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                    <text>March 18, 1991

Harry Prosen, M.D.
Chairman, Department of Psychiatry
Medical College of Wisconsin
9455 Watertown Plank Road
Milwaukee, WI 53226
Dear Dr. Prosen,

is with pleasure that I write this letter
It
behalf of DONALD P. HAY, M.D., in
of his

of recommendation
promotion to the
rank of Associate Professor. I have known Don for the past four years
in his research and writing on ECT and geriatric psychjiatry, and in
his work with the Association for Convulsive Therapy. As Editor of
Convulsive Therapv, I have often asked his advice about the
suitability of articles submitted to the journal, and we have
published some of his case material.
He has an active clinical practice from which he has
abstracted his experience in a useful teaching fashion. He has an
interest in education, and has been an active member of numerous
psychiatric organizations. He is willing to assume responsibility, and
has been elected Executive Director of the Association for Convulsive
on

support

Therapy in 1989.

is a dedicated, enthusiastic, empathic, and intelligent
psychiatrist. He has a well organized mind, knows the literature, and
is exceptionally sophisticated with regard to ECT and the special
problems of the treatment of the elderly. He speaks well at meetings,
command
and
Don

has a good
of teaching techniques.
I am pleased to recommend his promotion to the rank of
Associate Professor of Psychiatry, and do so with enthusiasm.

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

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                    <text>April 5, 1991

Ms. Rita Scheman

Raven Press
1185 Avenue of the Americas
New York City 10036

Dear Rita,
am responding to your request for advice regarding the publication
of the 1990 ACNP Satellite Conference proceedings on the development of new
antipsychotic medications. am well acquainted with the organizers of the
meeting and with most of the participants. believe that this symposium was
Sandoz-supported (possibly with contributions from other drug manufacturers).
As such, the main thrust was an exposure by laboratory researchers of their
newest putative antipsychotic entities. These substances have been selected for
their similarities in pharmacology to that of clozapine, which is being touted as a
major advance in psychopharmacology [which it is not].
I

I

I

As is generally true for such proceedings, the better material will be
published in refereed journals; the material in the book will be either re-hashes
or so preliminary that it would usually not pass muster before responsible

editors.

To answer your specific queries:
1.

no comment

2. No.

3. Yes.
4. No.

It is not clear from the outline for whom such a book would be
intended. Libraries are cutting back on their purchases, and if were asked by
my librarian, would surely not approve the purchase of such a melange.
Especially, if had to choose between such books and journal subscriptions (as
have been asked each of the past two years). presume the main market is
the researchers themselves (and their mothers) and industry libraries. Such a
market seems limited, and such a book will probably require considerable
subvention.
I

I

I

l

I

�Ms. Rita

Scheman

Page 2

Two attitudes regarding publication seem reasonable.
A non-judgmental attitude would argue that

such preliminary material

may stimulate research and eventually lead to new drug therapies. But the
critical publisher would know that the best material, the most illuminating and
stimulating, will be published in the main journals, and that nothing will be lost
by denying this publication in a book form, with limited distribution and limited
(to no) indexing.

A more cynical attitude may also be taken. Since

these articles were

selected with the support and encouragement of the pharmaceutical industry,
and since the industry will gain the most benefit from such a book [they will
surely peddle it to the FDA and their Boards of Directors as evidence of
’scientific’ validity], there is no reason why Raven Press should not publish the
book provided the industry guarantees the purchase of sufficient copies for
their use and distribution, or a sufficient subvention to justify this type of selfadulatory and limited interest publication.
I

trust these comments are helpful. My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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                    <text>April 19, 1991
Dr. J .A.G. Watt
Gartnaval Royal Hospital Psychiatric Services
1055 Great Western Road
Glasgow G12 OXH

United Kingdom
Dear Dr. Watt,

You suggest that two groups be studied, one of major depressed of the
mild type and another of dysthymia of 6 months to 2 years duration. Alas, you will
not be justified to use ECT in either population. For depressives of mild type, you
will surely exclude those with melancholia, psychosis, and suicidality precisely the
best candidates for ECT. As for dysthymics, such as are identifiable are those who
are chronically ill, for durations measured in years or decades, and who in the older
days, were identified as ’neurotic’ or ’reactive’ depressed. Surely, not candidates for
ECT.
-—

ECT remains a treatment for severely ill patients, those who are
hospitalized or who warrant hospitalization. Any study which suggests its use in
those with lesser degrees of illness will be difficult, in our society at least.
As for power calculations, these are quite easy. If delusional depressed
are selected, the success with ECT will bhe 60-80%, with any antidepressant alone,
less than 30%; a power calculation will find about 30 patients in each cell will do
nicely.

Good luck in your studies.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

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                    <text>gm
January 20, 1990
Dear Stan,

I enclose copies of the

and

my

reply.

He

letter

plans to attend the

APA

I received from Bernard Lerer
meetings in New York in May and

should he write to you, I hope that you will be willing to meet with

him.

you well know, the Department totters along, rather
direction-less. Its academic standard remains poor, and our resident
pool is even poorer. I made one pitch to the Dean in September to
suggest an external review of the Department, and was rebuffed. He
argued that he had more important problems on his plate.
As

My own work continues to be accepted. We have a fine ECT unit
and each year one or two residents take electives with me. We have one
of the two postgraduate training programs in ECT in the U.S. The journal
CONVULSIVE THERAPY is thriving. On lO-North we have two good clinical
projects in progress-- a random assignment study of ECT and drug
therapies as maintenance therapies for patients who complete a course of
ECT; and a therapeutic trial of ECT in patients with parkinsonism.

for

any help you can give Beni Lerer. He is a
who has moved to a Left Bank settlement, with
and very good co-workers.
head
scientific

Thank you

dedicated orthodox Israeli

an

excellent
My

best regards.
Sincerely yours,
Max

Fink,

M.D.

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                    <text>January 30, 1990
Morton Miller, M.D.
Lahey Clinic Medical Center
41 Mall Road
Burlington, MA 01805

Dear Mort,

I was delighted to get your letter. I have known
child and have watched her
Julie
with
pleasure. If she has the
progress in her schooling
would
ask her if she believes she can do
qualifications, I
she
the job; if
says she can, I would hire her immediately.
I enclose a description of the two ECT videotapes.
The one for patients and their families describes the
benefits and risks, to allow for 'informed consent'. The one
for professionals is more technical and seeks to answer the
questions most often raised at meetings about the ECT
process. The tapes are widely used. Last year, Leon Grunhaus
at the University of Michigan made a similar consent tape.
These are the only tapes available commercially.
The ECT service is doing well. I have two 4th year
Balaban since she was a

fellows who are working on good projects. We are randomly
assigning ECT patients to continuation ECT or drug
therapies; treating parkinson patients (without depression)
with ECT; studying the psychopathology of catatonia
(following the models of Taylor and Abrams); and continuing
the treatment of schizophrenic patients ('positive symptom
psychosis') with ECT and fluphenazine combined. We often see
patients with 'the Miller sign', and every few weeks we
diagnose manic delirium or acute catatonia. We have also
treated some 'reversible dementia' (pseudo-dementia) cases
with reasonable success.
Only Nisson Schechter remains at HSC from the old
days (and Richard Friedman and Pierre Hahn in C Building).
I called Stan last week to get some advice about Israel and
he was helpful and seemed to be bothered little by aphasia.
Thank you for your kind regards. Martha and our
children are well. We continue to work, despite reaching
retirement age, since we still enjoy teaching. My best
regards.
Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

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                    <text>March 4, 1990
Michael Taylor, MD.
Editor, NPNPBN
Department of Psychiatry
3333 Green Bay Road
North Chicago, IL 60064

Dear Mickey,
read the three editorials "Cold Beans &amp; Bacon", "The N.I.M.l.", and
"Persona Non Grata" with interest and amusement. The three seek to deliver a
message through humor -- a commodity sorely lacking in our scientific
dialogues. THey make points like Russell Baker in the New York Times and Art
Buchwald did some years ago. While have editorial critiques with some of the
remarks -- they may be improved with a few deft editorial amendments, am
neither dismayed nor turned off nor unhappy with their publication.
|

I

I

Indeed, if could write like Russell Baker would attempt to use such
style to get some messages across. For example, at the APPA meetings this
week, some players argued that the diagnosis of schizophrenia could not be
made with any assurance since more than 40% of the known schizophrenics in
a carefully studied sample changed their behavior (and the resulting diagnosis)
in follow-up studies; while others asked for 10 million dollars annually to find the
gene of schizophrenia! Such a ridiculous situation cries for humorous treatment
since no logical arguments seem to make a dent.
I

I

While

it

is not usual for ’scholarly’ journals to include

pieces by the

likes of Russell Baker, many do include articles that are not ’straight science’.
recall (with some pleasure) the JAMA section "Piece of My Mind"; the BMJ
commentaries by Minerva; Lancet’s ’Occasional Notes’; and Dick Shader’s
jokes as part of the J. clin. Psychopharmacology. These complement the solid
science of these journals, and as a reader, I enjoy these interludes as much

(occasionally more than) the straight science.

made some marginal Editor’s notes on each of the articles; these
are attached for your use.
I

My

best regards.
Sincerely yours,

Max Fink, MD.
Fellow Editor

A

I

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                    <text>March 21, 1990
Fridolin Sulser, M.D.
Vanderbilt University School of Medicine
AA-2215 Medical Center North
Nashville, TN 37232

Dear Fridolin,
am particularly pleased to nominate John M. Kane, MD. for
membership in the CINP. John is now the Chairman of the Department of
Psychiatry at the Long Island Jewish-Hillside Hospital Medical Center. am very
well acquainted with his work from his training with Donald Klein (1975-77), his
leadership of the Research Department of Hillside Hospital (1977-1987), and his
active membership in our Department of Psychiatry at Stony Brook (1977-1989).
I

I

John

is a dedicated clinical and theoretic

researcher with special

interests schizophrenia, antipsychotic drugs, and tardive dyskinesia. His
studies of the relative efficacy and safety of high and low dose fluphenazine
provide the best data on dosage, efficacy, and safety of antipsychotic drugs.
These studies led to prospective studies of the incidence of tardive dyskinesia,
and here again, his studies provide the most substantive data on the incidence
of TD, and the risks associated with dosing, time of exposure, age, gender, and
diagnosis. With Herb Meltzer, he is a principal investigator of the efficacy and
safety of clozapine in therapy resistant psychotic patients and is credited with
convincing the FDA to re-introduce clozapine in clinical practice. Finally, he is
the principal investigator of an NlMH clinical schizophrenia research center,
which is carrying out useful clinical and laboratory studies of a well studied
cohort of schizophrenic patients.
in

He became a full professor at SUNY at Stony Brook in 1985, an honor
that is sought by many and achieved by few. John is a fine clinician and able
administrator. His publication record is excellent and his standards are the
highest. His promotion to chairmanship provides him with one of the best
clinical services for research and am confident that he will continue to make
important contributions to biological research. He is a consultant and leader at
the NlMH, ACNP, and the American Psychiatric Association. I commend him for
membership in the ClNP with much enthusiasm and without reservations.
I

My

best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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                    <text>May 8, 1990

Richard Josiassen, Ph.D.
Department of Psychiatry
Medical College of Pennsylvania
3200 Henry Avenue
Philadelphia, PA 19129
Dear Richard,
Your questions are most intriguing, and hasten to argue my
idiosyncratic views against the present drive to the study of anatomic structure
as a basis for psychopathology. Since you limit the query to the past 25 years, I
am precluded from arguing that the seminal studies of the century remain those
of Wagner-Jauregg, Meduna, Weinstein and Kahn, Wikler and Martin. In the
period requested, the most impressive studies have been those of Taylor and
Abrams in identifying the syndrome of catatonia as associated as much with
affective disorder as with schizophrenia (which effectively vitiated the logic of
DSM-lll); the genetic identical twin studies in London which found both
schizophrenia and affective disorder among genetically identical siblings (which
effectively discredited the present genetic studies); and which led to the unitary
hypothesis of psychosis of Timothy Crow.
I

would credit Shagass with the best of
modern patient classification devices, the sedation threshold; DeWied and
others for discerning that brain peptides have behavioral effects; and the work
of the unheralded chemists who developed naloxone, providing the basis for a
life-saving technique in clinical medicine.
From psychopharmacology,

I

Your second query is even more intriguing. can more easily answer
the question about the two or three most damaging hypotheses underlying the
biological understanding of psychopathology. For example, the belief held by
many in neuroscience (and the ACNP and NIMH as well) that studies of rat
brains will lead to an understanding of psychopathology is clearly wrong. Rats
are not men; rat physiology and pharmacology is readily distinguishable from
that of man. Further, normal man is not the same as sick man, since it is the
differences induced by illness that are the basis for our interest. Similarly, it is
silly to assume that studies of the normal rat bear any relation to mentally sick
I

man.

�the same vein, the genetic and structural hypotheses of
psychopathology are old theories, espoused in the 19th century, and probably
as wrong now as they were then, albeit we have better ways to picture the
structures of the brain.
In

were to argue for the hypotheses that are outside the mainstream,
that may lead to an understanding of the bases of psychopathology in brain
function, would point to that model of psychopathology which argues (from the
diabetes and neurosyphilis experiences) that the expression of psychopathology
is the end product of a stressor (g9, spirochaete or hypo-insulinemia) and its
interaction in a psychological substrate (ggq ego and superego; or character
and personality; or memory and emotional patterns as modified by life
If

I

I

expeﬁence)

This view is best stated as the unitary hypothesis of psychosis. The
best example of this view is the case for catatonia (primary and secondary;
malignant and NMS) as a general brain disorder not part of schizophrenia, and
one that is highly responsive to ECT. That some patients with dementia praecox
exhibit signs of catatonia is not unlikely, given the high probability that catatonia
is an endocrine deficiency disorder.

Another support comes from observations that ECT is equally
effective in treating mania and depression, with or without psychosis, with or
without melancholia, with or without catatonia; with or without dementia
(’pseudodementia’). This varied effectiveness is often cited as an example of the
’dirty’ nature of ECT; view it rather as an example of the specificity of ECT and
the ’dirty’ nature of our psychopathology. (Recall the varieties of neurosyphilis in
this context.)
I

These views are outside the mainstream. That

is why I continue to be
intrigued by them, since I ’know’ (from history), that the pack is usually wrong.
And the present neuroscience pack is surely wrong since few, if any, have any

experience

If

in

the clinic.

you wish a concise view of catatonia, urge you to read the recent
I

review by Taylor in NNPBN.

best regards to Charlie, whose work with the sedation threshold
have long admired, but still cannot comprehend.
My

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

l

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                    <text>/

32f gé;;$ﬁxf

June 11, 1990
Layton McCurdy, M.D.
American Board of Neurology

&amp;

Psychiatry

Institute of the Pennsylvania Hospital
Street

111 N. 49

Philadelphia,

PA

19139

Dear Dr. McCurdy,
Like many of

my

peers,

I am

writing with regard to the proposed

Qualification in Neurophysiology" which is considered for
physicians qualified in Neurology. By excluding those qualified in
Psychiatry, I believe that the Board is inadvertently excluding a large
number of very qualified practitioners whose skills and interest in
"Added

electrophysiology complement those of their neurologic peers.

referring to those psychiatrists with interests in
quantitative EEG in assessing the effects of psychoactive drugs; those
specializing in the analysis of sleep EEG recordings; and those
interested in multi—lead EEG recordings in assessing patients with
affective illness who may be candidates for anticonvulsant therapies.
I am

certified both in neurology

psychiatry, my work in
pharmaco-electroencephalography is clearly of little interest to my
neurologic colleagues, but is central to a whole discipline in
psychopharmacology and psychiatry. Similarly, the work of my associate,
Wallace Mendelssohn in sleep studies, which is an important asset in our
While I

am

and

psychiatric assessments.

Clinical psychiatry has undergone at least three major
revolutions in my professional lifetime-— from the psychodynamic era in
which I was trained at the William Alanson White Institute; to the era
of psychopharmacology; then the excitement about neuroscience; and now
the return to our interest in neuropsychiatry.
By limiting the Iadded qualification’ to that small group of
practitioners who meet the criteria for Neurology would be a disservice
both to clinical practice and to research opportunities which are now

unfolding.

hope that the Board will see the wisdom of either not
added qualification in neurophysiology to neurologists, or
doing away with the added qualification in its entirety.
I

limiting the

Thank you for your consideration.

Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

ABPN

(P54) (N52)

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                    <text>August 5, 1990
Credentials Committee
Medical Staff Affairs Office

Box 0208, M-181
San Francisco, CA 94143

Gentlemen:
I am writing this letter regarding privileging in electroconvulsive
therapy, at the request and on behalf of Professor REESE T. JONES, Professor
of Psychiatry at the Langley Porter Psychiatric Institute and the University of
California at San Francisco. I have known Reese since the late 19605 when we
were both interested in research into cannabis. His electrophysiologic studies
paralleled my own, and we met frequently at national and international meetings,
and national committees of NIMH and NIDA, to talk about our work. Reese is a
sophisticated and experienced clinician, clinical pharmacologist, electrophysiologist, and researcher.
My interest in ECT goes back to 1952. NIMH supported studies of
ECT at Hillside Hospital and the New York Medical College led to numerous
publications in ECT; organizing a conference and publishing a book on the
Psychobiology of Convulsive Therapy (1974); a text Convulsive Therapy: Theory
and Practice (1979); and chief editorship of the quarterly journal CONVULSIVE
THERAPY since 1985. I was a member of the 1975-1978 APA Task Force on
ECT, edited many of the chapters of the 1978 report; and again, a member of the
latest APA Task Force which just published The Practice of ECT:
Recommendations for Treatment, Training and Privileging (1990). Since 1988, we
at Stony Brook have developed a ’hand-on’ training course in ECT for
practitioners, one of only two in the nation.

For the past five years, I have been director of the ECT Service at
Stony Brook, with full responsibility for privileging the professional staff in ECT.
(Fritz Henn, M.D., Ph.D., the Department chairman, is among those privileged in
ECT during the past few years.)
Sometime in 1989 Reese called to ask if he could come to Stony Brook
for training in ECT, as he was asked to re-establish a program in ECT at the
Langley Porter Institute. I agreed. In December, 1989 we met at the ACNP
meetings, reviewed his knowledge and experience, and based on that information
I laid out a 3-day program at Stony Brook which would meet the new guidelines
of the APA Task Force report. He invited me to San Francisco to meet the staff,
visit the facilities, and lecture on ECT. I did so on April 3-4, 1990. I was
impressed with the staff interest in ECT, met with the residents and made ward
rounds, finding three patients for whom ECT was clearly a legitimate option in
treatment. One was presented in a staff conference.

�Reese joined me at Stony Brook for three full days of teaching, on May

2, 3, and 4. I arranged for patients to be treated each of those days. His schedule
included ’hands-on’ treatment of 12 patients, some with unilateral and some with

bilateral placement; monitoring of seizure duration by cuff, heart rate, and EEG;
monitoring of ECG, blood oxygen, blood pressure, and heart rate; and the
determination of the degree of motor paralysis using a muscle stimulator. We also
demonstrated the seizure enhancing properties of caffeine; inductions with and
without glycopyrollate; anesthesia with methohexital and etomidate; modification
of blood pressure using trimethaphan; and blocking of a prolonged seizure using
diazepam. We discussed, for each case, the basis for the selection of energy,
electrode placement, frequency of treatment, and number of treatments. For our
out-patients, we reviewed the process of continuation and maintenance
treatments, using drugs and/or ECT. We also discussed the role and merits of
concomitant psychoactive drug use.
In addition, Reese made rounds each morning, interviewing each
patient on my service (about 15). We discussed the indications for ECT, how we
develop a risk/benefit analysis for each case to determine the suitability of ECT.
We reviewed the pre-treatment work-up including laboratory tests and the aims
of consultations with medicine, anesthesiology, and dentistry.
In the afternoons, Reese was in didactic sessions with my associates
and myself. He worked with our ECT nurse, Mrs. Irene Carasiti, and participated
in the discussions and videotape session which makes up our informed consent
process.I gave him a pre-print copy of the 1990 APA Task Force report; we
discussed the changes from the 1978 report; reviewed the main items of patient
selection, determination of risks and tactics to minimize risk; and the thorny
problems of training and privileging.
In didactic sessions, we reviewed issues of consent, mechanisms of
action of ECT, electrophysiology and cardiovascular physiology, and anesthetic
considerations.
At the time Reese left, we were both exhausted. I was delighted with
his knowledge and understanding. We had covered and met all the guidelines of
the new APA recommendations.
I am pleased to recommend Reese Jones for privileges in ECT; with
endorsement for routine treatments as well as the treatment of high-risk,
medically ill patients.
Sincerelyn yours,

Max Fink, MD.
Professor of Psychiatry
Attending Psychiatrist,
University Hospital

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                    <text>«~/

August 5, 1990

Reese T. Jones, M.D.
Langley Porter Psychiatric Institute
401 Parnassus Avenue
San Francisco, CA 94143
Dear Reese,
Fritz met me at the cafeteria on Friday and shared the story of your
dilemma, so your letter was not a total surprise. I am delighted to write a
supporting document, and attach it to this note. I will send these by Fax, and the
original will be sent directly to the committee.
Yes, Fritz has ’eliminated’ an ECT Service, and yes, he thinks he is
Jesus reincarnated, and he does not realize he has taken a first-class department
under Stan Yolles and created a pseudo-neurosciece program with hardly a single
psychiatric redeeming feature. No wonder our resident applicants are mainly from
off-shore schools.

