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                    <text>F

E

i
f
E

i.

April 9. 1979
mr. Glen Ross;

Box 5522 Duke

Durham,

NC

Station

27706

Dear mr. Ross,

been sent to

Your
my

letter

concerning

former University.

ECT was

Just received, having

The best source of demographic data concerning ECT may
be found in two recently published volumes- one is the report of
the Task Force of Baa American Psychiatric Association Report # 1h,
dated November 1978; and the second is a volume, "Convulsive Therapy:
Theory and Practice" which I published in February, 1979 (Raven
Press, New York). In both, you will find the latest survey data
summarised. These should be available in the medical school library.

For earlier reports, you will find the fill citation
in my book. There was attmme, in the 1950's, when ECT was given to
patients in the lower social classes in a greater degree than to
upper class patients. That situation is clearly reversed today, with
almost all EDT being given to upper class patients who attend private
or University hospitals. Practically none is given in state, municipal
and V.A. hospitals, where the largest concentration of lower class

mentally

ill

can be expected
Good

to be found.

luck.

i
E

Sincerely yours,

Hex Fink, M.D.
Professor of Psychiatry

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                    <text>‘_

-

-

an...“

..

.mpwwvwnwv

.7

.m.--‘—v.

-

Q

3W

v—n

‘1

w.”

.c

April 11, 1978

.

.

urns-I'm)..-

WW.

Mr. G. S. Avery, Editor—in-Chief
ADIS

Auckland,

New

Zealand

Dear Mr. Auery,
The

report

on Minaserin

written

by Brogden, Heel, Speight

is well done, and I find little to modify. There are some
errors in citations which I can bring to your attention, but the
sense of the text is consistent with my experience with mianserin.
and Avery

that could be modified has to do with the
screen and how this led to the study of
mianserin as a thymoleptic. EEG analysis as a basis for the
classification of psychoactive drugs has a long history with some
definitive studies in 1961 and 1963 published by myself and Itil.
In the mid—1960's, we saw the possible usefulness of the classification
in predicting the activity of new drugs and the first studies were
done with such drugs as fenfluramine, cyclazocine and doxepin. In each
instance, the EEG screen was a better predictor of the clinical
activity of the compound than the animal pharmacology. This was
particularly true for doxepin, whose pharmacology was scan as anxiolytic
in the early studies. Our study found it antidepressant, and since then,
this view has been confirmed. Based on these data, I recommended to
Organon that new drugs be screened and in 1970 they sent a number of
compounds to Itil and myself, than working in separate laboratories.
He found mianserin to be active and its profile as a thymoleptic led
to the subsequent development. Even after the EEG screen and clinical
trials, the pharmacology failed to meet the accepted thymoleptic standards.
The importance of-the EEG screen could be emphasized, because, as Dr.
Itil noted in his 1972 paper, he 'discovered' its thymoleptic activity.
One emphasis

significance of the

EEG

As to the citation errors-~ I note that Fall et al are
dated 1972 on page 6 and 1973 on page 7. 1973 is correct. The citation
is lacking in the citation list. Also, there is a citation to Pink
at al (1977) on page 6, which is lacking 6n the citation list. I enclose
a cepy of the 1977 report for your reviewer to cite if he wishes.

Thank you for the opportunity to review this article
presents the data in a fashion similar to my view of it.

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

which

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                    <text>March 29, 1979

Turan Itil, M.D.
Research

HZI

Tarrytown,

New York

Dear Turan,

I have had a chance to read the Final Report
Task Force on
with some
attention to the details, and Bioavailability
I am writing because I believe
the report is less sanguine than need be with regard to the
methods already available to us to assess bioavailability
and pharmacodynamics of drugs. Specifically, the section
7.2.2 should be expanded in some way to reflect the state of
knowledge presented at our sessions. You may recall that two
methods were discussed at length as
the changes in
brain function induced by drugs whichreflecting
crossed the brood-brain bustier
barrier, that of pupillography and of quantitative electroencephalography. These methods provide valid end~points to
the effects of drugs on the brain, and
as quantitative as
established biochemical methods in this are
regard.

of the

by

ACNPwFDA

Would you consider amending the paragraph 7.2.2
the addition of the following:
". . . There is currently no recognized standard

approach, although pharmacodynamic methods such as the
quantitative EEG and pupillography, which are responsive to
the effects of drugs which cross the blood-brain barrier,
provide the most logical opportunity for such development."
Quantitative EEG methods provide indices
the assessment
of benzodiazepines (diazepam, bromazepam),formianserin,
doxephn,

thiothixene, phenytoin, among others, in studies from my
laboratory alone. Others have made similar contributions, and
the negative statement of 7.2.2 ought to reflect this experience.
My best regards.
Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�Y'"

m...

wwwknm

April
Turan
HZI

Itil,

Research

150 White

Tarrytown,

-

10 , 1978

M.D.

l

Plains

Rdd

New York

Dear Turan,

It

nice seeing you again, and we did enjoy the
visit with Ellen. I felt a bit better after the debacle in
Ottawa since we did have the occasion to talk again.
was

I enclose the reprints from the recent work by
Bolwig. It is the clearest data that ECT produces an increase
in permeability of the blood—brain barrier, and is quite compelling.
Maybe it could be used in the TR? problem.
My

best regards.
Sincerely yours,

Max

Fink,

M.D.

