Tn'mble is a
good He would be the one to call for possible experience.
I know of no PET studies published or in progress.
Sounds like you have a good problem in hand. Go

row
Max

From:
Max Fink, M.D.

FAX:

TEL:

516 862-8604
516 862-6651

P.O. Box 457
St. James, New York 11780
Alternate FAX: 516 444-7534
Alternate TEL: 516 444-2990

�</text>
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                    <text>March 11, 1997
Mr. Philip A. Pardee, Membership Coordinator
American Psychiatric Association
1400 K Street, NW.
Washington DC 20005
Dear Mr. Pardee,
I should like to endorse the application of Guillermo Jose Castrofor
Quintela
membership in the American Psychiatric Association. I met Dr. Castro
during my visits to Montevideo as a consultant and speaker at national meetings over the
past few years. He is an associate of Drs. Alexander Lyford-Pike and Gabriel Savi in their
teaching program and clinical practice. He participated in clinical case conferences and
expressed a good knowledge of clinical practice.
Dr. Castro has attended meetings of the APA and has attended courses
with his co-workers. In one ECT course when I was the instructor, Dr. Castro
participated actively in the program. He is an excellent candidate for Corresponding
Member and I recommend him without reservation.

Sincerely yours,

Max Fink, M.D., F.A.P.A.
Professor of Psychiatry &amp; Neurology

�</text>
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                    <text>April 13, 1997
Mrs. Katherine Graham
The Washington Post
1150 15th Street NW.
Washington DC 20071
Dear Mrs. Graham,
Reading the story of Mr. Philip Graham’s death in your Personal History
is a sad reminder that even the best educated in America do not get the best medical care.

The tragedy reﬂects the failure of the early recognition of manic depressive illness, the
failure to use available medications, and what is most egregious, the failure to use
electroshock. While much has been learned since, the beneﬁts of electroshock, including
its use against suicide, were clearly well known in the profession at the time of the
tragedy.
Why write now? Because your tragedy is still repeated in America. It is
one thing to have a fatal illness for which no remedy has been devised; it is another to
have an available remedy and not use it because of professional bias and incompetence,
encouraged by the bias of the press and the media.

Electroshock, as you hint [pg 329], is different today than what was
available a quarter century ago. But the negative attitudes to electroshock expressed by
your husband’s physicians are as prevalent today. The legislature of the State of Texas is
considering a bill to abolish the use of electroshock in the state; it already has regulations
that proscribe its use in persons under the age of 16. A starting point could well be the
enclosed memorandum from Texas.
The bias against the use of ECT is largely engrained among mental health
professionals and managed care companies where ECT is seen as a ‘last-resort’ therapy -—
to be used only after all other possible treatments have been tried and failed. Dependence
of oft-repeated ineffective trials encourage suicide and death.

�Mrs. Katherine Graham

Page 2

Perhaps you can turn the powerful searchlight of the Washington Post on
national
bias
and hostility against the use of an effective and safe treatment for severe
our
depressive illnesses. Sadly, few of the active psychiatrists at NIMH have experience with
electroshock. The only two names that come to mind are Dr. Richard Wyatt and Dr.
Matthew Rudorfer; the ﬁrst has an academic knowledge but little clinical experience; the
second a limited clinical experience. But they are knowledgeable.
Thank you for writing such an interesting story and for expressing so
clearly the tragic effects of professional bias against an effective intervention.
Sincerely yours,
Max Fink, M.D.

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                    <text>State University of New York at Stony'Brook
School of Medicine — Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry and Neurology
PO. Box 457
St. James, New York 11780

Faculty Committee on Honorary Degrees
Graduate School
SUNY at Stony Brook
Long Island, New York 11794

Voice: (am) 516 444-2990
(pm) 516 862-6651
Fax: 516 862-8604
E-mail: mﬁnk@epo.som.sunysb.edu

April 25, 1997

Dear Committee Members,
Dr. Dale Deutsch has nominated Dr. Raphael Mechoulam of the Faculty
of Medicine of the Hebrew University of Jerusalem for an Honorary Degree at this year’s
commencement. I endorse his nomination with enthusiasm. Recognition of Professor

Mechoulam’s extraordinary achievements in medicinal chemistry, especially in the most
difﬁcult chemistry of botanicals, is well deserved.

I ﬁrst met Dr. Mechoulam in 1970 when I was the Principal Investigator in
NIMH
contract on the study of the chronic and acute effects of inhaled cannabinoids in
an
human subjects, both in Athens, Greece and New York. We were asked to examine the
behavioral, psychologic, and electroencephalographic effects of different cannabinoids to
assess which were the most active in altering behavior and their dependence liability. It
was from Dr. Mechoulam that we received large sample amounts of various cannabinoids
derived from special samples of hashish provided by Dr. Costas Miras of Athens and
marijuana from US. government ofﬁces. Based on his cooperation, we were able to
demontrate the activity of A9 and A8 cannabinoids, and contrast these with other complex
compounds.

His recent identiﬁcation of a natural cannabinoid-active compound in the
brain has sustained a good part of the academic research into cannabis, at a time and
under conditions of national and international confusion about its risks.
Such an honor is well deserved and I am delighted to join Dale Deutsch in
this nomination.
Sincerely yours,

Mug/Lac
Max Fink, M.D.
Professor of Psychiatry
and Neurology

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                    <text>State University of New York at Stony Brook
School of Medicine — Department of Psychiatry
.

’oe|

I

Max Fink, M.D.
Professor of Psychiatry and Neurology
PO. Box 457
St. James, New York 11780

Voice: (am) 516 444-2990
(pm) 516 862-6651
Fax: 516 862-8604
E-mail: mfmk@sunysb.edu

.

March 11, 1997
Alan J. Gelenberg, MD.
Department of Psychiatry
University of Arizona HSC
Tucson AZ
85724
Dear Alan,
Your reminder of a failure to review manuscript 4406 “The use of
ﬂumazenil in the anxious and benzodiazepine-dependent ECT patient” sent me to my
desk and ﬁles. I have not received the manuscript.
my custom.

Please send it on and I will get a review within a few days of receipt, as is
My regards.

W

Sincerely yours,
Max Fink, M.D.

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                    <text>July 16, 1997
Harold S. Orchow, M.D.
Montevista Hospital
5900 West Rochelle Avenue
Las Vegas NV 89103
Dear Dr. Orchow,
The relationships between number and frequency of seizures, reduction in
mood disorder (efﬁcacy), increase in cognitive symptoms (safety), and electrode
placement are described in an extensive series of reports. The details are well described
by Abrams in his textbook Electroconvulsive Therapy (Oxford U. Press, 3rd Ed., 1997).
The most recent reports are those from Jerusalem by Bernard Lerer and his co-workers.
1.

2.
3.
4.
5.

Efﬁcacy in ECT for mood disorder improves with both frequency and
number of treatments.
Cognitive symptoms worsen as number and frequency of treatments
increase.
Efﬁcacy is greater for bilateral electrode placement, but such efﬁcacy
is associated with greater cognitive symptoms.
Efﬁcacy is less for unilateral electrode placement, and such lesser
efﬁcacy is accompanied by lesser cognitive symptoms.
Twice a week treatments achieve the same efﬁcacy and less cognitive
effects than three times a week treatments; but two weeks after the end
of the treatment series, when efﬁcacy is equivalent, cognitive effects
are not distinguishable.

As a consequence of these syllogisms, practitioners select the parameters
of treatment according to the severity of the symptoms. For severely ill and debitated

patients, where one seeks immediate improvement and is less concerned with cognitive
effects, ECT is given 3x/week with bilateral placement. This assures the best results. [In
severely manic or psychotic patients, this series may begin with two to four treatments
daily.]
For patients who are not too distressed, where cognitive effects are feared,
with unilateral electrode placements, at 3x per week.
treated
patients are

�In the elderly, where cognition is a principal risk, treatments are given
with bilateral placements no more frequently than two times a week.
Some practitioners deliver two seizures in a single setting. This is a relic

of 'multiple monitoered ECT' developed by Blachly and Gowing in 1966. MMECT was

tested and shown to increase risks with limited gains. The practice is no longer endorsed
except in the very severely manic, psychotic, or stuporous patient where an immediate
effect is required.
The practice of giving 12 treatments in four to ﬁve days, even with
unilateral electrode placement, sounds like MMECT — a practice which is not generally
recommended. The APA Task Force of 1990 wafﬂed on these data and recommendations
because the members of the panel were aware that many practitioners were still using the
MMECT model. A better review of MMECT is to be found in Abrams' textbook.
I trust these remarks are helpful.

For other opinions, you may want to post a speciﬁc case example on the
intemet site of 'convulsive-therapy@psycom.net' and see what others answer.
Sincerely yours,
Max Fink, M.D.

�</text>
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                    <text>August 28 1997
Dr. Valdir Pricoli
Rua Albilio Soares, 639-123
04005-002 Sao Paolo
Brazil

Dear Dr. Pricoli,
Thank you for your letter. I am pleased to have been of help.
I am moving my teachiong and research operations from SUNY at Stony

Brook to the Long Island Jewish-Hillside Hospital complex in Glen Oaks, Long Island. It
is closer to the city. The hospital has a long tradition of ECT research -— back to 1953 -and I have developed a research team there.
We would be pleased to have you visit. Arrangements can be made to stay in
Great Neck, about 10 minutes from the hospital, or in New York City —- about 30
minutes.
You can reach me at my ofﬁce address as on this letterhead.
My regards.
Sincerely yours,

Max Fink, M.D.

�</text>
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                    <text>January 28, 1996
Dr. Lawrence C. Perlmutter

Department of Psychology
Finch University of the Health Sciences
3333 Green Bay Road
North Chicago, IL 60064-3095
Dear Dr. Perlmutter,
Dr. Avi Calev has been a neuropsychologist in our program since 1990, and has
asked me to write a letter on his behalf. I have known Avi for about a decade, ﬁrst becoming
acquainted with him through his work with Dr. Bernard Lerer at the Hebrew University in
Jerusalem. At the time, Dr. Lerer was studying the electroshock process, and Avi provided most
useful examinations focused on cognition. With Dr. Lerer’s encouragement, he applied and was
appointed in our Department as a member of our electroshock evaluation program. He was well
liked and when an opening appeared in the inpatient clinical services, he was appointed as the
psychologist of my inpatient team. My relationship with Avi is therefore at multiple levels -- as a
co-worker, supervisor, and friend.
Avi is a talented neuropsychologist with an excellent grasp of psychometrics,
projective testing, statistics, and experimental design. He has been an active co-worker and a
leader for various projects, as attested to in his curriculum vitae, where he has a large range of coworkers. In addition to the reports of the cognitive effects of ECT, he has also assumed
responsibility for studies to determine whether pre-treatment with caffeine will inﬂuence
therapeutic results and cognitive effects of ECT. He has already published the preliminary results
which argue that the effects are favorable and is now completing the data collection for a random
assignment study.
I have known him also as the team neuropsychologist on our inpatient service. As
he
has
been most helpﬁil in assessing patient characteristics, elaborating the techniques for
such,
our residents and medical students, and assuming responsibility for psychotherapy in selected
patients. In the latter instance, he both treated patients and supervised our residents.

�Lately, he developed a relationship with Dr. Lynn DeLisi, an expert in the study of
schizophrenia. Together, they are working on a number of projects with which I am not directly
acquainted.
Avi is a conscientious, interested, intelligent, and well trained psychologist. He is
well liked by his co-workers and I have been delighted to work with him. He is knowledgable
about the literature, is able to document his positions in argument, and is technically skilled. I am
distressed that he has been asked to leave -- a situation which has been occasioned by the
necessary down-sizing of our Department and not associated with any of his defects or actions.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry &amp; Neurology
Attending Psychiatrist, University Hospital

�</text>
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                    <text>Saturday, January 27, 1996
1300 EST
Dear Alan,
Martha and I have just returned ﬁom a delightful 5-days at the Spice Island
Inn in Grenada. The weather was excellent, the food adequate, the accommodations
among the best we have had in the various islands. The hotel was next door to the offshore medical school in Grenada. I was able to chat with many of the students who were
relaxing and reading on the beach -- their cafeteria and dining tables are on the beach
front. I was saddened by the thought that these -- what seemed to me to be ﬁne young
Americans -- had to get their education in what seemed to be poor facilities [despite a
glorious beach]. I could see little that would distinguish them from our students at Stony
Brook.
Among my mail on my return is the communication from Richard Horton,
Editor of Lancet. I had been in touch with him when I edited CT. I am puzzled by his
inquiry. First, I had to look up the word ‘aegis’ [see ‘egis’] and found that it is a
protective inﬂuence, a shield. As I read [and re-read] the article, I come to the conclusion
that the ‘withdrawal of aegis’ is a legitimate editor’s response to an unsatisfactory article
which passed through the review net. What do you think?
I am still pausing in getting to write about ECT on the Internet. I have an
invitation from ‘www. mhsource.com ’, the home page of John Schwartz [CME, Inc., The
Psychiatric Times], and another from Ben Green [Psychiatry On—Line-- www.
cityscape.co. uk/users/ad88/psych.htm]. In addition, Stony Brook has decided to has
invested in a server for the medical school ‘home-pages’ and has invited faculty members
to set up their own. If my work-load decreases, I will think more about it.
It is pouring this afternoon -- why am I here instead of in Grenada? ? ?
My best to Carol.

a.
W

�</text>
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                    <text>Dr. Richard Horton

February 3, 1996

42 Bedford Square
London WC 1B 3 SL
United Kingdom
Dear Dr. Horton.
I read the essay ‘Revising the research record’ with much interest and
sympathy. As editor of Convulsive Therapy, no problems of scientiﬁc error have been
brought to my attention. Our level of error has been at a more triﬂing level, and so we
have not been faced with the difﬁcult decision as how to alert the readers to scientiﬁc
error. I am impressed that the Table ‘Taxonomy of error’ in your essay reﬂects the best
stande available today.
Since a published report has gone through the journal’s peer review, when
is
found
error
or charged, it seems logical to go through the same procedures to establish
error. Assuming the review concludes that error of fact or procedure occurred, such
conclusions warrant publication. The suggested ‘withdrawal of aegis’ by the journal is a
reasonable and innovative step in maintaining scientiﬁc integrity. The principal downside
risk is the assurance that the material presented the readers in the ‘withdrawal of aegis ’ be
complete and able to withstand procedural and legal scrutiny. The guidelines for authors
should reﬂect the possibility of such review of published material and the possibility of
such published revision.

Should you wish a publisher’s point of View, Dr. Alan Edelson, the founder
of Raven Press and the former President of Lippincott may be able to answer an inquiry
more formally than I [amedelson@aol.com;or 16 Washington Avenue, Irvington NY
10533}
Incidentally, I have stepped down as Editor of Convulsive Therapy, but am
still interested in the problems of editing and editors.
My regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>February 8, 1996
Dr. Sydney Archer

Rensselaer School of science
Troy, NY 12180-3590
Dear Sydney,
My recollections of the patients are hazy. But I called Dick Resnick and he
seemed more au courant. I have sent him your letter and asked him to call you.

If I can be of help,

let me know.

My regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology
cc: Richard Resnick MD.
43 West 94 Street
New York City 10025

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                    <text>February 17, 1996
Ms. Sarah Lentz

DMS Box 470
Hanover, NH 03755
Dear Ms. Lentz,
Thank you for the opportunity to read you report on ECT and pregnancy.
It is quite good, but as an Editor, I have some suggestions to improve the history and the
practice.
In the history, the introduction of electrical inductions by Cerletti and Bini
was a modiﬁcation of an established treatment, that of Metrazole convulsive therapy. The
induction of seizures with camphor and then pentylenetetrazol [Metrazole] was introduced
by Ladislas Meduna in 193 4, highlighted in an international conference in Muensingen,
Switzerland in 193 7, accepted throughout the world as a treatment [see the supplement to
the Am J Psychiatry 193 8]. These events preceded and were surely the stimulus to the
Italians [Bini attended the 1937 meeting]. It would be better to state that the introduction
of convulsive therapy by Meduna was the innovation that altered psychiatric practice. He
deserves the credit.
The charge of overuse and inappropriate treatment of ECT is incorrect. All
treatments that are perceived as successful and safe are ‘overused’ as practitioners seek to
extend and deﬁne the indications. Think of the present enthusiasm for ﬂuoxetine or the
newer alleged psychotropics; or the extensive overuse of coronary artery bypass surgery;
or of caesarian deliveries. The canard should not be repeated and this section should be
deleted.
Further, ECT like other somatic treatments in use in the 19505, was
replaced by medications, but its renewed interest [in contrast to psychosurgery and insulin
coma] was occasioned by the failures of pharrnacotherapy. Despite the enthusiasm of the
public and the blandishments of the pharmaceutical representatives, many patients fail
modern drug therapies and are later successﬁil with ECT.