But the elimination was accompanied by a substantial raise in my salary
and no additional duties, so after being upset for a few weeks, I have settled
down to treating my ’private’ referrals. The shift gives me a chance to look, once
again, at my pharmaco-EEG experience, an experience which I have neglected for
some time in favor of ECT.
I hope the letter is helpful. Let me know if there is more that I can do.
My regards.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

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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

StOﬂYBrOOk

telephone: (516) 444-2929

August 23, 1990

Stephen Koslow, MD. and Herman van Praag, M.D.
Chairmen, Credentials Committee
ACNP
Vanderbilt University
Nashville TN 37235
Dear Steve and Herman,
It is with great pleasure that I submit this letter in support of the
admission of HAROLD SACKEIM, Ph.D. to membership in the ACNP.
I have known Harold for about a decade, first meeting him when he
in academic research in the neuropsychology of perception. He
interest
expressed an
used ECT as a way to modify brain function, and did so intelligently. He joined Sidney
Malitz at the New York State Psychiatric Institute where he developed the nation’s
strongest research program in ECT. We have worked together on the APA Task Force
on Electroconvulsive Therapy and on the editorial board of CONVULSIVE THERAPY.

Harold is an outstanding neuropsychologist, a direct descendent
(conceptually speaking) of Joseph Zubin, Richard Wittenborn, Conan Kornetsky, and
other SOphisticated psychologists who did so much to make the ACNP a scientific
organization with holistic interests.
Harold has a detailed knowledge of neuropsychology and
electrophysiology. He is an expert in perception, memory function, anti-amnesic drugs,
cerebral physiology (cerebral blood ﬂow and SPECT, to be specific), statistics, and the
psychopathology of affective disorders. He first came to the attention of the research
community in his innovative studies of the role of facial asymmetry in the manifestation
and perception of expressed emotion. He has made important contributions to our
knowledge in ECT; specifically, in the role of the stimulus in treatment response, and on
the physiologic and memory effects of different dosages and electrode placements. The
ongoing studies of cerebral blood flow and SPECT are promising to add more
information on its mechanism of action. His clinical skills in interviewing and diagnosis
are excellent. He is friendly, warm, enthusiastic, and an extraordinarily hard worker.

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                    <text>December 12, 1990

Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino

I-l6l32

Italy

GENOA

Dear Walter,

that

we

on obtaining support for a stay in the U.S. I hope
work
out an arrangement that will be useful for you.
can

First, congratulations

details, such as the proposed dates and duration of the stay;
and
needs; and projects you may wish to investigate. If a study
your expectations
has a clinical component, approval must be obtained from the appropriate committees,
and that may take up to four months, so any work done in advance is critical.
Separately, I will send you copies of ongoing protocols as examples of what may be
I need more

of

interest.

I have a young Israeli psychologist/Fellow working in the laboratory, and
senior
resident has asked to work with me later in the year. The Fellow is
a
interested in ECT; the resident is spending two months with Itil learning the H21
system. Perhaps the three of you (and a technician and our equipment) could answer
some interesting questions.

letter

I have no problem with the presentation at the AACNP, but neither your
nor that from Bodis-Wollner give the specific dates. When?

I have received an unusual letter in Italian from a Roman psychiatrist in
response to a paper that I wrote last year for an Italian audience. I asked one of
my residents to translate it, and it seems to relate a pathetic story about a
criminal indictment for a death associated with ECT. Because the details are
critical, I would be grateful if you would provide a valid translation so that I can
understand the nuances of the events. Also, can you advise me whether a reply is
warranted or expected? Is Dr. Gherardini asking (implicitly) for help or advice? Do
you know of him, or can you obtain an opinion as to his status in his community?
New

My

regards to Titty and your daughters (I assume you plan to bring

My

best regards.

York?)

Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

all

to

�</text>
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                    <text>December 22, 1990
Dr. Gian Francesco Gherardini
Via di Grottarossa 1282
Rome,

Italy

Dear Dr. Gherardini,

for your letter of November 2, which arrived two weeks
translated to better understand the message. It is
the
that
patient had such a poor outcome. A severe response to
regretful
known,
since it is neurotoxic and its use is often
haloperidol is
with
associated
dystonia, parkinsonism, akathisia, and the neuroleptic
malignant syndrome (NMS). The case material suggests that he had a severe
NMS. ECT is described as effective in NMS, as well as in catatonia, so it
is unclear why society is criticizing your treatment decisions.
Thank you
which
and
I had
ago

rise in temperature following each ECT may reflect a
persistent effect of haloperidol.
The sequence of events after the onset of status epilepticus is
The

puzzling. What was the etiology of status? (It is not a feature of ECT
which is essentially anti-epileptic since it raises seizure thresholds.)
Did the patient receive additional neuroleptic medications?

picture

Patients with lupus erythematosus may develop a catatonic
status epilepticus. Was the patient tested for lupus?

and

Is there something that you believe we can do to help in your
defense? Thank you again for bringing this interesting case to my

attention.

Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

�</text>
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                    <text>December 24, 1990

Richard Weiner, M.D., Ph.D.
Department of Psychiatry
Duke University MedicaI Center
P.0. Box 3920
Durham

NC

27710

Dear Rich,
Ever since I read the report by Xue
’eIectro—acupuncture convuIsive therapy’, I have
possibiIity. Dr. Xue was in Canada Iast year but
return to China. He is trying to visit again. He
which I am unabIe to provide.

Chongcheng in 1985 on
been intrigued by its

failed to teII

needs

Perhaps you couId find a way to encourage his
through Duke University or the APA?
My

best wishes for

a happy and

me

untiI his

Ietters of invitation,

visit, either

healthy 1991.

Sincerer yours,
Max

Fink,

M.D.

Professor of Psychiatry

�</text>
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                    <text>December 23, 1990
Xue

Chongcheng, M.D.

Institute of Acupuncture

3

Haiyuacang

Beijing

and Moxibustion

100700 China

Dear Dr. Xue,

for your Tetter of November 29, indicating that you
have permission to visit the United States. You ask for a Tetter of
invitation. I am unabTe to write a letter to request your attendance at our
Thank you

University.

research units studying ECT in the United States where I
beTieve you could demonstrate EACT remain those of Dr. Richard Neiner at Duke
University (P.0. Box 3920, Durham NC 27710 USA); Drs. Haron Sackeim and
Sidney MaTitz at the New York State Psychiatric Institute (722 West 168
Street, NYC 10032); and Dr. Richard Abrams at the UHS/Chicago MedicaT SchooT
The main

(3333 Green Bay Road, North Chicago, IL 60064). Of these, Dr. Neiner is aTSo
chairman of the American Psychiatric Association Task Force on
ETectroconvuTsive Therapy, and as such, has direct connections with the
Committee on InternationaT ReTations of the Association.

Shoqu you come to the U.S. and
techniques, pTease have your host caTT me. I
EACT

in practice.
My

be

able to demonstrate your
every effort to see

wiTT make

regards.
SincereTy yours,

Max

Fink,

M.D.

Professor of Psychiatry

�</text>
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                    <text>StOﬂYBIOOk

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

June 15, 1989
Mr. Wolfgang Kudrnofsky
ORF
ORF

Centrum

Vienna, Austria
Dear Mr Kudrnofsky,

It is clearly difficult to

communicate

at this distance.

While

I would like to be cooperative, it is difficult to do so. We are not a
source of film or video materials, but we are members of an academic
department of psychiatry at a medical school. As such, we have
collected some materials for our students and teaching, and have, at

these available to others, including radio and television.
We do not do so for stated fees, but will cooperate if the
objective is within our missions as educators. As such, we ordinarily
serve as consultants. As such, we usually obtain our satisfaction in
our teaching, and to a lesser extent in the fees for our time.
From time to time, we have been asked to allow the media to
film our patients, before, during, and after treatment. We generally
are able to obtain patient and family cooperation and for such efforts
we generally ask that they be paid at prevailing commercial acting or
consulting rates.
If you wish our help, you or one of your associates should
discuss the details of your proposed programming, and we
visit us to be
will try to
responsive as to what we can provide.
times,

made

Singzzzjy

.4 Fink,

yours,
M.D.

Professor of Psychiatry

�7..

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-

I

[-

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"

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"W“

7

mw‘l‘w‘wmvv'nw-mm”m‘

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.

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//

April 10, 1989
Dr. Wolfgang Kudrnofsky
Gsterreichischer Rundfunk
Wiirzburggasse 30
1136 VIENNA
AUSTRIA

Dear "Dr. Kudrnofsky,
Over the years I have collected documentaries of ECT and Metrazol shock
therapy, and recently I made some videotapes for my students and patients. Our
materials have been used by the major American television networks and BBC.
The source of the older material is diverse and the quality fair to poor. It
would be necessary to see the material and if any is of interest, we can then decide
on how best to get consent from the sources for your reproduction.
The recent material is also diverse. 1 have academically made 'teaching'
tapes, some abstracts of commercial tapes, case material of interviews of patients
before and after ECT, and finally, two commercially made videotapes developed as
teaching tools for our students and our patients. For our patients, the tapes are
used in obtaining 'informed' consent for electroshock therapy.

It would be useful to know what use is planned for these materials; the
anticipated size of the audience; number of reproductions; whether you are
requesting our tapes for your editing, or whether our participation in the
presentation is also requested.

—-

1 do
not have lobotomy or insulin coma films but am acquainted with
of
sources old films, made for teaching purposes.

can be reached most mornings at 516-4“; 2929; and most afternoons and
evenings at 516 862 6651. Our FAX is 516-4“ 753$.
I

Thank you for your inquiry.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�May 23, 1939

Dr. Wolfgang Kudrnofsky

Osterreichischer Rundfunk
Wiirzburggasse 30

1136 VIENNA
AUSTRIA

Dear Dr. Kudrnofsky,

it is not clear

from your FAX of 12 May what more i can tell you.

Videotape of new material (ECT) made in the last few years is available.
The older material of insulin coma and Metrazol is on film.
We are not a commercial source of educational material. As an academic
institution, we use educational materials as part of our teaching and consultations.
We have worked often with producers and educators to develop teaching
programs,
and if you wish us to work together, please outline the aims of the project. The
expenses and fees for such consultation depends on the demands in time and effort.
1

am not sure that we can obtain lobotomy films but there are some sources
if the program requires specific footage.

that we can try

Since rely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>{K'w

June 25, 1989
Mr. Bruce Williams
Associate Product Manager

Asendin amoxapine

Lederle Laboratories
Plaza

One Cyanamid

Wayne, New

Jersey 07470

Dear Mr. Williams,

I

am

a

supervising psychiatrist at University Hospital at

Stony Brook. Your recent 'Dear Doctor' letter describing the efficacy
of Asendin in patients with delusional depression was brought to my
attention by one of my residents. I am not acquainted with the
specific articles on which this claim is based. I would be grateful
for citations (and reprints if from foreign literature) of any
prospective, well controlled, comparative studies of Asendin against

the combination of an antipsychotic and an antidepressant drug in

hospitalized delusional depressive patients.
Are there any reports of the use of Asendin in comparison to
electroconvulsive therapy in hospitalized delusional depressed
patients?
Thank you

for your cooperation and help.
Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>July 31,

1989

Muriel Young, M.D.
E-43

SK-Beecham
1500 Spring Garden

Philadelphia,

PA

Street

19101

Dear Dr. Young,

produces a systematic amnesia which is proportional
to patient age, frequency and number of treatments, electrode
placement, intensity of currents, waveform, and associated
medications. The amnesia is reversible, with an improvement in
time after the last treatments such that patients no longer show
measurable deficits from 6-12 weeks after the last treatment.
There are some patients, however, who consistently complain of
amnestic disturbances and these have been associated with
specific currents and electrode placements, and some modified
frequencies of treatment (like multiple treatments in one
ECT

session).

The animal model

(Electroconvulsive shock- ECS) has an
extensive literature as the effects of drugs on ECS induced
amnesia in rats or mice is a standard pharmacological test for
almost any psychoactive substance. In man, there have been
systematic trials of some putative anti-amnestic agents on the
ECT process, notably with pemoline (Cylert), ACTH 4-10 (ORG
2766), piracetam, etiracetam, vasopressin, and l-tryptophan. Many
of the studies have been well designed with adequate controls,
but the results have generally been disappointing, i.e., the

effects

on

ECT

induced amnesia have been modest.

recent trial, a collaborative study of
pramiracetam, has not yet been published or officially presented,
but the 'grapevine newsletter' states that the experimental and
control groups were not distinguishable in the effects on tests
in a cognitive battery but that the experimental group fared
The most

better

on improvement

scores.

�on hydergine and ECT in press in the J.
Psychiatry finds an effect on improvement scores for the
experimental group but not an effect on memory tests.
A

report

is

The ECT DATABASE
a service of the
CONVULSIVE THERAPY
readers and authors.

to its

citations for memory enhancing, nootropic,
elicited the citations which are attached.
a

basis for deciding whether the

ECT

and

clin.

editors of
Culling the 4500
specific drugs

These should give you
model may be useful in the

assessment of your compounds.
As for the usage of ECT in the U.S., we lack any good
assessment. The last measurement was done in 1977 by the APA Task
Force; similar assessments were done in Great Britain in 1980 and
Ireland in 1982. These find that usage is about 4.1 to 4.5
patients treated annually per 10,000 population. These figures
should be corrected for the fact that ECT is rarely given to
persons under 20 years of age, and more often in patients over 50
years of age. It is my impression that usage is increasing,
although my impression may be faulty, resulting from the number
of inquiries about ECT which I get each day.
I trust these comments are useful.

Sincerely yours,
Max

Fink,

Editor

cc: J.0. Cole

M.D.

�</text>
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                    <text>August 11, 1989
Dr. K. Stephan

Arzneimittelforschung
Kurfurstendamm 217
1000 Berlin 15

AFB

GmbH

in Berlin

West Germany

Dear Dr. Stephan,
Thank you for the helpful translation of my report to
the Austrian funding agency. It was most helpful and I have sent
it on; hopefully it will serve to encourage their research

interests.

My

regards.
Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�August 11, 1989

Edith Piroska
Medizinisch-Wissenschaftlicher Fonds
des Bﬁrgermeisters der Bundeshauptstadt Wien
Ms.

Schottenring

24

Austria
Dear Ms. Piroska,
was a pleasure to review the application of Dr.
It
Greta Koinig of the University of Vienna. My recommendations are
attached, translated for your use. I hope these are helpful.
Sincerely yours,
1010 Vienna,

Max

Fink,

M.D.

Professor of Psychiatry

�July 28,

1989

Werner Herrmann, M.D.

Kurfurstendamm 217
1000

Berlin

West Germany

15

Dear Werner,

of being asked to
I am in the embarrassing positionMedical
Science
review a grant application by the Austrian
Foundation and not able to translate my report into intelligible
German. The application and letter are in German (which
apparently I can read easily enough), but I cannot get the die's

der's correct -—
Hence this request. Would you ask your secretary or
into good, technical German
translator to put the attached report
and return it to me for retyping? I (and the Austrians) will be
most grateful.
and

We

are looking forward to your

My

best regards

August. Except
visit in the
house, we

a mess about
for re—doing our kitchen and having month.
unencumbered
and
home
all
be
should
and

my

thanks.
Sincerely yours,
Max

Fink, M.D.

�</text>
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                    <text>November 13, 1989
Larry Koran, MD.
Department of Psychiatry
Stanford Medical Center
Palo Alto, California 94305
Dear Larry,
Two events brought your name to mind -- a letter from my son
describing the devastation on the Stanford Campus by the recent earthquake, and
the enclosed letter from Dr. Howard Fenn of the Palo Alto V.A.

How did you fare during the quake? My son’s letter remarked that the
geology buildings were closed and no one could get in to get their records, data,
or computer files. At least not during the week after the quake.
The enclosed letter came ’out of the blue’. Dr. Fenn seems to have
thrown a bottled message into the US. post office maelstrom, and it landed on
my desk. My reply is meant to encourage him to provide me with some data.
Since my image of ECT at Stanford is that it hardly existed until you told me last
year that you had (finally) stimulated its use, I was surprised by the letter. Do you
know Dr. Fenn? Does he ’really’ have cases and the facility to treat? Is there a
mature sponsor at the site?
Meanwhile, our department of psychiatry has emerged, after six years
of metamorphosis, into a department of neuroscience, focussed on brain cells,
receptors, and genes. Our younger clinicians are all devoted laboratory scientists,
with as much experience with rats, rat brain tissues, and chemicals, as with the
mentally ill patients on 10 North.
How is your ECT program progressing?
My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>November 13, 1989
Howard H. Fenn, M.D.
Psychiatric Intensive Care Unit
VA. Medical Center
3801 Miranda Avenue
Palo Alto, CA 94304
Dear Dr. Fenn,
Many important clinical and theoretic issues in ECT are under active
study, or deserve active study. The APA Task Force on ECT has prepared a
report on The Practice of ECT: Recommendations for Treatment, Training and
Privileging which is wending its way through the APA approval process, and
should become public by May 1990. That report will provide useful guidelines for
the decision to use ECT, the implementation of good practice, and encourage
greater usage.

The specific problems which may be usefully studied depend on the
population sample (numbers, age, medical status), whether mainly in-patient or
out-patient, and your specific interest. Some important issues are:
Maintenance and continuation ECT: What is an optimal course of treatment?
How can improvement be sustained?
1.

2. ECT and pharmacotherapy. The facilitation of antipsychotic drug activity by
ECT has been demonstrated; what is the interaction of antidepressant drugs and

ECT?

3. ECT in schizophrenia. The present enthusiasm for clozapine highlights the

poor results with neuroleptics in patients with schizophrenia. The efficacy of
clozapine is estimated at 30% in the best of hands. What is the efficacy of ECT
in clozapine treated failures?
4. ECT in parkinsonism. Many parkinson patients have periods of incapacity

alternating with relative comfort. The ’on—off’ phenomenon has been modified by
ECT. We need prospective studies of ECT in parkinson patients with the ’on-off’
phenomenon.

�These are some of the ideas under study in my laboratory. If you would
describe your population in detail, with numbers of cases, diagnoses, age, and
medical status; your experience with ECT and how the interest came about; the
type of equipment available; and whether any senior clinicians are interested in
supporting or encouraging such studies, I could be of more specific help in your
research efforts.
You may wish to subscribe to CONVULSIVE THERAPY. The journal
is comnpleting its fifth year of publication. It has highlighted each of these issues,
and many others of interest to the clinical and research communities.
Thank you for your inquiry.
Sincerely yours,

Max Fink, MD.