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                    <text>Turan Itil, M.D.
HZI Research
150 White

Tarrytown,

Plains
New

Road
York 10671

~

Dear Turan,

It

was a pleasure to visit your laboratory on Thursday.
The development of a neuropsychologicai test battery which can be

easily applied, and easily scored, in an important contribution to
diagnosis and I look forward to the developments in your laboratory.

I were heavily involved in
psychiatric probleﬁs for computer resolution, we
organized a diagnosis system based on the interaction between the
psychiatrist and a computer terminal. Our aim was to ask the salient
questions, and based on the psychiatrist's response, provide him
with a statistical statement as to the most likely diagnosis for
the subject and the confidence with which the statement could be
Some

when Donald and

years ago,

programming various

viewed.

Two

programs were completed and

included in the report enclosed.

I hope that
My

it

is of

some

their program listing is

help.

best regards.
Sincerely yours,
ﬂex Fink, M.D.

grotessor of Psychiatry

�</text>
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                    <text>.
Dr.

M.

tar

B.

Hoar

Elsevier/ North Holland
Cambridge, UfK.

Dear Dr.

tor Hoar,

Enclosed is a draft copy of a report, "ECT, Hood and
for your consideration for TfKS. I tried to follow the
'guidelinos and I hope the text meets your standards.
Hormones" ,

Hone

of the material

is

copyraghtod elsewnere,

For your book review section, you may wish to ask someone
volume, "Eonvulaivo Therapy: Theory and Practice" (Raven
Press, N Y., 1979) which has Just been published. or the practitioners.
in Great Britain who would provide a reasoned review, I would
recommend Professor Max Hamilton of the Department of Psychiatry
at Leeds, Professor Martin Roth at Canbridge, or Dr. Grahame~$m1th
of Oxford.

to review

my

b.

Sincerely ydurs,

’

Fink, M.D.
Preseasor of Psychiatry

Mgr

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                    <text>April 23, 1979

Fritz A. Freyhan, M.D., Chairman
U.S. National Committee (USNC/PTD)
2015 H. Street, N.W.
Washington, D.C. 20009
Dear

Fritz,

for the invitation to visit the P.T.D. Committee
Unfortunately; I will not be able to attend
the APA sessions as I will be at the DAHLEM Conference on pattern
recognition. I am interested in the work of the Committeo, and
particularly therapeutic issuos and drug therapy~reaistant depression.
Thank you

exhibit at the

know.

APA.

If there is

a specific contribution that I can make, let
I look forward to reading tﬁo P.T.D. bulletin.

My

me

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

MF:bc

�</text>
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                    <text>3M”

April 23, 1979
Albert J. Stunkard, M.D.
Professor of Psychiatry
Hospital of the University
of Pennsylvania
205 Pieraol Bldg./Gl

‘

Philadelphia, Pa. lQth
Dear Mikey,
much

I will miss you
less erudite.

on

the

V. A.

committee, and the sessions

will be

I found reading your report on fenfluramine interesting and
The data tables are more imgresaive than the figures, which
suggest that the placebo treated subjects lost almost as much weight

useful.

.

;

f

as those who were medicated. The graphs indicate a median loan of
9.5 kg for the medicated aubJecta and 7.5 kg for placebo. What was
the secret ingredient in both groups? WOuld the report be strength—
ened by adding some weight lose data? Have you considered OPT for

these data?

report of our study on fenfluramine is enclosed. we were
less interested in the clinical effects than in the EEG profile.
In another study in 1968, we carried out an open trial of fenfluramine in obese subjects, found sedation and dry mouth with weight
and appetite loss. We did not publish these data, which were
useful principally in examining whether sedation or stimulation
occurred in our subjects, as a follow-up of our EEG assessment.
A

My

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

MF:bc

Encl.

�</text>
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                    <text>April 2h, 1979
A/

3.0.3.

D

er,

M.D.

Department of Psychiatry
University of Louisville

Louisville ,

Ky.

Dear By.

I

to receive the'Textbook of Clinical Peychopharmacology".
sections thougquarovoking, with views of drug usage that
are quite distinct from my own. The case vignettes, in particular, are
helpful. Considering my present interest, the references to the use of
was pleased

I found

ECT

many

are appropriate and well balanced.

So few of our peers have been willing to present their experience
volumes
in
of their own. In earlier times, such volumes were fashioneble. Now, Joint offsets, sympoeie, and invited volumes are common.
You know what they lose. You are to be congreﬂuleted in your volume,
and my thanks for the inscription.

Incidentally, I attended the Antiquarian

Book

Fair last

week.

John Geeh of Baltimore had a bound volume of Freud's ”Translation of

Charcot'a"1ecturea on hysteria for sale. By itself, the volume would
sell for less than $100. But this copy was inscribed by Freud, to his
teacher and friend, Josef Brewer, and the asking price was $12,500!
My

regards.

Mszc

Ab

M

Sincerely yours,

:

Max Fink, M.D.
Professor of Psychiatry

�</text>
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                    <text>April 25, I979
Giacomo D'Elia, M.D.
Psychiatric Institute

Bergen, Norway
Dear Giacomo,

Thank you

Therapy in Sweden".

return address.

for the reprint of the article, "Electroconvulsive
More interesting than the reprint, was the new

Congratulations on your appointment. I look forward to the
papers that you will stimulate in your new center. If there is
something I can do to

assist you, let

me know.

I have completed my book on convulsive therapy and it has
appeared in the U.S. It should be in Europe shortly. Not only
this
volume, but apparently there have been many new articles on ECT ythat
have appeared during the past few months, and I think there is a renewed
interest in the problem. I have been talking to my associates, Richard
Abrams and Michael Taylor, and will try to set up a collaborative
study
of ECT mechanisms in the U.S.
Congratulations again, and

my

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

Max

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                    <text>“wuwwmw'mw—

WWW—v”...