�In your suggestions about ECT in pregnancy, there are a few that are more
dangerous than you consider. Vaginal examination is not only not necessary but a
dangerous procedure during pregnancy and should not only not be recommended, but
enjoined unless compelled by signs or symptoms that warrant such an examination. There
is nothing about the examination that would alter or affect ECT, if ECT is compelled by
the patient’s mental state.
Anticholinergic medication as part of the ECT procedure is acceptable and
useful. External fetal monitoring during the procedure has been done, and remarkably, the
fetal heart rate is unaffected by the procedure. There is no justiﬁcation for such monitoring
as a routine procedure because the expense is excessive and the information yield nil.
In patients in the second half of pregnancy, intubation is part of the
standard of anesthetic care, and it is routine for all our cases. The use of antacids is
optional and our anesthesiologists no longer ﬁnd it useﬁil.
I am puzzled by the CME credit questions 2 and 3. ECT is indicated during
because
the patient is so psychotic as to require hospital care and is exhibiting
pregnancy
either suicidality, mania, inanition, or command delusions which threaten the life of the
mother or the fetus. The emphasis on diagnosis does not reﬂect the compelling indication
for ECT, that is behavior which puts patient or others at risk.It is not the diagnosis that is
the indication; many mentally ill mothers cany to term without medication or treatment.
Question 3 is ambiguous. Each of the modiﬁcations of procedure are
relevant to the care of pregnant patients.
Aside'from these quibbles, I commend you on your report. We are now a
main center for treating pregnant psychotic patients and treat at least one a month. Two
are in treatment now, one for severe depression and suicidality and one who was in manic
delirium. The ﬁrst is continuing in ambulatory treatments and cares for her other child; the
second has just had the delirium erased and is still being treated for mania and psychosis.
Good luck in your career.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>DatezFebruary 22, 1996
TO:

D.R. Milne

FAX #

419 382-2378

Total Pages (including this sheet)-1-

Dear Mr. Milne,

I do not participate in public debates except for and with mypeers.
The tragedy in public discussions of electroshock is the anger shown by
many in the laity and some in my profession to the mentally ill. The same persons who
would undergo coronary artery bypass surgery or hysterectomy or other surgery with
alacrity are distressed out of all proportion at the idea of electricity coursing through
their brains, not realizing that their brains are hotbeds of electrical circuits already.
You would do better to ask the question: Why is it that E CT is available at

the leading academic centers in the nation but not in almost all the state and veterans
administrationpublic mental hospitals? Why do we have a two-tier treatment
program? [It is notﬁnancial since mentally ill patients are equally likely to be
admitted to the academic hospitals in your state as to the publicfacilities.] Try the
professor ofpsychiatry in your [or any] state and its commissioner of mental health.
Max Fink
From:
Max Fink, M.D.
P.O. Box 457
St. James, New York 11780
FAX:

516 862-8604

TEL: 516 862-6651

�Date: Feb 21, 1996

TO:

Mr. D. Milne
L9

FAX # 419 382-23175

Total Pages (including this sheet)-lDear Mr. Milne,
The essay by Gary Figiel is in the nature of ‘Chicken Little’s fears.
The four articles to which he refers ﬁnd no justiﬁcation for the routine use of
labetolol or esmolol other than the anxiety of the physicians. ECT is no more
riskful to the heart than climbing a ﬂight of steps -- indeed, less so.
More harm is probably done by routine use of anti-hypertensives
than by unmodiﬁed seizures, since severe and persistent hypotension is a
common accompaniment of such use.
If you publish such anxious statements, perhaps at the least you
would ask the author to specify what he means by ‘MAJOR’ and what he
means by “MINOR’ effects. Also, a complication is an unexpected, and
potentially damaging event. You may ask the author what the consequent
‘complications’ were in the unmedicated series.
I will not consider a reply. You do no service by such publication.
Max Fink

From:
Max Fink, M.D.

P.O. Box 457
St. James, New York 11780
FAX:

516 862-8604

TEL: 516 862-6651

�</text>
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                    <text>March 19, 1996
Greg Fricchione, MD.
Division of Psychiatry
Brigham &amp; Women’s Hospital
75 Francis Street
Boston MA 02115
Dear Greg,
What a terrible story about Anthony Bouckoms! I liked him very much;
last November I invited him to join me and Charlie Welch in an ECT symposium at the
Boston APA meeting. He did well, and he told us of the changes in progress at Hartford
Hospital. Pity, such an untimely personal and professional loss; more than doubly sad for
his wife and remaining children.
I have read the article on catatonia with interest. My suggestions -- I
cannot read any article without and editorial pen in hand -- are in the text and margins.
Overall, I think the essay presents the experience well. But, if we are to be of service, we
should be more deﬁnite about the conclusions which we wish to leave as the ‘messages’.

The ﬁrst message is to recognize catatonia, and that is done well. Andy and
George will probably wonder why you do not recommend the use of their handiwor -the catatonia rating scale. By the time you get this note, it will be published [it is in the
March number of the Acta]. Instead of tables 4-6, should you not adopt the rating scale
and test method? We will surely have no objection to such use. [There is one small point -both George and Andy saw the scale as their ‘special’ handiwork and in the text of the
article labeled the scale as the ‘Bush-Francis Catatonia Rating scale’ or BFCRS —- a
cumbersome title that will not sell well. I believe you can adopt the scale without the
mnemonic label, as I have done elsewhere]
Similarly, you may wish to amplify the paragraph discussing the Bush et al
experimental ﬁndings in incidence of cases and treatment results, much as you do for the
Ungvari and Rosebush data (pg 16).

�The discussion of the theory of the mechanisms in NMS, catatonia, and
malignant hyperthermia deserves a clearer message (pg 23). When NMS was discerned as
an entity in the late 1970s, it was seen as similar to malignant hyperthermia, leading to the
suggestion that dantrolene be tried. But no commonality between MH and NMS has been
demonstrated except the superﬁcial appearance of the syndromes. Further, the evidence
for the efﬁcacy of dantrolene alone in NMS is anecdotal at best. (I am not convinced that
it does anything material in CNS disorders.) It does no good to continue to recommend its
use in NMS.
In the theoretic argument (pg 24), you argue for a speciﬁc site for
pathophysiology. Perhaps you would include a statement that one should assess PET with
xxxx as the ligand or SPECT for lesions in yyyy and/or zzzz. Such speciﬁcity may bring
you more attention than the more general, non-speciﬁc loci recommended now. [I believe
Mickey Taylor did himself a disservice by hsi trepidation in not seeking to argue for more
speciﬁcity; as a result his work is usually seen as ‘something happens to the brain, more in
the front than the back, I think . . .]
Finally, the summary argumen -- which is usually the most read- should be
clearer about what you recommend as a course of treatment. The journal is ‘critical care
medicine’, read, I assume by clinicians. What I have learned since we treated our patient
on 16N together is that that all neuroleptics need to be discontinued promptly; that
supportive measures instituted; and that lorazepam needs to be ‘pushed’. My present
dosage range for lorazepam is up to 16mg/day. I see no need to ever consider
bromocn'ptine or dantrolene -- if lorazepam fails, ECT is the deﬁnitive treatment. If the
diagnosis of catatonia is secure, such Rx will surely optimize the best for the patient.

I have also pencilled in corrections for some of the citations.
On a more personal level, I do not need to be a co-author of another paper.
I am delighted to help in this effort -- and will gladly review a penultimate draﬁ -- and all I
warrant is a note of thanks in the acknowledgements.
Many thanks for the opportunity to read this review. My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>Health Sciences Center
School of Medicine
Department ol' Psychiatry and Behavioral Science

April 16, 1996
TO:

Charles Kellner

From:

Max Fink

Subject:

Letter of Mr. Herman

W

I am in receipt of a copy of a letter addressed to you by a Mr. David Herman
regarding the use of CT pages for Szasz.

DH is a chronic psychotic who has latched on to ECT and drugs as the cause of his
difficulties; he is active in writing to everyone about his desire to save the world by stopping ECT
and drugs. He likes Szasz and Breggin.
He has written often; and as often, I have not answered.
My lack of reply is no sign of agreement or acquiescence.
See what being an editor gets you!

State University of New York at Stony Brook
Stony Brook, New York 1 17947810]
5i 6444—2990 Fax: 5 ()7444—7534
I

�</text>
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                    <text>Robert M. Post, M.D.
NIMH
Building 10 Room 3N212
9000 Rockville Pike
Bethesda, MD 20892

May 21, 1996

Dear Bob,
I am pleased to nominate Harold Sackeim of Columbia University for the

NARSAD Selo Prize.

For the past decade, Harold has been the nation’s leading researcher into
the practical issues in electroconvulsive therapy. He has deﬁned the importance of the
seizure threshold, energy dosing, and electrode placement in the eﬂicacy of ECT for
affective illness. In addition, he has clariﬁed the role of ‘pharmacotherapy-resistance’ in
the efficacy of ECT in affective disorders. Leading from those experiences, he has
organized and is now analyzing the data of the nation’s only study assessing the relative
efﬁcacy of continuation TCA vs continuation lithium plus TCA vs placebo in the aftercare
of patients who complete ECT. He has also made important suggestions as to the
mechanism of action of ECT, and in the present brouhaha about TMS, he is carrying out
the most organized and detailed studies of this possible alternative induction method.
He has been an NIMH scholar, a NARSAD scholar, received an award of
the ACNP, and is now a member of the APA Task Force on ECT.
For the decades of the 19605 to the 19803, it could be said that I led the
ECT research community. In the past decade, that role has surely been taken by Harold
and his leadership should be acknowledged. I am pleased to nominate him for the honor.
My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

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                    <text>Self &lt;PSYCH|ATRYIMFINK&gt;
taylorm@mis.finchcms.edu(Taylor Mickey)
Re: congrats on MEDLINE

From:
To:

Subject:
Date sent:

Wed, 2 Oct 1996 15:48:19 -0500

Dear Mickey,
Monday morning visited the library and the librarian showed me the
list of new journals accepted for indexing by NLM, and l was so
delighted to see ourjournal listed! Then came home and the mail
said the same thing.
I

I

How reassuring! How wonderful! You are to be congratulated on getting
the journal so far.

have decided that the lay-world needs a verbal explanation of ECT,
something akin to the videotape. So have been working on a
'popular' book for the trade market titled ELECROSHOCK!
Two publishers are interested, but before signing a contract l
decided to finish a good part of the book and then see if get a
better deal. So far, 21 chapters are written -- in various stages.
hope to have it done by the winter.
I

I

I

I

Harold Sackeim is the chairman of the SBP meeting in May 1997. He

visited us yeaterday and among topics, asked whether he was
interested in a discussion [debate, symposium, whatever] on the
difference in the US eclectic view of catatonia and the European
classical view that catatonia IS schizophrenia. He seemed interested.
suggested Beckmann and Stoeber of Germany, Taylor and Fink for the
US. Any thoughts? Could you go to California in May if carry
this through?
I

I

I

All my

best.
Max

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                    <text>July 17, 1995
Worrawat Chanpattana, MD.
Department of Psychiatry
Srinakarinwiroth University
Vajira Hospital, Samsen, Dusit
Bangkok, Thailand
Dear Dr. Chanpattana,
I have read the outline of your proposed study of continuation ECT in
interest. There is a need for a prospective study of ECT contrasted with
with
schizophrenia
neuroleptic drugs in schizophrenia. The basis for this belief is the review, now in press in
Schizophrenia Bulletin, which I recently completed with Dr. Harold Sackeim; a copy is enclosed.

The question which you seek to answer with the design of your study, however, is
not central to our present concerns. Most patients are treated with neuroleptics ﬁrst, and only
treatment failures are considered for ECT. In such a group, there would be little justiﬁcation to
continue treatment with a failed compound [such as a neuroleptic]. If you wish to answer the
question which intervention reduces relapse rate for longer periods, and at what cost, then patients
who failed an adequate neuroleptic trial for schizophrenia could be assigned to receive either a
continuation neuroleptic [although an atypical neuroleptic like clozapine would be preferred]
contrasted with those treated with ECT [either alone or combined with the atypical neuroleptic].
Such a study would parallel ongoing US studies comparing the relative efﬁcacy and safety of
continuation ECT, continuation lithium combined with a tricyclic compared, and lithium alone.
It is probably inappropriate to use haloperidol combined with ECT since there are
few studies of this combination. Considering the high risk of haloperidol for inducing dyskinesia, it
is not favored by many psychiatrists.
I am not directly involved in the support by our governmental or private agencies
of mental health research, and so cannot answer your query about support.

My regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>State University of New York at Stony Brook

.

\J
’

9 a

I

School of Medicine — Department of Psychiatry
,

Max F ink, M.D.
Professor of Psychiatry and Neurology
PO. Box 457
St. James, New York 11780

Voice: (am) 516 444-2990

(pm) 516 862-665
Fax: 516 862-8604
E-mail: mﬁnk@epo.som.sunysb.edu
1

November 26, 1995
Dr. Daniel Flores Amargos
Inst. de Psiquatria y Psicologia de Montevideo
Ellauri 1221

Montevideo, Uruguay
Dear Dr. Flores Amargos,
I am indeed ﬂattered by your invitation to particpate in a medical specialty
training program in Montevideo, and whicl I am inclined to accept the invitation, I am
aware that there is no suggestion as to what is expected of me. Do you intend to develop
courses over extended periods in Montevideo, or single day seminars? Or, do you wish a
list of sites to which you can send trainees, much as you did Dr. Savi? I will reserve my
answer until I am apprised of the details of your program.

Meanwhile, I am interested in hearing of any programs developed since Dr.

Savi’s visit here.

My regards to Dr. Lyford-Pike and Dr. Savi.
Si

erely ours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>November 26, 1995
Lizzie Sand Stromgren, MD.
Department of Biological Psychiatry
Psychiatric Hospital in aarhus
Skovagervej 2
DK-8240 Risskov, Denmark
Dear Lizzie,
I read your essay on ECT in acute delirium with much interest. I marked up
the text, and made suggestions which I believe will clarify the presentation. I also made
marginal numbered notes which are discussed in the attached memorandum.

There is little question about the efficacy of ECT in severe melancholia,
stupor, or acute manic states. The argument which I believe you wish to present is that in
acutely ill patients with histories of psychiatric or systemic disorders, the appearance of an
acute delirium, with or without fever, with or without rigidity, with or without autonomic
signs, is a possible indication for ECT; and if ECT, the use of en bloc [2-?3 ?4] treatments
may be life-saving. The discussion of unilateral and bilateral ECT and cognitive features is
beside the point. I believe we need a follow-up of the Kramp and Bolwig article as an
invitation to others to entertain the possibility of using ECT in this special type of case.
Thank you for the opportunity to read this report. My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>Directions in Psychopharmacology
Published by
The Hatherleigh Company, Ltd.
420 East513t Street
New York NY 10022-8095

EDITORIAL BOARD RESPONSE FORM

Name Max Fink, MD

IE

I

D

In addition, I would like to write a lesson on:

would like to serve on the Program Advisory Board of Directions in Psychopharmacology.
h

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W
AIM!

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JW

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Please return this form, along with an updated curriculum vitae, and send to:
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�</text>
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                    <text>December 5, 1995
Chittaranjan Andrade, MD.
Department of Psychopharmacology
NIMHANS
Bangalore 560 029
India
Dear Dr. Andrade,
Thank you for sending me your most recent publication which outlines the
research contributions of NIMHANS to our understanding of ECT. It is impressive.
By happenstance, Dr. Sanjay Sandragiri was assigned to work on my
service this month. He is a trainee in our residency training program. He appears to be
talented, enthusiastic, and well trained already, so that it seems a shame for him to spend
the next three years in pedestrian learning activities. I was considering encouraging him to
undertake studies in ECT concurrent with his residency training. I understand that he
spent some time at NIMHAN S. I would be grateful for any remarks that you would share
with me regarding his potential for an academic career and his ability to assume the double
burden of residency training and innovative research.
My regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>February 8, 1994
Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
GENOA
Italy

Dear Walter,
First, the good news that your good fairy deposited a check for $9,980 to your account on
January 10, giving you a balance of $14,335.
As for compiling a book from a meeting, it is a good idea and many publishers will
welcome the opportunity to publish, provided that you can convince them that there is a market.
That is usually done by showing that a society is behind the book, and that the society will ‘sell’
the book to the members by making it part of the annual dues; or by internal advertising; or by
subvention. The latter method is the most secure, since the publisher asks that you assure him of a
set amount [usually enough to cover his direct costs for 500, 1000, or 2000 copies], and he will
then gamble on making some money from additional sales.

It is not the list of speakers, nor their eminence, that will make the book -- but the
eminence of the authors, that is, the actual submissions that you receive to publish. The usual
procedure is to develop a ‘proposal’ for the book, which you can present to science editors of
publishing houses. I have attached the topics for a proposal.
Raven Press is a good bet, and when you have a proposal, send it to me, or bring it when
next you are in New York. Other publishers are Elsevier, Academic, Plenum, Karger, Thieme,
and others.
Having a co-editor is a pain, unless you can ﬁnd one who is obsessive and wishes to do
the work involved.
Ciao!
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>December 27, 1993
Werner Herrmann, MD.
Clinical Psychophysiology
F reie Universitéit Berlin
Eschenalle 3
D—lOOO Berlin 13
FRG
Dear Werner,
I received your Fax regarding your nephew and took it up with Fritz Henn.
He will ask for approval from the Dean’s ofﬁce and should know within a few weeks.