Editor

�</text>
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                    <text>November 28, 1989
Prof. Oded Abramsky

Chief Scientist
Israel Ministry of Health
Jerusalem
Dear Prof. Abramsky,
I write this letter to encourage the application of Dr. Seth Kindler for
support as a research scientist at Ezrath Nashim and the Hebrew University. I
have known Dr. Kindler through his publications and his presentations at
international psychiatric meetings. I have known his mentor, Prof. Lerer for more
than a decade, and have been an enthusiastic supporter of their important

research in electroconvulsive therapy and the receptor mechanisms in depression.
Despite his youth, Dr. Kindler has an impressive record. He graduated
the Hebrew Medical School in 1982, and in seven years, completed his formal
psychiatric training, published important research findings, and developed
laboratory and clinical skills. He seeks to combine these in studies of the
neuroendocrine aspects of depressive disorders.
I am particularly impressed with the importance of these studies for

our understanding of the mechanism of action of ECT, a most useful treatment.
Prof. Lerer has already contributed much to this knowledge. In 1980, Prof.
Ottosson of Goteborg and I proposed a neuroendocrine theory of the mode of
action of ECT. Much work has been done in the United States, Greece, the UK,
and Israel on this theory. It remains Viable and I believe that Dr. Kindler’s
research into serotonergic mechanisms is important in our progress.
Few laboratories in the world are as well equipped and as interested in
research in the affective disorders as those at Ezrath Nashim which I visited a few
years ago. Under the leadership first of Prof. Belmaker and now Prof. Lerer, the
studies have made important contributions to our knowledge. Any encouragement
that can be given Prof. Lerer, as in the support of Dr. Kindler, should pay
handsome dividends in research and in the position of Israeli research in world
psychiatry.
I congratulate the Ministry of Health on having such a promising

opportunity to support important research.

Sincerely yours,
Max Fink, MD.

Professor of Psychiatry
Editor, CONVULSIVE THERAPY

�</text>
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                    <text>STATE UNIVERSITY OF NEW YORK AT STONY BROOK
SCHOOL OF MEDICINE - DEPARTMENT OF PSYCHIATRY

November 27, 1989

Prof. Bernard Lerer

Yaacov Herzog Center
Ezrath Nashim
P.O. Box 140

for Brain

&amp;

P.O. BOX 457
ST. JAMES, N. Y. H780
P“0"”315W444-29l8

Psychiatry Research

Jerusalem, Israel
Dear Beni,

Congratulations on your successful endeavors to
a research center in Israel. The announcement
which I received today carried two messages -- that Ezrath
Nashim has a new research facility (an NMR or PETT scanner?)
and that you are the new chairman of Psychiatry at Hebrew
University.
The second is a real coup, considering the
perception that psychiatry at Hadassah has been social
psychiatry.
Good luck in your new ventures. I thank you for the

establish

announcement.

THERAPY

If

think that a paragraph or two in CONVULSIVE
describing your program in ECT research would be
you

helpful, send it on.
My best to Ziona,

who

must be

especially proud.

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

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January 6, 1989
Shepard Kantor, M.D.
310 West 86 Street
New York City 10024
Dear Shep,

..._...._.m,.

...

it was good of you to send me the material on the role of oxygen-freeradicals (OFR's) in brain functions, and specifically in affecting the cognitive
effects of ECT. I did not know these findings and so read them with much interest.
There may be merit in your suggestion, but only systematic study (as you propose)
will tease out the support for these views.
My own laboratory is devoting its time to study the mechanisms of action
of ECT, mainly the neuroendocrine effects of seizures, and it is not possible for us
to deflect our energies to this interesting clinical question at this time.

Thank you for sharing these interesting ideas. My best regards.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

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January 31, 1989
Michael Alan Taylor, M.D.
UHS/Chicago Medical School
3333 Green Bay Road
North Chicago, IL 6006!}

Dear Mickey,
At the request of Conrad Swartz, M.D., Ph.D., lam submitting this letter
in support of his application for tenure. I have known Connie for about six years,
mainly through his research and chiefly as an editor —- in reviewing Connie's
submissions to psychiatric journals; and in his responses to my requests for reviews
for CONVULSIVE THERAPY. l have observed his presentation of papers at national

meetings, and have read many, if not all, of his recent publications.

Connie is Well trained, intelligent, and innovative. As a graduate of the
University of iowa training programs, he has the hallmarks of a hard-headed
scientist, with a dedicated reliance on data. He has shown the ability to combine
unusual mathematical and engineering skills with the skills of a physician. He has
contributed materially to our understanding of the convulsive therapy process, to
our knowledge of neuroendocrine mechanisms, and to lithium therapy. His studies
of prolactin release and the formulation of a mathematical model to estimate the
amount released under different interventions provides the best estimate of central
re5ponses to seizures. indeed, the demonstration that the amount of prolactin
released by seizures is influenced by electrode placement, current type, and
current dose provides an excellent index of the strength of the stimulus in ECT. His
suggestion for a better way to monitor lithium therapy is innovative and promises
to be useful. His models of the TRH test also seem useful. The development of the
audible EEG monitor for seizure duration is innovative.
His breadth of interest is unusual. His studies are clinical, and apply his
knowledge of statistics, mathematical models, pharmacokinetics, neuroendocrine
systems, and alcoholism. Connie has achieved a fine national reputation for
independent research with a firm mathematical and statistical base. He lectures
and writes well although his style is prolix. He is highly intelligent and innovative,
and is clearly a self-starter and very independent investigator. He would be a
welcome member of our faculty, and i believe he has shown the skills not only to
warrant his appointment as professor, but with tenure as well.
My

best regards.
Since rely yours,,
Max Fink, M.D.

Professor of Psychiatry

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.; m.-

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,

.. (h

February 15, 1989
Dr. Steven Bressler

EEG Systems Laboratory
51

Federal Street

San Francisco, CA 94107

Dear Dr. Bressler,
would be pleased to collaborate and consult on your project
"Neurocognitive Pattern Recognition of Drugs of Abuse". Studies of the effects of
dependence producing psychoactive drugs, especially drugs used for recreational
purposes, are timely. Our early studies which depended on quantitative com puterbased assessment of the electrical activity of single leads were productive, but
were limited by their expense and technical difficulty. Recent achievements of
multi-lead quantitative EEG assessment, such as those undertaken in your
laboratory, corn pel the re-assessment you propose.
i

For your records, I enclose a cepy of my c.v. which details the studies of
cannabis and opioids which i did with Jan Volavka, Peter Irwin, Rhea Dornbush,
Costas Stefanis, and others while at the New York Medical College, 1966—1973.
Citations to our pharmaco—EEG studies are also detailed.
Good luck in your studies.

Since rely yours,

Max Fink, M.D.

Professor of Psychiatry
IRS 11-2133166

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wu—u-wwmw-w-u-w

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February 15, 1989

wry-v:

vaw

Paul Fink, MD.
President, American Psychiatric Association
1400 K

Street, N.W.

Washington, D.C. 20005

Dear Paul,
This letter is in response to the story in Psychiatric News that the APA is
seeking nominations for representatives to the ABPN. If I can be of service, I would
be pleased to support the role of the ABPN in our teaching programs.
My certification in psychiatry (1954) and neurology (1952) by the Board
should be helpful, as should my graduation from the William Alonson White
Psychoanalytic Institute. While my career and record are well known, 1 enclose a
full c.v. for your review.
My

best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>March

‘13,

1989

Lothar Kalinowsky, M.D.
Klinik Dr. Dohrn

Driesenstr.

10

8182 Bad Wiessee am Tegernsee
West Germany
Dear Lothar and Hilda,

1

Thank you for your kind note about the early days at the Psychiatric
I do not know as yet how i will use it, but something will come up.

Institute.

L “M”
i

a

1

i
i.

i

i

1

The APPA held a fine meeting earlier this month, with much emphasis on
the anatomy of the "brain as the basis for mental disorders. Some of the speakers
jumped from animals to man in a truly fantastic fashion. I am still not comfortable
*wffﬁatﬁe st'Fon'g em pha51son neurosdence which now dominates psychiatry
(especially in my department); it reminds me of the excesses of the psychoanalytic
teaching which dominated my training and my years at Hillside Hospital. Too much
of a good thing is still likely to unsettle one' s stomach.

Tony O'Connell invited the associate editors of COMPREHENSIVE
PSYCHIATRY to lunch and the discussion was interesting. The APPA is committed
to publishing the papers of the annual meetings in separate volumes. These have
poor sales, are not indexed in the national indices, and the published articles tend
to get lost. We discussed the possibility of issuing a supplement to the journal for
the articles, as well as asking the membership to subscribe to the journal as part of
their annual dues. Both ideas were rejected by the officers -~ largely, I believe,
because they want to have a 'book' edited by them. Also the APPA officers do not
know Tony and probably would want to name one of their own to be editor. So, as
each perceived the suggestions as threats, they were scuttled at its inception.
The first issue of- CONVULSIVE THERAPY for 1989 was edited by Richard
Abrams and is dedicated to "ECT in the High-~Risk Patient". is a special, larger
issue which is very well done and it should be very helpful for teaching in the next
few years. As] do not know whether your copy will be sent to you, I am enclosing
one for your use.

It

My

best regards and wishes for continued improvement.
Sincerely you rs,

Max Fink, M.D.

Professor of Psychiatry

�V'-

v

“w‘mﬂw~

‘

-

--

v

wimww ~MYwW—vuy

.77

‘VVWV. w... r~._—..—. "WW—”w

wruva—‘mw—wv._._.._r

7—- ,,

January 31, 1989
Lothar Kalinowsky, M.D.
Klinik Dr. Dohrn

Bad Wiessee am Tegernsee

West Germany

Dear Lothar and Hilda,
Thank you for your very nice card, and the news that the Klinik is a fine
one. am delighted.
I

&lt;

The next issue of CONVULSIVE THERAPY is now complete; it is dedicated
to papers and reviews of the medical aspects of ECT. Dick Abrams has put it
M-together, and is the issue editor. it will be put out as a regular issue-oi the journal,
but also reprinted, supported by Dick's company, and distributed at the APA
meeting in San Francisco. There will also be another special issue devoted to the
mode of action of ECT, and this one is being put tOgether by Harold Sackeim for

later this year.

The American Medical Association has formally endorsed the use of ECT.
print the resolution but it already has been discussed in the APA News. it is
of the progress of ECT.
sign
a good
We will

'

Harold Sackeim told me that the Psychiatric institute is planning a special
meeting in September honoring the 50th anniversary of the first use of ECT at the
institute. It would be a timely topic to cover in our News at Notes section. What
was it like in the early days at the Institute? In the early days in New York? I have
the notes from the Abrams interview with you. Could you supplement these? Is
there anyone else that I could interview to report the events of that period? 1
swoutd‘be =gald‘td put something together for your approval. Think on it; any notes
or recollections would be most helpful.

That is all for now.

My

best regards and wishes for continued improvement.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

.

_

�</text>
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                    <text>October 25, 1988
Mr.

Peter Alexis, Executive Director

Psychiatric Institute, Fort Worth

815 Eighth Avenue
Fort Worth, TX 7610‘}

Dear Mr. Alexis,
In response to the inquiry by Ms. Robin Moore, I enclose the information
requested. I know of no official standards for credentialling practitioners, nurses or
anesthesiologists in electroconvulsive therapy. The American Psychiatric
Association has a Task Force which is now considering guidelines of ECT
treatment, privileging, and training; that report is due late in 1989.

There are two academic programs for training practitioners in ECT; one
under the supervision of C. E. Coffey and R. Weiner at Duke University, and the
second under the supervision of L.’ Greenberg and myself at Stony Brook. Both are
five-day, 'hands-on' courses, and carry CME credit hours. The Duke University
program has a special course for nurses; we invite nurses and anesthesiologists to
take part in our program.
Many teaching materials are already available, including textbooks,
videotapes, and journals. In our course, we provide these materials to our students
as part of their fee. Some descriptions are enclosed for your use.

The question of a visiting lecture series was raised. It is possible for a
from our program to visit your hospital and lecture on ECT. Such
member
faculty
is
standard for us; I have just completed such a tour of the seven
rather
practice
medical schools in the Netherlands. It is also possible to survey the standard of
practice; examine the facilities and records of ECT; and to provide a report on the
degree to which the program meets established standards of care (using the 1978
APA Task Force report as a guide; or the proposed guidelines when these appear).
We can assist in preparing a manual of procedures for ECT at your facility.
I was told that there are six PIA hospitals in Texas alone (and 52 in the
nation). With that base, it should also be possible to develop a-special training
program at one of your facilities, by importing two or three of the faculty from
Stony Brook for a few days, to provide representatives from each of the PIA
facilities with an opportunity to become acquainted with present standards of care.
Fees for such services would be negotiated probably on theybafsi‘s‘ of the daily rates
usually provided for consultations off-site; a copy of, those rates is attached.
I

trust these remarks are

helpful.gG.ooEiM-luck in

your efforts.

Sincerely yours,
J

ﬁx.“
~

V,»

r;

'

‘_

'

Max Fink, M.D.

Professor of Psychiatry

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                    <text>smmw“tn mus»:.-.

‘

'

,

w“.

,

S

e»

c",

,

“mum -;~hw;'vyw7——wa' m-wamm.

u

—-——

;.‘m'

,

,

.

-s—v—u

March 20, 1989
Ms. Amanda Hopkins-Alexiadis

Psychiatric Institute, Fort Worth

315 Eighth Avenue
P.O. Box 69
Fort Worth, TX 76101

Dear Ms. Hopkins-Alexiadis,
in response to an inquiry by Ms. Robin Moore for a survey of ECT practice
and accompanying training at PIA hospitals in Texas, 1 indicated that training was
best provided at the two established courses at Duke University and SUNY at Stony
Brook. The SUNY course is a five day, ‘hands-on‘ course which is taught by six
members of the faculty. intensive sessions discuss clinical indications, ECT
techniques, nursing care, anesthesiOIOgy, medical aspects, instrumentation, theory,
and consent. (A description is enclosed.) Such an intensive course cannot be
duplicated outside our facility at this short notice. Therefore, we believe it would
be preferable to have members of your staff attend the next course, planned for

mid-June.

But it such attendance is not feasible, we beleve we can create a
reasonable facsimile for your staff at Fort Worth. As it is not possible for any of us
to teach consistently and continuously for the required minimum two or three days,
it would be necessary to include more than one member of our teaching faculty,
and I would invite Dr. Lawrence Greenberg, attending psychiatrist and Mrs. irene
Carasiti, ECT nurse. Both have worked with me for more than five years in our
EC‘l' unit.
'

A program would be focussed on practical clinical issues: indications for

ECT, selection of cases, consent, medical examinations, demonstration of
treatment practice (dosage, electrode placement, frequency), adverse effects and
their management, identification of high-risk cases, and malpractice concerns.
Such sessions would require a clinician to spend time in the clinical facility to
determine the types of cases to be used in the clinical sessions; and to survey the
treatment facilities for ECT. A suggested two-day curriculum is attached.
The addition of a third day will allow sessions for nurses and
anesthesiologists; didactic sessions on ECT theory; discussions of the role of the
consultant, management of the high-risk patient, credentialling and privileging, and
extended applications as maintenance ECT, treatment of adolescents, and
neurologic and medical (mmpsychiatric) applications of ECT.

�Psychiatric Institute of Fort Worth

Page 2

it would be possible to invide Mrs. Carasiti to work with your nurses in
parallel on one of the first two days.
In discussing the facilities now at the Psychiatric Institute, 1 was told that
patients are not now being treated with ECT. We consider a hands-on
demonstration so useful, that every effort should be made to take the students to a
facility where EC? is actually given; or, to allow us to demonstrate ECT at the
institute in suitable cases.

design our teaching to encourage our students to teach others at their
We provide each student with texts, videotapes, and readings to
supplement the textbooks. For the preposed training program, we will supply one
(or multiple) set(s) of the texts and videotapes at our discount of $405. A set of the
supplementary readings is duplicated at the nominal charge of $10 and either one
or multiple sets can be provided.
We

institutions.

We have not developed charges for such an off-site training course but are
prepared to use the fee schedule for off-site patient consultation and court
appearance as a reasonable basis. We will set a ﬁlly fee of $2,000 for each of the
psychiatrists and $1,000 for Mrs. Carasiti. in addition, travel costs at first class
rates and local hotel and meal costs will be charged as paid.
We

can deveIOp this program in the period Sunday-Wednesday, April 23-26.

can be reached at my office most mornings at 516-4411 2929. Our FAX
number is 516- 4% 7534. I trust these ideas are helpful, and thank you for your
inquiry.
1

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�1

Psychiatric Institute of Fort Worth

“w

Page

PROPOSED COURSE: CLINICAL ASPECTS OF ECT

w»

Dag (-12: Preparation afternoon/evening
er.—mw-w

Yewwm—uy.

Visit treatment facility; review charts and interview patients in course of
ECT, being considered for ECT, or recently completed ECT. Interviews with other
patients who may provide bases for discussion. Visit ECT treatment facility; meet
with ECT nurse] physician] anesthesiologist. Plan actual course with project

coordinator.
Day

i:

am. indications for ECT: didactic; patient interviews; videotapes. (MF)
p.m.

l?

Pre~treatment examinations (LG)
Technical issues in treatment; instrumentation; electrode placement (LG)
Discussion of risks; risk management; malpractice issues (MP)
Consent (LC or 1C)

a.m. Treatment demonstrations (MP, LG)

w

wvn

pm.

mm—

~.-

—.-

Nursing and anesthesiology questions (LG)
Frequency and number of Rx; indications for termination; concurrent and
sequential use of drug therapies (LG)
Maintenance ECT (MP)

m-w—n-

-

4

-—w—-

ymvw

y.

Do! 3:

am.

Medical issues; high-risk case management; role of consultants (LG)
Other indications: Neurologlc; medical (MP)

pan.

Concurrent sessions:

a...

Nurses: Role of nurses in ECT (1C)
Pre and Post-EC! management

Consent procedures
Group therapy for patients

Anesthesiologists: Medical risks of ECT (LG)
Pre-ECT examinations
Ultra—brief anesthesia
Airway management
High risk medical cases; pregnancy
Physicians: Theories of ECT (MP)
Credentialling and privileging
Malpractice issues
instrumentation
Continuing emanation for professionals
Community education

WWW.

3

...

v...-4v.w-u».r.-~.-,. ..-,

.1

_,

.7...“

�Psychiatric Institute of Fort Worth

Page a

Training Materials

BOOKS:

Fink, M. CONVULSNE THERAPY: Theory and Practice, Raven Press,

1979.

‘

American Psychiatric Association: Task Force Report #14, Washington,

D.C., 1978.

Abrams, R. ELECTROCONVULSIVE THERAPY. Oxford University press,

1988.

Malitz, S. and Sackeim, H. ELECTROCONVULSIVE THERAPY: Clinical
and Basic Research Issues. New York Academy of Sciences, New York 1986.
JOURNALS:
'CONVULSWE THERAPY, Raven Press, New York. Quarterly.
VIDEOTAPES:
.

Bluff,

INFORMED ECT FOR PATIENTS AND FAMILIES. Somatics Inc., Lake
1986.

11.,

MIND AND BODY. Health Information Network. Distributed by MECT A
Corporation. Portland Oregon, 1987.
*'

SUPPLEMENTARY READINGS IN EC?

The set of books and videotapes may be obtained at our cost of $475 each. The
supplementary readings can be duplicated here at about $10 each or we can supply
an unbound set for your duplication.

�</text>
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                    <text>iarch 29, 1989
John M. Ackerman, M.D.
2417 Castillo

Street

Santa Barbara, California 93105
.v—

-

"

i am acquainted with publications describing electro—acupuncture ECT
(EACT) by Dr. Xue and his coworkers in Beijing, and another by Drs. He and
Zhuosan (in a separate report from Xian). Both reports appeared in CONVULSIVE
THERAPY in 1985. They suggested an equivalence in efficacy between EACT and
conventional ECT but greater safety for EACT. in the absence of a random

-._w;,.v~——..—.—-—

W.

V,

.,
&lt;

”w...”—

—w-mw—r—---

-.

"nu-v!"

Dear Dr. Ackerman,

'

assignnient study with independent assessments of outcome and cognition, we
remain in the dark as to the importance of these reports.