A

rwv—(VJ'

u a

"a

n" “a...“ w

"m

«w

H

,

.‘

m,

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\

April

Fritz Freyhan,
2015 R Street,

M.D.
H.W.'

Washington, D.C. 20009
Dear

26,;“511979

1
,

'4

\\

Fritz,

Ten days ago I shared the platform at the 100th anniversary
celebration of St. Vincent's Hospital at Harrison with Tony O'Connell.
In chatting about the-Journal, Comprehensive Psychiatry, I came to
understand that the publisher was requiring a long lead time for

articles.

A few days later I was in my publisher's office, Dr. Alan
Edelson of Raven Press, reviewing the progress with my book. He talked
about a number of new Journals that he was setting up and asked what I
thought about a new Journal in psychiatry or psychopharmacology. Believing
that only a very good new Journal would serve a useful purpose, and
recognizing the effort that went into such a venture, I thdught that
he might do better by taking over a Journal that was already active,
but one that could use his drive and publishingoslills. I mentioned

respect for Comprehensive Psychiatry and the little history that
knew. Yesterday, I-received a letter in which he asked whether I could
tell him any more about the Journal.

my

I

I

have no knowledge

of the arrangements with Stratton, or your

satisfaction with them. If there is an opportunity to consider moving
the Journal to another publisher, and if you think it may be useful,
would you like to meet with Dr. Edelson to explore the possibilities ?
At the least, he is an excellent host and raconteur.
Let
My

me

know.

best regards.
Sincerely yours,

,.

Max

Fink,

M.D.

..Professor of Psychiatry

1..

e...

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                    <text>April 30. 1979
Marc D. Schwartz, M.D.
26 Trunbull St.
New

Haven, Conn. 06511

Dear Dr. Schwartz,
Thank you for the copies of the past issues of Micro-Psych.
Psychiatrists were among the firstvphysicians to see the merit of
digital computers and the present enthusiasm based on smaller and
less expensive devices continues this drive. There are many
excellent applications vhich are being developed and I expect such
devices to be as secure in clinics and offices in the 1980's as
typewriters areztoday.
Our initial interest in digital computers was to reduce the
tedium and inaccuracy of hand counts of EEG and ECG wiggles, and in
measuring the changes induced by drugs on behavior. My first digital
computer EEG analyser was established in 196h at the Missouri Institute
of Psychiatry (IBM 1710) with the support of the staff of the Computer
Center of Washington University; second an IBM 1800 system developed in
New York in 1967, by D. M. Shapiro, D. So. This system is operatidnal at
SUNY at Stony Brook and consists of an IBM 1800, 36K memory, 2 disks,
printer, typewriter, card read and punch and assorted other gear. The
system has steadily churned out EEG analyses using period analysis and
power spectral density analysis for the initial data reduction, and I
wide range of statistical and display packages for later presentations
(t—test, AHOVA, AECOVA, linear and quadratic regression, etc.). The
system analyses tapes from drug studies ~—- about 8/year from our
laboratory and as many from outside laboratories that collect their
data and ship the tapes to us for analysis.
‘

also developed an interactive diagnosis system based on a CD0
interactive display terminal (one 217A with digiscribe) and an IBM ass/ho.
The programs were written in PL/I (DOS) and were basedoon two diagnostic
logics --— that of DIAGNO—II develOped by Spitzer and Endicott and the
We

by Overall and Gerham. These exercises found such interactive
diagnostic systems very useful in research studies but their expense

BPRS

�M.

2.

D. Schwartz, M.D.

April 30, 1979

precluded a general utility. Those programs were published in 1971, and
I have-not gone book to that problem since, but the newer systems of
psychiatric diagnosis, particularly the DEM—III and RDC use logics that
allow computerization with little translation. I an optimistic that
some of your headers will be able to accomplish these translations and
programs for the smaller machines. Such facitity will provide the
necessary underpinning for a more systematic diagnosis system and much
better data for the inevitable revisions of D8M~Iv and —V which are
sure to come.

Quantitative EEG analysis is esteblished as a useful process in
psychOphsrmscology ——— to classify'and identify new psychoactive drugs
one to define their pheroacodynamic properties. Some references are
cited betas for the readers who may be interested. There is an oppor»
tunity for those who wish to collect EEG or ECG date on compatible tapes
(IRIG T~channel Annex SP 300, 1/2 inch; or 1316 h—chsnnel Hewlett Packard
3760A or 376b, l/h inch) to have them processed in our laboratories at
nominal expense.
Good Luck

in your venture.
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

References:
Fink, M., Shapiro, D.M,,ssdckman, c. and Itil, T. Quantitative Analysis
of the Electroencephalogrsm by Digital Computer Methods. III.
Applications to Psychophsrmscélogy. Computers and Electronic Devices
,' in Psychiatry, (Ed.) H.S. Kline and E. Leaks, Grune and Stratton,
109-123, 1968.

Fink, M.,
EEG

Fink,
.

Itil,

:

T. and Shapiro, D.

in Psychiatric Research.

classification of Psychoactive Compounds in Man: Review and
of
Behavioral Association. Psychopharmacology A vaisw of
Theory
Progress, 1957-1967, (Eds.): ﬁ. Efron, J. Cole, J. Levine and
J. R. Wittenborn, v.8. Govtt.”Printing Office, washington, D.C.,
M.