We have had such scholars previously. Our third-year students have a
clinical course of 6 weeks which is both didactic (lectures) and clinical. It is preferable that
he be assigned to work on 10-North at University Hospital and if possible, should be there
when either I or Fritz Henn are ‘on service’. When approval comes, let me know what
dates he has available and I will advise you how to maximize his experience.
My best wishes for a happy and healthy 1994!
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>April 29, 1994

Donald F. Klein, M.D.
NY State Psychiatric Institute
722 West 168 Street
New York City 10032
Dear Donald,
After your letter about the hunt for the article on an evaluation of
psychoanalysis, I thought of calling Abe Lurie [516 681-5004]. He recalled a similar story,
stated that he had brought the tale to HH aﬁer sitting next to the author on a ﬂight. He
recalled that there was another evaluation done at Hawthorne-Cedar Knolls in the 1960s
The report was critical of psychotherapy, but could not give me any more data.
Perhaps you can jog his memory a bit more.
My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>“State University of New York at Stony Brook
School of Medicine — Department of Psychiatry
Phone: 516 4442929

Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 1780

516 862-6651

Fax: 516 862-8604

1

April 29, 1994
TO:
FAX:

Greg Fricchione, MD.
617 738-1275

FROM:

Max Fink, MD.
516 862-8604

FAX:

There is no secure literature on ECT in patients with amyotrophic lateral
sclerosis. The closest are the early reports of the successful use of ECT in patients with
multiple sclerosis [Savitsky and Karliner, N YSla/e .1. Med. 1951; 512788] and Alexander
[JNMD 1951; 1 14:283-306]. Others have written about the usefulness ofECT in
Parkinson Disease, general paresis, progressive muscular dystrophy, and intractable
epilepsy, in each case without negative effects on central nervous system ﬁmctions.
While none of these experiences are directly relevant to a case with
amyotrophic lateral sclerosis, I believe the consensus today is that if ECT is compelled,
there are no systemic disorders that would prevent the administration of ECT. I would
anticipate no speciﬁc difﬁculty other than that associated with swallowing and respiration
-— if brainstem signs are present sufficient to compromise these functions, the
anesthesiologist may well decide to intubate.
patient, keep good records and have your
junior write up. While cannot promise the response of my successor as Editor of
Comm/Siva 'l'herapy, I expect that he would look upon such a report with favor.

Ifyou decide to treat such

it

a

I

Good luck, and my best regards.

�</text>
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                    <text>State University of New York at Stony Brook
School of Medicine ~— Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 1780

Phone: 516 444-2929
516 862—6651

Fax: 516 862-8604

1

July 8, 1994
TO:

FAX
FROM
FAX

Dr. Sweeney Pillay

617 855-3754

Max Fink, MD.
516 444-7534

7

The citations you requested are:
Fink, M. :EEG and behavior: Association or dissociation in man? Integrative Psychiatry [in
press, 1994]
Fink, M., Irwin P., Weinhold P.: EEG proﬁle studies of clozapine in volunteers and psychiatric
patients. Neuro-Psychopharmakologie1979; 12: 184-90.

My best regards to Jonathan.

�</text>
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                    <text>A

State University of New York at Stony Brook
School of Medicine —— Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 11780

/

/4
jail”!
9?

b

'

Phone: 516 444-2929

516 862—6651

Fax: 516 862-8604

July 23, 1994
TO:

Robert Hirschfeld, M.D.

FROM:

Max Fink, MD.

Subject:

Ted Hutchinson’s memorandum14 July 94

M

Ted is a lay-person who was advised that his son needed ECT in California,
and he came up against the community prejudice and legal devices to frustrate its use. He
succeeded in getting treatment which was most helpﬁil. Since then, he has read widely in
ECT, developed a unique knowledge of the legal issues, especially those affecting the
FDA, and the role of the anti-psychiatry movement in the US. His ‘alerts’ to members of
the ECT community are respected.
He was instrumental in getting D. P. Devanand, Tom Bolwig, and Harold
Sackeim to compile the data in the reecent review of the pathology of ECT, the review
appeared in the recent number of the Am. J. Psychiatry. [He is a co-author].
I take his advice seriously and respect his knowledge.

The APA Task Force on ECT, headed by Richard Weiner, was establsihed
in response to requests for advice by the FDA in 1981 or 1982. It is still responding to the
FDA, and you may wish to get his advice, to correlate your responses. [Te1: 919-681
8742}

�</text>
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                    <text>Dr. Denise White

July 29, 1994

Department of Psychiatry
Groote Schuur Hospital
Observatory 7925
Cape, South Africa
Dear Dr. White,
Thank you for the recommendationof Dr. Ian Lewis for the position as Fellow in
our Department of Psychiatry. The application needs documented evidence of the completion of
medical training; satisfactory completion of residencytraining in psychiatry; letters of
recommendationfrom three sponsors [he should advise us to whom to write]; and satisfactory
grades in the FMGEM or USMLE examinations. [The last is essential for all trainees in the US]
It is my understanding that the examination schedule can be obtained from the US. Consular
offices. Please ask him to write a letter of appliication addressed to me.
I attach a copy of the letter I recently formulated for another applicant; it will give
Dr. Lewis a better idea of the work that is ongoing and planned.

It was a pleasure to work with you again in Philadelphia. It has taken me more
time than it has taken you, but I am now convincedthat NMS is a variant of catatonia. In talking
to Teri Rummans of the Mayo Clinic who recently described their experience with malignant
catatonia, she added the modiﬁcation that NMS should be seen as a variant of ‘malignant
catatonia’ -- a correction which I consider reasonable. Such associations lead logically to a
different protocol for the treatment of NMS -- that of‘lorazepam and ECT rather than dantrolene,
bromocriptine, amantadine, and l-dopa.
I am rather pleased with the changes in DSM-IV regarding catatonia, and decided
that since it is most likely that the APA Task Force will get brickbats and complaints, that perhaps
someone should extend a friendly hand. I did so in an editorial for Biological Psychiatry; a copy of
the accepted article is enclosed for your interest.

from him.

Thank you for the recommendationof Dr. Ian Lewis. I look forward to hearing
My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>November 7, 1994
Fred H. Frankel, M.B.Ch.B., D.P.M.
Department of Psychiatry
Beth Israel Hospital
330 Brookline Avenue
Boston MA 02215
Dear Fred,
I regret your impression that Dick Abrams’ remarks honoring my work in
ECT detracted from the work of the 1978 Task Force. Faced with the task of writing a
note honoring my contributions, he cited a long list, including the experience with our
1975-7 8 committee. I know that he meant no disservice to others.
This note reminds me of your earlier suggestion that the Task Force be
memorialized in 1995, at the 20th anniversary of its inception. Somehow, I think that is
premature, since our product was not available until 1978 -- would a recognition in May,
1998 be more appropriate?

My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>November 15, 1994
Dear Dr. Lasch,
I recommended Norman Endler: Holiday of Darkness: A Psychologists ’s
Journey Out of His Depression, originally issued in 1982 by John Wiley &amp; Sons in hard
cover, and re-issued in 1990 in soft cover by Wall &amp; Thompson, Toronto [6 O’Connor
Drive, Toronto Canada M4K 2K1]. I do not know any other testimonial that is as
effective in portraying the tragedy of depression and the recovery process.

It is kind of you to ask about my lecture schedule. I am scheduled to
present an ‘Update’ on ECT at a professional meeting in New York at the New York
Hilton Hotel on Saturday, December 3 from 11:45 to 12:30. The conference is a joint
presentation of the Albert Einstein College of Medicine and the American Society of
Clinical Psychopharmacology. Unfortunately, they are requesting hefty registration fees,
and I am not sure that you will get your money’s worth. A more productive meeting on
ECT will be held February 27-28 at the Ritz Carlton in Naples, Florida. Those sessions
will be led by the nation’s leading therapists. A brochure describing the course is, as yet,
not available but an inquiry can be directed to Dr. Charles Kellner at the Medical
University of South Carolina [803 792-9072].
I am pleased that we were of service to your mother. I can claim little
credit since her care was under the direction of my co-worker Dr. Laura Fochtmann.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>December 7, 1994
Edward Shorter, Ph.D.
Faculty of Medicine
University of Toronto
88 College Street
Toronto, Canada MSG 1L4
Dear Dr. Shorter,
In 1983, in preparation for the 50th anniversary of the ﬁrst induction of seizures
for mental illness, I sought historical data from Meduna’s family [could not ﬁnd any member] and
from his co-workers. One sent me a hand edited copy of an autobiography, seemingly written in
response to a shorter version prepared for Marti-Ibanez, Sackler, Sackler &amp; Sackler: The Great
Physiodynamic Therapies, 1956, Hoeber-Harper, New York.
The text needed much editing. As Editor of Convulsive Therapy, I published the
text in the ﬁrst two numbers of Convulsive Therapy [1985; 1:43-57; 121-138]. I used this text
and the shorter Marti-Ibanez et al text for my 1984 article.
Another version of Meduna’s history was written by Walter Freeman, MD. in The
Psychiatrist: Personalitiesand Patterns, Grune &amp; Stratton, New York, 1968.

Of the various versions, the edited autobiography rings truest. I met Meduna on a
number of occasions, and was impressed by his modesty, sincerity, and appreciated him as a
‘

gentleman’

.

The journal Convulsive Therapy is available at the Clarke Institute.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>December 20, 1994
William Graettinger, MD.
University of Nevada - Reno VAMC
1000 Locust Street
Reno NV 89520
Dear Dr. Graettinger,
I am pleased to write this letter of recommendation on behalf of your consideration

of Edward Coffey, MD. for the position of Professor and Chair of the Department of Psychiatry.
I have known Ed for about 8 years, ﬁrst through his research studies at Duke University , then in

our association as teachers of convulsive therapy at various teaching sessions throughout the
country, as editors of Convulsive Therapy, and as members of neuropsychiatric societies. Ed and I
have not worked directly in research, but our common interests in neuropsychiatry, seizures, and
ECT have led to many discussions.
Ed is well trained in psychiatry, neurology, and neuroradiology. His record as a
researcher is outstanding. He is the nation’s leader in applications of MRI technology to problems
of changes in brain ﬁmction with depression, aging, ECT, and drug therapies. He has recently
edited a book on neuropsychiatry and a few years ago edited a volume on advances in ECT, both
for the American Psychiatric Press.
He is an excellent teacher and speaker; a man of high moral character and
impeccable manners. Ed is a family man; he has three children and is happily married. [I have met
him and his family on numerous occasions] He is well liked by his co-workers and by his peers.
He is at the right age and with the right record to consider dedicating the next few
In October, when the chairman of our Department resigned, I recommended
chairman.
years as a
Ed among three clinician/scientists to the search committee. I would be delighted if he were to join
our faculty.
I appreciate his record, his personality, and his dedication, and recommendhim for
the position of leadership with enthusiasm. I trust these comments are helpﬁil.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>January 9, 1993
Dr. H. Folkerts
Klinik und Poliklinik fiir Psychiatrie
Albert-Schweitzer—Strasse 11
D-4400 Munster

Germany
Dear Dr. Folkerts,
One week fellowship courses are available at Columbia University
[Harold Sackeim, Ph.D., New York State Psychiatric Institute, 722 West 168
Street, NYC 10032] and at Duke University [Richard Weiner M.D., Ph.D.,
Department of Psychiatry, Duke University School of Medicine, Box 3309,
Durham NC 27710]. These are formal courses, with a set syllabus. They charge a
fee and provide a certificate of completion at the end of the course.
At one time, we had such a course but the work was too onerous. We
often have visitors who come for a day or a week or longer. We are accustomed
to having visitors attend our rounds to see the patients on my service; attend the
ECT sessions; and work with my ECT Fellows. The latter are directly responsible
for the actual administration of the treatments and they supervise the ongoing
research projects. We do not charge vistors, nor do we provide an ’official’
document of attendance.
Our laboratory is equipped with the THYMATRON DG and MECTA
SR-l and SR—2 ECT devices. These are brief pulse devices. Our treatments are
fully monitored according to the best established standards. We also treat a
number of high risk medically ill, as we are a tertiary care referral center for
complicated cases.
The best time to visit would be when I am ’on service’, responsible for
the treatment of patients at University Hospital. I am ’on service’ in
February/ March this spring, and again later this summer.
If you decide to come to Stony Brook, it would be helpful to have a
letter of referral or request for attendance from the director at the clinic.
Thank you for your interest.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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                    <text>Ma

April 3, 1993

Barbara Melisch, M.D.
Universitatsklinik fiJr Psychiatrie
Auenbruggerplatz 22

A-8036 GRAZ, Austria

Dear Dr. Melisch,
For reasons that are outside our control, regret to say that we are
unable to accept a Fellow in ECT for the coming year.
I

Thank you for your interest, and my regards.
My regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

and Neurology

�Post-It" brand fax transmittal memo 7671 lilo! pages
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8604

“Ca/oy—
February 13, 1993
Barbara Melisch, M.D.
Universitatsklinik fiJr Psychiatrie

Auenbruggerplatz 22
A-8036 GRAZ, Austria
Dear Dr. Melisch,

This letter is in response to your inquiry regarding
a fellowship at this
University for 1993-1994. Ordinarily, our committees have their budgest
assigned and have made their decision by this date. This year, however, the
University budgets have not yet been assigned, and i am writing to tell
you that
a ﬁnal decision will not be made until the end of April.
I

difficult.

recognize that such a delay is frustrating and makes any planning

My

regards.
Sincerely yours,
Max Fink, MD.
Professor of Psuchiatry

�August 26, 1992
Barbara Melisch, M.D.
Universitatsklinik fUr Psychiatrie
Auenbruggerplatz 22
A-8036 GRAZ, Austria
Dear Dr. Melisch,
We received your letter of application for a fellowship in psychiatry and
the supporting material. Thank you.

The file is as complete for the present as we need. The Fellowship
committee will consider the application in the late winter and announcements of
awards are made in early February for the next academic year which begins in
July, 1993.

Before the end of this year, you will receive additional inquiries and
advice about your application for a suitable visa from our Training Office.
understand that such an application will have to be made by yourself in Austria.
I

look forward to seeing you in Munich. Hopefully, will have more
information at that time.
I

I

.

'

Have a good holiday.

Sincerely yours,
Max Fink, MD.

Professor of Psuchiatry

the

f’/

l/ 5

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�August 26, 1992
Barbara Melisch, M.D.
Universitatsklinik ftir Psychiatrie
Auenbruggerplatz 22
A-8036 GRAZ, Austria

Dear Dr. Melisch,
We received your letter of application for a fellowship in psychiatry and
the supporting material. Thank you.

The file is as complete for the present as we need. The Fellowship
committee will consider the application in the late winter and announcements of
awards are made in early February for the next academic year which begins in

July, 1993.

Before the end of this year, you will receive additional inquiries and
advice about your application for a suitable visa from our Training Office.
understand that such an application will have to be made by yourself in Austria.
I

look forward to seeing you in Munich. Hopefully, will have more
information at that time.
I

I

Have a good holiday.

Sincerely yours,
Max Fink, MD.

Professor of Psuchiatry

wW
-

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�July 3, 1992

Barbara Melisch, M.D.
Universitatsklinik fiJr Psychiatrie
Auenbruggerplatz 22
A-8036 GRAZ, Austria
Dear Dr. Melisch,
Thank you for your inquiry about research opportunities in our
Department. Each year we offer fellowships to qualified candidates in
consultation &amp; liaison, sleep disorders, ECT and psychopharmacology, and
child psychiatry. If you specifically wish to work with my team, the fellowship
ECT and psychopharmacology would be appropriate.

in

Please send me a new letter requesting consideration for a specific
fellowship, effective July 1, 1993, describing what experience you seek. if
possible (and know it is difficult), the note should specify why you seek U.S.
training. [e.g., to undertake a specific research project; or for general research
experience to allow you to return to Austria and an academic career; or for
greater exposure to US. clinical experience; etc. If you have a specific project in
mind, would you include a few paragraphs describing the project?]
I

We will also need the following information:
-

curriculum vitae
copy of ECFMG and any other certificates of training in English
copy of certificate of any post-M.D.training.

Zapotocky (or other senior psychiatrist) would describe
your education and experience. It would be particularly helpful if the letter would
suggest what expectations are held for the additional training.
It

would be useful

if

Dr.

This reads like a lot to do but
application for a fellowship.
My

regards to

Dr.

it will

be useful to support your

Zapotocky.
Sincerely yours,
Max Fink, MD.