‘

The second report, "An investigation of Transient Absence of Brain Wave
During Convulsion of EACT and ECT" seems to be an abstract. The citation is not
given. From the abstract, it is not clear when in the course of the seizure, the
TAB W occurred. In 1966, Blachly and Gowing described the end-point of EEGmonitored seizures as 'precise' or 'imprecise‘. Recent studies of the end point find
that more than 2/3 of seizures end in a period of iso-electric activity, a flat EEG
which may be what is described by Dr. Xue as TABW. The period of isoelectric
activity in ECT varies but may be prolonged for more than a few minutes in
unusual cases. Usually the duration is under 30 seconds. We are now investigating
whether a precise end-point is a favorable prognostic sign (and am imprecise endpoint, an unfavorable one). If i am considering the same phenomenon (TABW =
isoelectric activity), then Dr. Xue's observation that 4.1% of cases with EACT had
TABW while 31.496 of ECT cases had TABW, would suggest that ECT was the more
favorable (effective) treatment. But such speculation needs to be examined with
Dr. Xue or another practitioner of EACT.

At one time, Dr. Xue correSponded with me and I invited him to visit Stony
Brook where l was prepared to let him demonstrate his technique in our unit. He
was unable to accept, so i do not have any direct experience with EACT.

ww.

'Wumv

‘vw'qm'wwwimmm

A

”m—

Like other modifications of ECT, the burden of proof of claims of efficacy

or safety lies with the protagonist. I do not know how many Cases would be required
to define a difference between EACT and ECT, or if there is a difference. i

suppose one could estimate the number of cases needed after observing EACT
practice in a few model cases. in assessing differences between unilateral and
bilateral electrode placements, for example, it required a few hundred cases to

demonstrate a difference.

�Dr. John Ackerman

EACT vs ECT

-

Page 2

If Dr. Johnson is enthusiastic to try EACT, an open clinical trial in
characteristic depressed (and delusional) cases would be of some interest. If he
could verify the claims that seizures were induced with remarkably low currents;
that needle electrodes were safe and effective; and that the number of treatments
needed were either equal or fewer than ECT, it might justify others trying EACT.
During Dr. Xue's visit, did he demonstrate EACT? if yes, I would be pleased
to talk to an American observer who may have participated in such a

demonstration.

'

"

Thank you for bringing Dr. Xue's arguments to my attention. if there is
more that needs discussion, you can call me most mornings at my office (5164M
2929).
Sincerely yours,

Max Fink, MAD.

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                    <text>May 25, 1989

Dr. Thomas Bewley
Senior Lecturer
Department of Addictive Behavior
St. George's Hospital Medical School
London SW17
England, United Kingdom

Dear Tom,
What a delightful review! Your review of SPYCATCHER as a study in
alcohol consumption said so much that should be said, in an engaging manner, that
read and re—read it. I am writing to congratulate you on a fine job.

Alcohol abuse is so common in our population that it is a feature of fully
half our admissions. Similarly benzodiazepine use is a feature of our middle aged
patients.
In any case, your review was excellent, and l congratulate you on a fine

analysis of modern political leadership.
My

best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

P.S. It was good seeing you in‘ Brighton. When next you come to New York, would
you let me know? i would like my associates to meet you.
.

1

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                    <text>May 28, 1988

Mr. Jess Buckelew
NDMDA

P.O. Box 79672!
Danes, Texas 75379
Deer Mr. Buckelew,

it was a pleaswe meeting you in Montreal.
in 1986, lappeared in an educational segment on the McNeil/Lehrer News

Hour.mtreportwasqm‘tesuocesstul,andledmetoworkwiththesamevideo

team to make two new videotapes for the education of professionals and of
patients and thek families. The production of the tapes was supported by Somatics

lnc.Youmayhavehadanoportmitytoseeasegmentofonevideotapeattheir
at the America Psychiatric Association meetings. The videotape for

booth

Patients and Their Families may be particularly appropriate for your educational
program. I enclose a description of the tapes; they are available from

50th

A few years ago, the Carrier Foundation (Belle Meade, New Jersey) had a

two day educational senior: on ECT. This was recorded and the audiotapes are
available from the Foundation. An audiotape of my presentation "ECT: How it
Works: Patient Selection" is 15-04: 16—85.

You may also be interested in the recem presentation on ALL THINGS
CONSIDERED, the NPR radio program of April 16, 1988. They reviewed the
present status of electroconvuisive therapy, highlighting the 50th anniversary of

the intromction of the treatment.

Finally, 1 enclose a few copies of the recent historical section of

CONVULSIVE THERAPY for your use.

Thank you for your inquiry.

Sincerely yours,
Max Pitt, M.D.

Editor

�</text>
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              <elementText elementTextId="65903">
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                    <text>u—n

&lt;"1“"-anr-

"v—AVWWn

'—'

v.

«w»

.v

-W

-,

~«r.A~———

‘
m-

vaewr.»

w

"1."

August 15, 1988

'
"

l
""

"
c

Mr. Ronald B. Schwartz
4916 Conrad Street

Skokie, IL 60077

""

.

"—"'"‘

‘7

Dear Mr. Schwartz,

.—

‘7

‘

A

Mr. Buckalew contacted me and my response was to advise him of the
variety of videotapes and audio cassette recordings about electroconvulsive
therapy in which I have been a participant. I did not make a special tape for the
library. I am unable to transfer the copyright to any of these recordings.

‘

WWWMMW-

‘-

Good luck in your efforts.

Sincerely yours,

_—

v.1—

«mm

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>August 18, 1988
Herman M. van Praag, M.D.
Albert Einstein College of Medicine
1300 Morris Park Avenue
Bronx, New York 10461
Dear Herman,
Thank you once again for copies of your annual report. I have watched the
of
the report, which surely reflects the progress in your Department, from
growth
few
a
pages of xeroxed material to these two descriptive volumes. While they
reflect much, I am sure that they tell only a fraction of the sweat and anxiety that
went into the Department's growth.
I looked through the sections for reflections of the use of EC!” and found
I recall that one of your associates was interested in developing a
useful.
this
manual of procedures. Now that our science has become so complex and high—tech,
the APA has found the same need and has established a new Task Force on ECT
which is writing guidelines for treatment and for accreditation of practitioners.
The report should be available next May.

One interesting aside. My impression is that EC!” is rarely used in the
Netherlands. The amount of published new work is small. I was surprised a few
months ago by an invitation from Organon to come to Holland for a week in
October, to lecture on the topic of EC‘I' at each of seven medical schools. The
faculties apparently requested the topic! Even though the assignment is clearly
overwhelming and onerous, I gladly accepted gladly the opportunity to meet
colleagues and re-establish relationships. I asked to meet with David de Wied. Are
there other researchers with an active interest in EC'I' whom I should try to meet?

Wrwwww

Stony Brook is also growing nicely. Fritz has placed his imprimatur on the
Department (most of the appointees made by Stanley Yolleshave left), and we are
moving forward as a full fledged neuroscience center. I have taken these months
off to write a book on an old love, that of pharmam-electroencephalography. I
hope to get it done by early Spring.

meet Gregory Asnis from time to time, and read often of his work. I
met
recently
your graduate, John Zach who has become restive in White Plains and
is interested in a move. At one time, he spoke to me about setting up an ECT unit;
his most recent work has been in eating disorders.
I

Thank you again for keeping me informed. My regards.
Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>August l7, 19 88
Alan Edelson, Ph.D.
Raven Press
1185 Avenue of the Americas
New York City 10036
Dear Alan,
The enclosed letter speaks for itself.
Alfred Freedman has been a remarkable leader in American and world
psychiatry- thoughtful, liberal, productive. It was his vision that launched the
Comprehensive Textbook of Psychiatry and its many offshoots. He launched this
journal, and although it has not made a big impact, its issues are among the most
thoughtful in our profession. The closest relative in my ken is the Behavioral 6c
Brain Sciences (Cambridge University Press) edited by Steven Harnad of Princeton.
Alfred is retiring, but remains active and enthusiastic. He probably needs a
project to keep his interests high during his retirment, and the journal may be a
useful vehicle.
I know that some exploration has been done by Raven
Press, and perhaps
the issue is moot. Nevertheless, lam bringing it to your attention again. Alfred is a
connection to the 'political' leaders (vis a vis the 'scientific') of the world of
psychiatry. That may be of some merit.

My best regards.

Sincerely yours,
Max Fink, MD.

Editor

P.S.
Martha and I very much enjoyed your visit. Carol's suggestion led us to get
the electrician in and, among other changes, the face plate for the light switches
is
level. And, I did not get to Munich after all; my mother fell and fractured her hip;
the surgery and hospitalization kept me here. She is progressing nicely now, but the
timing was inopportune.

�</text>
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                    <text>-

‘rw-w-v

”W'WW‘I"

August 23, 1988
Murray Wexler, Ph.D.
Department of Psychiatry 6: Behavioral Sciences
University of Southern California School of Medicine
LAC/USC Medical Center
1934 Hospital Place
Los Angeles, CA 90033
Dear Dr. Wexier,
i am pleased to submit this letter in support of the promotion of Dr.
BARRY A. KRAMER to the rank of Associate Professor of Psychiatry. I have
known Barry since his tenure at Hillside Hospital when he was interested in

electroconvulsive therapy and we developed a collaborative research protocol. He

left for California in i9 82, as we were completing our protocol, and we sought to
develop the project at USC but that was not feasible. We have collaborated on a
number of reports since then. His survey of the usage of ECT in California is an

important historical and social document, often quoted. He also carried out a
survey of the use of ECT as a maintenance treatment, and published a fine report
last year. He participated in a number of programs with me at national society
meetings.
Barry is a well trained psychiatrist, with a keen appreciation of the role of
ECT in clinical practice. He has made significant contributions to convulsive
therapy research and his publications are well regarded.

recognize Barry as a dedicated, responsible, and excellent clinician. He is
friendly, interested, and enthusiastic about his work. He is a dedicated parent.
Barry is an established clinical teacher. His presentations are clear and well
thought out.
I

He clearly meets the standards for promotion at this University, and i
would heartily endorse his promotion.
As for the question of tenure at this University, it is not possible to make
such a judgement since tenure is reserved for full-time faculty. if Barry were a
faculty member on a full-time basis, I believe we would recommend his promotion
with tenure, although there may be a question regarding the absence of laboratory
investigations in an aspect of neuroscience in his record. Such evidence seems now
to be the standard in our department.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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  <item itemId="6585" public="1" featured="0">
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                    <text>——-——-—-—m

«n

vumvm

w-wnv

—.,
&lt;

'7

-vm'Fw—uu—n

"v.1..-

W

September 6, 1988

.vmm

w.

m,

a“nun...”

_N—v'y-W

Leon Grunhaus, M.D.
Department of Psychiatry
University of Michigan Hospitals,
D9702, Box, Oil 8
Ann Arbor, Michigan #8109-0118
Dear Leon,
Thank you for sharing your videotape with us. My nurse, Mrs. Caraslti and I
viewed it together. We famd it a fine presentation of case material and the ECT
treatment process. We found no portion to criticize. The overall effect is clearly a
positive one. I have asked Mrs. Carasiti to use the tape instead of our own for the
next few teaching sessions and I will let you know it the patients or their families
have any feedback.
1
am delighted that another tape now exists and 1 encourage you to make it
available
as
to users in other centers as Somatics has made my tapes. I! it does
become available, please let Richard Weiner know so that he can include it among
the list of available teaching materials in the forthcoming APA Task Force report.

Your letter to Harold was enclosed with the tape and lam returning it to
that
you so
you can address the special requests to him again.
My best regards.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>September 6, 1988
Joseph Jaffe, NH).
New York State Psychiatric Institute
722 West 168 Street
New York City 10032
Dear Joe,
vu, all over again! Yes, I do remember our little diagnostic
experiments, and I must say that our experience has inﬂuenced me all my life. In
our Hillside days, we learned that diagnosis was not particularly useful when we
were asked to treat patients, since from time to time, the obviously 'wrong'
treatment seems to have been useful. Our random assignment imipramine,
chlorpromazine and placebo studies laid the groundwork for the studies of
imipramine in phobic disorders, for example.
De}_a_'

In the 19703, when the APA committee under Bob Spitzer was devising the
Chinese
menu diagnostic scheme, I argued for consideration of biological
present
(at the time, mainly the sedation threshold and the nascent neuroendocrine tests)
and treatment results as cutting tools, arguing that the main advances in syphilis
came about only after the Wasserman test was devised. Such views were
disregarded as 'premature'.

From time to time I am asked to consult on complex cases, and usually I
discard the diagnoses presented in favor of any diagnosis for which a treatment
exists. A few weeks ago, I was sent a 25 year old man, ostensibly with
schizophrenia (2 consultants agreed), with the statement that BC!" was clearly
useless in schizophrenia and therefore neither psychiatrist would treat the boy.
This despite the record that 4 years earlier he had responded well, albeit for 13
months! We have since treated him and he is doing nicely.
.

Another case is that of a 56 year old confused and apathetic woman who
was diagnosed as Alzheimer disease, confirmed by a neurologist, and again by a
second opinion; consigned to a nursing home for 5 years. She was referred to
University Hospital because of a medical condition. When she was on our medical
service, our consulting team thought she was depressed. She was referred to our
team, and we could not agree on a psychiatric diagnosis; but since the diagnosis of
Alzheimer disease was untreatable, we suggested to the husband that since she
looked depressed there was the option of a course of ECT, which could make her a
little worse for a while, but if it worked . . . It did, and she has now been at her
own home for more than 3 years. (When she returned home, she could not believe
that her daughters were her own, for she had the Rip van Winkle syndrome,
believing that her daughters were five years younger.)

�Dr. Joseph Jaffe

Page 2

Another more recent case is that of a 25 year old married mother with a
history of lupus erythematosus, admitted in manic excitement, treated with
haloperidol, and seen the next day in a catatonic state. Internists believed she had
lupus cerebritis with epilepsy continua, and they tried various voodoo treatments
including high doses of antiepileptic medications; the psychiatrist laid on the
benzodiazeplnes (he feared antipsychotics as neurotoxic). The patient was
incidentally presented to my ECT training class and after some discussion, I argued
that ECT was the preferred treatment regardless of her diagnosis (lupus cerebritis
or NMS or epilepsia continua) since her main symptom was catatonia. Four weeks
later she was finally sent for ECT when her catatonia became the aggressive
variety and she required continuous restraints. Four weeks of ECT, and she is now
home, alert and well.

-

0! course, not all such agnostic diagnoses work as well as these did; but it
only takes one such diagnosis every so often to convince me that our present
disgnostic schemes in psychiatry, especially the Chinese menu approach of your
institute, is Rorschach testing in real life; and that more is in the eye of the
beholder than in the face of the object, despite the professional belief in their

objectivity.

_

'

'

Yes, i remember those experiments very well, and often tell my students
about them. Perhaps we should do the experiment over and publish the results in
the American Journal of Psychiatry? (Under pseudonyms, of course.)
Thanks for the very pleasant reminder. My best regards.
Sincerely yours,

Max‘ Fink, MJ).

�</text>
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                    <text>.m wwwmm—r—u-w «v.0u-r-xn—‘w-a-m-W-~k'“~ﬁfww.mr1wwmr&lt;uﬂ«' r w‘v “~-vu‘--'mw'wwarutrv" w .w-rmmr --y—.w._.,..
~

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September 9, 1988

wrmww

en

"7.:

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.
-

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rm.

m

.

var-v

m

Larry Koran, M.D.
Department of Psychiatry
Stanford University Medical Center
Stanford, CA 94305

1!

‘

Dear Larry,

it was kind of you to write and to give me the news of your work. I enjoyed
much.
it very
I continue on service on the inpatient unit at University Hospital six
months a year with two residents and two medical students during their rotations;
run the ECT service (which is ﬂourishing); and do some research in EEG, as before.
My main work is in editing CONVULSIVE THERAPY, a challenge which 1 accepted
in 1984 and which has kept me busy since.

Our Department has changed markedly under Fritz Henn. We are a
neuroscience center, with good relationships with the V.A. and with the State
services. So much so, that we are planning a new 250 bed psychiatric research
hospital adjoining University Hospital. Planning and architectural drawing funds
have been approved. I have put in my bid to run a neuropsychiatry unit when that
center opens, but we will surely have a large medical/surgical psychiatric unit, as
well as research units for dementia, schizophrenia, and affective disorders.
Meanwhile, Mort Miller‘s successor, Tom Craig left to head a unit in New
and
we are seeking a new Director for the CPD programs. Do you have an
Jersey,
interest to get back into academic research? The position would be good if you

were interested.

Thank you again for your kind words and the reminder that sometimes good
deeds are rewarded in one's lifetime.
My best regards.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>September 9, i9 88
Robert Shaw, M.D.

1542 Leroy Avenue
Berkeley, CA 94708

Dear Bob,
It was such a nice note; thank you.

have had occasion to recall your insulin coma/ chlorpromazine study.
have argued that it was one of the most important studies at Hillside as it
rang the death knell, in an academic and research sense, for insulin coma therapy.
The study uniortunately is not well known, despite its publication‘in JAMA, since
few of the present practitioners even recall that insulin coma existed.
I

Indeed,

I

Hillside remains an active part of the SUNY clinical campus structure and
our students rotate through there for their third year rotation. Their residency
continues to have a good reputation, and their research is excellent. Don Klein
succeeded me as Research Director, then went on to Columbia University. John
Kane, his student headed the research for the past decade and has a clinical
research center in schizophrenia. He was juSt promoted to be the medical director
of Hillside and chairman of the Division of Psychiatry of LIJH. He should be able to

continue its research interest.

I continue on service on the in-patient unit at University Hospital six
months a year with two residents and two medical students during their rotations;
run the ECT service (which is flourishing); and continue research in EEG, as before.
My main work is in editing CONVULSIVE THERAPY, a challenge which I accepted
in 198‘! and which has kept me busy since. It is a quarterly journal, now completing
its fourth year of publication.

It was kind to have a reminder of our work together; my best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>p‘

October 25, 1988
C. w. Erwin, M.D.
Duke University Medical Center
Durham, North Carolina 27710
Dear Dr. Erwin,
I

am pleased to submit this letter in support of the promotion of Dr. C.

EDWARD COFFEY to the rank of Associate Professor (Psychiatry). 1 have known
Ed for about three years, initially through his research writings in convulsive
therapy, then as a contributor and reviewer for CONVULSIVE THERAPY, and
lately as a member of the journal's Editorial Board. I have observed Ed present
‘

reports at many meetings, and have read many of his reports, not only those
submitted to our journal, but to many other journals as well.

Ed is a well trained neurologist and psychiatrist, one of a few young
academic psychiatrists who has completed formal neurologic training. While it was
customaryfor trainees in my generation with an interest in an academic career to
complete neurologic training, it is (unfortunately) much less common today, and
such experience has contributed materially to Ed's writings and teaching. He
clearly has the opportunity to become a leader in the rediscovered discipline of

‘neuropsychiatry'.

When I read his c.v., i discovered that he was a Rhodes Scholar. It did not
surprise me, for despite his youth 1 already thought of him as an acknowledged
expert in ECT and brain imaging, to name two aspects of his research interest.
Ed has published more than 35 good scientific articles on MRI scans, EC‘l’,
and neuropsychiatric topics. His studies of the effects of caffeine in lengthening
seizure duration in ECT are the main citations in an active field. Lately, he has
focussed on MRI imaging in elderly depressives, and I believe he is making useful
contributions to that preliminary and complex literature.
He is among a small band of young, articulate, and enthusiastic researchers
in clinical psychiatry. I recognize him as a dedicated and responsible researcher
and excellent clinician. He is friendly, warm, genteel, interested, and enthusiastic
about his work. He lectures well, and responds to questions with a relaxed and
softspoken demeanor. He is an established independent researcher and teacher. He

meets the standards for promotion at this University and I recommend him for
promotion with much enthusiasm and without reservation. I also would support a
recommendation for tenure.
Sincerely you rs,
Max Fink, M.D.

Professor of Psychiatry

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                    <text>4.

r,_v«--.y-

,_

.