EEG

—

pp. h97~507. 1968.

3

Fink,
.

Fink,

Computer Analysis of the Human
Qbmprohsns. Psychiat., 8: 521-538, 1967.

Digital

:

5.3 aes- S. and Fink, M. computer Aided Interactive
Psychiatric Diagnosis Programs. New York, Biodeta, Inc. 75 pp., 1971.
M.

in

M.

EEG

Profiles of Fenflurenine, Amobarbitel and Dextroemphetemine
volunteers. Psychogharmooologia (Barl.)'23:,369—383, 1971.

Normal
EEG

Profiles

Itil
Problems in
In: T.

Biosvailability Measures of Psychoactive Drugs.
(Ed.): Psychotropic Drugs and the Human EEG. Modern
Pharmaopsychiatrﬁ, Basel, S. merger, pp. 76-98. 19714and

�www—ssz

Fink,

Cerebral Electrometry: Quantitative EEG applied to Human
Psychopharmacology. In: H. Kﬂnkol and G. Dolce (Eds.): Chan M.

computeriacd’EEG

analysis.

Sﬁuttgart,

G.

Fischer, 271-288, 1975.

Empirical Comparison of Three EEG Digital
In: M. Matejcek and G.K. Sohnnk (Eds.):
Quantitative Analysis of EEG.“ Konstann, Switzerland, AEG Telefunken.

Irwin, P. and Fink,

M.

An

Conversion Techniques.

—.—

1“

379-39h . 1976.

AA.._,_—,_.‘V.

._.V

April 30, 1979

References continued:

-

_m

2.

Schwartz, M.D.

M. D.

:

Fink, M., Irwin, P., Gastpar, M. and de Bidder, H. EEG, Blood Level,
and Behavioral Effects of the Antideyressant Mianserin (ORG GB 9h).
Psychopharmaaologia 54: 2h9—25h, 1977.

Fink,

M.
Mania and
Manic Illness.

Mszc

Eloctroseizure Therapy (EST). In: Shopsin,
New York, Ravgn Press, 221-230, 1978.

B.

(Ed.):

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                    <text>.

.

A...” aim—.wv—u—V

wry—mu.—

\

‘

ra-w’rw

:

..«_.

'In-“vm-m Tum-war

v—nvw:—:

mm

w"

--r

vwd‘w—‘W'wv—Wm-wr—w'Lx'mmmmIv-lrn‘.

May 3 .

Inns

.

~

w—r

1979

Dr. Gerald Roskin
LIJH- Hillside
Glen Oaks, New York llOOh
Dear Dr. Roskin,

It was kind of Dr. John Kane to invite me to lecture
at Hillside in April, 1980, and I had looked forward to that meeting.
What was not clarified in my discussions with him were the topic of
the session and the reimbursement and fees. I believe he assumed
that you or your office would handle these details.
As I indicated in our conversation, the customary fee
for such lectures is $350, and expenses. Fees are waived for
institutions in the Office of Mental Health of the State of New York
and post-graduate teaching sessions of the University. It was a
surprise to me that the invitation was based on some agreement that
no fees would be paid to the staff at Stony Brook. Since I am not
a member of the LIJH faculty, nor a party to the agreement which you
enunciated, the usual conditions of lectures will apply.

Unless I hear otherwise, I will assume that the invitation
has been withdrawn.
Thank you

his kind invitation.

for your time,

and please thank John lane for

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

Max

«yu.mm ,u ,—.-.~p.w-w.w-u~--uwux

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                    <text>HIV

7. 1979

Fritz Freyhen, M.D.
2015 B. Street, N.W.

Whahington, D.C.
Dear

Fritz,

Thank you for the explanation of the present status
of nggrehensive Pszphietgz. I understand fully new, and I am a hit

ambarreeeel that I may have misinterpreted the signals from Tony O’Connell.
I have called Dr. Edelson and told him of the content of your note,
suggesting the$ if there is any desire to take over a Journal, he V111
have to seek elsewhere.
my

best rsgarda.
Sincerely yours,
Me: Pink. M.D.

Professor of Psychiatry

�an

May

5%“

3. 1979

Alan Edeleon, Ph.D.
Raven Press

llho Arcana of tho

New

York City

American

Dear Alan,

Following our discussion and your note regarding further
explorations with the editor of Comprohensive Payohietry, I wrote to
Fritz Froyhan, opening the dialogue. His reply is enclosed, and it
indicates that no matter how poor tho outward atpearanoes, the Journal
is operating to his satisfaction.

I

know

of no other Journal with as good a reputttion
if you are interested, perhaps you will

which may be on the block, so,
consider a new one.
My

’

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

Max

�</text>
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                    <text>W

New

ADCMD

25. 1979

for Operations (lSlJ)

Department of medicine and Surgery
V100

Washington, D. c. eohso
‘Gentlemen:

I an pleased to write this letter on behalf of Dr. Richard D.
Weiner, M.D., Ph.D., vho is applying for a position as e V.A.
Clinical Investigator. I have known Dr. Weiner for three years,
and in this period, I have come to respect his enthusiasm and his
dedication for research.
Dr. Weiner first came to my attention as e member of the
American Psychiatric Association Teak Force on Convuleive Therapy
when he was asked to serve as a consultant for the electrical
parameters of the ECT process. His report and discussions were
very ugeful and served to expand the final report.which appeared
in 197 .
became acquainted with his work when his application
V.A.
research
for a
grant was reviewed by the Merit Review Board
of which I an a member. Hie application showed a good knowledge
of the ECT process, and reflected his reading. The application
was approved and since then I visited his laboratory. We have
communicated often and I have reed a number of his reports before

I next

they have been published.
Following his

training in electrical engineering at M.I.T.

and

the University of Pennsylvenie in $973, he received his Ph.D. in
neurophysiology and his M.D. from Duke University in 1973. Subsequent

training at Durham in psychiatry and in electroenecephelogrephy
”provided the skills he needs for his present research efforts.