PRofessor of Psuchiatry

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                    <text>April 23, 1993

Captain Richard Pico, MC, USAF
Wilford Hall USAF Medical Center
Lackland Air Force Base, TX 78236-5300
Dear Rich,
Thank you for your very nice letter of April 5.
You should apply to NARSAD for a startup grant for your first-break

psychosis study. would be glad to support your application and provide the
needed letter as mentor/advisor. However, it would be better if your sponsor
were someone in San Antonio or at a neighboring city in Texas. The reviewers
are aware that distance is a deterrant to useful interaction. Ray Faber should be
supportive; if not, A. John Rush at Dallas is a good friend and would get the
two of you together if you are willing to get to Dallas. [If you have another
sponsor, will gladly write a supporting letter.]
I

I

I

am not sure what is best for your third year time, since do not recall
the constraints. The brain imaging laboratory at UT is at the forefront of a
national brain imaging database collection program, and am impressed that if
you came to master the techniques described at the ANA meeting, you would
be doing yourself an excellent service -- both for your science and for any
clinical future.
I

I

I

As for EEG, much good work has been done, but the neurologists
and electrophysiologists have a less sanguine image of EEG brain imaging than
do I. Newer methods, like MRI, PET, and SPECT are flashier. Newer methods
get more industrial and academic support [there is more money in MRI, CAT
than EEG]. Perhaps, the clinicians are correct, and we have reached the limit of
what can be learned in an individual case from scalp recording. do not believe
that we have reached the limit of EEG as a scientific brain imaging tool -- it is so
I

responsive to set and emotional change, so easily and safely recorded, so
easily quantified, and so much has already been done to relate EEG change to
behavior. can see no harm in getting to read EEG records by the usual page
turning methods; at the least, it will provide a source of income should you wish
to continue such work in practice.
I

Call me any late afternoon or evening at my home-office: 516 862
6651 and we can discuss this further.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

and Neurology

�</text>
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                    <text>May 10, 1993

Kenneth R. Kaufman, MD.
8635 West Third Street, Suite 985W
Los Angeles, CA 90048
Dear Dr. Kaufman,
Thank you for the excellent case summary of your patient with
seizure disorder and surgical lesion with suicidal ideation warranting ECT. look
forward to the outcome.
I

am not sanguine about a position at this University but am willing to
send your records for review in our Departments. Please send a copy of your
c.v. and three or so reprints that may be useful. [The case report was
incomplete-- only page 51 was enclosed]
I

trained

in

I

Dr. Janowsky at UNC in Chappel Hill is advertising for

ECT. You may wish to write to him.

someone

Good luck with your patient.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

and Neurology

�</text>
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                    <text>May 8, 1993

Committee on Ethics
American Psychological Association
1200 Seventeenth Street, NW; Room 406
Washington, DC. 20036
Gentlemen:
am writing in response to the complaint of improper ethics charged
by Ms. Linda Andre against Professor Harold Sackeim of Columbia University.
I

am acquainted with the professional activities of Dr. Sackeim for
more than a decade. participated in the symposium on ECT which he
organized at the New York Academy of Sciences in 1985; we worked together
on the American Psychiatric Association Task Force on Electroconvulsive
Therapy, 1988-1990; and he has been an invaluable member of the Editorial
Board of the journal Convu/sive Therapy since its inauguration in 1985.
I

I

date of the complaint, the ECT
review course under the auspices of CME, Inc. chaired that course and was
responsible for inviting Dr. Sackeim and for planning the course.
With regard to the cited location and

I

am personally acquainted with Ms. Linda Andre. first became aware
of her activities when was asked to be an expert witness for defendants in a
malpractice suit in which she alleges that she received ECT without proper
consent, that the diagnosis was erroneous, and that she has been left with
permanent memory lacunae for events over her whole lifespan. In reviewing this
case, have read the hospital record, including summaries of her prior
psychiatric hospitalizations; her record of suicidality and psychosis; her
deposition and that of her treating therapists; as well as supporting
documentation.
I

I

I

I

On the occasion of the course in which Dr. Sackeim is alleged to have
lied, Ms. Andre took the microphone during the question period, harangued me
for my failure to acquiesce to her statements that memory loss was permanent.
During this time, she stood with a large covered object, and when failed to
answer her queries, she marched up to the platform and placed a large black
skillet with an animal’s brain in it; the brain was lying on a bed of dollar bills.
I

�American Psychopathological Association

Page 2

When gave a public lecture before the SUNY History of Medicine
the history of the anti-psychiatry movement, Ms. Andre attended and
on
group
again argued with me about her rights as a patient, and my failure to credit her
brain damage or to acknowledge that she had been assaulted by physicians.
I

She travelled to an international meeting on ECT in Graz, Austria. As
chairman of the first session, called for questions after presentations on the
practice of ECT in Europe. She took the floor and again challenged me for my
lack of interest in her memory problems and those of other patients whom she
alleges had been assaulted by psychiatrists.
I

On the specific allegations made in her complaint, I find these
fabricated and the result of her pathological imagination and thoughts. In
response to inquiries from the audience, Professor Sackeim described events in
his practice which reflected the problems of the intrusiveness of the antipsychiatry advocates. He did not mention Ms. Andre by name, nor did he
specify any individual. Her association that the description referred to her is a
paranoid identification, and is consistent with her psychopathology.
On the more general complaints, the present effort at harassment is
part of her present life activity as the leader of the Committee for Truth in
Psychiatry. Ms. Andre dedicates her life to challenging psychiatrists, and
particularly those interested in convulsive therapy. Her legal suit has not been
adjudicated, and she seeks adjudication in the public arena before that in the
legal arena.

urge the APA to hold Dr. Sackeim blameless and return the
challenge to Ms. Andre with an appropriate admonition.
I

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

and Neurology
Editor, Convulsive Therapy
Member, APA Task Forces on
ECT, 1975-1978; 1988-1990

�</text>
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                    <text>June 10, 1993
Dr. John Little

H&amp;CS
Lakeside Hospital
Gillies Street
PO Box 63 Ballarat 3353
Victoria, Australia
Dear Dr. little,
It is not clear why you sent the proposed guidelines for ECT to me. The best U.S
guidelines are those proposed by theAmerican Psychiatric Association Task Force in its 1990
report Electroconvulsive Therapy: Recommendationsfor Treatment, Training and Privileging
(APA Press, Washington DC.) or the 1992 text written by Richard Abrams (Electroconvulsive
Therapy, Oxford University Press, 1992). Both contain the present consensus in the US.
regarding all the questions you summarize in your report.
I attach some speciﬁc comments on your document, which may be idiosyncratic with me
and my team.

There is no experience to warrant or justify any speciﬁc decisions regarding pulse width or
frequency in treatment efﬁcacy. Swartz makes claims about duration, arguing that some brief
pulse trains at 4 to 8 seconds are more eﬁ‘icient (more effective?) than the short trains of the
MECTA. There is evidence that total energy (mC) is a factor in efficacy when unilateral electrode
placement is used. For my part, we are dedicated to the THYMATRON device which allows
changes in energy and duration. When we use the MECTA device, we use the SR—2 as the more
facile of the MECTA devices.
In the US, it is no longer acceptable to undertake ECT without EEG monitoring; we
would no more think of unmonitored ECT than we would think of unmodiﬁed (no anesthetic)
ECT.

�Page 2
I have not been to Australia, and would probably be pleased to come if the arrangements

were suitable.

Much of what I know about modern ECT comes from articles in Convulsive Therapy, the
quarterly journal now in its ninth year of publication. I do not think you know it in Australia -perhaps you could subscribe and educate your peers.
Sincerely yours,

Max Fink, MD.
Editor

�Page 3
Electroconvulsive Therapy: A Medical Guide
page 1: In discussing theories, why not cite the neurohumoral and the GABA-ergic hypotheses?
These are detailed in Convulsive Therapy (vol 5, #3, September 1989).
page 2: Why is catatonia cited among both psychiatric and non-psychiatric reasons for ECT? And
what makes the non-psychiatric 'controversial'. For catatonia, if benzodiazepines are not effective
in a few days, ECT is clearly justiﬁed even in catatonia secondary to systemic disorders (lupus,
typhoid, NMS).
The contraindiCations are not consistent with the APA discussion. We no longer accept
any absolute contraindication. We now approach each case with a risk/beneﬁt analysis, and if ECT
is commanded by the psychiatric conditon, no systemic condition is seen as a contraindication.
page 3: ECT was not the ﬁrst effective treatment for mental illness; it was believed to be effective
for dementia praecox and that was its novelty.
Inanition and manic delirium are conditions that should be added to the list.
We would not accept the statement that the anesthetist decides whether a patient is ﬁt for
ECT. That is the psychiatrist's decision; the anesthetist is to do his best with what is given to him,
much as he has to do with traumatic or non-elective surgery. (When ECT is compelled by a
patient's illness, it is not elective.)
page 4: It is too sanguine to say that permanent brain damage does not occur. At times, as a result
of poor techinique, a prolonged seizure is not recognized, an airway is not maintained and a
permanent dementia ensues. You can say that 'permanent structural brain damage does not occur
under usual treatment schedules'.
page 5: A common problem is post-seizure agitation or delirium.
For consent for ECT, we usually insist that a 'signiﬁcant other' to the patient consent as

well as the patient.

�Page 4
page 7: I believe fractures occurred in T10, not T5.
Pre—oxygenation does not reduce the seizure threshold unless you have evidence not in our

literature.

The eﬁicacy/ energy relationships are restricted to unilateral electrode placements.

Brief pulse currents produce less cognitive impairment than alternating currents.
page 9: I cannot believe you mean 2780 amperes -- perhaps milliamperes? Any reference to the
electric chair in an ECT document is pejorative. Delete it.
page 10. AT this late date, you cannot be serious in stating that the observer can tell when a
seizure starts or ends in ECT when patients are effectively paralyzed and asleep. In our studies in
1980-81, we showed that cuff monitoring and EEG monitoring were essential. By 1987-90, we
became convinced that EEG monitoring was essential, mainly as a protection against missing a
prolonged seizure.

�</text>
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m/ﬂ

June 16, 1993
Robert T. McQueeney, MD.
1110 Tenth Avenue
Menominee, Ml 49858
Dear Bob,
Thank you for the copy of your letter to John Greden. The request is rather clear,
but to whom do you wish his comments sent? Is it to you?
Attached is another such note, addressed to you, which you may submit to the
appropriate boards in Michigan.
Good luck in your efforts. My regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

and Neurology

�</text>
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Markus Gastpar, MD.
Direktor der Klinik ﬁir Allgemeine Psychiatrie
Hufelandstrasse 55
4300 Essen 1
Germany
Dear Markus,
It was good to see you again in San Francisco. As the enclosed preprint will show, I took
your advice and asked my co-worker to complete her report which will now be published in the
September number of Convulsive Therapy. I thought you would like to see a copy before it is
printed.
Our experience with maintenance ECT continues, and for the most part, we now believe
that such continuation treatment is an important addition to our treatment program.
My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>July 8, 1993
G. Northoff, M.D., Ph.D.

Zentrum der Psychiatrie

Klinikum der Johann Wolfgang Goethe-Universitat
Heinrich-Hofmann—Str. 10
6000 Frankfurt am Main 71, Germany

Dear Dr. Northoff,
In response to your letter of June 17: We occasionally appoint Fellows for
post-residency training and research. These appointments are usually made from our own
graduates, but about half the positions are given to trainees from other programs. For
those interested in clinical research, we require the satisfactory completion of the ECFMG
examination, and a visa which will permit the candidate's stay in the US. This is usually
the J-1 Visa which is issued on the request of the University.
A letter of application, accompanied by a copy of your curriculum vitae,
and a statement of your ECFMG status (Passed, date; or, scheduled examination date) will
start the application process. The letter should indicate the date on which you anticipate a
willingness to begin training, the duration of your willingness to take such training, and
your social status (married or single) and dependents.
We are actively involved in research in catatonia. These are under the
supervision of my associate, Dr. Andrew Francis. Our prospective study of incidence and
our rating scale developments are being written for submission for publication this
summer. We are continuing these studies and are developing a prospective study of the
biology of catatonia. We hope to have a protocol completed and submitted for funding by
the early fall.
Thank you again for your interest. Let me know how we can be of ﬁirther
help.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>September 11, 1993
Mr. Ivan Schick
ElCoT
14 East 60th Street; Suite 1207
New York, NY. 10022

Dear Ivan,
I had a very ﬁne lunch with Dick Glabers and Bob Ewing (we met at the Mirabelle,
our **** restaurant near my home). Their questions were mainly about the present status
of ECT as a practice; the impact of health care changes on ECT practice; the relative
strengths [and weaknesses] of the present devices and their manufacturers, and the [my]
experience with the ElCoT devices. I do not know whether I was of some help to them (or
to you), but we did agree that if another device were to come to market, the manufacturer
(or the manufacturers together) would probably need to develop an educational program
for both psychiatrists, generalists, and the public on ECT in order to expand the market
for ECT devices.

In any case, we missed you. Call me when you return from Turkey and we can
discuss their ideas.
My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>September 13, 1993
I»)

Dr. B. Verﬁey

Ziekenhuis Rijnstate
Postbus 9555; 6800 TA Arnhem
The Netherlands
Dear Dr. Vervey,
What a pleasure to receive such a happy follow-up on your case of lethal
catatonia. I was happy to be of help, and am doubly delighted that the results were so
welcome and that you will be writing it up. Yes, I would very much like to read the report
when it is published, but you could send me a preprint before publication if that is delayed.
There is increased interest in catatonia in the US. and Canada, and your
would
be of interest to this group of investigators.
experience
With regard to electro-acupuncture, I know of no follow—up reports.
Surely, none have been presented in the Western literature. A few years ago, Dr. Xue
wrote that he was coming to the US. and I tried to arrange a meeting but that fell
through. I have kept his papers in a travel folder in my ﬁle, hoping to visit China, but have
not done so.
What is clearly needed is for a Western trained psychiatrist, with some
skills in ECT, to observe the procedures in China and assess whether actual grand mal
seizures occur; their characteristics; a measure of the cognitive effects immediately aﬁer a
seizure and one—day and one week after a series of treatments; and EEG measures during
the seizure and 24 hours after 6 ECT or the end of a series. Such information will provide
an impetus to replication in the West.
Have a good trip to the US. and keep up the good work. My regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>9W
State University of New York at Stony Brook
School of Medicine — Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 11780

Phone: 516 4442929
516 862-6651

September 21’ 1993

Fax: 516 862-8604

Mr. Marty Madison
Quest Publishing Co.
Brea CA 92621

Dear Mr. Madison,
Thank you for sending me the DHEW announcement in the Federal
Register regarding the FDA classiﬁcation of Cranial Electrotherapy Stimulators. Yes,
these devices are the same as we assessed in the early 19605. It was the reports of RB.
Smith in the 19805 that led the US. Army physicians to examine the advisability of reimbursing CHAMPUS personnel for such treatments that led to my review.
My library contains two volumes which cite such research.
Reynolds DV, Sjoberg AE (Eds): Neuroelectric Research: Electroprosthesis,
Electroanesthesia and Nonconvulsive Electrotherapy. C.C Thomas, Springﬁeld, 1971,
466 pp.
Wulfsohn NL, Sances A. (Eds): The Nervous System and Electric Currents, Plenum
Press, New York, 1971, 171 pp.
Another set of data can be found in the literature of convulsive therapy
under the term 'subconvulsive shock' or 'nonconvulsiveelectric stimulation' or
'electrosleep'. A good source for such experience is to be found in two old texts:
Alexander L: Treatment ofMental Disorder. W.B. Saunders, Philadelphia, 1953, 507 pp.
Kalinowsky L, Hoch P: Somatic Treatments in Psychiatry, Grune &amp; Stratton, New York,
1961 [or earlier editions].
I would like to read your report when it is published. Thank you for
keeping me informed.

M

Sincerely yo
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�</text>
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                    <text>School of Medicine
.
D epartment or PSychIatry and Behavioral Science
.

September 23, 1993
Medical
New Mexico Board of
PO. Box 20001
Santa Fe, NM 87504

Examiners
'

Gentlemen:

William Turner for
the application of Dr.
of
in
support
Bill for more
writing
I am
Mexico. I have known
New
of
State
the
in
medicine
then as a researcher at the
Island,
licensure to practice
in
Long
clinician psychiatrist
member in the
than 40 years, ﬁrst as a
1973, as a fellow faculty
since
ﬁnally,
and
Central Islip Psychiatric Center, School of Medicine.
at our
Department of Psychiatry
who have
dedicated cadre of patients
with
a
clinician,
them
Bill is an outstanding
and has been honored by
groups
support
in
patient
active
is
with special interests in the
been helped by him. He
researcher,
outstanding
communit He is an
as a leader in our
and in psychopharmacology.
genetics of mental illness
maintained continuing
active, alert, and has
Despite his age, Bill is
and students.
relationships with the faculty
.

without reservation.
I commend him to you
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

A

:7

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,

CASELLES
New York
Count-y
Suiiolk
No. 5.6775616.
luly 31. 19
Term wires
DCROTHY L.
01
791101-10. State

NOTARY

State University of New York at Sto
11794-810:1y
Stony Brook, New York

516-444-2990

Fax:

516-444-7534

BFOOk

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                    <text>State University of New York at Stony Brook
School of Medicine —— Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 1780

Phone: 516 444-2929
516 862—6651

Fax: 516 862-8604

1

September 22, 1993
Dr. Douglas Glover

Department of Psychiatry
University of alberta Hospitals
Edmonton, Alberta, Canada
Dear Dr. Glover,
Permission is hereby given to dupliicate and distribute to your students
copies of the report " How does convulsive therapy work? from the journal
Neuropsychopharmacology [1990; 3:73-82] and my "Response to critiques
Neuropsychopharmacology [ 1 990; 3 :97- 1 00].
Subscriptions to Convulsive Therapy may be obtained either directly from
the publishers (Raven Press, 1185 Avenue of the Americas, New York City 10036) or by
membership in the Association for Convulsive Therapy. Membership dues includes a
subscription to the journal. Membership information can be obtained from Dr. Donald
Hay, Executive Director (1221 South Grand Boulevard, St. Louis MO 63104).
I hope the students enjoy the report.