October 25, 1988
Louis Jolyon West, MD.
Department of Psychiatry
UCLA School of Medicine
760 Westwood Plaza
Los Angeles, CA 90024

Dear Jolly,
am pleased to submit this letter in support of the promotion of Dr. I
LEWIS BAXTER to the rank of Associate Professor in Residence I at UCLA. have
known Lew for about four years, initially through his research writings, and more
Two years
recently as a contributor and reviewer for CONVULSIVE. THERAPY.
showed
and
me
host
Lew
was
UCLA,
I
my
ago, when was a visiting lecturer at
I
his
interests.
shared
and
his
ceaworkiers,
to
through his laboratory, introduced me
also have seen the ECT videotape which he produced for his research and teaching.
I

Lew is a well trained psychiatrist, with skills and interests in
psychopharmacology and brain imaging. He has published more than 30 good
scientiﬁc articles on a wide range of topics ~— PET scans, neuroleptic malignant
syndrome, ECT, and clinical psychopharmacology. Lately, he seems tois have
iocussed on imaging studies as his particular interest, and i believe he making
useful contributions to that preliminary and complex literature.
He is among a small band of young, articulate, and enthusiastic researchers
in clinical psychiatry. In late 1986, when Fritz Henn sought a candidate to head our

him Lew's
imaging programs in conjunction with Brookhaven Laboratories, i sent
of
Reimann
Washington
Eric
(like
Lew,
do
that
today),
(and
c.v. for i thought then
brain
imaging.
in
{17,15 a leader psychiatric

recognize Lew as a dedicated and responsible researcher and excellent
clinician. He is friendly, interested, and enthusiastic about his work. He lectures
is
well, and responds to questions with a relaxed and non-hostile demeanor. He an
established independent researcher and teacher. He meets the standards for
promotion at this University and I recommend him for promotion with much
enthusiasm and without reservation.
I

Sincerely yours,
Max Fink, MJ).
Professor of Psychiatry

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                    <text>w

“Wm

www.—

W

-r»—--—-n—-—-m-————

1W,

”a."

October 25, 1988

-..”W...

W...”

”mm

aw

.w.

w

Walter Sannita, M.D.
Laboratory for Neurophysiology
Universita
V. le Benedetto XV
1-16132 GENOA, Italy
.Dear Walter,

.W

,
1W..W

W“

r—

.7,

Awmm

van-Ur

Martha and I were delighted to hear that you escaped from Japan intact,
without the benefits of octopus tea. It was a good meeting, and I am still relishing
the many fine recollections.
‘

.

i received the application of your young M.D., and gave it to our new
Director of Residency Training, Gregory Friccione, who agreed to write a personal
letter regarding the application process. I hope it was helpful.

Meanwhile I am back at work after a hectic week in the Netherlands,
where I lectured on ECT at seven universities in five days -- yes 7 in 5 days. It was
fun and i am just about recovered.
No word from our friends at Sigma Tau, although Milt Kletzkin called for a
report of our meeting. 1 gave him the glowing one that I had prepared and he
seemed rather pleased. Invited me to lunch in New York, soon.
My

best regards.

UWWWWWT'J-n

.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>October 26, 1988
Alfred M. Freedman, M.D.
Department of Psychiatry

New York Medical College

Westchester Medical Center
Valhalla, New York 10595
Dear Al,
The advertisement1n the March issue of the British Journal of Psychiatry
caught my eye; hence my note to you about an article on ECT. Perhaps the editor
moved the article to a later issue.
was sorry to hear that the recommendation for the McAlpin did not
materialize; we should try again.
I

Meanwhile, I have kept up with Lothar's progress and plan to see him
tomorrow, as I am coming to New York after a month's travelling. Turan and I
presented our work at the international Pharmaco-EEG meetings in Kobe, Japan.
He did well and he has many loyal students who attended the sesssions reliably and
enthusiastically. My own impression (it was my first trip to Japan) was that I had
never seen such a fine organization nor were my questions answered so quickly and
so well in more than 35 years of attending national and international meetings. Our
hosts were most solicitous and the meetings were quite good. Martha and l
travelled about, from Kobe to Osaka/Kyoto/Nara by trains, finding them prompt,
efficient and generally clean. Language was no problem, and we thoroughly enjoyed

ourselves.

lam sorry to have missed the program in New York. My trip to the
Netherlands (seven lectures at seven universities in five days) was an educational
success, mainly because I learned much about the politics of medical care in a
socialized society. It was enough to turn one into a confirmed reactionary.
As for Australia,

I

you anyway for your help.
My

do not see myself getting there in the near future; thank

best to Marcia.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>October 29, 1988
Alexander Gralnick, M.D.
Upper King Street
Rye Brook, New York 10573
Dear Alex,
Good for you! Your article in yesterday's New York Times expressed what
we feel, ashamed and uneasy, on hearing and seeing the anti-liberal, NO—NOTHING,
anti-American attitudes of Mr. Bush and his accomplices. i did think the American
people were stupid when they elected Mr. Reagan, and when they did it again, it
was a disaster. But the blatant anti-liberal, anti—black, pro-Redneck, flag-waving,

anti-abortion, and anti-environmental blandishments of the Republicans far
exceeds even the excesses of the sleazy government which Mr. Reagan brought to
Washington.

Your article is important and you are to be congratulated, and thanked, by
all of us 'liberals' who see the U.S. Constitution as the main hope of mankind in this
crazy world.
Keep it up. My best regards.
Sincerely you rs,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>October 29, 1988
Alan J. Gelenberg, M.D.
THE ARBOUR
49 Robinwood Avenue

Jamaica Plain,

MA

02130

Dear Alan,
The Therapy Resistance Conference was most interesting and clearly a
successful and important occasion. The topic deserves the study that it is now
getting. Perhaps I over-reacted to the Post slides, but is it not a reflection on our
practice when a leader of what is presumably the most prestigious, expensive, and
over-funded psychiatric research venture in the [1.5. unashamedly tells a public
audience that he subjects his patients to one experimental regimen after another,
month after month, year after year, without prior attempts at an effective
treatment? is that not a sign of hubris? I cannot imagine a similar scenario at The

Arbour or

at University

Hospital (or at McLean, or Payne Whitney, or the many

other fine clinical/ research centers in the U.S.)
In any case, the
My

article by Kroessler is enclosed.

best regards.
Sincerely you rs,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>November 4, 1988
Norman Endler, Ph.D.
Department of Psychology
York University
l‘700 Keele Street
North York, Ontario, Canada M33 1P3
Dear Norman,
Yes, the meetings-in Philadelphia were quite good, and much better than
had heped for. It was indeed a celebration, despite the protesters, who seem to
have made their greater mark on the press, and seemingly little on the

I

participants.
you.

Yes, I have received a copy of ECT: The Myths and the Realities; thank

reported earlier this year, I am committeed to so many projects that I
can hardly get to my clinical work; but I will, do what I can to contribute the
requested chapter.
As

1

a

My

best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

�May 26, 1988

C. Douglas McCann, Ph.D.
and Norman Endler, Ph.D.
Department of Psychology
York University
’4700 Keele Street
North York, Ontario, Canada M33 1P3
Dear Dr. McCann and Norman,
While Iseem to be committeed to so many projects that I can hardly see
the top of my desk, 1 will do what i can to contribute the requested chapter later
this summer.
What is not clear to me is the intended audience. The chapter titles are too
diverse to be of interest to the practicing psychiatrist or psychologist; and too
unfocussed to be attractive to the research/academic type. Students of
psychology? Laity? Please advise.
Thank you for your consideration.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>November 27, 1988
Sidney Malitz, M.D.
New York State Psychiatric Institute
722 West 168th Street
New York, New York 10032
Dear Sid,

It was kind of you to nominate me for membership in the Royal College of
Psychiatrists. Alan Miller was pleased to endorce the nomination and the papers
went off promptly on Wednesday.
My

best regards.
Sincerely you rs,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>December 21, 1988
ml—m'vr

,-

ﬂaw”

w».

www—r—r—,~

GretaKoinig, M.D.
Psychiatrische Universitéitsklinik
Allgemeines Krankenhaus der Stadt Wien
Wilhringer Gurtel 18-20
1090 VIENNA
AUSTRIA

Dear Greta,
What a pleasant surprise to receive your informative letter and greetings.
have regularly received news from Vienna from our young Ph.D. scientist (who
seems to be doing very well in his laboratory work, and his social life).
We

Protocol: Dr. Gangadhar has been a regular contributor to CONVULSIVE
THERAPY and he had informed me that he was planning to study in Vienna. I read
the proposal and it is consistent with our present knowledge and experience. There
are a few points that you may wish to consider.
A study focussed on a defined course of 6 ECT argues that about 1/3 or
of
the subjects will be inadequately treated at that measurement. Whatever
more
benefits ECT may provide, may yet develop with more treatment. it may be better
science to design the study so that that the ratings of depression reach an arbitrary
(though low) value as the time at which the prolactin measures are re-examined.

Prolactin release is influenced by electrode placement, amount of energy
(threshold or supra-threshold), type of current (sinusoidal or brief—pulse), and sex
and age of the subject. One problem with the Siemens Konvulsator is that it
delivers variable amounts of energy. Some attention should be paid to these
variables in the design of the study.
While the study is of temporal

interest, a more illuminating study of
dopaminergic phenemona in ECT might be one of patients with parkinson disease
and depression. Suggest that Dr. Gangadhar read CONVULSIVE THERAPY g: 321327 (Fochtmann) and 3: 189—191 (Fink).
Hypothesis: As for the other questions, I enclose a copy of a report which I
have just sent to the journal Neuropsychopharmacology, and’which is under
editorial review. It is the latest version of the neuroendocrine hypothesis of ECT.

.

"W

wwwt‘

�Dr. Greta Koinig

December 21, 1988

Training: We do not have a formal ECT training program for our
psychiatric residents. in the first year, they receive lectures on affective disorders
and the treatments available; about 3 hours are devoted to ECT. In their second
year, while on the in-patient service, they spend two months on the 'ECT Team',
managing every case referred for ECT. On average,’they manage about 8-12 cases.
ECT is also discussed in the weekly attending case rounds.

Finally, selected residents may do research in ECT duing their elective
period (fourth year) for periods up to six months. We average one resident each
year.

in addition, we have organized a formal hands-on' training in ECT. A
description is enclosed. The next course is sceduled for the week of March 6, 1989.

lPAAE: The details of the lPAAE are enclosed. (The society is changing its
name to The Association for Convulsive Therapy (ACTH.
ECT DATABASE: Citation searches for tapics in ECT are available to
subscribers and contributors to CONVULSIVE THERAPY, by request addressed to
my office. There is no formal citation list that is made up periodically; each issue
of CONVULSIVE THERAPY contains the citations included in the database in the

previous quarter.

There are numerous ways to reach me. Using the University BITNET
system, my address'is MFINKQSBCCMAIL.BITNET. For FAX, my temporary
number is 516- 862 8604 (although this will change in about a month). My home

number is 516-862 6651.

i am delighted that there is a resurgence in interest in ECT in Vienna. i
have been gratified by the continuing acceptance of ECT and CONVULSIVE
THERAPY; its portrayal as a reasonable treatment; the greater investment in
training and improved facilities; and the greater attendance and interest in ECT at
conferences and meetings. The main thrust today is no longer the acceptance of
ECT, nor its indications, nor the technical details of currents and electrode
placements, but in its mode of action. Hopefully, this interest will improve our
understanding of both the treatment and the pathOphysiology of affective

disorders.
1989.

i trust these responses are helpful. 'iy best wishes for a happy and healthy

Sincerley yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>”it 3"

yu—a-v.

a—u—w

April 7, 1988

Charles Kellner, M.D.
Department of Psychiatry
Medical University of South Carolina

l

i
E

i

l

171

i

Ashley Avenue

Charleston, SC

29‘325

Dear Dr. Kellner,
We would be pleased to assist you in the development of both research and
clinical skills in convulsive therapy, and agree to supervise your education at
University Hospital at Stony Brook for a period that is mutually satisfactory.
in response to the prevailing need for education in ECT practices, we have
developed a five-day, 'hands-on' ECT course. Our first class of four psychiatrists
and two nurses went through the course in February, and we have scheduled a
second course the week of May 16. A description of the course is enclosed. The fee
for psychiatrists is $1,500.
,

»

On occasion, we have had fellows attend our service for periods of up to
two months, and would be willing to do so again. in addition to our active ECT
teaching and treatment programs, our research programs in ECT include:

ECT and Antipsychotic drugs in Patients with Positive-Symptom Psychosis
(Schizophrenia).
Comparison of etomidate and methohexital anesthesia: Inﬂuence on seizure
'

'

,

duration.
Pentylenetetrazol vs Caffeine in Altering Seizure Duration.
Electrophysiology of seizures: Comparison of Brief pulse, Sinusoidal
currents, and Pentylenetetrazol enhanced seizures.
Relations between Neuropsychological changes and the duration of
isoelectric EEG period after seizures.
Effect of ECS and antipsychotic drugs on blood brain barrier.
Effect of ECS on brain catecholamines in animals with learned
helplessness.

Finally, wt edit the journal CONVULSIVE THERAPY and manage the
CONVULSIVE THERAPY DATABASE from these offices.
Good luck in your program.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

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April l7, 19 88
Michael A. Taylor, MI).

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Professor 6c Chairman
Department of Psychiatry

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3333 Green Bay Road
North Chicago, Illinois 60061:

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Dear Mickey,
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V

was pleased to send the enclosed to the Search Committee of the
University of Vermont. I have been there twice, about six and two years ago. It is a
good campus, and seemed to have well qualified students. I was not impressed with
the research interest, since my hosts impressed me that they were busy earning
their salaries through their practice plan. But if anyone can shake the
establishment and raise the academic sights, I am sure that you can.
I

When I was a boy, I camped often on Lake George, and canoed Champlain.
Indeed, was camping on Lake George on June 6, 19M (ID-Day) and can still recall
I

the thrill of our fishing the next few days, with the optimism that the war would

now soon come to an end. In the early 1970s, we usually rented a camp for a month
on Raquette Lake. You will surely like the fishing in the Adirondack streams and

lakes.

’

I

do hope that you get the position if that is what you want.

Is there anything else lcan do for NNérBN? lam not too surprised that the
reviewers didn't accept the pharmaco-EEG article. The question, whether there is
anything more than noise in the waking EEG, remains an interesting one,
particularly since the technical issues of recording and analysis have been solved so
handsomely. Now that the ECT issues are fairly cut and dried, I have decided to
take time off the second half of the year and write a book on Brain and Behavior:
Pharmaco-EEG Revisited. I will emphasize theory, much as I did with Convulsive
Therapy. If Iam successful, we should be able to get reviewers of NNchN to look
at the article with a fresh eye a year hence.

My best regards.

Sincerely yours,
Max Fink, MD.

Professor of Psychiatry

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April 18, 1933
Norman R. Alpert, Ph.D.
Chairman, Search Comm. for Psychiatry
Dept. Physiology 6: Biophysics

Given Building
University of Vermont School of Medicine
Burlington, VT 05305
Dear Dr. Alpert,

lam pleased to submit this letter of recommendation on behalf of
Professor Michael A. Taylor, who is being considered for the position of chairman
of the Department of Psychiatry. He is ably qualified and fully capable of
accepting the responsibilities outlined in the job description sent to me.
I

have known Mickey Taylor for more than two decades, since his residency

training at the New York Medical College. Among a group of excellent students, he

was outstanding, an independent thinker, and a careful worker. Taking an idea from
a single report from Michigan, he examined the incidence of male and female
offspring born to psychotic mothers in the State hospitals in New York, mothers
who were psychotic at the time of conception. He. found a higher incidence of
female infants born to such mothers.'He then examined the impact that medication
may have had on the gender advantage for female infants. Such innovative studies
were awarded the prestigious A.E.Bennett award of the Society of Biological
Psychiatry.
«v-

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,

After a tour in the U.S. Navy, where he also published clinical research
studies, he returned to join our faculty at Stony Brook. He took over a routine state
hospital ward without a single distinguishing or redeeming feature. Within a year, it
became an outstanding study and research unit, indeed, the premier unit of the
many at the hospital. He was rapidly promoted to Associate Professor and was
under consideration for promotion to Professor when he was invited to the chair in
Chicago where he became Professor and Chairman.
in research, Mickey is an outstanding clinician and phenomemlogist. He
and his associate, Richard Abrams have led a re-assessment of the genetic and
familial contributions to clinical phenomenology; the classification of
schizophrenia and catatonia; and the neuropsychological consequences of subtle
brain damage, both generalized and localized. Their independent thinking and databased studies are outstanding.
in teaching, his texts are excellent. Both his Neuropsychiatric Mental
Status Examination and General Hospital Psychiatry are innovative and important
texts, widely used in teaching psychiatric residents. He is an outstanding lecturer.

-

�Michael A. Taylor, MD.

University of Vermont

Page 2

Based on his record of contributions in neuroscience and neuropsychology,
he was invited to become the founding editor of a new scientific journal,
"Neuropsychology, Neuropsychiatry and Behavioral Neurology”, published by Raven
Press of New York.
His administrative abilities are also excellent. i watched the development

of the teaching unit at the Central lsiip Psychiatric Center. I have visited his units
in Chicago, where he not only has developed a productive Department of
Psychiatry, but established such fine relationships with the Department of
Psychology that i believe he has been acting chairman for an interim period. And, I
am amazed by the continued productivity of his students and associates.
can think of few psychiatrists in the U.S. who match Mickey's talents as a
clinician, researcher, and teacher, and I recommend him heartily for the
chairmanship. Mickey is an avid fisherman, and lam conﬁdent that the waters of
Lake Champlain and the many lakes of the Adirondack Mountains will be a positive
attraction. i hope that you can attract a man of his experience and talent. Good
1

luck.

-

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>genufﬂ...‘

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...,” “usurp—...". ..-

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mar .. -...—,—.v«-~i.m.,_.»---_-nn, “2...“. mm; :.

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April 23, 1988
...T.,..—‘.v.‘

A

Dr. John Waterhouse
Department of Psychiatry
Western General Hospital
Edinburgh EHQ ZXU
United Kingdom
Dear Dr. Waterhouse,
I

Your letter of November 25 arrived (inexplicably) at the end of March, and
it
sent through the Department Chairman to the professorial faculty. While we

would be pleased to have you participate in one of our many research or teaching

programs, present State regulations regarding appointments of outside faculty
preclude our providing an appointment which has clinical (therefore reimbursable)
service as the basis for an appointment and support.
The strictures which apply to a State facility do not ordinarily apply to a
private hospital or university. You may wish to write to the two principal
psychiatric academic centers in New York City, Dr. Herbert Pardes at Columbia
University (722 West 168 Street, New York City 10032) or Dr. Gerald Klerman at
the Cornell Medical College (Payne Whitney Clinic, 525 East 168 Street, New York

City 10021).

‘My regards to Professor Hamilton.

Regrettably,

Professor of Psychiatry

�</text>
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                    <text>'1‘»-

.

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.41

203.7 lop“?
April 30, 1988
Dr. John W. Goethe
and Dr. Martin R. Ford
Institute for Living
t$00 Washington Street
Hartford, CT 06106
Dear Dr. Goethe and Dr. Ford,
1
was so sorry the weather did not hold for your flight on Thursday. I very
much understand the frustrations of being at the airport and getting weather
reports every 15 minutes, only to decide that the trip had to be cancelled. It is then
that instrument rating looks so good.

had searched the ECT Database for citations to EEG and culled the
attached list as those that seemed most relevant. Interest in EEG studies has reawakened as we have become more interested in the definition of an 'adequate’ or
i

'therapeutic' seizure.

Two other topics have surfaced. Are focal or lateralized post-ECT findings
related to treatment outcome; and do focal or asymmetric records predict a good

or a bad outcome with treatment.

There is an international association, not well known in this country, that
meets every two years to discuss quantitative EEG and psychopharmacology. They
occasionally have papers on ECT, but the main benefit of the group is their interest
in the problems of quantification. Your 1986 report in Biological Psychiatry is
clearly within the interest of the group. The IPEG (International Pharmaco-EEG
Group) meets later this year (September 28-October 1) in Kobe, Japan.