�2.

Mey

25. 1979

is interested
in the convulsive therapy process,~end his skills are directly applicable
to his studies. He has a demonstrated ability to formulate a progrem,to
write the necessary applications well, and to undertake the studies
without additional supervision. He is clearly an independent investigator
with the skills and enthusiasm necessary to establish a V.A. research
In

all,

Dr. Weiner

is a well trained scientist.

He

study.

For these reasons, I

Clinical Investigator.

am

to recommend his appointment as a
pleased
'
Sincerely yours,
Fink. M.D.
th
Professor of Psychiatry

�</text>
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                    <text>June 13, 1979
Joyce G. Small, M.D.
Larue D. Carter Memorial Hospital

Indianapolis, Indiana

h6202

Dear Joyce,
Thank you for the copies of the progress report on ECT and
the preprint on the lithium-BOT study. I found both interesting and
useful. If I understand the ECT-drug study, so far the ECT alone,
drug alone and combined treatments are equally effective with son:
advantage for the combined drug—ECT combination. I do hope that these
findings are examined further.
The lithium study is quite stimulating. The data are the.
basis for a prospective study witch needs to be done. I found three
citations that I missed (Hoenig &amp; Chaulk, Ray, and Remick)-- and I thank
you for bringing these to my attention. I believe that the cautions
you recommend (not to use ththium and ECT together) are good ones, and
I will adopt them, until further data are developed. (While the other
combination, lithium and haloperidol [or chlorpromazine] is controversial
as to its toxicity, as a therapeutic conservative, I still do not like to
use the two together, and so teach my students).
Many thanks. My regards to Iver and
help in teaching in the two courses in Chicago.

my

thanks for his

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

Max

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                    <text>June 18, 1979

TD:

Carl Letson, Program Aide
Assembly Whys and Means Committee
Capitol

The

'

Albany, N.Y.
FROM:

122148

Fink, M.D.
Professor of Psychiatry
School of Medicine

Max

‘

at Stony Brook
Island, N.Y. llT9h

S.U.N.Y.

Long
SUBJECT:

Assembly

Article

Bill

3h.

The proposed law

7237: proposed amendment

to Mental

Hygiene Law

ignores present procedures which already provide

that psychiatric treatments only be given after proper consent has been
obtained. The law ignores the experience that when the restrictions on

medical practice are increased, treatments are no longer given and
patients are deprived of the best (most effective and safe) treatment
for their care. The preposed amendment will serve to further deprive
patients in state mental facilities of the type of care which may he
most effective. As an example, we found that less than 1% of patients
admitted in 1975-1976 to state facilities received ECT, while 5.2% of
patients admitted to University hospitals received this treatment (Annie,
Fink and Saferstein, 1978).
This

is particularly true for

patien€;who have the following

diagnoses: psychotic depression. involutionsl depression, depression in
the elderly, endogenous depression, depression with delusions; as well
as some patients with mania and catatonia. It is for such illnesses that
ECT is particularly effective, with efficacy rates that are greater than
other available therapies, including drugs (APA Task Force Report, Chapter 2,
8. Pp. 13-56. 1978; Fink, Chapter 3. pp. 21-h1).
The proposed law restricts the sunber of ECT treatments to 15 in
any-12 month period. Such a restriction ignores variability in response

of subjects, relapse rates, and experience with different illnesses.
While most patients respond with an average of 7-9 treatments, about 10%
require more treatments. About 10% of depressed patients who are not
given maintenance drug therapy

may

relapse within six months.

�Letson

C.

2.

June 18, 1979

risk—benefit analysis of ECT finds it more effective and as
safe (or safer) than antidepressant drug therapy for patients with
A

psychotic depression (Fink, 1978; Pink, Chapter 5, pp. 51-58, 1979).

also believe that present guidelines for consent as described
Task Force (Chapter 7. pp. 132-151, 1978) and Fink (pp. 219-222,
1979) are adequate safeguards. This is particularly true for experimental treatments. which already must meet peer review under existing
by

we

APA

IRB

guidelines.

This proposed law is heincus on many counts - deprives patients
of an effective treatment, increases”the cost of care, increases risk
of suicide and death, as well as impairs confidentiality, consent and
freedom of choice in the doctorupatient relationship. Further. the
history of such laws, as exemplified by the effects of a similar law
in California, is to deprive lower class minority patients (those
'served principally'lthWate mental health services), of a useful treat;ment, while upper class patients, with the same illness ere able to
obtain care in facilities in neighboring states. Such deprivation of
fservicee of our minorities is not an acceptable position for the
y'legislature of the Empire State.

ra'References:
American

ikAsnis,

Psychiatric Association, Task Force Report #1h,

6., Fink,

end
‘h79-h82, 1978.
M.

Saferstein, 8.

Am.

J. Psychiat.

1978.
135:

i

a

h

Fihi;
Fink,
MF:be

M.

”Convulsive Therapy: Theory and Practice.

-‘Nsv_York, 1979.
M.