Wide
Sincerely you

,

Max Fink, M.D.
Professor of Psychiatry
and Neurology

Post-WM
To
Co.

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brand fax transmittal memo

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                    <text>October 21, 1993
Captain Richard M. Pico, M.D. USAF MC
Wilford Hall Medical Center (AETC)
Wilford Hall USAF Medical Center
Lackland Air Force Base, TX 78236-5300
Dear Rich,
Thank you for your recent letter keeping me informed of your research.
The imaging work is interesting and you are to be congratulated on the drive. Such
imaging studies are becoming increasingly important in psychiatric research. I understand
that Dr. Edward Coffey has been invited to be a Visiting Professor at Wilford Hall. You
should discuss your proposals with him as he has done the most elegant MRI/ECT and
MRI/depression studies. His facility in Pittsburgh may interest you when you leave the air
Force.
there.

I do not plan to attend the Neuroscience meetings, so we cannot meet

I was in Austin last week, lecturing at St. David's Rehabilitation center. In
the face of the new Texas legislation forbidding ECT in anyone under the age of 16 [even
with parental and patient consent], there was a brouhaha at the sessions, with Scientology
pickets in front of the hospital and 3 disruptionists in the audience.

Good luck in your work.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>Post-It” brand fax transmittal memo

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School of Medicine
Department of Psychiatry and Behavioral Science

November 5, 1993
Sam Gershon, MD.
University of Pittsburgh School of- Medicine
Pittsburgh, PA

Dear Sam,
Attached is a formal answer to your inquiry, with some citations. There are
other excellent reports which use the same methodology, and I can supply a more detailed
list if you require it. The citations selected -- Lerer, Brandon, Sackeim -— represent our
best scientiﬁc efforts of the recent decade.
My best to Lisl.
Sincerely yours,

ﬂair/7
Max Fink, MD.
Professor of Psychiatry
and Neurology

State University of New York at Stony Brook
Stony Brook, New York 1'] 794—8l01
516—444—2990 Fax: 516-444—7534

�</text>
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                    <text>MM

December 18, 1993
Ms. Lynne Mascarella

CME Oﬂice
U. Arizona Health Sciences Center
Tucson, AZ 85724
Dear Ms. Mascarella,
I am pleased to permit the use of my report in the Acta Psychiatr Scand.
for your CME course in February.

The ideas in that report have been updated, however, by a presentation in
Paris in January. That report, titled “Optimizing ECT” is now in press in L ’Encephale. I
enclose a copy for your use, suggesting that this draﬁ is more up to date and of greater
interest to your students. The main point of difference is in the thorny question of whether
repeated threshold determination is necessary or indeed safe.
Good luck in your course, and my bets regards to Dr. Gelenberg.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

�</text>
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                    <text>December 27, 1993
TO:

F aroukh Maneksha

George Petrides
From:

Max Fink

Subject:

Follow—up

on trimethaphan study

Now that the dose range of trimethaphan has been deﬁned, we should use a
similar design to study the relative efficacy [and safety] of a beta-blocker compared to
trimethaphan.
Attached is the output of abstracts from a search of the ECT Database for
the substances labetalol, esmolol, and nitroglycerine, post-1987. Would you review
these and select one as a contrast for trimethaphan? Can you define a-commonly used
dose? Is there a design that you favor?

�</text>
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                    <text>July 13, 1992

Jonathan 0. Cole, MD.
Director, McLean Affective Disorders Program
McLean Hospital
115 Mill Street
Belmont MA 02178-9106
Dear Jon,
We seem to have gotten the same bug pharmaco-EEG -- at the same
time and we seem not to be able to get over it. I, too, believe that pharmacoEEG methods have not had the applications to which they lend themselves,
especially as the initial evaluation of potential new psychoactive compounds, nor
in the management of treatment courses, especially of therapy resistant patients.
The IPEG sessions in Boca Raton in May were a good sample of our present
experience. Unfortunately, except for some work in pharmacokinetics of
benzodiazepines by Greenblatt, and of opioids and anesthetics by
anesthesiologists, little has been added to our theoretic or functional knowledge
since the spate of NIMH/PSC supported studies between 1959 and 1975. These
studies developed the main algorithms for data reduction which are still in use
today. The main difference between 1990’s and the 1970’s is in the speed of data
reduction, ability to record and analyze multi-lead inputs (compared to our single
and 2-channel analyses), and the sharp reduction in costs; so much so that
practically any academic laboratory can do superior (to 19705) recording, data
reduction, and data analyses for under $15,000 for 4 to 8 channels.
-—

Unfortunately, the theoretic underpinnings remain the same as at that
time. And, many of the applications which we recognized as useful and feasible,
[and which are even more feasible today], have never had adequate trials.
Further, the present loyalty to the neuroscience reductionist belief structure
[which so dominates the ACNP, SBP, NIMH, and many academic psychiatric
departments] rejects any human recording studies as too gross. The main
exception are the polysomnographers with their activity in medical physiology and
the idiosyncratic, essentially impractical, sleep EEG studies of Kupfer.
A few years ago I summarized my experience with pharmaco-EEG in a
which
was not published. From time to time I have gone back to it, and I
report
enclose an incomplete draft, dated October 1991. On another occasion, I was
asked to review some reports by Herrmann which he submitted to the journal
Pharmacopsychiatry. I wrote an editorial that accompanied the papers. Finally, I
enclose a historical review which was published in 1984 which provides a basis for
our present knowledge.

�J.

0.

Cole

Pharmaco-EEG

Page 2

At the IPEG meeting in May, the applications of QEEG for
pharmacokinetics was well demonstrated. Its use in pharmacodynamic studies in
man was suggested, but there are few new studies such as Peter Irwin and I did
two decades ago. The industrial laboratories are apparently funding quantitative
pharmaco-EEG studies in various species. The pharmacologists are enthusiastic
that they can identify our present list of human psychoactive drugs, but they have
few examples of new compounds that have an identifiable pharmaco-EEG profile
in an animal species which helped in the clinical study of the compound. [I am
not impressed that this expenditure has much merit; rats, mice, dogs, and cats are
quite distinct in their pharmacology from man (indeed, mice have been bred to
be remarkably sensitive and insensitive to a host of CNS active compounds) and
it is pure happenstance when a compound has an EEG effect in an animal that is
predictive of its EEG pattern or sensitivity or clinical activity in man]
As for multi-lead recordings (such as the BEAM), these have not been
more helpful than single lead recordings in man. Herrmann and Coppola
undertook detailed analyses of multi-lead recordings of compounds which had
been classified by classical single channel recordings. Their findings were no
more useful than what was already known, at much greater expense. There are
some authors who argue that localized EEG changes should occur and they hope
that such differences will have predictive merit. But, so far, the data are very

weak.

With that introduction, I will answer your questions as best as I can.
1.

The enclosed papers are a good beginning. Get the issue of Phannacopsychiatry

24 (Nov):196-225, 1991. The three reports by Herrmann show what can be done

with pharmaco-EEG studies.

2. The best citations for the relation between EEG changes and clinical response

are cited in my report in progress.

3. Few studies fund pharmaco—EEG studies. I was recently contacted by Tetsushi
Inada, Ph.D. (Kyowa Hakko Kogyo Co. Ltd., 599 Lexington Avenue, Suite 2780,

New York City 10022). They have an antihistaminic compound and are seeking
ways to define its central activity. They were impressed by our 1979 report of the
EEG study of terfenadine and diphenhydramine (Phamtakopsych. NeuroPsychophannakologie 12:35—44). I sent them to Kurt Itil and have not had a
follow-up.
4. I am always willing to visit McLean. It might be useful to arrange a Grand

Rounds on pharmaco-EEG. I recently gave a talk for the neurologists: PharmacoEEG: Science or Pseudo-Science. Dr. Vasile should visit Itil in Tarrytown and get
an idea of which directions he is taking this technique. Turan and Kurt are quite
hospitable and seem willing to show off their techniques.

�</text>
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                    <text>July 14, 1992
William T. Donner, M.D.

Abington Memorial Hospital
Abington, PA 19001

Dear Dr. Donner,
The concern with ’informed consent’ for ECT was first reviewed by the
the 1978 Task Force report. It was reviewed again in its 1990 report. in
both, a balance between the facts as known and the mis-perceptions of the
public were considered. Memory complaints are mostly reported by patients
who have not improved with treatment. Objective evidence of memory
impairment is rare, especially in the past decade with the introduction of the
routine use of continuous ventilation with oxygen, brief pulse currents, graded
electrical dosing, selective electrode placement, variations in frequency of
treatments, and duration of course. We have also come to realize that the usual
associated treatments, like lithium, benzodiazepines, and tricyclic
antidepressants, which are often used as continuation treatments, do
themselves impair cognition and memory functions.
APA in

The best documentation of the present state of knowledge on long
term effects of ECT is found in the 1990 APA Task Force report, and in the
second edition of E/ectroconvu/sive Therapy by Richard Abrams (Oxford
University Press, New York, 1992). The older experience is best summarized in
Convu/s/ve Therapy: Theory and Practice which wrote (Raven Press, New
York, 1979) and the first APA Task Force report (#14, APA, Washington, DC,
1978). Each publication contains a useful model consent form.
I

Much of the concern with memory effects of ECT is sustained in the
public by the hysteria of the Church of Scientology. Present concerns are not
with the form, but with the consent process. Many clinicians now use a
videotape describing the ECT procedure to educate the patients and their
family. Commercial videotapes are available from Somatlcs and from MECTA,
the principal manufacturers of modern brief pulse ECT devices.

published

A lengthy consideration of competency to
in Convu/sive Therapy (8292-102, 1992).

consent was recently

Sincerely yours,
Max Fink, MD.

Editor

�</text>
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                    <text>July 17, 1992
Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
I-16132 GENOA
Italy

Dear Walter,
would interpret the letter of Dr. Gary Rosenberg as an exploratory
invitation, a statement that he is willing to explore a relationship and the
development of funding. He clearly does not say that he has an opening and
that you should make a formal application for it.
I

his third paragraph, he asks for a proposal (it would be helpful if
you would be more specific) in which you specify your needs (= a project
description with the usual format of aims, background, methods, personnel and
equipment needs, and a budget). He also asks whether you see yourself as a
pure researcher or whether ’these could be combined with some clinical
activities, either teaching or patient care as a visiting professor’. If he is to find
funds, he anticipates that it is easier to support someone who provides clinical
services for which reimbursement and support is possible.
In

He is asking whether you have passed the ECFMG qualifying
examination which would permit him to seek a clinical appointment for you.
He seems to depend on the collaboration of Dr. Okada.
in

you brought your own funds, he would have little difficulty
developing a project.
Of course,

if

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

F:\lPEG\SANNlTA\19-UNNM.GAR

�</text>
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                    <text>July 17, 1992

DearJana,
Thank you for the articles on bibliographic software. do wish that
could transfer from Scimate, but it works well enough. just took a course in
EMBASE and found, to my chagrin, that there are many more articles in ECT in
journals not indexed by MEDLINE than had thought. Unfortunately, EMBASE is
quite expensive, both in search time and in downloading citations. But had to
begin and downloaded citations for 1991-92 that did not have in MEDLINE.
I

I

I

I

I

i

am often asked why Convulsive Therapy is not indexed in MEDLlNE,
and can only answer that the MEDLINE review board makes its decisions in its
own way (like NlH Committees?). But Convulsive Therapy is indexed in many
other indices, and all can do is to urge readers to seek citation lists outside
I

I

MEDLINE.

incidentally, the last citation list contains a review of ECT in
Czechoslovakia. Their therapist are also male chauvinist pigs, shocking women
more often than men! But they seem to either have a different appreciation of
the efficacy of ECT in schizophrenia than we do [or their diagnostic criteria are
different]. assume the difference is probably the latter reason.
I

Let’s get together soon. My best to Vojta.
Max

�</text>
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                    <text>July 31, 1992
Ms. Mary DiCicco

Nepperhan Avenue
Hastings-on-Hudson

ll

New York 10706

Dear Ms. DiCicco,
Thank you for the copy of the textbook Psychology: Boundaries and
Frontiers by Buskist and Gerbing. As read the text, recalled the many years in
which collaborated with experimental and clinical psychologists, the years that
held membership in the American Psychological Association, and the many
meetings of psychologists at which or my associates presented our research.
But that is so far back in history.
I

I

I

I

I

read the section on somatic treatments in this textbook and was not
surprised by the outdated, anti-psychiatry views of the authors. It verified my
caution (and surprise) at your invitation.
I

I

am not the man for the job.

can recommend two outstanding experimental ’card-carrying’
psychologists with excellent credentials in electroconvulsive therapy. Both have
been or are members of the Editorial Board of Convu/sive Therapy.
I

Harold Sackeim is Professor of Psychology in Psychiatry at Columbia
University. He is the principal investigator of the two largest NIMH supported
programs in ECT research, and a member of NIMH committees. He has the
capacity and the staff to develop as fine a demonstration as you may wish. He
can be reached at 212 950 5855.
Helen Pettinati is Director of Research at the Carrier Clinic in Belle
Mead, New Jersey. She is the author of numerous excellent ECT reports; a
collaborator in a large NIMH sUpported clinical study with Dr. Sackeim; and has
the staff and capacity to develop the product you need. She can be reached at
201 874 4000 (Research Department).

Good luck

in

your efforts.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

�</text>
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                    <text>August 14, 1992
Morton Miller, MD.
Lahey Clinic Medical Center

41 Mall Road
Burlington MA 01851

Dear Mort,
When attended the Medical School graduation exercises this year,
was aware that we had failed to attract any of our own students to our
residency in psychiatry. noted that there were a number of prizes awarded
graduates for excellence in various subjects, but none for excellence in
psychiatry.
I

l

I

thought that we should develop a prize for excellence in clinical
psychiatry, associated that Satn had done an excellent job in establishing a fine
program, and discussed the development of a "Stanley Yolles Prize Award" with
the associate Dean for student affairs, Dr. Gardner. He encouraged me to
proceed.
I

would require the collection of some funds from Stan’s colleagues at
Stony Brook, and perhaps some at NIMH. Since you are coming to visit the
Department soon, would you think of this development so that we can discuss
It

it?