Please re-schedule your trip. Weather in May is always better; I did my
New York to San Francisco flight in a Cessna 172 in May.
My regards.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�We”. w (. ”TAM.

V

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.V.

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acme—"why.

v.» ;

March

mam“

II,

,_,,

i

“WW. .5.“

,

4~._‘-.‘V._‘r~r~p-.~‘rr‘ w~&gt;1m~ um

1988

John W. Goethe, M.D.
Director of Clinical Research
Institute of Living
‘‘00 Washington Street
Hartford, CT 06106
Dear Dr. Goethe,
I

would be pleased to have you visit our laboratories in April.

at the University most of the month except for April ll; to 20.

I

expect to be

The EEG recordings are mostly done on Thursdays, and a visit on that day
would permit us to demonstrate the ongoing work.
I can be reached most mornings at 516-444 2929; and most late afternoons
516-862
6651. The best time is from 11 a.m. to noon, after I have completed
at
rounds.
morning
'

The University is 60 miles east of New York City on the North Shore of
Long Island (Long Island Expressway, Exit 62). The best entry by air is to Long
Island MacArthur Airport (20 minutes) or LaGuardia Airport (1.2 hours). If you

drive, the Bridgeport/Port Jefferson Ferry brings you about
University.

15

minutes from the

Come for lunch and we can have the afternoon together.
I

look forward to your visit.
Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

-

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                    <text>V’""' "aw."

.—

.

H.

w.

mm.

WWW—mnp—m—w,

,

“ﬂy,“

run.“ WW

-w—nrv—

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Ma...

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7

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we.“

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w,"

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w,

-

.

May 25, 1988

Michael A. Taylor, M.D.
Department of Psychiatry
Chicago Medical School
North Chicago, IL 60064
Dear Mickey,
am delighted with the list of papers accepted for the first issue of
NNPchN; and i will review the Hales 6r Yudofsky book in early June. i just read the
enclosed review in JAMA of another book that may interest our readers; perhaps
you should consider it for NNPGIBN.
I

Meanwhile, Al Freedman's rattling of the cages at the Society of Biological
Psychiatry was successful, and Martha and I had a most pleasant occasion. We sat
with Oliver Sacks (who gave a special lecture on "lmpulse") who is: l) delightful in
a peculiar, idiosyncratic way; 2)looks very much like his cousin, Abba Eban; and 3)
seems to be a much better writer and poet than neurologist. (I tried to get him to
talk about anosognosia, exosomesthesia, aphasia, and the retardation of
parkinsonism, but what he said was mostly poetry.) Still, a most delightful man.
My

best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>E

May 30, 1988

David Kroessler, MD.
Department of Psychiatry
Rhode Island Hospital

Providence, RI 02903
Dear David,

Last month you enquired about support for continued research in ECT. At
the APA meetings, I became acquainted with the NARSAD program. This looks like
an appropriate place for you, with Barry's support, to obtain funds for your
research.
Good luck.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�April 7, 1988
David Kroessler, M.D.

Department of Psychiatry

Rhode Island Hospital
Providence, RI 02903
Dear David,

I know of no special foundation grants in electroconvulsive therapy. From
time to time, we have been able to get special funding for a seminar or a
colloquium at a meeting from some of the ECT companies or a few small
foundations. But felloewship money sufficient to allow someone like yourself to
develop an academic career has generally come from the National Institute of
Mental Health.
'

There has been an announcement of a new career fellowship program for
medical graduates who have less than five years of post-residency experience. You
may qualify and should consider applying. One applicant called me and asked
whether I would agree to having him study here for a training period of one to two
months, and I agreed. If you wish to arrange such a training program, I will do what
I can to make the arrangements at those centers that may be of interest to you.
As for project grants, these come exclusively from NIMH. There is a
fund
at Veterans Administration hospitals which allows investigators to get
special
funds
($25,000) and then to apply through a special VA funding program.
start-up

The work here is going well. We have started a five-day CME 'hands-on'
training program in ECT. The first class went through in February; we are
scheduling the second for the week of May 16. Our research projects are running
well and we have a steady output of papers. Larry has taken over the ln-patient
service; Krish Gujavarty is moving to the V.A. I append a list of our active ECT
projects for your information.
Tell Barry that I included a review of his book (which I like very much) in
the next issue of CONVULSIVE THERAPY. My best regards.
Sincerely yours,

Professor of Psychiatry

�</text>
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                    <text>June

1, 1988

Dominick P. Purpura, M.D., Dean
Albert Einstein College of Medicine
1300 Morris Park Avenue

Bronx, New York 10461
Dear Dr. Purpura,

I am puzzled by your letter of May 31, asking for an additional assessment
of Dr. Gregory Asnis' qualifications. 1 will do what Team. The request is to 'expound
on how much time and originality he contributed to these articles . . '.

Dr. Asnis came to my laboratory fresh out of his residency at the Mount
Sinai Hospital, where he had undertaken independent case material studies,
sufficient to receive the annual award for the best 'resident' presentation.
Our first published study (his {I 5) was a survey of the use of ECT in
metropolitan hospitals. The study was undertaken at my request. Sue Saferstein
was a third year medical student, and Greg Asnis was her supervisor in the study.
The commission came from the APA Task Force on Electroconvulsive Therapy. My
recollection is that I developed the design of the study; Greg and Sue Saferstein
carried it out, and wrote the initial reports; and that I edited the final report. I do
not think that Greg was interested in ECT thereafter.
The second study (his #9) was an outgrowth of an interest in abnormal
motor movements. Both Ed Sachar and Herb Meltzer had shown that active
antipsychotic drugs elevated serum prolactin. I cannot recall whether the idea of a
study came from Greg or another of our team, but my main contribution was to
develop the relationship with Ed Sachar, obtain his agreement to undertake the
assays, and make one trip to Columbia University to meet Mrs. Halpern, the
technician who carried out the assays. Greg left Stony Brook after the samples
were collected and the patient' status defined. The report was written at Columbia
University, and I received a penultimate copy for my advice. Ido not recall making
a contribution to the analyses, nor do I know what processing went on at Columbia
University.
Greg's experience at Stony Brook was marked by our unsuccessful attempt
to organize a research unit at Central lslip Psychiatric Center. I was given that
mission by Stanley Yolles, and it was a frustrating and unhappy experience.
Because we could not provide a satisfactory site for research, I urged Greg to go to
Ed Sachar (and I moved my research to the V.A.). That is one reason why his two
years with us appears so unproductive in his record.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>June 3,

19 88

V. N.

Bagadia, M.D.
Broadway Building, 2nd Floor
Matunga
Bombay #00 019
India
Dear Professor Bagadia,
Yes, I believe that our readership would be very interested in a survey of
the use of ECT in India. There is a dearth of good data on ECT usage, and much
argument, whether usage is increasing or decreasing, whether the indications are
changing, and whether consideration is being given to the effects of electrode
placements, current type, dosage, frequency of seizures, seizure durations
monitoring, and other technical details. I enclose a copyright release which should
be signed to accompany the article.
The article "Reevaluation of ECT ~6: Right Tempemparietal vs Bitemporal
Electrode Placement in Schizophrenia", is scheduled to appear in the third issue of
CONVULSIVE THERAPY, in September this year.
I

look forward to hearing from you. My best regards.
Sincerely yours,

Max Fink, M.D.
Editor

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-..v

v

~

,

IF:

,

v—w

rmw—mwuuf

-

-—m-wm"l‘v-—lwv-L’-‘V"V.

May 30, 1988

Alfred M. Freedman, MD.
Professor 5: Chairman
Department of Psychiatry
New York Medical College
Valhalla, New York 10595
Dear Al,
Enclosed is a copy of your nomination for the 1988 McAlpin Award.

it may be helpful if another letter is sent. If you will suggest names of
leaders outside the Department who may also send a letter, i will contact them. I
think of Leon Eisenberg as a long-standing friend, or Milton Greenblatt. Have your
secretary call me at 516—3“ 2929 so that icon do what needs to be done, before
the end of June.
My best regards.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
.

.

»
WW»;

Ww— vu't—u'r -‘ - . -1“

�</text>
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                    <text>June 3, 1988
Alan Stone, M.D.
Harvard Law School
Langdell Hall,
Cambridge, MA 02138
Dear Alan,
Thank you for agreeing to support the nomination of Al Freedman for the
National Mental Health Association McAlpin Award. I enclose copies of the award
announcement, Al's 'short' biography, and my letter of nomination.
have submitted all the requested documentation, including the curriculum
vitae, photograph, etc. It would be helpful if you would write a suitable endorsing
letter, which should-Fe sent to the McAlpin Award Panel in Alexandria, Virginia.
I

I

have also asked Leon Eisenberg to send a letter of nomination.

My best regards.

Sincerely yours,

Professor of Psychiatry

�</text>
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                    <text>June 1, 1988
Leon Eisenberg, M.D.
Department of Social Medicine
Harvard Medical School

25 Shattuck Street
Boston, MA 02115

Dear Leon,
Thank you for agreeing to support the nomination of Al Freedman for the
National Mental Health Association McAlpin Award. [enclose copies of the award
announcement, Al‘s 'short' biography, and my letter of nomination.
have submitted all the requested documentation, including the curriculum
vitae, photograph, egg. it would be helpful if you would write a suitable endorsing
letter, which should be sent to the McAlpin Award Panel in Alexandria, Virginia.
i

Note that the award includes a medal and $5,000. The least that we should
be able to extract from Alfred and Marcia is a dinner at our favorite restaurant.
Since last we met, I have continued supporting the proper use of ECT, by
my research, editing the journal CONVULSIVE THERAPY, and training clinicians
who seem, in increasing numbers, to seek direct experience with this complex

treatment.

My best regards.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>May 30, 19 88

McAipin Award Panel
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
Dear Panelists:

lam pleased to nominate Professor Alfred

M. Freedman for the 19 88

McAlpin Mental Health Research Achievement Award. Few psychiatrists have done
as much for the education and training of psychiatric professionals, have
encouraged such useful and important academic research, and have provided
leadership for the nation’s major scientific societies as has Dr. Freedman. His
formal academic curriculum vitae is attached, but I would like to highlight a few
aspects of his record which encourage me to make this nomination.

Formally, Dr. Freedman was certified in psychiatry and psychoanalysis
his
after
graduation from the University of Minnesota Medical School in 1942. He
assumed the chairmanship of the Department of Psychiatry at the New York
Medical College in 1960, and created an outstanding research and teaching center.
His major contributions in academic research are in the treatment of opiate
dependence with narcotic antagonists and long-acting opioids; and in his studies of
the effects of psychoactive substances on brain functions.

joined him as a member of the faculty of the New York Medical College
in 1966. At the time, opioid addiction had surfaced as a national problem. Few
psychiatrists were willing to undertake the treatment of those afflicted with drug
addiction, yet he established the first municipal hospital treatment unit for drug
dependence. He supported two separate research programs in addiction, one based
on sociological models (under Richard Brotman) and another, based on biological
models of narcotic antagonism. His program developed the merits of naloxone,
cyclazocine, and naltrexone as treatments for opiate dependence; and broadened
the applications of methadone and ievo—acetyimethadyl as narcotic substitutes. He
encouraged the collaborative study of chronic hashish users in Athens; and began
studies of the central effects of cocaine, when cocaine use was a rare and
i

occasional dependence.

addition to developing a Department and teaching programs for medical
students and residents, and encouraging the research studies, he found time to edit
the definitive Comprehensive Textbook of Psychiatry, which is now used worldwide. ile also founded and edits the journal integrative Psychiatry.
In

�Nomination of Alfred M. Freedman, MJ).

Page 2

in his residency training programs, he recognized the special needs of

women physicians, and he developed the first post~graduate training program for
women psychiatrists. lie established a Day-Hospital program for the severe
mentally ill; and has always maintained relationships with many community
hospitals for the education of their personnel. (i believe that the present program is
affiliated with 14 community hospitals).
in his support of the studies of
is not well known in this
which
pharmaco-electroencephaiography, a discipline
And
in his willingness in 1968 to
and
Japan.
country, but well established in Europe
when
the treatment was outside
support studies of convulsive therapy -- at a time
the main stream of psychiatric practice and research. That encouragement led his
student, Richard Abrams and myself, to become international leaders and authors
in ECT.
The diversity of his

interests is to be seen

His reputation in research led to his election as President of

the American

College of Psychopharmacoiogy 0972), President of the American
Psychopathological Association (1971). in 1973, he was elecred President of the
American Psychiatric Association.

Dr. Freedman has an enviable record of participation and interest in
international psychiatry. He invited leaders from foreign countries to visit the
Department and lecture, in the Goldman lecture series that began in the early
19605. He has been an active member of international psychiatric associations and
is well known as lecturer, teacher, and friend throughout the psychiatric world, not
only in Western countries, but in many developing countries as well.
Al has received many awards and much recognition for his leadership,
humanity, and support of academic principles in research and teaching. He is a
warm, friendly, and encouraging man, with friends throughout the world. His wife,
Marcia is a Professor at Columbia University, and both their sons have enviable

academic records.

Considering the long list of outstanding recipients of the McAlpin Award,
am proud to recommend your consideration to add his name to this list. i have
discussed this nomination with him, and he has agreed to be considered for the
award, and to attend the symposium in Los Angeies in September. His current
address and telephone numbers are listed in his 9.x;
Thank you for your consideration.
Sincerely yours,
(V‘ax

Fink,

649,-).

Professor of Psychiatry

1

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                    <text>Ii

_......_.,..,,,_.A_

June 2“, 1988

,_..V

.

w...

John M. Kane, MD.
Department of Psychiatry
Long Island Jewish Medical Center
75-59 263 Street
Glen Oaks, New York llOOQ

is...

V
V,

.,,

1
T
m

V'mﬁ'm—VV'WM-rwr‘

Dear John,
w:

Congratulations on your appointment as Chairman of Psychiatry at LIJH. It
is a particular pleasure to know that the hospital has sought a researcher as its

leader, and to join with other graduates of Hillside‘s training programs in wishing
you a fruitful tenure of leadership.

,

It was 30 years ago that Israel Strauss, Joseph S. A. Miller, and the Medical
Board of Hillside Hospital endorsed their research aims by creating a full time
position of Research Director. When Don Klein and my co-workers in the
Department of Experimental Psychiatry (that was the fashionable term in those
days, much like Division of Neuroscience would be today) wrote a review of our
activities for the Journal 9__f the Hillside Hospital in l96l, we not only looked back
at our accomplishments, but sought to direct the Board's eyes forward by calling
for a 200 bed clinical research center. We saw something specialin Hillside.
Perhaps it was ambitious, but we were encouraged by the dramatic gains of the
psychopharmacologic drug revolution, the nation was in an expansive mood (preViet-Nam, pre-Kennedy/Johnson),and we thought the cure of mental illness was in
our grasp.
In the interim decades, the leadership of the hospital seemed too concerned
with fiscal and operational matters to fully utilize its outstanding research
opportunities. Your success in building on Don's programs has given you the unique
opportunity to realize even more of the potential in Hillside's patients, staff, and
history. it is a fine opportunity, and the staff at Long Island Jewish Hospital and
the community it serves are to be congratulated in their selection.

My congatulations on your appointment; and my best regards.

Sincerely yours,
Max Fink, MD.

Professor of Psychiatry

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-&lt;

‘//4' 7 a; {1/9

’(0)

4/4, -223 éBﬁZ “W
wv—m-wm‘nmwwwv—V-v—w‘W.

.

June 25, 1988
Norman Endler, PM).
Department of Psychology
York University
4700 Keele Street
North York, Ontario M33 1P3
Canada
Dear Norman,
Enclosed is a draft of 3 Forward for your new book. in acknowledging Dr.
Persad's contribution, iassumed it was to assure the details of the treatment,
indications, and risks, and iso noted on page 3. if that is incorrect, or you wish me
to include a different statement, please let me know.

Let me know if there is something that you wish changed. 1 will be at my
office this week, but will be away from July 3 to 12 in England.

it is a pleasure to make this small contribution to the success of the book.
When it is published, ask Ms. Stillman to send me an additional copy for review, and
i will ask one of the members of the Editorial Board of CONVULSIVE THERAPY to

review it promptly. (indeed, if she will send an unbound copy of the page proofs,
and we get a review by the end of August, we may get it into the December issue.)
My

best regards and my best wishes for the success of this effort.
Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

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Michael Faumann, MD.
25824 Dundee Road
Huntington Woods, Ml 48070
”Dear Mike,

Enclosed is our ﬁle copy of SCIMATE and two diskettes.
The diskettes contain the BACKUP files for our ﬁle ECT 87. (Get them by
RESTORE.) The second diskette also contains three copied ﬁles- TNAMEFILDAT,
TEMPLATEDAT, AND FNAMEFIL. DAT. When you install SCIMATE, you will find
that the template files contain the standard templates given out by 15!. Copy my
three ﬁles over the Scimate templates; this will conform the templates for ECT87.

Return the manual and original diskettes when you have made your copies.
Good luck. If you have any questions, 516-“th 2929. My regards.

Sincerely yours,

”um...

w~—v—

m

January 2, l9 88

é‘

E

,

Max Fink, MD.

Professor of Psychiatry

‘Vu‘mWs-s

�</text>
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January 28, 1988
Mrs. Edward M. Bigler
#0 Doubling Road
Greenwich, CT 06380

Dear Mrs. Bigler,
Thank you for your request that I participate in the Phil Donahue show.
Beginning with the appearance of the New Yorker article by Berton Rouche
"As Empty as Eve' in 1974, and my subsequent work with the APA Task Force on

Electroconvulsive Therapy, 1 have actively assessed the merits and limitations of
the ECT process. What may have been a debate in the 19703, as to the merits of
the treatment, has been resolved by the many assessments by individuals and
international commissions and committees, culminating in the 1985 NIH Consensus
Conference. The question of ECT efficacy is resolved. Until a more effective and
safer treatment for the serious mentally ill is devised and tested, ECT remains a
useful and needed treatment. That is not a matter of public debate, either by the
Phil Donahues or the Opreh Winfreys of the entertainment world.
Indeed, the acceptance by laymen that there is a 'debate‘ on efficacy and
into the hands of the anti-psychiatry lobby. There is no more reason
plays
safety
for a debate by the laity on TV or radio of the merits of ECT than it would be
reasonable for a debate on the merits of insulin in diabetes or penicillin in
neurosyphilis or any other technical medical therapy.

In the face of the anti-psychiatry lobby, there is a need for public
education, but in proper fora. For that reason, my associates and I were responsive
to the requests by Susan Squire for an opportunity to meet treated patients before
she wrote the November 22, 1987 article in the New York Times Magazine; and
why we have been cooperative with the PBS/BBC producers of the series MIND, to
appear later this year.
We continue to seek to improve the delivery of mental health services, and
my present missions support this aim for ECT. I wrote my review of ECT in 1979,
launched the journal CONVULSIVE THERAPY in 1985, and have developed a
training program in ECT at SUNY at Stony Brook in the past year.

But I will not cooperate with a 'show', surely not one of the kind produced

by Phil Donahue under the guise of a 'debate‘ or a 'balanced‘ presentation. But if I
can help you present the facts of EC‘I‘ history and present practice in educational

venues, please call on me. I enclose articles that may be of interest, as well as a
description of CONVULSIVE THERAPY.
Sincerely yours,

cc: Donald Klein, M.D.

Max Fink, M.D.

�</text>
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                    <text>February 8, 1988
Librarian

Smithtown Public Library
1 North
Country Road
Smithtown, New York 11787
Dear Sir:
As a subscriber to the library, 1 was surprised to see the volume: "ElectroShock: Its Brain Disabling Effects" by Peter Breggin among the new books. The
book was published in 1979.

Peter Breggin has taken the position that the treatment is both ineffective
and dangerous. His position is considered idiosyncratic. The treatment is used
widely throughout the world, and is available to patients in this county at
University Hospital as well as private and public psychiatric hospitals.
Patients and families who may be considering the treatment are likely to
look to your resources for advice and help. It is unfortunate that this volume may
be considered timely, when in fact, it is out-dated. in 1985, the NIH held a
Consensus Development Conference on this topic. Peter Breggin was one of many
witnesses. The Consensus commission did not accept his views of the treatment and

recommended its continued use.