Campr.

h

Psychiat. 19: 1.18, 1978.

Raven Press

�</text>
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                    <text>‘

Judith

June 20, 1979

H. Quattlebaum

President and Executive Director
National Committee on the Treatment
of Intractable Pain

P.O. Box 3h571

Washington,

D. C . 2003‘:

Dear Mrs. Quattlebaum,
My experience with Opioids in limited to experimental studies
of.the central effects of heroin, methadone and levomethadyl. and
their antagOnists, naloxone and cynlaaooine. These studies were done
between 1966 and 1972, at the New York Medical College. Some reprints
derived from these studies are attached. It is not clear to me how

;

othese experiences, which are focussed on EEG, pupillary response,
gheart rate, respiration and mood, would be helpful to your mission.
In our experience, we did find that intravenous heroin could

produce a seizure. This effeet'could be blocked by naloxone. We
‘also found_that tolerance to methadone and levomsthadyl developed
rapidly (balk days), as did tolerance to the agonist (opioid) effects

ﬁftcyclazocine.

concluded that the narcotic antagonists could be a useful
therapy'of opioid dependence, if drug delivery could be assured; but
opme to no conclusions regarding the usefulness of heroin.
1;

1
§

we

I

J],

e.

K."

-

‘

As

1.

Evidence of heroin

2.

No

effects.

See

reports.

special knowledge.

‘3, h, 5.

Not

studied.

6.

Hot as therapy; only as a "challenge"

7.

Ho.

__

‘w.
.:—‘/¢fy

.

to your specific questions;

activity of antagonists.

to determine

�J.

H. Quattlebenm

8.

2.

June 20, 1979

I could testify to the experience noted in the references.
Scheduling e drug is an aﬂminiatretive and political act,
not medicel. Nothing in our experience would suggest that
heroin is uniquely different from other opioide, except in

rate of entry to the brain and in half-life. The present
restrictions are not based on the pharmacology of heroin; but
on political considerations. Similarly, the suggestions that
heroin is a "uniquely" mofe effective analgesic than other
opioids, is not clearly pfoven.

9.
10.

No.

Probably not.

history, and my con experience from 1966—1967.
You may wish to write also to Dr. John Kramer (University or
California at Irvine) and Dr. Arthur Zeke (971 Madison Ave., N.£.I.).
11.

who haVe

Only by

extensive experience and knowledge of the pharmacology and

history of heroin use.

I trust these reports ere of

game

help.
Sincerely yours,
Fink. M.D.
Profeeeor of Peychiexry
Mex

MF:bo

Att.

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                    <text>June 22, 1979
v.—

WWW—

W

Ww-W..&lt;,—~

‘IIKW

W

V.

.
.7

“a."

WW

_
w
w

VIPI'-w

‘I’y‘m‘l

~Wﬂ'lm4

wWWWWWWW—w

Dr. Barend

ter

Hear

Trends in Neurosciences
Elsevier/North Holland

Cambridge C32 lDB U.K.

Dear Dr.

ter

Hear,

Following the receipt of your detailed letter of June 12
regarding the review of the manuscript, "ECT, Mood and Hormones", I

went through the text with the comments of the reviewers in mind.
To minimally document the facts in the article, and to allow for the
separation from speculation, will require about 80 citations. In
writing the report and submitting
initially, I was mindful of

it

the instruction regarding referencing: "Since TINS is primarily intended
as a newspaper for the neurosciences, only a limited number of references
should appear in the text.". . . of up to 10 titles in alphabetical order. .
For this reason, I cited my book so frequently, since it is in that volume,
of 308 pages and more than 1000 citations, that complete referncing is
available.
I think it would be unfortunate to withdraw the artecle
since I believe it does follow the spirit and the interest reflected
in the earlier reports by Crow and Johnstone and by Green. The decision
to accept is yours, but if you wish to include the article for your
readers interest, I am.prepared to re-submit with an extended citation
and speculation.
list and with some clarification as to observations
wonder
and
indeed
such
I
am
not sure that
I
is
if the reviewers'
necessary,
comments do not reflect their difficulty in making the Jump from their

preconceptions regarding ECT. The present views may in time be proved
wrong, but they have as much, if not more evidence in their support than
other theories of the mode of action of ECT. Perhaps they deserve the
opportunity to appear in your press, at the least for the response they
seem

to engender.

cbtations

can re-submit the article with extended or with
within a few days of your reply.

I

My

thanks for your review.

limited

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

Max

"

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                    <text>0 ‘

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December 21, 1978

Michael A. Taylor, M.D.
Chicago Medical School
North Chicago, Illinois
Dear Mickey,
While

I

am

not at

all enthusiastic

about your going to

Deteoit —— I am sure you can do better -- I have answered the letter
of inquiry with appropriate enthusiasm and encouragement. I know the
Clinic and there is a good research base, good equipment, and some
financing-- but it is a state school which will always remain in the
shadow of the Mental Health Institute in AnnArbor, both in reputation
and funding, and in status with the legislature (not to mention

location).

Have you given any thought to returning to Stony Brook ?
The changes in the last two years have been truly astonishing. The

climate is surely better, and

social turmoil,

we

have

better delicatessen, lesser

the Division
position in Clinical Sciences or both.

and a few more Jews. You could head

of Diagnosis or take

my

My ECT book is at the binders and should be out at the
end of January. My debt to you and Dick is spelled out and you
should be pleased with the chapters on usage, prediction and theory.
For a few weeks I had a post~partum depression, wondering what I
would do with my free time, and now seem to have filled it up with

some experiments
When

can

with putative psychoactive peptidefstudées.