My

best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>September 8, 1992
Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
I-16132 GENOA
Italy

Dear Walter,
am ’on service’ in September and ’off service’ in October for the inpatient service. have planned a number of trips in October: October 5-8, 14-20,
and 27-Nov. 1. It would be best if you came at the end of September.
I

I

have a research fellow, George Petrides for studies in ECT. He has
been trained by Itil in the HZI system, and we received an updated version of that
system last week. It should be operational in the next few weeks. would be
pleased to have you consult and supervise George in his EEG studies.
I

I

Any news from Albuquerque?
My daughter-in-law delivered a healthy girl two weeks ago. Martha and
are grandparents now. As tell all, don’t feel different, but suppose it has been
a turning point in our lives.
I

I

My

I

I

best to Titty.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>November 30, 1992
Murray Wexler, Ph.D.
Department of Psychiatry
USC School of Medicine
LAC/USC Medical Center
Los Angeles, CA 90033

Dear Dr. Wexler,
am pleased to write this letter describing my experience with Barry
Kramer, MD. who is being considered for promotion to the rank of Professor
of Clinical Psychiatry. have known of his work since his appointment at Hillside
Hospital and to this Department in 1978. Until 1982, we collaborated on ECT
projects during his tenure. In 1985, when assumed the editorship of the journal
Convulsive Therapy, called on Barry to collaborate on some new projects. In
1991, he was appointed to our Editorial Board. also know him through his
activities in the Association for Convulsive Therapy and the American Psychiatric
Association.
I

I

I

I

I

Barry is a dedicated, intelligent, and bright clinician and researcher. He
is active in clinical research and in research meetings. He is specifically qualified

the management of patients
geriatric psychiatry.
in

in

high risk ECT and he has a special interest in

From his writings and discussions, am impressed with his clinical
teaching skills. His presentations at meetings are cogent, concise, and clear,
reflecting his skills as a lecturer.
I

view of his academic record, believe that he is fully qualified for
promotion to the rank of Professor of Clinical Psychiatry, and am pleased to
recommend his promotion without reservation.
In

I

I

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>January 5, 1992
Michael Taylor, MD.
Department of Psychiatry
UHS/Chicago Medical School
3333 Green Bay Road
No. Chicago, Illinois 60064

Dear Mickey,
read “Are schizophrenia and affective disorder related? A selective
literature review" with much interest and relief, mainly relief. have been finding it
increasingly difficult to identify patients with schizophrenia, finding that many
patients so labelled responded (with varying degrees of success, sometimes
dramatic) to treatments which are ordinarily prescribed for affective illnesses.
The cases have not been limited to those with ’catatonia’. These experiences
led me to adopt the attitude that no patient should be labelled as suffering from
’schizophrenia’ until after failure of vigorous treatment for affective illness. This
view has put me into conflict with my associates Fritz Henn and Lynn DeLisi
(firm believers in the genetic dichotomy theory), and even some younger faculty
trained at Hopkins. Hence my relief at your review and the challenge it provides
to the ’establishment’.
l

I

Keep up the good work. My thanks and my best wishes for a healthy
and happy 1992.
Admiringly.
Max Fink, M.D.
Proferssor of Psychiatry

�</text>
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                  <elementText elementTextId="107119">
                    <text>January 6, 1992
Mrs. Renee Bigler
Doubling Road
Greenwich, CT 06830

4O

Dear Mrs. Bigler,
have searched my collection of videotapes and cannot find one of
the Phil Donahue interview to which you refer. Since your letter asks that it be
returned, it is probable that did so at the time.
l

I

I

appreciate the problems with your son. Looking back at our

experience since 1987, do believe that we have confirmed the observation first
reported by Meduna in 1937, that patients who have been seriously and
continuously ill for more than two years achieve little persistent benefit from
ECT. We treat only one such patient, mainly because without ECT he becomes
aggressive and hostile, and with it is more relaxed and cooperative. His family
insists that we continue, even though he remains in a protected environment.
I

It

is probable that the hope of an important effect from ECT for your

son is misplaced.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>January 17, 1992
Governor Mario Cuomo
Executive Chamber
State Capitol
Albany, NY 12224
Dear Governor,
have been notified that the Comptroller has ceased retirement
payments to TlAA/CREF for most employees of the SUNY system. As with the
forced loans demanded by your office from all employees last year, this lack of
faith is destructive of employee loyalty
l

The law linking TlAA/CREF, a defined contribution system, to TRS and
ERS is unfair and illegal. This cynical and political maneuver will probably save a
few million dollars from this year’ 5 budget, only to be placed on the backs of the
next budget when the courts demand redress.
I

urge your support of legislation to re-instate payments retroactively

and immediately.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

ﬁg

�</text>
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W

March 14, 1992
Werner Herrmann, MD.

Clinical Psychophysiology

Freie Univesitat Berlin
Eschenalle 3
D-1000 Berlin 13
FRG
Dear Werner,

First, about the IPEG Program. Turan and I met yesterday and
completed the program, worked out the program printing, and made suggestions
regarding the social calendar for the meeting. It looks good.
With regard to the MacNeill et al report in Neuropsychobiology. I agree
that you accept what you deem useful. When reviewers differ as to their
recommendations, I do not think ’democracy’ is effective; the editor must make a
judgement based on the merits of the paper [as he sees it] using the advice of
reviewers for specific points.
You ask how I proceed as editor of Convulsive Therapy. I see the role
of the Editor as ’gatekeeper’and as a ’leader’. I try to determine whether an
original article asserts something new, whether it is likely to be true, and whether
it is likely to be ’true’ in a few years. Articles that meet these criteria and the
support of reviewers are accepted with enthusiasm. Other articles are accepted if
they usefully teach -- an experience that might be useful to others, or a technical
point that has merit. If the report is an opinion piece -- a commentary or
editorial -- I ask that it be related to something published recently, or that it
makes a new argument. Finally, reviews are very helpful if they are reasonably
complete (I check the citation lists myself) and if the conclusions may be helpful
to the reader, whether as a student or as a researcher.
The Editor is expected to stimulate and request articles that make new
points. I often leave a scientific meeting with notes that lead to letters and later
to editorials or reviews which I publish.
The section on pharmaco-EEG in Neuropsychobiology has not made a
concerted effort to improve our practice. As I recall the articles, they are mainly
archival reports of studies that follow standard models. Many are not definitive,
weakening our message. They have rarely been accompanied by critiques or
editorials.
‘

�Werner Herrmann, MD.

Page 2

The next IPEG meeting has two important issues that warrant
publication. The papers of the Classification Symposium may usefully be
published, perhaps as a special supplement, with a discussion of the relevance of
animal models for clinical psychopharmacology. Opinions are divided between the
pharmacologists who have a distinct faith that rat studies are the road to defining
new psychoactive entities [after all, it is their livelihood], and the clinicians who
recall that almost all that is useful in clinical psychiatry has come from clinical
efforts, and that so far, no new compound or idea has come from pharmacologic
studies.

The PK/PD symposium exemplifies a most useful application. It
deserves a separate publication, with a discussion of the BGA and FDA positions,
and arguments that pharmaco-EEG studies in man have something to offer
clinical medicine, something more than is offered by routine PK/PD testing when
applied to psychoactive (and neurologic active) drugs.
My principal argument with Kiinkel was that he appeared passive in
attitude, leaving the section archival and ’no fun’ to read. Miiller-Oerlinghausen
made a good point in the latest issue of Pharmacopsychiatry, when he accepted
your three papers and then asked me to write a commentary. The ’package’ should
have been part of the Pharmaco-EEG section of Neuropsychobiology. [Is it
premature for two journals to compete for the limited pharmaco-EEG material?]
As editor of the section in Neuropsychobiology, it will take much work;
a good beginning can be made at the IPEG meeting where you should try to

capture the best papers.

My best regards.
Sincerely yours,

Max Fink, M.D.
Professor of Psychiatry
,

�</text>
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Prim

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,

Department of Psychiatry and Behavioral Science

March 21, 1992

George Simpson, MD.
Department of Psychiatry
Medical College of Pennsylvania
3200 Henry Avenue
Philadelphia, PA 19129
Dear George,
lecture material on efficacy of ECT, with slides of efficacy in
major depression, major depression with psychosis, schizophrenia, mania,
catatonia, NMS, parkinson disease, and a few others. There are also slides of
the risks of ECT, considerations in treating the elderly, and maintenance and
continuation ECT. The whole represents one of my two stocks in trade.
I

If

slides or,

if

have

full

you focus your question more specifically,
can find them, send the negatives.

I

will

be glad to copy the

I

Many recent texts give the data in summary form. These include:

Abrams,R. Electroconvulsive therapy. New York: Oxford University Press, 1988,

‘

231 pp.

American Psychiatric Association. The Practice of Electroconvulsive Therapy:
Recommendationsfor Treatment, Training and Privileging. Washington,
DC. APA Press. 1990.
Kellner, C. (Ed.): Electroconvulsive Therapy. Psychiatric Clinics of North America.
14 (4): 793-1020, Dec., 1991.

I will be away this week, returning on Monday March 29. Call me
afternoon or evening at my home/office- 516 862 6651, or in the mornings at the

University- 516 444-2929. I’ll do my best.

Max Fink, MD.

Professor of Psychiatry

state University of New York at Stony Brook
Stony Brook, New “York 11794—8101
516-414141-2990

Fax:

516444-7534

�</text>
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                    <text>{if

‘

4!“:
_

I!r“.;,"‘,./"';':’/

May 9, 1992
Wilma Harrison, M.D.
Roerig Division Pfizer Inc.
235 East 42 Street
New York City 10017-5755

Dear Wilma,
Thank you for the invitation to participate in the teaching commitments
am delighted to do so. As you know, am now identified with ECT
and catatonia than in standard antidepressant research. My ’expertise’ is rather
specialized and may, or may not, fit into the Roerig teaching program.
of Roerig.

I

I

ECT is a most effective treatment, which is offered mainly at major
academic hospitals in the U.S. It is hardly available at Veterans Hospitals, state
mental hospital, municipal hospitals mental health services, or the NIMH clinical
center. Despite the confirmed efficacy and safety of modern ECT. Despite the
reports of numerous commissions and study groups. Despite the belief by many
psychopharmacologists that the drugs can do all, for all, if only their knowledge
and skills were applied. [Even Don Klein, however, has begun to refer patients
for ECT.]

What can be done?
ECT, can surely help.

If

you wish to support lectures or conferences on

I

Perhaps Roerig is interested in something more. Each year at the
APA, the industry sponsors large lectures, with food and excellent P.R. Each
year, the topics are focussed on drug treatment for mania or panic disorder or
therapy resistant schizophrenia, each a topic designed to support a defined use
of a specific drug. Roerig could do more. Offer a symposium on the evaluation
and treatment of the severe mentally ill, with a focus on the relative efficacy,
indications, and combined uses of drugs and ECT. By including ECT, you will
capture a large [and growing] group of physicians who feel that their training
has been deficient [it generally has] and who are now asked to use ECT [by

insurers]. A symposium could be organized about a single diagnostic group
[depression, bipolar disorder, psychosis] or about a problem [treatments in
pregnancy, the elderly, or young adults] with a focus on guidelines for the use
of drugs and ECT, in association or sequentially.

�Wilma Harrison, MD.

Page 2

Catatonia is a second topic. A few years ago, Mickey Taylor and
wrote an argument that catatonia should be separated from schizophrenia [it is
only defined as a subtype of schizophrenia in D-SM-lll] into a separate class in
DSM-IV. The DSM-IV committee agreed, in part, and now recommend that
catatonia be a modifier of four conditions.
I

Our interest in catatonia is based on two issues. ls catatonia a part of
schizophrenia or is it something else? Considering the particular efficacy of
ECT, should it not be separated from other conditions so that ECT can be used
early in the treatment? Further, are catatonia and NMS similar or different

disorders?

also enclose an editorial “Pharmacotherapy and ECT” which
expresses my opinion of some present lacks in the education of
psychopharmacologists and clinicians about ECT.
I

Some specific suggestions. For lectures, the following titles are
descriptive:
For whom should ECT be considered?
ECT and pharmacotherapy: Combined and sequential use.
Efficacy and safety of modified ECT.

Catatonia and NMS: Identification and treatment.
Catatonia: Not so rare and very treatable.
For the APA, a conference can be organized on the topic of catatonia, or
therapy resistant depression [psychosis], or the pregnant psychotic. Each topic
can be organized to be rather unique in modern APA annals.
I

enclose some reprints for your review, and a copy of my ’short’ c.v.

My

thanks foryour consideration and my best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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ll?“
May 15, 1992
Ellen P. MacKenzie, MD.
2216 Belle Chasse Highway

Gretna,

LA

70053

Dear Dr. MacKenzie,
very much appreciate your letter of May 5. am heartened, rather
than discouraged, by your plea to use my influence and reputation to enhance
the education of your colleagues. You represent one of those who came to a
course, and are now using your skills to treat patients who need ECT. That is
gratifying enough.
I

I

gave a lecture on ECT at the Ochsner Clinic. They sent a
to my laboratory for a week. And while have not
Heinz,
trainee,
Jerry
young
heard directly from him that he has begun to treat patients, another resident
introduced herself at a recent course and said that they had begun an ECT unit.
Last year,

I

I

The best can do is visit again, if the professionals at Charity Hospital
seek some help, either in teaching or in organizing an ECT service. But the
need must be felt by the professionals at the facility.
I

I

believe we are making progress.

The case reports published by Sandoz are not meant to educate, but
to indoctrinate. So long as medical schools and psychiatric organizations
depend on the largesse of industry, they will be subject to this type of
’education’. Gilbert Honigfeld is poorly acquainted with ECT, and has no interest
in any comparison bevvteen clozapine and ECT. When clozapine was still
’experimental’, proposed to Honigfeld, Kane, and Meltzer a study of their
treatment failures, i.e., the 70% of clozapine treated patients who did not
improve, with ECT at no extra expense to the patients. But we never received
referrals and only recently have Meltzer and Kane begun trials of ECT with
clozapine or after clozapine.
I

Good luck

in

your efforts, and many thanks fgor your kind remarks.
Sincerely yours,
Max Fink, MD.
Editor

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                    <text>June

3, 1992

Laureen Froimson R.N.C., M.S.N.
@-South
University of North Carolina Hospitals
101 Manning Drive

Chapel

Hill,

NC 27514

Dear Ms. Froimson,
It

is true that Convu/sive Therapy is not indexed in MEDLINE, but that

is as much a political as a scientific/academic decision. It used to be that all
medical periodicals were indexed after they produced two complete years of
publication, but with the flood of new journals, the decisions are now made by a
committee of NLM. You can be of help if you would write about your concern
to the Director of the National Library of Medicine, pointing out your difficulties,
the importance of ECT at your hospital, etc. You may wish to send a copy to
Sheldon Kotzin, Chief of Bibliographic Services Division of NLM. (National
Library of Medicine, Bethesda MD 20894).

We do not have a special set of guidelines for nursing in preparation.
We are working on a set of Policies and Procedures that can be adapted at
your hospital. enclose a copy of the University of Michigan document that is a
I

model.

My regards.

Sincerely yours,

Max Fink, M.D.
Edhor

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                    <text>June

3, 1992

Herbert Meltzer, MD.
Department of Psychiatry
Case Western Reserve Medical School
2040 Abington Road
Cleveland OH 44106
Dear Herb,
Your telephone call about my letter to the APA regarding Dr. Orne led
me to my files. enclose a copy of my letter to Dr. Sabshin and his office’ reply.
That is the extent of my involvement, which followed on the public presentation
of what was alleged to be Dr. Orne’s release of confidential tapes from
psychotherapy sessions after the death of a patient.
I

do not know how my name is associated as a lead name in a
complaint. called Dr. Sabshin’s office and was told that my letter was one of
many that had been received and that had been forwarded to the Psychiatric
Physicians of Pennsylvania.
1

I

The matter is not personal, either with regard to Dr. Orne or the
author to whom he released the tapes.
I

trust this information may be helpful. My best regards.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

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                    <text>June 23, 1992
Arnold J. Friedhoff, M.D.
Chair, Lieber Prize Advisory Panel
Department of Psychiatry
NYU School of Medicine
550 First Avenue
New York City 10016

Dear Arnie,
would like to suggest that MICHAEL ALLEN TAYLOR, M.D. be
considered for the Lieber Prize. Mickey is Professor &amp; Chairman of the
Department of Psychiatry &amp; Behaviorasl Sciences at UHS/Chicago Medical
School. have known him since his residency days, and was his mentor when
he received the A.E. Bennett award of the Society of Biological Psychiatry in
1969.
I

I

He has been an avid student of the psychopathology of
schizophrenia. His major contribution has been to provide important criteria to
subdivide and identify populations of patients with schiophrenia for family,
genetic, and biological studies.
In studies from 1972 to 1980, he and his colleagues examined the
of
validity the diagnosis of schizophrenia and manic-depressive illness by
examining the clinical phenemoenology of these diagnostic groups to
demographic, family illness, neuropsychological and treatment response

variables. They demonstrated that catatonia was more prominent in patients
with affective disorders than in those with schizophrenia. They carried out
prospective studies to classify patients using cross-sectional criteria and
developed an objective basis for classifying patients with the major functional

psychoses.

Their studies suggested that the diagnosis of schizophrenia was being
made too often, with a low degree of validity for the diagnosis of acute,

paranoid, good prognosis, catatonic and schizo-affective schizophrenia. His
studies demonstrated that if a patient satisfied the diagnostic criteria for affective
disorder, a good prognosis was the rule, despite the additional presence of first
rank symptoms of schizophrenia [Schneider], formal thought disorder, or
catatonia.

�Page 2

Michael Taylor

the past decade, Mickey has developed rigorous, validated
criteria
to establish homogeneous patient samples for schizophrenia
diagnostic
research; focussed studies on the functional relationships between neuronal
In

groups and behavior, using neuropsychological techniques; and regional
cortical functioning in patients with major psychoses. He is carrying out
independent studies of family illness data to define subgroups of schizophrenic
and affective disorder patients, relating these data to biologic and clinical

variables and comparing various models of genetic transmission of illness.