Alternatively, the library may consider making the book "Electroconvulsive
Therapy" published by the American Psychiatric Association (1400 K Street, N.W.,
Washington D.C. 20005) equally available. That report appeared in 1978.
I enclose a copy of the Consensus Conference
statement. Perhaps it would
be a service to your readers to append the report to Peter Breggin's book?

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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«a:

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--7

January 28, i9 88
‘

Mark Abramowicz, M.D.
The Medical Letter
New Rochelle, NY

Dear Dr. Abramowicz,
i am disappointed with present methods of psychoactive drug evaluation.
The debacles in assessment which are cited in the article on fluoxetine are
matched by the over-investment in the use of benzodiazepines as antidepressants.
The present methods of contract assessment in out-patients, with inadequate
monitoring of the case material or the 'blindness' of the assessors; the inflation of
rating scale data to suggest that individuals can be working with Hamilton
Depression Scores above 22; the very high fees paid assessor groups (up to
$2500/patient); the failure to consider the likelihood that practitioners do know
when the patients begin a new medication and therefore know when to inflate and
deflate scores; and the lack of placebo controls all serve to make modern
assessments of efficacy of antidepressant and anti-anxiety agents highly suspicious.

-

While I have not worked with this compound, 1 would still caution readers
more strongly -- " Until effective in-patient trials of fluoxetine against placebo

and active antidepressants are published in indeprendent review journals, the
responsible physician will use these compounds only in patients properly cautioned
that the results are tenuous and that the treatment must be seen as experimental."
Thank you for sending me the Medical Letter. The reports remain

invaluable.

mw’W'V-l"

Sincerely yours,

w

'

no

Max Fink, M.D.

Professor of Psychiatry
wmv-mmn-W'IWW'dW-IW

"I“lwu'ﬂ‘x-u'fwhz

'r-""WF'WIW

M1?!

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any-M

P.S. Much has changed in the treatment of severely depressed patients with
electroconculsive therapy. Perhaps it is time for the readers of the The Medical
Letter to read about the efficacy and safety of this treatment.
J

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                    <text>February 2, 1988
Ralph A. O'Connell, M.D.

St. Vincent's Hospital

144 West 12 Street
New York City 10011

Dear Tony,
Thank you for the invitation to attend the meeting of the Editorial Board
of Comprehensive Psychiatry. lam pleased to accept.
Shall we try again to get the APPA to accept subscriptions to

the annual dues?

My regards.
,

.u-

Sincerely yours,

,.

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We

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Max Fink, M.D.

Professor of Psychiatry

Q as part of

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                    <text>'7 ‘JW-mw'ﬂ-r-ww-

.

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um“.

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February 19, 1988
Ms. Michelle Trudeau

c/o Steve Potkin, MD.

Department of Psychiatry
UCIMC

City Drive 5., Route 88
Orange, CA 92668
101

Dear Ms. Trudeau,
We treat ECT patients at University Hospital on Monday, Wednesday and
Friday mornings at 0800. You may wish to come the afternoon before and meet the
patients and their relatives (visiting hours are from 2 to 4 p.m.). Patients are
usually cooperative for interviews. We recently entertained the BBC/PBS crew for
the series “MIND", and they filmed patient interviews and treatment sequenceswith patient and family consent, of course.

The campus is 55 miles from mid-Manhattan, due east on Long Island. It is
best to come into Long Island MacArthur (lslip) airport, if that is feasible; it is a
short taxi ride to our community. If you come to JFK or LAG, Winston Limousine
service (800 942 l+222) or Colonial Taxi (800 832 7878) generally give the best ﬂat
rate service to our area. It you plan to stay over, the best accommodations are at
the Three Village Inn (516 751 0555) in Stony" Brook. There is one *** restaurant in
our village (Mirabelle).
The next issue of CONVULSIVE THERAPY is celebrating the 50th
anniversary of the introduction of ECT. Among the articles is a translation of the
eye-witness account of the first ECT treatments by Ferdinando Accornero, an
active participant in the research studies at the University of Rome. The article
was published in Italian in 1950; I have had it translated and I enclose a copy of the
proof. (The account is veriﬁed by another participant in the research in Rome,
Lothar Kalinowsky of New York.)
I

look forward to your visit to Stony Brook. My regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

.

.

wrwqm-wr

.‘

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                    <text>February 21,

19 88

Michael A, Faumann, Ph.D., M.D.

Arisoft Systems

25 824 Dundee Road
Huntington Woods, MI 48070

Dear Michael,
Thank you very much for sending me a copy of BOOK PRO PLUS, and for
translating one of my SCIMATE ﬁles to the BOOK PRO format. I have used the
system, following your suggestions.

It is a useful system for citation retrieval, and easy to learn. I was able to
use the search strategy and to enter new citations. In each activity, the program
performed well.
After some thought, i find that I cannot adopt the system .for my use;
mainly because my investment in SCIMATE is so great, making it uneconomic for
me to convert all my files to the new system.
I

am returning the material sent me, with my thanks. My best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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                    <text>February 23, 1988

Stanley Ibmhauser, Ph.D.

NIEI, Inc.

P.0. Box 4633
Bay Terrace, New York 11360
Dear Dr. Konmauser,

Wipt

for
invitation to admit a
EEG
of
with
imagijg
nulti-lead
experience
our
describing
mblication
psychiatric patients. Our work has progressed slowly, and I regret
that we are not in a position to present any useful information at
imam you for the

Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

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                    <text>n.

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December 14, 1987
Ross Baldessarini, M.D.
Mailman Research Center
McLean Hospital

il5 Mill Street

Belmont, MA 02178
Dear Ross,
The letter by Lieber in the American Journal of Psychiatry seems to have
been a spontaneous letter, not submitted in response to an article in the Journal. It
looks like an old-fashioned testimonial. For my part, it argues for a complex
polypharmacy whose worth is not known but whose risks are formidable.
i have written to Morry Lipton as

attached; and am sending you a copy as
one of the two established psychopharmacologistson the Editorial Board. Should
the Journal not publish a disclaimer noting that the recommended methodology is
not substantiated either by published studies or established practice?
in the past few years, i have been asked by lawyers to review the records
of patients treated by polypharmacy;patients who have had significant damage

(including two cases of death) which could be ascribed to such practice. One well
established practitioner gave up his practice when faced with charges of abuse of
practice largely due to polypharmacy. Should we not respond to the Lieber letter?
My

best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

..,,,».~.—....V

,,

1“. ,H".

cw

mm

.

.

�</text>
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                    <text>December 14, 1987
Herbert Y. Meltzer, MD.
Department of Psychiatry
Case Western Reserve University School of Medicine
2040 Abington Road

Cleveland, Ohio

#14122

Dear Herb,
The letter by Lieber in the American Journal of Psychiatry seems to have
been a spontaneous letter, not submitted in response to an article in the Journal. It
looks like an old-fashioned testimonial. For my part, it argues for a complex
polypharmacy whose worth is not known but whose risks are formidable.

have written to Morry Lipton as attached; and am sending you a copy as
one of the two established psychopharmacologistson the Editorial Board. Should
the Journal not publish a disclaimer noting that the recommended methodology is
.‘LOE substantiated either by published studies or established practice?
I

In the past few years, I have been asked by lawyers to review the records
of patients treated by polypharmacy; patients who have had significant damage

(including two cases of death) which could be ascribed to such practice. One well
established practitioner gave up his practice when faced with charges of abuse of
practice largely due to polypharmacy. Should We not respond to the Lieber letter?
This is another small annoyance, like the arguments of Johnstone and
Crow, which we heard in San Juan.
My

best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>»-

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December 1’4, 1987
Morris A. Lipton, M. D.
Deputy Editor, American Journal 93 Psychiatry
1400 K

Street, N. W.

Washington, D.C. 20005
Dear Morry,

It was a pleasure to talk with you in San Juan. On my return, I read the
letter by Lieber on the "Treatment of Rapid Cycling Bipolar Patients"in the latest
issue of the 5.13. The letter recommends complex polypharmacy as a treatment of
therapy resistant depression. But the letter gives no data as to patient characteristics, history, in-patient or out-patient status, assessment of efficacy of
treatments, trials with established treatments, Egg. The letter seems to be a
throwback to the old—fashioned testimonial which modern psychopharmacology
eschews.

letter is published in the Journal, it suggests that the practice has
review
standards of the Journal and the Association. Do spontaneous
met peer
in response to an article'in the Journal, meet the peersubmitted
letters, not
review standards of Journal articles? Was this letter reviewed by any of the
acknowledged psychopharmacologistsof the Board of Editors? If yes, is there a
message in the letter that our attitude to polypharmacy should change?
As the

if no, would you consider soliciting letters to argue against the adoption of
the Lieber recommendations until they have met established standards of study for
efficacy and safety?

a fact of practice, as we often read in the
which
records
come our way, polypharmacy is not generally condoned
malpractice
by our experience or by our science. is the publication of this letter not a
regrettable mis-step?
While polypharmacy is

My best regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>mq:"u 5"“ "‘.1m‘-I‘qm§&lt;vvm

Wr-Vx-I"'IV' -—-

"vault—'7-

_-

m'RF—"r-Fy'

arm-N.

.

1." m’,‘ vmv

.

raunwmw—q-v

yer

February

"M.

8,

w-rm‘

\w‘n-«m’ﬂ .,

“Juan-vvgg-‘r'v-

-

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quwv-

1988

John C. Nemiah, M.D.

Editor, American Journal of Psychiatry
1400 K

Street, N.W.

Washington, D.C. 20005
Dear John,
Thank you for your and Morrie‘s replies on the Arnold Lieber letter. i am
satisfied that suitable review requirements have been met and that the difference
in opinion is just that..
While lam not likely to advocate or use the treatments described, I also
am not in a position to present data on the risks or benefits of such a complex
regimen. It would not raise the level of discourse to state that such treatment
remain unproven, so i shall not send a response.
I am grateful that you and Morrie have taken the time to answer my query.
Thank you and my best regards.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

.

mum

van-”m.

~

_

�</text>
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                    <text>March 26, 19 88

Professor Paul J. Poppers, M.D.
Department of Anesthesiology

at Stony Brook
Long Island, New York 1.1794

SUNY

Dear Paul,
I am pleased to submit this letter in support of the promotion of Dr.
FARROKH R. MENEKSHA from the rank of Clinical Assistant Professor of
Anesthesiology to Clinical Associate Professor. 1 have worked often with him in the
ECT treatment unit. I first met him during his residency training, and since then he
has frequently been the attending anesthesiologist for our treatments. It may be
useful at this point to indicate that our ECT facility is a tertiary care center, with
many high-risk patients sent to us from other treatment facilities for this complex

treatment.

He is a dedicated and responsible clinician, well trained with a sincere

interest in our patients. He shows good clinical judgement, relates well to patients,
and is well liked by the psychiatric staff. Regardless of the medical and anesthesia

complexity of the case, he has been deliberate, careful, and reasoned in our
collaboration. He has a knowledge of a wide range of interventions, and l have yet
to see him upset by a case.

He is well versed in the anesthesia literature and discusses the treatment
with assurance. His knowledge of anesthesiology appears excellent, and he likes to
teach. He is comfortable teaching both anesthesia and psychiatric residents and

students.

Farrokh has been interested in our research studies, and he has been most
cooperative regardless of the delays which our tests and requests imposed on the
clinical process.
Finally, Farrokh is friendly, relaxed, interested, and enthusiastic about our
work. Given encouragement, I believe he will expand his research accomplishments.
He is a valuable member of the clinical staff, and lam delighted to recommend his

promotion to associate professorial rank.

This letter may be shared with him.
Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>August 3, 1987
Jovan Simeon, M.D.
27 Davidson Drive
Ottawa, Ontario K13 6L7

Canada

Dear Jovan,
Thank you for the reprints and for the advance notice of the article by
Barry Martin. There seems to be some continuing activity in Canada in ECT, both
clinically and in research, and it is good to read of these things as they appear.
Gabe Carlson has taken a firm hand of the child psychiatry service, opening
the in-patient unit, and in encouraging the residents to work with her. Two of them
are taking a fourth year child psychiatry elective and they enquired as to the
feasibility of following the course of. methylphenidate therapy in ADD children
with QEEG measures. lam pleased to cooperate with them, but asked that they do
a literature review first. Considering the long standing interest in this topic, 1 was
surprised by the dearth of reports. Yours are of some help. We will proceed, in any
case.
i will send the Annals back by separate mail. My best regards.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>i

v

,
m

August 20, 1987
Dr. Allan Scott
Department of Psychiatry

Royal Edinburgh Hospital
Morningside Park
Edinburgh EH10 5HF
United Kingdom
Dear Dr. Scott,

"'Ivn

"tum-WI

‘T'V‘WVLWFNTW""W"’VW_"F!""=V"

(Following your call, we made reservations for you and your wife at the
Three Village inn in Stony Brook, N.Y. for late arrival on Saturday, September 19,
and departure on Tuesday, September 22. The room is a double, with one bed. The
charge is $75 to $95/night, depending on the location. (Inn: 516-751 0555).

Kennedy Airport is about 55 miles from Stony Brook. The principal
connection is by airport limousine. If you let us know your flight number and arrival
time, we can arrange for either Winston Limousine (516-589-3938)or Colonial Taxi
(516-589 7878 or 800-645 7878) to pick you up. if we arrange a limousine, you will
call the appropriate number on arrival and they will tell you where to find the car.
The rate is about $35. Do not take a regular taxi —- the meter rate is excessive. if
you are in trouble, call us from the airport (516- $2 6651).

V1"'WI""'~“"N"WVW

~
-

mw-cw-ﬂ-wv'w—v

‘

We plan to be at home (about 7 miles from the Inn) that week-end, as I am
'on call' at University Hospital. You will be welcome to join us Sunday afternoon or
evening, according to your jet-lag. i will plan to pick you up at the inn on Monday
morning at 0715; I will be treating patients with ECT at 0800 that morning, and
making patient rounds later in the morning. You are welcome to join in. After
rounds, approximately noon, 1 will be free to work with you.

Stony Brook, and the associated villages of Setauket and Old Field, are
quaint Old English villages, with a strong association with Long island Sound. There
are museums and old houses in the villages. A neighboring village is Port Jefferson,
which is a major port. A trip East along the North Fork will bring you to the
wineries and farms. A trip to the south will bring you to the Hamptons and Montauk
-- the ‘in' communities for the yuppies, the rich, and the famous around here. Or,
directly south is Fire Island and Jones Beach -- among the finest beaches in the
world. Bring bathing suits and boating shoes.
Have a good trip West.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�.
.
m...“

_.-

February 9, 1987
&lt;w..-,,.W——w«

—.,

W—wrv

vv'Vll‘F'r'mr'v-W»

Dr. Allan Scott.
Department of Psychiatry
Royal Edinburgh Hospital
Morningside Park
Edinburgh EHlO 5H1”
United Kingdom
Dear Dr. Scott,

at Stony Brook later this year.
end
the first Monday in September. A visit anytime
Summer holidays traditionally
after mid-September should be convenient.
We will be pleased to have you visit us

I

University Hospital is about 60 miles from mid-Manhattan. it is usually
more convenient to stay at one of our local inns; the Three Village inn (Main
Street, Stony Brook, New York 11790) is most favored.
Our present interest is in two projects -- the efﬁcacy of ECT in therapy
resistant psychosis with an associated study of prolactin metabolism; and the
el-ectrophysioiogy o1 induced seizures. For the latter, we are re-examining the
relationship between the seizure EEG’and the efficacy of seizures; and between the
inter-seizure EEG and clinical outcome. We have completed a study of DST and
outcome in ECT, with disappointing results.
‘

.Your studies of ECT are indeed of interest to us, and i look forward to
reading the results of your studies. As you may know, i launched the journal
CONVULSIVE THERAPY in 1985. We are in our third year and i am quite pleased
with the quality of the material which we are receiving. You may wish to consider
the journal for the publication of reports from your studies.
Oswald.

We look forward to welcoming you in New York. My best regards
I

Sincerely yours,

Max Fink, M.D.

.

Professor of Psychiatry

to [an

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                    <text>ww~vww

.qu.x.v~—w———r_,._:

P—"vmd‘: -w;,r-l.mw~

u

rnwwm

.

—

-..

.7..-x~—.—»—,-mw»m

a...“

September 1a, 1987

’

Prof. Anthony Clare
Department of Psychological Medicine
St. Bartholomew‘s Hospital Medical College
West Smithﬁeld, London E. C. 1
England

,

Dear Tony,
Following your letter of August 28, we will expect you to give a lecture at.
the University on November 10 on the topic "Depressive Disorder in Primary Care".
We have made arrangements for you to stay at the Three Village Inn in
Stony Brook on the night of November 9. When you are in the States, would you call
my secretary, Mrs. Carolyn Paul (516 MM 2929) and she will clue you in to getting

to Stony Brook and the lm from local airports. it would be best to fly into the Long
Island Macarthur (lslip) airport rather than LaGuardia, Kennedy, or Newark
airports.
you come before dinner on Monday evening, i will arrange to have some
associates meet you and your wife for dinner.
it!

We look forward to your visit.

Sincerely yours,
Max Fink, MJ).
Professor of Psychiatry

cc: G. Carlson

.

.

. .

..

"var—V

�July 31, 1937
Prof. Anthony Clare
Department of Psychological Medicine
St. Bartholomew's Hospital Medical College
West Smithfield, London E. C. 1
England

Dear Tony,
Thank you for your advice in the matter of the Wesner and Winokur article.
Another assessor is equally unenthusiastic and we will probably return it to the
authors with your advice when I get the advice of a third.
It was good to hear that you would be visiting New York this Fall. Our
Department has weekly 'Grand Rounds' for invited speakers on Tuesday mornings.
The dates you made available, October 30 and November 10 includes two Tuesdaysthe first is Election Day and an annual State holiday; the second date, November 10
is provisionally open for you.
The presentations are in a main auditorium, with about 40-50 members of
the staff present. Duration is usually one hour with discussion up to U6 hours. This
is usually followed by an informal lunch with the psychiatric residents. Some
clinicians also make informal rounds, either before or after the presentation, on
one of the psychiatric services, either seeing a number of cases in walk-rounds or a
single case presentation.
I would be pleased to be your host. We can arrange for your stay at the
University, and we usually provide an honorarium of $250.

Let me know if these arrangements are agreeable, and select a topic of
your present interest. While the main thrust of the Department is clearly in
neuroscience, there is a nascent interest in the more psychosocial aspects of

clinical practice as well.
I

look forward to your visit.

Sincerely yours,

cc: G. Carlson

/

Max Fink, M.D.

Editor

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                <text>Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).</text>
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                    <text>September 15, 1987
Nathan Epstein, M.D.
Chairman, Department of Psychiatry
Brown University
c/o Butler Hospital
3&amp;5 Blackstone Boulevard
Providence, RJ. 02906
Dear Dr. Epstein,

Ref: DAVID KROESSLER, M.D.

It is a pleasure to submit this letter of reference on behalf of Dr. David
Kroessler who is being considered for an initial appointment in the Department of
Psychiatry at Brown University.
met David when he was in his residency training program" at University
Hospital at Stony Brook in 1984-1986. Early in his program, i was his supervisor
during his PGY-Z year on the impatient service at University Hospital. David
showed a keen interest in his patients, and stood out as one who was willing to read
original articles when these were considered during our rounds. An interest in the
treatment of delusional depression led to his study of the literature and the writing
of an excellent review article, which was published in the first year of publication
of CONVULSIVE THERAPY.
1

in his senior year, he was chief resident and carried out his assignments
well. He became interested in an academic career and applied for a position with
Barry Fogel in your Department. David and Barry have developed a series of
innovative research protocols, which they have discussed with me.
David is a warm, enthusiastic, dependable, andinter’ested young physician.
He is well liked by his peers, by the staff, and the patients. He seeks and academic
career and iam pleased to endorse his quest and recommend his appointment to
your Department.
My regards.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>Viv—W‘w‘w-v

October i9,

&lt;7..-

19 87

Tn.

ma.