I get the protocol

on

testosterone

luck in your interviews in Detroit. I
helpful.

Good

have been

My

?

hope

that I

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

Max

P.S. I have Just returned from a lecture in Vancouver. Now, that is
a fine center with an excellent residency training program. I
lectured to the redidents—— not only did they all speak and understand
English, about half were women and there were a few tho looked like

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m...

January 7, 1989

.
m

m—p

um"?

_m

"a...

r

W'mﬂ'l‘

v-m-arrsrm

s-

«WWW

WY’

‘g’MWa'avﬁ'v—"W‘M

Frank Ayd. M.D.
Medical Communications

Ayd

Baltimore, Maryland
Dear Frank,

Enclosed is a copy of the report which we recently
published describing our experiences with phenytoin. From these data,
I think we can understand that the varied reports of the efficacy of
this compound in the treatment of the mentally 111 may have resulted from
inadequate dosage“ poor compliance with resulting plasma levels that were
possibly inadequate for the induction of changes in brain function. If
these findings are to be trusted (and I think they should be), then we
are justified in undertaking additional studies of phenytoin in cases
of neurotic depression and anxiety, monitoring the plasma levels so that
persistent levels of at least Sag/ml are maintained.
My

best wishes for

a healthy and

successful

1980.

Sincerely yours,
Max Pink, M.D.
Professor of Psychiatry

�</text>
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                    <text>,-.

A,

.-.A

H

3‘
«.-

mum—v.

January 16, 1979

‘ryl..:'l$'-r;."

\v'

.&lt;

William Karliner, M.D.

20 Franklin Road
Scarsdale, R.Y. 10583

..

vm'ewrm‘-$wwu:www“

Dear
Kevan-'33

an

'dv‘r

Bill,

Enclosed are xerox copies of the relevant pages from the
book, Convulsive Therapy: Theory and Practice, which will be
published in February by Raven Press, New York.

crazy—-

awn-w

“Maw—11w:

1?”

.

I have found very little about maintenance ECT, and I have
abstracted the two sections from the book and the citations which
may be of help to you. There is a distinct need for a study of
maintenance treatment, particularly the benefits of repeated seizures
compared to drug therapy.
You may also wish to look into the APA Task Force report
#lh which has Just been issued. I recall notstatement about maintenance treatment in that volume, and since it lacks an index, I
cannot check it easily.

.v-wv

)‘Q‘

and

Kalinowsky and Hippius have a small paragraph (page 181)
Geoghegan and Stevenson.

report only the findings of

wrnx-vwvm-

r.

I know of no other sources for your search. I look forward
to your paper in Chicago.
My

best regards.

‘(t'nt‘rlr’z‘4-M-ﬂwbr1‘r‘wae'iﬁ'3wuwv'rf'nxn—hl'

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

Max

z

,x

mgr

Wov-

y
5.1
.

[Ivy-mitiwulm'wrtmr:”Jory“.

-

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                    <text>January 2h, 1979
Mr. James

Kipfer

Mental Health Association in Michigan
Lathrup Village, Michigan
Dear Hr. Kipfer,

I am pleased to write this letter on behalf of
Dr. Richard Abrams who is being considered for the
position of
Chairman, wayne State University Department of Psychiatry.

I met Dr. Abrams when he returned from
service
to complete his psychiatric residency training at thehisNewmilitary
York Medical
College in 1966. Based on his experience with ECT in the Army, we
designed a study of ECT which was funded by the NIMH and which was
done at the Gracie Square Hospital. The work was done between 1967
and
1972. During that time, Dr. Abrams completed his residency with
distinction, and Joined our staff as a staff psychiatrist. In
rapid progression, he became the chief of the inapatient unit at
Metropolitan Hospital, and then moved to Stony Brook where he directed
the University service at Central Islip Psychiatric Center. In 1976,
he moved to the Chicago Medical School with Dr. Michael
Taylor.
is an outstanding clinician, researcher and
work has been innovative and with Dr. Taylor,
they have challenged some of the diagnostic concepts which have been
{current for a number of decades. Their work on the identification of
/ mania, catatonia and bipolar disease is exemplary.
~teaeher. His

Dr. Abrams

clinical

In his teaching, Dr. Abrams has shown excellent skills,
particulary in encouraging resdients to undertake research projects.
A record is seen in the
long list of publications which he has with
Junior personnel. Another evidence has been his rapid rise in academic
grade, from assistant professor, 1971-197h, associate 197h-1976 and

progessor since d976.

In his research, he has exhibited skill and a
of the literature. His work in convulsive therapy,thorough
in directing
the ECT studies under MB 15561, has resulted in many publications,
particularly regarding the efficacy of unilateral and multiple ECT,
the changes in EEG and biochemical parameters, and effects
on memory.
knowledge

�-2.
His

Joint efforts in psychopathology with Dr. Taylor have already
to, and it is in this effort that he has shown excellent

been alluded

skills.

Finally, his administrative experience also encourages
his consideration for the position of leadership. At the time that
he took the position of director of the University Service at
Central Islip Psychiatric Center, the unit was little more than a
back ward in a primitive state hospital. By the expenditure of
much effort and travail, he impaoved the staffing, trained personnel,
obtained the support of the adminsitration, and with the aid of the
resdlents, developed a fine teaching unit, which served to treat
patients and as a source of publications and research. (It is fair
to say that his successors have been unable to maintain the high stand—
ard of academic excellence which he established.)