Mickey has written a classical analysis of catatonia which is the basis
of the separation of this disorder, with defined treatment and prognostic criteria,
from schizophrenia in DSM—IV.
He is among the most innovative of the present generation opf
in schizophrenia. He is an eminent teacher and scholar, editor,

research leaders

and administrative leader.
I

commend him for your consideration for the Lieber Prize.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>June 29, 1992
Carl Salzman, MD.
Department of Psychiatry
Massachusetts Mental Health Center
74 Fenwood Road

Boston MA 02115
Dear Carl,

Turan ltil asked me to write a letter of reference for Dr. Pierre LeBars
who is applying for a fellowship in psychopharmacology. have known Pierre for
about three years, since he began to work with Turan in pharmaco-EEG. My
association has been limited to working with Pierre as a consultant in ongoing
and proposed pharmaco-EEG studies, and in our communications at the recent
IPEG (International Pharmaco-EEG Group) meetings at Boca Raton.
l

Pierre is a well trained neurologist with both an MD. and a Ph.D. in
neuroscience. While his publication record is limited, his training record is extraordinary.
found Pierre most knowledgeable about EEG, drug
pharmacokinetics, and pharmaco-EEG practice and theory. He participated
actively in the meetings. He is a charming French-man, with an excellent
command of English, and a keen sense of humor. He is a delight to be with,
and he has captivated Turan, his family, and all their friends.
!

commend him to you with enthusiasm. Considering his neurologic
and EEG backghround, a firm grasp of modern psychopharmacology should be
most helpful in assuring useful contributions in pharmaco-EEG.
I

My regards.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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                    <text>November 30, 1991
Martin B. Keller, M.D.
Dept. Psychiatry &amp; Human Behavior
Butler Hospital

345 Blackstone Blvd.
Providence, RI 02906
Dear Martin,

am pleased to write this letter in support of the promotion of Barry
Fogel, MD. to the rank of Professor in the Teaching Scholar track at Brown
University. have known Barry for about six years, since he began his NIMH
Geriatric fellowship. At that time, he introduced himself and asked for guidance
in the application of ECT in his studies. have met him at numerous
professional meetings and cooperated in his leadership role in the American
Neuropsychiatric Association.
I

I

l

.

Barry’s strong points are his interest and skill in teaching and
education, his friendly personality, and his enthusiasm for clinical care of the
elderly. His weak point is his lack of a productive academic research focus.
His personality and enthusiasm has led to his appointment to
committees in geriatric societies, and the many calls for him to write chapters
multi-authored texts. With Dr. Stoudemire, he has published an excellent
textbook of medical psychiatry which is useful as a clinical reference. His
publications reflect his scholarship but lack independent creativity.
With Randy Schiffer of the University of Rochester, he

in

created the

American Neuropsychiatric Association and has led that Association to have an
interest in education and special certification in the American Boards. He was
instrumental in supporting the Association’s affiliation with the APA journal of
neuropsychiatry, with its focus on clinical case material, rather than the more
academic and research oriented competitor published by Raven Press.
Barry is a good lecturer. l have not seen him work in a clinical setting
so cannot comment on his clinical skills.

Considering the guidelines of your letter of November 16, Barry clearly

meets the requirements for promotion in a teaching track, and recommend his
I

promotion with enthusiasm.
My regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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                    <text>December 2, 1991
Wagner Bridger, MD.
Medical College of Pennsylvania
3200 Henry Avenue
Philadelphia PA 19129
Dear Wagner,
am delighted to recommend the faculty appointment of Charles
MD.
as Professor of Psychiatry at MCP.
Shagass,
I

have known Charlie since 1955, when he had developed the sedation
threshold test, the first of the modern biological tests for classification of the
mentally ill. It was my good fortune to undertake confirming studies of this work
which remains an important part of my evaluation of patients.
l

A leader in electrophysiology, Charlie has written numerous books and
articles on EEG and behavior. A leader in the academic world, he has been
instrumental in propelling the Society of Biological Psychiatry to the forefront in
biological psychiatry. A leader in the international scene in biological psychiatry,
he was instrumental in organizing the International congresses of biological
psychiatry.
His record includes all

aspects of professorial activity

-—

pre-eminent

research, active teaching, administrative leadership, and important clinical

contributions.

Charlie is well liked by his peers and his co-workers, as witnessed by
the many honors and appointments that he has had.
recommend his appointment as Professor, with enthusiasm and
without hesitation or reservation.
I

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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                    <text>December 4, 1991

James Ballenger, M.D.

Chairman, Department of Psychiatry
Medical University of South Carolina
171 Ashley Avenue
Charleston, SC 29425-0742
Dear Jim,

great pleasure that | submit this letter in support of the
promotion of Charles H. Kellner, MD. to the rank of Professor of Psychiatry.
It

is with

have known Charlie since about 1985 when he moved to South
Carolina and asked for my advice in training in ECT. Since then, he has been an
active reviewer for Convulsive Therapy and an occasional contributor. have
followed his research publications and listened to his presentations at scientific
societies. encouraged his acceptance of an active role in the Association for
Convulsive Therapy, as well as the course in ECT which he is chairing in
Charleston in February, 1992.
l

l

l

Charlie is a well trained psychiatrist, certified by the American Boards
with special certification in geriatric psychiatry, and eligible for certification in
neurology. His teaching and administrative skills are defined by his roles in
residency training, ECT, and consultation/liaison.
He is an active researcher. In his period at NIMH, he reported useful
findings brain imaging (CT and MRI) in relation to measures of cognitive
impairment, hypercortisolemia, and lately in patients with obsessive compulsive
disorder. He has published numerous letters and commentaries in ECT, and
has a series of contributions in ECT accepted for the 1992 APA and ACT
in

meetings.

He is an enthusiastic clinician. While I have not had the opportunity to
observe his clinical work directly, have read numerous clinical research
contributions and these exhibit enthusiasm, interest, and breadth.
I

At this time, he is one of a handful of ’young’ researchers in ECT in
the US. Considering the general antipathy to ECT among psychiatrists, his
willingness to use, teach, and study ECT is remarkable. A few months ago,
was asked by Bob Cloninger for recommendations for a young researcher in
ECT for his Department in St. Louis. gave him three names, with Charlie’s at
the head of the list.
I

I

�Re: Charles Kellner, MD.

Page 2

His contributions to Convulsive Therapy have been intelligent and
enthusiastic. In recommending new appointments to the Editorial Board for
1992-1996, Charlie was unanimously invited.
like his calm and quiet ways, and his enthusiasm and willingnes to
admire his academic skills; recommend him for promotion without
reservation, in the full expectation that he will continue to contribute to the
academic vigor of our field.
I

work;

I

I

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>December 18, 1991
Mr. Bert Ellis
7 High Trees
New Barnet, Herts., EN4

England

900

Dear Mr. Ellis,
am rather surprised that anyone could have gotten anything positive
from the third hour of MADNESS. After viewing my copy, thought that the
hoopla of history and dramatization had destroyed the message.
I

I

The diagnosis of schizophrenia is difficult, and the rules for such
determination have changed three times in my professional career.
Electroconvulsive therapy has been in active use since 1938, and many reports
argue that patients with severe psychoses and severe affective illnesses (mania
and depression) respond well to ECT. The major complaint against its use has
been the high relapse rate, but that followed the attitude that the shorter the
course of treatments the better. That attitude was spawned by public antipathy
and fears that patients receiving treatment were ’brain-damaged’. Recent
determined studies find the fears of brain damage unfounded. The development
of techniques for treatment which minimize risks has made the treatment more
available.

These experiences led to the use of maintenance treatment, and my
statement in the interview in MADNESS.
The question of suitability of ECT for your daughter is not to be
determined by the diagnosis, but by her symptomatology and course. Mood
changes, vegetative symptoms, positive symptoms of psychosis, periodicity,
and signs of catatonia are some predictors of good outcome with ECT,
independent of the perception or diagnosis of ’schizophrenia’.
While there are many competent psychiatrists with a knowledge of
ECT in Great Britain, the ones who have written the most recently are Sydney
Brandon of Leicesterhire and John Pippard of London and commend them to
I

your attention.

Thank you for your inquiry.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>Health Sciences Center
School of Medicine
Department of Psycl'tic—itry and Behavioral Science

December 20, 1991
Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
1-16132 GENOA
Italy

Dear Walter,
I received the short note to be edited and because the text required
numerous hand-written marks, I returned the whole by air—mail one week ago. I
did not retain a copy of the edited text, but will do it again if the letter has not
reached you.
As for your book, I have printed out your final version and have read it
once. As I said when I read the prior draft, you have much to say that is unique. I
urge you to continue. You have more to say than the book that I had in mind;
your knowledge of physiology is greater than any of the the other pharmaCo-EEG
experts and perhaps a presentation of your views will enhance the science.
No one can anticipate the response of readers to a written report or
book, but I encourage you to go ahead with the writing. If you wish to get an
outside opinion, it would be helpful to propose a provisional Table of Contents
and to answer the following queries in a letter form.

What is the probable size of the text? How many figures? How many
tables? How many citations?
For whom is the book intended? What is the probable audience?

Which membership lists would be appropriate to canvass?

research?

Do you consider the book a review, textbook, or summary of individual

To whom should a publisher turn for independent opinions as to the
merits of the book?
If the publisher accepts the proposal, in what time-frame can he
anticipate a first draft?
Do you require an advance for figures and tables, typing or editing?
State University of New York at Stony Brook
Stony Brook, New York 'll794—8lOl
510-444—2990

FaX15l6—444—7534

�Sannita—

December 20, 1991

Page 2

With these in hand, you should approach a number of publishers in
letter form. In the U.S., Raven Press, Elsevier Press, Oxford University Press,
Academic Press, and Wiley come to mind. I can find others in booklists. In
Europe, the German and the Italian presses are very active.
My best regards to Titty and the girls, and my best wishes for a healthy
and happy 1992.
Sincerely yours,

W

Max Fink, MD.
Professor of Psychiatry

RS. 1 have received about 10 abstracts for the IPEG meeting so far. I will copy
these during the first week of January and send them off by air-mail for your
advice.

�</text>
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                    <text>May

2, 1991

Mrs. Robin Nicol
MECTA

Corporation

7015 SW McEwan Road
Lake Oswego, OR 97035
Dear Robin,

It

was a

36

Spring Hollow Road

to work with you, Gorham, and your
pleasure
CME course in New York. Despite the
unpleasantness of the intrusions, the students seemed to get
much from the course. John Schwartz was sufficiently pleased
to call to say that he would like to undertake another
course this Fall, and perhaps establish an 'Advanced Course'
as well.
I would like to return the modified MECTA SR-l which
you kindly sent us last year. It is in excellent shape and
could well be returned to your inventory. Would you send me
the appropriate carton and packing materials so that I can
return it in good form?
Again, send the material to me by UPS or other
freight handler to:

associates at the

My

St. James,
regards to all.

New

York 11780

Sincerely yours,
Fink, M.D.
Executive Director

Max

�</text>
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                    <text>May

2, 1991

Dr. John Schwartz

Inc.
Tustin CA 92680
CME,

730 El Camino Way

Dear John,
An

old friend wrote the enclosed note in response to
New York. I thought you would like to see it.

the events in

As a confidential note. Linda Andre, the woman who
intruded so emotionally in the course, is not accepting a
reasonable settlement of her malpractice suit. The lawyers
called this week to say that they were preparing to go to
she apparently wants her day before the media rather
trial;
than a reasonable resolution of her complaints.
I look forward to seeing you in New Orleans. My best
regards.
Sincerely yours,
Max

Fink, M.D.

�</text>
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Myron

Sandifer,

2, 1991

M.D.

4008 Mayflower Lane
Lexington, KY 40504

Dear Myron,
was

Thank you very much for your kind words. The session
and one never knows how to react to such an

painful,

impassioned intrusion. We are still trying to get ECT
accepted, not only by the laity, but also by our peers.
Despite the two APA Task Force reports, the NIH Consensus
statement, and endorsement by the AMA, ECT remains a

stepchild in many training programs and in most State, V.A.,
Federal, and municipal hospitals.
As I continue to give courses, I have noticed that
the audience is changing. A few years ago, most auditors
were 'old-timers', men and women who had been doing ECT for
some time. In the past few years, the auditors have become
younger; many are recent graduates in psychiatry who have
gone into the community to practice and have found their
training deficient. These students are a delight to teach.
My best regards.
Sincerely yours,
Max

Fink, M.D.

Editor

�</text>
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                    <text>May

2, 1991

PhiIip SIavney, M.D.
Department of Psychiatry

Johns Hopkins HospitaI
600 N. Woife

BaItimore,

Dear

MD

Street

21205

PhiIip,

It was kind of you to recommend The Life and Work of Josef
Breuer. It was difficuIt to find, but I am deIighted that I finaIIy got

it.

The picture of Viennese medicine at the turn of the century
much
Tess
a few decades ago
is
idyIIic than the anaIysts portrayed
I
I
(when
sat at the feet of the anaIysts). appreciated the notes on
Anna 0., particuIarIy Breuer’s case history. The emphasis on opioids (my
own) is Tess c1ear in this text, aIbeit stiII present in sufficient
detaiI not to vitiate my argument that dependence was a feature of her
’dis-ease’ and many and prolonged hospitaIizations. In my defense I see
in these notes, and in some others from that period, a reminder of our
present attitude to anxiontics and hypnotics. Many patients are

to read

it

admitted or referred to us with detaiIed notes about their use of TCA,
anti-psychotics, Iithium, carbamazepine, a1cohoI, and cocaine, and
onIy passing reference to the prescribed aIprazoiam and f1urazepam.

MAOI,

Andy and Laura are doing weII. They proposed a ’smaII study’ of
as a mode] of maintenance ECT which we are able to fund from a
gratefu] famin. The parents are wi11ing to support this research even
ECS

though they admit that our course of

IittIe reIief.
i1] patient

ECT

for their daughter

gave her

Andy aiso has become interested in a high risk medicaIIy
with a very recent repaired aortic aneurysm who was

successfuIIy treated with
Thank you again

ECT.

for thinking of

me.

My

best regards.

Sincerer yours,
Max

Fink,

Editor

M.D.

�</text>
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                    <text>May 17, 1991
Dr. P. J. Cowen

Psychopharmacology Research Unit

Littlemore Hospital
Oxford OX4 4XN
United Kingdom

Dear Philip,

share the information about Peter Breggin with your
colleagues so that they can be better prepared if called upon to challenge him
By all means,

in

the lists.

After my letter, completed the enclosed historical note in response to
from the editor of a special number of the Psvchiatric Clinics of
invitation
an
North America. This is a draft; you may share it as you see fit, but the language
may change when the editor has his say.
I

The anti-psychiatry movement in the US. has taken on Prozac
(fluoxetine). They aroused not only the manufacturer, but the whole
pharmacetical establishment, and with it, the press and television. TIME had a
lengthy article attacking scientology (May 6, 1991), as did the Wall Street

Journal

(April 19, 1991).

the U.S., the main response to the anti-psychiatry movement is
spear-headed by the APA Task Force on Electroconvulsive Therapy, chaired by
Richard Weiner, MD. of Duke University.
In

My regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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["1513

Wednesday May 15, 3:00 p.m.-5:00 p.m.
Side
Effects of Methylphenidate (Ritalin)
Efficacy and
for Post-Stroke Depression
Lawrence W. Lazarus, M.D., Psychiatry, Rush- Pres- St.
Luke's, 1653 West Congress Parkway, Chicago, IL 60612;
David Winemiller, B.S., Venkata Lingam, M.D., Carolyn
Hartman, M.D., Ida Neyman, M.D., Mehrdad Abbassian, M.D.,
Usha Kartan, M.D., Pauline Langsley, M.D., Virginia Markvart,
Fi.N., Jan Fawcett, M.D.
Summary:
Large numbers of stroke victims suffer significant depression
within the ﬁrst two years following stroke. Use of tricyclic antidepressants among elderly patients is often complicated by side effects
such as orthostatic hypotension. Methylphenidate has been shown
to be a rapid , safe, and effective treatment for depressed geriatric
patients.
Methylphenidatewas studied for safety and efficacy in the treatment of post-stroke depression at Rush-Presbyterian-St. Luke’s
Medical Center in Chicago. Ten elderly stroke patients with a DSMIll-R diagnOsis of major depressive disorder, a minimum Hamilton
Depression Rating Scale score of 15, and a minimum Mini Mental
Status score of 14 were treated with methylphenidate and studied
for three weeks.
Four of the 10 subjects showed Hamilton score reductions of
50% or greater. An additional four subjects showed Hamilton score
reductions of at least 25%. No subject had adverse side effects
necessitating discontinuation from the study. Five of the 10 subjects reported between one and three individual side effects.
Methylphenidate appears to be a safe and effective treatment
for elderly patients with post-stroke depression. Its rapid onset of
action and relatively low side effect profile may offer advantages
over tricyclic antidepressants, particularly in a rehabilitation or acute
medical hospital setting.

�</text>
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                    <text>July 15,

1991

David Neubauer, M.D.
Francis Scott Key Medical Center
4940 Eastern Avenue
Baltimore, MD 21224

Dear Dr. Neubauer,

theory

It was kind of you to send the reprints and citations on chaos
and EEG. The reprints arrived fortuitously when I had a visiting

scientist/electroencephalographer from Genoa, Dr. Walter Sannita, who
has been interested in the theory as another way to analyze EEG signals.

assume the concept is of interest as a novel way to reduce
form for further study (as in pharmaco—EEG, for
example) and as a basis for understanding the origins of the EEG. After
reading these reprints, I am reminded of the search for other techniques
to reduce EEG signals to numeric form: Drohocki integrator, pattern
analysis, shape analysis, period analysis, power spectral density are
some methods that we have used. After some extensive (and expensive)
computer comparisons of three of these methods, we realized that each
method is based on a massaging of the original numeric digital signals
as presented by the amplifiers, and therefore, one system must be
related to every other system; and that they can only be compared on the
I

EEG

signals to numeric

basis of efficiency, not

for

an

on ’meaning’.