'Wuw

"

'

vw-rrr".

va

"-Im“w'

ww'mwu-w-

-.-

"K‘Fv'vv-g—W-

Stanley H. Kornhauser, Ph.D.
National Institute of Eiectromedical Information, Inc.
P.O. Box #633
Bay Terrace, New York 11360-4633
Dear Dr. Kornhauser,
Thank you for the invitation to join in membership of the National Institute
of Electromedicai» Information, Inc. I regret that Iam unable to join another
organization, as my time for participation in new ventures is severely limited.
My

best wishes on the continued success of your organization.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

�</text>
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                <text>Correspondence to: Kornhauser, Stanley H.</text>
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              <elementText elementTextId="65397">
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              <elementText elementTextId="65400">
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            <elementTextContainer>
              <elementText elementTextId="65402">
                <text>&lt;a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank"&gt;IN COPYRIGHT - EDUCATIONAL USE PERMITTED&lt;/a&gt;</text>
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          <element elementId="48">
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            <elementTextContainer>
              <elementText elementTextId="65403">
                <text>Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).</text>
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                  <elementText elementTextId="104268">
                    <text>..

v

,

W. .--_~...~.,_..;.:‘_y..

~1D~WHYW‘$~—.'wnr',r-

"kn—r- :

w;m.w.v

1

:uv

n

»v..-r—-_-

-m...

"vw—r

m".

rumm— -.——.'—‘.~,..-u

~‘»x.vu.l‘-—(‘r .»..~_.r

October '19, 1937
Ms. Christa Brandt

587 Echo Valley Road
Salinas, CA 93907
Dear Ms. Brandt,

._

Your request for information regarding the psychiatric phenomenon of
multiple personalities was sent to me for reply. This organization tocusses its
research interests on biological treatments in psychiatry, and we have little
experience with the problem of multiple personalities.
Our recollection is that the classic study "Three Faces of Eve" was written
by fellow biological psychiatrists Corbett Thigpen and Hervey Cleckley of Georgia.
The book was published in 1957 by McGraw Hill and should be in your library. I
commend it to you.
Good luck in your studies.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

.-_

_,—-mwp~ws

�</text>
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                    <text>October 26, 1987
Ms. Karen Tkach

Excerpta Medica
PO Box 1126

1000 BC Amsterdam

The Netherlands
Dear Ms. Tkach,

am chagrined to have received your kind letter regarding the article
requested by Professor Hamilton for Psychiatry i_n the §_Q_'_§.
I

When Professor Hamilton was a guest in my home in early September, we
spoke of many things, including my concerns with psychiatric classification systems
as well as my interest in coanisive therapy. We discussed a guest article on
convulsive therapy, and I offered to write one whenever he asked. When he called a
few weeks ago, it was to ask for an article on DSM-HI and the classification
dilemma. I said that I would lookinto it, ”and do what i could. After a week, i wrote
to say that I was not prepared to write such an article in the time limit he
suggested. I recommended that he'consider an invitation to one of my students,
Professor Michael Alan Taylor of the UHS/Chicago Medical School.

Professor Taylor, and his associate Professor Richard Abrams, have
published systematic studies of psychiatric diagnostic systems. He has carried out
surveys of actual usage of the system, and has first-hand information on its
limitations. He is well qualified for the task set by Professor Hamilton.
Professor Taylor can be reached at 3333 Green Bay Road, North Chicago,
IL 60064 (312-578 3330), should Professor Hamilton wish to invite his participation.
Should you wish a commentary on aspects of the ECT process, I will be
pleased to write one for Psychiatry in the .3895. Again, my thanks for your kind
,

invitation.

,

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>December 13, 1987
Herbert Pardes, M.D.
Department of Psychiatry
Columbia University College of Physicians
722 West 168 Street
New York City 10032

dt

Surgeons

Dear Herb,

Iam pleased to write this letter in support of the promotion of Dr. Sukdeb
Mukherjee to the rank of Associate Professor of Clinical Psychiatry (Annual) in
your Department. I have known of his work since his EEG studies with Dr. Turan
Itil at the New York Medical College during his residency training. Lately, I have
become better acquainted with the reports of his studies of electroconvulsive
therapy with Drs. Sidney Malitz and Harold Sackeim, and his collaboration with
members of our faculty in neuropsychiatric studies.
Dr. Mukherjee is experienced in psychiatry and neurology, and has
developed special skills in electrophysiology. His major contributions are in the
description of the effects of psychoactive treatments, both drugs and EC’I‘, on
brain function and behavior. In developing these skills, he is clearly in the new
mainstream of 'neuropsychiatry' in clinical psychiatry.
He has a very extensive publication record which reflects a lengthy
research interest. His work is generally shared with many others and he is well
liked. However, it is difficult to discern the area of individual expertise which may
become his main research interest; a development which may be needed for him to
establish professorial independence.
am unable to comment on his skills as a treating psychiatrist, nor as a
teacher, as I have not had the opportunity to assess these aspects of his work. He
has established a firm foundation for his research, and when he identifies an area
of individual expertise, I anticipate that he will extend his important contributions.
1

‘

His record is robust and quite sufficient to support his promotion to the
recommended rank. His academic career will continue to be productive, and I
recommend his promotion with confidence.
'

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>December 21, 1987
Jay Amsterdam, M.D.
Depression Research Unit
Hospital of the University of Pennsylvania
36th 6: Spruce Streets
Philadelphia, PA 19104—4283
Dear Jay,
When you called on Friday, you' seemed surprised that many Europeans
knew of your plans to develop a conference on the treatment of therapy-resistant
depression. Reading the latest Bulletin of the Royal College of Psychiatrists should
clarity the mystery “.- one of your co~workers or consultants has let the cat out of
the bag.
My regards.

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>m»»-m. w,

“ﬂag"...-

w—r, .

7’.»

m7..-

awn—e"

"aw—.7.

7~ru¢mmnmﬂwra

"are".

._‘..w.._..._

,

.

December 22, 1987
Francis A. Gagliardi, M.D.
177-30 Wexford Terrace
Jamaica, New York 11'132
Dear Frank,
A

enclosed.

formal summary of our experience with Mr. DOMINICK CHINDAMO is

At the time of his discharge from the hospital, we were not assured that
the relief that ECT had afforded him would persist, and encouraged him to
continue on tricyclic antidepressant medication. His daughter called me a few
weeks after his discharge, relating that he had some recurrence of symptoms. I
encouraged continuation of medication, but failing that, offered to see him again
for further ECT at University Hospital if his physicians thought it would be useful.
My

best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>Of

College

Physicians

C?

Surgeons of Columbia University

DEPARTMENT OF PSYCHIATRY
Donald F. Klein, M.D.

‘

New York, N. Y. 10032
722 West 168th Street
(212) 960-2307

Professor of Psychiatry

December 22, 1987

Mrs. Edward

M.

Bigler

Doubling Road
Greenwich, CT @6830
40

Dear Mrs.

Bigler:

Delighted to hear that Tom is doing so well.
With regard to the panel on the Phil Donahue Show, I would be pleased
to join it. However, I must point out that I am not really a
national expert on ECT but rather on medication. My old boss, Max
Fink, M.D., who is Professor of Psychiatry at State University of New

at Stony Brook, is an international authority on ECT and
I think he would be an excellent person for
your panel.
York

extremely well spoken.

has recently told me that he has seen a number of patients
somewhat like your son who have an atypical schizophrenia where
had worked in the face of substantial drug resistance.
He

Cordially,
”,7

/I/

/7

‘1’

0K/wxfx
Donald F.

Klein,

dcd
bcc:

Max
"'

Fink
.3

M.D.

ECT

�</text>
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                    <text>December 26,

19 87

Frederick H. Kasten, Ph.D.
Department of Anatomy
Louisiana State University Medical Center
1100 Florida Avenue
New Orleans, Louisiana 70119
Dear Dr. Kasten,
i recall Leo Alexander well; he was an active, outspoken, and critical
member of the audience at many of the meetings of the Society of Biological
Psychiatry and Electroshock Research Association that iattended. i did not know
him personally, and i can recall no direct interaction with him.
He wrote the textbook TREATMENT OF MENTAL DISORDER which was
published in 1953 by $1.8. Saunders, Phildelphia. In it, he has extensive sections on

convulsive therapy, as well as the psychotherapies. Reading the index today, one
gets the impression that he was trying to resolve the dilemma of the success. and
risks of the somatic therapies with the elegance and greater acceptance (especially
in Boston) of the psychodynamic model. He does notsucceed in balancing these
antithetic attitudes well.
Leo Alexander was a practitioner seeking to make the best of an impossible
of
test allegiance. His textbook is idiosyncratic and limited; it contrasts rather
poorly with other texts published at the same time (see Kalinowsky and Hoch or
Sargant and Slater).
The APA Task Force report on Electroconvulsive Therapy is report #14,
published in 1978. It should be available in your library, or from the APA in
Washington, D.C. l was a member of the panel, and contributed to, but did not

write the report.

_-

i met Reuben Reiter back in the 19505 when I was interested in ECT
devices. 1 used one of his devices for a while but thought his instruments were
poorly designed. They are no longer in active use. i was told a few years ago that
he had died, but have no further information.

i

trust these comments are helpful.
Sincerely yours,

Max Fink, Md).

Professor of Psychiatry

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                    <text>May 20, 1987

Samuel Barondes, MD.
Department of Psychiatry
University of California, San Francisco
401 Parnassus Avenue
San Francisco, CA
~

‘

9“”

Dear Dr. Barondes,
At your request, I am writing this letter regarding the promotion of Dr.
Edward Merrin to the rank of Associate Professor. I do not know Dr. Merrin, and“
was not acquainted with his writings before reviewing the publications sent to me.
I am impressed with the quality and sophistication of Dr. Merrin's research
studies using quantitative. EEG methods. His choice of problem (laterality in
schizophrenia) is timely and important; the methods used (power spectral analysis,
unlinked reference leads, medication controls) are reasonable; and the quality of
the reports excellent. The latter are clearly written, and Dr. Merrin uses good
statistical and data processing procedures.

These studies are important and they reflect an interest that should
continue to be productive in the forseeable future. It is difficult to assess the
importance of these studies in the field, since there is much activity and little that
has been conclusive. These studies of laterality are well done and must be
considered in any further studies of the problem. And, as a young investigator, I
believe that these reports are of high quality, comparing most favorably with other
reports in the field. For example, he has not made the glaring errors of Duffy, E.
Roy John, and Morihsa, who failed to control for handedness, drug use, and
electrode montage in their conclusions (which have since had to be retracted.)
Dr. Merrin’s clinical reports are also well written and useful. I am unable to
assess the studies of saccadic eye movements, since I am not conversant with the
theory of these studies.
_
i have examined his list of Departmental, V.A., and University teaching
responsibilities, and these seem consistent with his rank. I am, of course, unable to
assess their quality.

To the extent of this review, I am impressed with Dr. Merrin's reports and
output, and would have no difficulty in endorsing a recommendation for his
promotion to the rank of Associate Professor at this University. I am comfortable
in making the same recommendation for the University of California, and
recommend Dr. Merrin's promotionwithout reservation.

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

'

‘

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                    <text>l

E

l

i

‘

l

May 23,. 19 87

Mr. John S. Purvis
Division of Neuropharmacological Drug Products
Food 6: Drug Administration

Rockville, MD 20 857
Dear Mr. Purvis,

E

E

S

The studies of ORG 3770 (6-azamianserin) under IND ”.915 were
completed. The results were published in 1982 (Psychopharmacology 78:44-48).
We were the only investigators under this IND.
We no longer have supplies of

6-mmianserin.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>May 23, 1987

Alfred M. Freedman, M.D.

IPMS

Department of Psychiatry
New York Medical College

Valhalla, New York 10595
Dear Al,

am unclear about the mission of the new International Association
for the integration of Psychiatry and the Medical Sciences (IPMS), I am pleased to
work with you on this project.
While

1

In the latest number of CONVULSIVE THERAPY, I have written an
editorial about the increasing interest by neurologists in behavior and of
psychiatrists in brain function, with the re-emergence of neuropsychiatry (under
the code-name of Behavioral Neurology). Indeed, it was only yesterday that 1
proposed the development of such a journal to Alan Edelson at Raven Press and
recommended that he consider inviting Michael Taylor to develop such a project.
‘

Perhaps we are responding to similar awarenesses, with a slightly different
emphasis.
in any case, I look forward to hearing more about the forthcoming meeting
in New York of IPMA.
‘

My best regards.

Sincerely yours,

Max Fink, MD.
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 1794—8101
telephone: (516) 444-2990
1

StonyBrook
May

S. Reddy Pasem, M.D.
1301 River Oaks Drive

Colonial Heights,

VA

26, 1987

23834

Dear Dr. Pasem:
Thank you

for your inquiry.

I

will not

be

available to

course until October. I think your needs can well be
served by the program at Duke University.
Duke University has just announced its programs in ECT.
I
enclose an announcement and suggest that you contact Dr. Coffey
directly. If that does not work out please get in touch with me
after the summer.
supervise

a

Sincerely yours,
Max

Encl.

C.

M.D.

Professor of Psychiatry

MF:cjp

cc:

W

Fink,

Edward

Coffey,

M.D.

�</text>
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                    <text>May 28, 1987

Dr. H. Babikian
Department of Psychiatry
New York Medical College
Westchester Medical Center
Valhalla, New York 10595
Dear Hrair,
For a course in convulsive therapy for the residents, we propose three
sessions, each of take hours.
.

1. Seminar: History; Indications; Clinical Issues in treatment; Risks and
Side-effects; Maintenance therapies.

Videotape: Information for Professionals.
2. Technical issues in Treatment: Electrode Placement; currents;
anesthesia; high risk cases, instruments; seizure duration monitoring.

Consent. information for patients and relatives.
7 Videotape #2— Information for Patients and Families
3.,

Review.

Clinical Case Seminar:

Question Period; Case presentations by the residents from your wards; and

The first and third sessions will be by myself; for the second, my associate, Dr.
Greenberg will talk about the technical issues; and our nurse, Mrs. Irene Carasiti,
who teaches patients and families about ECT, answers their questions, and obtains
consent, will discuss these aspects of the treatment.
We will provide reprints from the literature as well as a reading list for
the latter well in advance of the course so that the materials
reproduction;
your
can be made available for the students.

if this sequence is helpful, we can set aside the time and discuss the
honoraria involved.
'

My regards.

'

Sincerely yours,
Max

seamen.

Professor of Psychiatry

�</text>
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                    <text>‘.,,_...

Ww-y.w~.m

June 3, I9 87
Conrad Swartz, M.D., Ph.D.

Department of Psychiatry

UHS/‘i'he Chicago Medical School
3333 Green Bay Road
North Chicago, ll. 6006!;

Dear Connie,
Thank you for sending me the videotape of your unusual interview on the
demasculinizing and cardiac effects of chronic alcohol use. To the long list of other
reasons which I have dutifully expressed to the students about the hazards of
alcohol use, lcan now add these data. The argument that alcohol use contributes to
myocardial infarction is another compelling one for the anti-alcohol lobby.
Two decades ago, similar questions about demasculinizing effects were
raised about cannabis use, mainly by Gabriel Nahas. l have often wondered whether

these reports have merit. Is there any data on cannabis use and myocardial
infarction? A question to Costas Stefanis at the University of Athens may
encourage a parallel study in chronic cannabis users.
am so glad that I am not an alcohol user, and when
your ﬁndings, she was also pleased.
I

I

told Martha about

'

Keep up the good work. My best regards.
Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

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                    <text>May 23, 19 87
'Mr. Henry Feiwel
850 Park Avenue
New York City 10021

Dear Henry and Maria,
At the recent APA meetings in Chicago, I was introduced to a psychiatrist
from Lima, Peru. Recalling that Dr. Honario Delgado, a previous Professor, had
displayed the art of his patients, I enquired what may have happened to the
collection. 1 was told that it is maintained as a permanent museum under the
direction of:
-

Dr. Grover Mori
Victor Larco Herrera Hospital
Pabellon #2
Lima 27 - Magdalena

Peru.

It was not clear whether they had a catalog, but part of the collection had been
exhibited in Paris some years ago.
It may be of interest to enquire as to the state of the
collection, so
written to Dr. Mori.

I

have

am delighted that you will be on the Island this summer. We are
completing the refurbishing of our pool-side apartment, and it should be ready for
visitors in a few weeks -- as soon as we can get the air-conditioning installed.
I

My best regards.

Sincerely yours,

Max

-

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                    <text>June 30, 1987
Greta Koinig, M.D.

Allgemeines Krankenhaus der Stadt Wien
Psychiatrische Universitﬁtsklinik
wahringer Gartel 18-20
1090 WIEN
AUSTRIA

Dear Greta,
Because flights to Kennedy Airport are so irregular, it is not feasible to
meet arriving passengers. When you have cleared customs, find the telephones for
suburban limousine services, and pick up the telephone which is labelled "Long
Island Limousine Service” or "Winston Limousine Service (Long Island)". Tell the
operator that you wish to go to Stony Brook (Railroad Station). When you know
what time you will be arriving at Stony Brook, let me know and we will pick you up
at the station. (Or call from the station; we will be about 15 minutes away.)
Or, call me before making limousine arrangements and 1 will explain again.
at work (516 MW 2929) or at home in the late

i can be reached most days
afternoons (516 862 6651).

We will make arrangements for your stay.
My

regards to Gerhard.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�April 25, 1937

Greta Kolnig, M.D.

Allgemoines Krankenhaus der Stadt Wlen

Psychiatrlsche Universltlltsklinik
wantinger Gurtel 18-20
1090 WHEN
AUSTRIA

Dear Greta,
We should be in New York dorlng much of July. While I will not be ‘on
service', I will be able to have you meet my associatos and work with us on July 13.
I

will arrange some accommodations.

When your plans are finalized, let me know. I can be reached most days at
work (516 #44 2929) or at home in the late afternoons (516 862 6651).
My regards to Gerhard.

Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

�</text>
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                    <text>. ~,W.',-W-n‘wa.._ ,___,._..._

_

s
,...

we.

WA.

July 15, 1987
Professor Fritz Henn, Ph.D., MD.
Department of Psychiatry 6: Behavioral Science

SUNY at Stony Brook
Long Island, New York 11794

Dear Fritz,

lam pleased to submit this letter in support of the promotion of Dr.
Krishnareddy Gujavarty from the rank of Clinical Assistant Professor of Psychiatry
to Clinical Associate Professor of Psychiatry. I have worked closely with Dr.
Gujavarty for more than four years, as a collaborator on research projects, as a
team-mate in both the in-patient unit at lO-North and the Affective Disorders
Clinic in the CPD, and as a fellow teacher and member of the Department.
I have come to know his professional work very well. He is a dedicated and
responsible clinician, well trained (in our own resdiency training program, I might
add), with a sincere interest in our patients. He shows good clinical judgement,
relates well to patients and their families, and is very well liked by our co-workers.
He reads the literature avidly, and often presents the latest clinical findings in our
case conferences. He has accepted additional assignments within the Department,
including the medical management of the cases in the Sleep Disorders Program
when it was headed by Drs. Mitler and Baker, scientists without clinical

certification.

His knowledge of clinical psychiatry is excellent, and he likes to teach. In
addition to the supervision of residents, for many years he has taught psychopharmacology to each rotation of third year clerks. Each year, he has accepted the
repsonsibility for presentations in our Grand Rounds program.

He has accepted numerous departmental administrative assignments with
enthusiasm; the latest is his appointment as acting clinical director for the inpatient unit at University Hospital -- a position which he is carrying out with elan.
In his research work, he has made independent observations and reports in
sleep physiology and convulsive therapy. At present, he is principal investigator in
drug therapy studies.

�His greatest strengths are in clinical care and the teaching of medical
students and residents. in his research, he has been slow to identify an area of
expertise, although his recent sleep studies show considerable promise of achieving
wider recognition.

lam delighted to recommend his promotion to associate protessorial rank.
He is a dedicated, reliable, and loyal member of our staff and we have come to
depend on him for his clinical and teaching skills.
This

letter may be shared with Krish.
Sincerely yours,
Max Fink, MD.

Professor of Psychiatry

�</text>
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