I cannot contribute thoughts to whether chaos theory is useful
understanding of the origins of the EEG.

studies.

Again,

my

thanks and

my

best wishes for success in your
Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

�</text>
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                    <text>INTERNATIONAL ASSOCIATION FOR PSYCHIATRIC RESEARCH, Inc.
BOX

457, St.

lames, NY.

I

I780

l5I6I 862—665]
(516) 444-2929

July 12, 1991

Chown
Exmouth House
3-11 Pine Street
London EC1R OJH
Davall

&amp;

UK

Dear Ms. Ravenhill,
was either in the British Medical Journal or Lancet that a news story
within
the past six months noting an unusual report by an Australian
appeared
Royal Commission (presumably medical) which explored the claims of a
scientist that Deep Sleep Therapy was particularly useful in treating the mentally
ill. The inquiry was launched because of allegations of deaths associated with
It

this treatment, and the Commission was reported to have found the methods
unsafe and recommended their discontinuation. lack the original note as it was
sent to my librarian who returned only a note from the Royal Society in London
that Davall &amp; Chown was a source for this material. enclose a copy of their
leﬁen
I

I

based on experience with insulin coma therapy of
psychoses, electroconvulsive therapy, and what has conventionally been called
’sleep therapy’ without the ’deep’ modifier. The latter therapy was described in
1922 by Swiss psychiatrists, and was used until the late 19305 when insulin
coma and electroconvulsive therapy were replacements.
My interest is

I

would be grateful for your help.
Sincerely yours,

ﬂwab‘wc

Max Fink, M.D.
Executive Director

�llNTERPUNHCNVAL/K
SSOCIATION FOR P SYCFHATRK:RESEARC}ilnC

&amp;m4315Lmnmst&lt;H7&amp;)

(516)862-6651
(516)444—2929

July 2, 1991
Davall &amp; Chown
Exmouth House
3-11 Pine Street
OJH
London EC1R
UK

Gentlemen:
We

of the Australian
copy
a
obtain
I have beenb
Therapy.
would like to
Sleep
on Deep

Report
Royal Commission is available from your
advised that
FAX

it

office.

the charges for
to
as
advise
Please 8604.

this report.

#: 516 862

Thank you.

Sincerely yours,
Fink, M.D.
Executive Director

Max

Our

�</text>
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                    <text>July 24,

1991

Honorable Daniel Moynihan
U.S. Senate
Washington, D.C. 20510
Dear Senator Moynihan,
As a psychiatrist with more
experience, I am writing with regard

than 40 years of professional

to the progressive deterioration in
medical care in our nation.
effects of the Great Society legislation
been
have
not
on medical care
salutary, and the present considerations
RBRVS
HCFA
fee schedules for Medicare for psychiatry will make
of
by
matters considerably worse.
The

guidelines provide inadequate payment for
practitioners for all psychiatric services to the elderly. Because these
guidelines will become the standard for all insurers, the impact on
psychiatric care throughout the nation will be negative.
Psychiatrists have been among the less paid members of our
profession, and instead of improving the availability of psychiatric
treatment, the proposed regulations will make care even more limited
The proposed

than

it is.

Are you aware that various psychiatric treatments are not
available in our State for the patients of the Office of Mental Health?
For example, convulsive therapy is an effective and safe therapy (see
NIH Consensus Conference report, 1985) which is available only in
academic and private hospitals and the few academic affiliated hospitals
of OMH. Under the present regulations, this effective treatment will be
even less available.

urge you to vote to eliminate the 50% copayment for
psychiatric services, and to improve the proposed MFS for psychiatric
I

treatment.

Thank you

for your attention.
Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

�</text>
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                    <text>July 25, 1991

Jacques

M.

Quen, MD.

New York State Psychiatric Association
200 Garden City Plaza
New York City 11530

Dear Dr. Quen,
I

responded to your letter of July

and Senators.

11

and wrote to my Congressmen

am interested in the guidelines for electroconvulsive therapy. Would
be possible for your office to abstract the relevant RBRVS recommended
schedules for ECT, as well as anesthesia for ECT, and send these to me?
I

it

Recently, wrote to Harvey Bluestone about the unavailability of ECT
for patients at Kings Park and Rockland Psychiatric Centers, and that their
patients were being treated at University Hospital. He wrote that my note to him
was sent to you for consideration. Dr. Oldham of OMH appointed a committee
two years ago to consider ECT in OMH hospitals; the committee under Dr.
I

Russakoff surveyed the practice (and probably found it wanting). The report has
not been made public, nor has OMH taken any action to rectify a defined lack of
services. Perhaps the matter deserves consideration by the Association?
Thank you for your help.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>August 2, 1991
Robert P. Hopkins, M.D.
Chairman, Credentials Committee
McLean Hospital
115 Mill Street
Belmont, MA 02178-9106
Dear Dr. Hopkins,
I am pleased to write this letter in support of the application of Morton
G. Miller, MD. for the professional staff of McLean Hospital. Mort was a
member of our Department at Stony Brook for more than a decade under the
leadership of Stanley Yolles, and I knew him as a co-worker and unit chief. Mort
came to Stony Brook with Dr. Yolles from NIMH. In our Department, he was the
organizer and leader of the in—patient service, and I worked closely with him as
an Attending Psychiatrist.

Mort is an excellent clinician. He is skilled in clinical descriptive
psychiatry, and an excellent psychopathologist. He was instrumental in defining
the group of manic patients who come in a state of delirium, and who are
immediately responsive to ECT. He organized our affective disorders program
and the lithium aftercare clinic. In this unit, he inspired a number of his juniors
to credible research (Aronson, Shukla) with excellent publications.
He is an excellent and well organized teacher. He knows the academic
literature, including much history, and is able to lecture in an inspiring and
thoughtful manner.
He is a fine administrator, and is well liked by the professional staff.
He is honest, thoughtful, and adheres to the highest principles of our profession. I
am not aware that he has ever been denied any professional privilege or
membership which he requested; nor has he been denied licensure. He stood
before our tenure committee and was promoted to Full Professor with tenure in
due course. He is rather abstemious in his use of alcohol and there has never
been a hint of drug use.
I have no hesitation in recommending him for full professional
privileges in psychiatry, and do so without reservation.
Sincerely yours,
Max Fink, MD.

Professor of Psychiatry

�</text>
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                    <text>August 28, 1991

John Kane, MD.
Department of Psychiatry
LIJ-Hillside Medical Center

PO. Box 38

Glen Oaks, NY 11004

Dear John,
I received your memorandum of August 13 noting the By-Laws
requirement that members of the medical staff are to attend at least 50% of the
department/divisional conferences or meetings during the year. This note is to
request an exception, as I am actively involved in the campus at Stony Brook and
get to Hillside on occasion.

If you think it important, I will meet the non-onerous standard set in
the memorandum.
My regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>January 24, 1991
Dominick P. Purpura, M.D., Dean
Albert Einstein College of Medicine
1300 Morris Park Avenue
Bronx NY 10461
Dear Dr. Purpura,
with pleasure that | write this letter in support of the appointment of Dr. Bertrand
the
rank of Visiting Professor of Psychiatry.
Winsberg to
It is

first met Bert in the mid-19703 when he joined the faculty of the Long Island
Research Institute, a state supported facility of the Department of Psychiatry. His work in Child
Psychiatry was a central teaching unit of our residency training program. My contacts with Bert
were in two arenas -- the administrative meetings of the senior faculty of the Department, and in
his psychopharmacologic research.
I

Bert was an active and thoughtful member of our faculty, who provided reasoned
judgement on issues of concern. He ’fought’ actively to develop a child psychiatry fellowship
program, and was enthusiastic about both the clinical research and teaching activities of the
Department. think he was sorely disappointed that we were unable to convince the hospital
administration to open an in—patient child/adolescent unit.
I

His research was mainly psychopharmacologic. When was interested in the
pharmacology of a new entity, mianserin, he studied its pharmacology and pharmacodynamics
in children and adolescents. He provided a much needed complement to our own studies in
adults. His studies of methylphenidate were also illuminating.
I

Bert left Stony Brook in the mass exodus following the decision by New York State
no longer to support the scientists of the Long Island Research Institute. He was well liked and
we were disappointed when no other funding was available.
Bert is a friendly, enthusiastic, energetic man, with a keen interest in clinical
He
has specialized skills in child psychiatry and psychopharmacology. He is an able
psychiatry.
teacher and a dogged supporter of his staff. His administrative skills are reflected in his creation
and maintenance of a Child Psychiatry Program when none existed before. He trained a skilled
staff, and encouraged young researchers to develop careers in child psychiatry.
l consider Bert
a leader in clinical psychiatry and am delighted to recommend him,
without reservation, for appointment as Visiting Professor of Psychiatry.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>January 29, 1991
Jay Cohen, MD.

FAX: 305 321 8024

Dear Dr. Cohen,
This letter is with regard to Mrs. Sandy Ruttenberg of Pittsburgh, who
has sought your advice about a gynecological problem.

About a decade ago, Mrs. Ruttenberg had symptoms referable to the
CNS and in an examination, an abnormal electroencephalogram, consistent with
seizure disorder, was reported. Phenytoin was prescribed, with the admonition that
it be continued indefinitely.
After a number of years, she sought advice as to whether such treatment
Re-examination and repeat EEG found no evidence of CNS
terminable.
was
disorder, and phenytoin was discontinued, without recurrence of CNS symptoms.
Two years ago, she again experienced some symptoms which couold have
been of cerebral origin. Neurological, EEG and other imaging tests failed to define
a CNS lesion or disorder and no treatment was prescribed. Her symptoms remitted
and she has not had other CNS symptoms since.

In the absence of neurological complaints, there is no reason in this
experience which would preclude her receiving any treatment for a gynecological
disorder, including surgery requiring general anesthesia.
Sincerely yours,

Max Fink, M.D.

Attending Psychiatrist

�</text>
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                    <text>February 16, 1991
Editor
Letters to the Editor
New York Times
Times Square, New York 10036
Sir:

Enclosed is a letter in response to the excellent OP-ED review by Oliver
Sacks of the state of our State Hospitals. It is submitted for your consideration for
publication.
.

The persistent failure of the State services to take advantage of our
knowledge is a reﬂection of a failure of leadership; the appointment by the
Governor of a non-physician as the head of the Office of Mental Health has not
been salutary. In this letter, I suggest only one method of helping the severe
mentally ill.
There is a lack of training and understanding of other therapies, as well,
including lithium therapy, new antidepressants, and clozapine. Many State Hospitals
have closed their medical wards, and are no longer able to care for the medical
needs of their patients.

I describe only one aspect of this failure to properly treat patients, and

seek public support for a public investigation of the state of our State Hospitals.
Thank you for your consideration.
Sincerely yours,
Max Fink, MD.

Professor of Psychiatry
Attending Psychiatrist
University Hospital

�February 16, 1991
To the Editor,

Oliver Sacks (New York Times, February 13, 1991) correctly complains
about the impact of the cuts in the State’s mental health budget on the care of our
severe mentally ill. We are reliving the ’Shame of the States’ of the 19405, but only

part is due to budget cuts. There

is also a failure to take advantage of advances in

mental health care, specifically the unavailability of electrconvulsive therapy for
patients in the State Hospitals.

Patients who require ECT from these hospitals have often been
transferred to the psychiatric unit at University Hospital for treatment, the only
public hospital in Suffolk County organized to give ECT. Other patients, from
Rockland Psychiatric Center where ECT is also not available, have also been sent
for treatment. The usefulness of ECT is well documented. Mrs. R, sustained in a
manic delirium for more than three years, is now well and at home after a course
of ECT. As is Mrs. W., a patient with a similar illness. Mr. K., is living in a halfway
house after more than a decade of continuous hospitalization with a catatonic
psychosis. Others were transferred with severe inanition, severe suicidal drive, and

malignant catatonia, and were successfully treated.

�The 1985 National Institutes of Health Consensus Conference on
Electroconvulsive Therapy concluded that "ECT is demonstrably effective for a
narrow range of psychiatric disorders in a limited number of diagnostic categories:
delusional and severe endogenous depression, and manic and certain schizophrenic
syndromes." It is precisely this range of severe mentally ill that populate our State

Hospitals.

In response to these evaluations, psychiatrists of both Great Britain
(1989) and the United States (1990) wrote guidelines for the use of ECT which

make the practice safe as well as effective. Its use has increased in the academic
and non-profit hospitals of the state, but it is available in only a few State
Hospitals. In Suffolk County, with three of the largest facilities for the mentally ill
in the state, ECT has only recently become available on a research basis in one

hospital, and even this usage is threatened by the proposed budgetary cuts.

The usual justification for failure to provide ECT is the lack of funds for
and adequate professional staff (mainly anesthesiologists), and for training. We
should not accept such explanations, since ECT is effective, humane, and even costeffective by reducing protracted hospitalization and the need for specialized nursing
care. The degradation of the State’s mental health services has already had tragic

consequences for our community. Rather than accept the Governor’s budget and
decrease services, we need a blue ribbon investigation of the state of our State
Hospitals to seek ways to use available treatments to help the mentally ill, of which
ECT is only one example.

Max Fink, M.D.

Attending Psychiatrist
University Hospital

�</text>
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                    <text>March 2, 1991
David L. Braff, M.D.
Chairman, Membership Committee
Society of Biological Psychiatry
UC-San Diego
San Diego, CA 92103-1990
Dear Dr. Braff,
I have been acquainted for about four years with the work of Dr.
Chittaranjan Andrade of the National Institute of Mental Health and Sciences of
India. He is a talented investigator who has tackled a topic of little concern among
neuroscientists, that of the behavioral effects of induced seizures in man. He, and
his associates Drs. B. Gangadhar, G. Swamineth, and S. Channabasavanna have
been very productive in their research into clinical ECT. Dr. Andrade also spent a
fellowship year in Vienna with Drs. Ianger and Koinig in studies of neuroendocrine
effects of ECT.

Dr. Andrade and his associates were instrumental in organizing the first
Conference
VAll-India
on ECT this Fall; a meeting which I understand was most
successful in highlighting the national progress in clinical use and research into this
hardly used therapy.
There was a time when the Society of Biological Psychiatry (formed as a
union of biological, electroshock, insulin coma, and carbon dioxide specialists) was
interested in ECT. If that is still true, then Dr. Andrade is a fine example of the
new breed of clinician/researchers whose work should be encouraged; membership
in a US. organized society may do much for him, and I recommend him highly to
the Society.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

19505, a winner of the first A.E.
Bennett Award, and winner of the Gold Medal Award of the Society.

PS. I have been a Fellow of the Society since the

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                    <text>March 7, 1991
Xue Chong-cheng, MD.

PO. Box 591524

San Francisco, CA 94159-1524

Dear Dr. Xue,
Welcome to the United States.
If you can give me a telephone number I can call to discuss your
schedule of visits in the United States. Perhaps we can find a place and time to
meet and talk about EACT.
Either write to me at my PO. Box or call 516 444 2929; I am at the
University most mornings until 1 pm.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>March 12, 1991
Dear

,

I have been a faculty member of the Health Sciences
Center at Stony Brook since 1973, and I am well acquainted
with the important work of the scientists at the Nathan 8.
Kline Institute for Psychiatric Research. I knew Nate Kline
well, and it was his pioneering studies of antidepressant
drugs that led to our present psychopharmacologic revolution
in the care of the severe mentally ill. He was an important
asset to the mentally ill of the State, with many creative
and novel innovations which served our patients and fellow
citizens very well.

Institute that carries his name has continued his
and I am writing to encourage you to restore
the funding of this Institute. It is only through clinical
research, of the kind being done at the Institute, that we
can ever hope to improve the lot of the thousands of severe
mentally ill that populate our State hospitals.
The

excellent work,

I was involved in the closing of the Long Island
Research Institute in 1983. That closing resulted not only in
the loss of the research studies, but in a decline in the
services to the patients at Pilgrim State, Kings Park, and

Central Islip Psychiatric Centers.

never recovered.

We,

in Suffolk County,

Please do not allow another important creative
research asset to be destroyed. Re-instate the budget of the

Institute.

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>Department of Psychiatry and Behavioral Science
Health Sciences Center
State University of New York at Stony Brook
Stony Brook, New York 11794-8101
telephone: (516) 444-2929

StonyBrook

/

&gt;
Post-It” brand fax transmittal memo/2671 |#of pages
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10%, Farr/14a n
1

Co.

Dept
Fax #

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3/3 #2.? If)”;

/

FAX: (516)

444—7534

Co.

Phone#
Fax #

m5;

.

,_

U'lk-a:

L.

wisp/‘3

”or.“I“:
.Vg-«féz F!
(F

March 14, 1991
To Whom It May Concern,
Dr. Mark Fettman has been invited to attend ECT treatments and ward
rounds at this Department at Univeristy Hospital on March 20-22, 1991. I look
forward to his visit.

Sincer

1y

M.“

yours,

Max Fink, MD.
Professor of Psychiatry

Attending Psychiatrist
University Hospital

�</text>
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