It is clear that

Dr. Abrams has

the academic, clinical

research experience to undertake the position of chairman at wayne
State University in psychiatry, and I recommend him highLy.
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

and

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                    <text>,
-

n

:er-tl’wvo—r‘v—y

w..77¢

"w

u.

way

v—rxuru-e

'wwwc

,r.

Im

January 30, 1979
Dr. L.C. Kiloh
School of Psychiatry
University of New South Wales

Little

Bay,

Australia

Dear Dr. Kiloh,
Thank you for sending me the review, "ECT:Its Place
and Value in Present Day Psychiatry". I found
thorough and detailed,
and congratulate you on the effort. While I agree with most of what

it

is included, including the conclusions, there is

our understanding of the mode of action.

.

7mm,

mpg“!

,

.

a,

some

question about

It seems to me that one can deduce much about the efficacy
of convulsive therapy from the information in your review—~ notably
the
importance of the bilateral central seizure, the equivalence of inductions,
the need for multiple seizures, the predictors of outcome, the diagnostic
classes which respond, and the neurophysiological evidence of the importance of bilateral EEG changes in the adsessment of efficacy. From these
-observations, it seems to me that there must be an influence on some
centrencephalic structure, an influence which is expressed after a
number of seizures, and therefore in the persistent biochemical
changes.

It has been the influence of the neuroendocrinologists that
suggests the next step in the process. The neuroendocrine changes which
mark endogenous depression have been defined in part; and in your
excellent review of the predictors of ECT, you noted that the vegetative
symptoms are the best predictors of ECT outcome. These observations,
plus the notes on changes in calcium metabolism and the btood brain
barrier have led me (and others, as Jan Otto Ottosson) to define the
present view of the mode of action of convulsive therapy in terms of the
hypothalamic effects. Surely, in relation to our knowledge of the mode of
action of other psychiatric therapies, we are farther along in convulsive
therapy, and a ummary of your views is the only omission in your report

which I missed.

other question of persistent concern is the role of
It is not clear from the literature whether such treatments
are effective, for whom, and at what rates. Their role should be clarified
One

maintenance ECT.

�”an?”

-2in the review.
I am acquainted with most of the citations but that of
Osselton which you cite as personal communication, 1978. I would be
grateful if this report is published, if you will let me know the

citation.

work on the Task Force and the reviews which you
volume which will be published
by Raven Press next month. In "Convulsive Therapy: Theory and Practice",
I expanded on the theoretic background of the process and (hopefully)

cite led

My

me

to expand the reports into a

present a cogent theory of

mode

of action which is quite testable.

to Graham Burrows in Vienna, I had hoped it
to Australia this year, and I had hoped to
visit with you. That seems unfeasible at this time. Should you be
coming to the States, let me know and I will be pleased to arrange
for you to visit us, to discuss this and other similar issues.
Thank you again for sending the preprint. I look forward
to its publication.

would be

When-I spoke

possible to

come

Sincerely yours,

Fink, M.D.
Professor of Psychiatry

Max

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                    <text>.

wow-pv-

,

w—m

“we—“rm.“

“unwan-ntv

WWI-“1”,”.

—A'rI.-‘

February 6, 1979
Barry Maletzky, M.D.

Portland, Oregon 97202
Dear Dr. Maletzky,
Your letter of inquiry relating to our experience with
the MECTA and with MMECT was referred to me fbemreply. As you know,
I visited Paul Blachly in Oregon in 1968 and undertook a series of
confirming studies of MEOT. The publications relate our experience,

which was not good.

In 1976,

we

purchased a

MECTA

instrument. In our

initial

treatments, we were unable to achieve a grand mal seizure using maximum
current intensity and settings. We called the manufacturer, returned the
instrument as he requested, and it was returned to us, with the
assurance that a faulty part had been replaced. We again attempted
to induce seizures and could do so at the maximum settings. When we
attempted to use unilateral electrodes, we were unable to achieve the
higher currents needed for such inductions. Gradually, the therapists
replaced the instrument and when it was no longer useful, it was
shelved, where

it

remains today.

In the review of

which was undertaken by the

MECT

(among

other modifications of

ECT)

Task Force on Convulsive Therapy, we were
unable to find systematic data which would assure us that this modification
was safe or more effective than routine ECT, expecially with unilateral
APA

electrode placements. Our conclusions are cited in the Task Force report,
#lh of the APA reports, dated November, 1978.

In my own review of ECT, which is in press and which will
be available by the end of the month, I come to the same conclusion, that

ﬂlﬂl indications for MECT are unclear, and further study is necessary before
its role in treatment is defined." In that statement, I am being kinder
than my real feelings, which are that MECT the little Justification
except as a research

tool.

acquainted with your very interesting report on the
outcome in ECT, as published in the
issue of Comprehensive Psychiatry. I have cited the report in

I

am

relation of deizure duration to

latest

�MuetZky,

wv.

BoMo

Coco-ell... FGbrum 6,

1979 ocean-000.co- page 2

review, and find your conclusions most useful. The possibility of
a therapeutic window for ECT is an important concept, and is consistent
with the experiences reported from my laboratory by M. A. Green,
who found that the duration of seizures changed with treatment,and
that thresholds usually fuse. But we were unable to define a ’window',
my

but then

we

didn't

have the concept.

With regard to the MECTA, there is need for better
ECT, and perhaps the unidirectional brief stimulus
approach recommended by Lieberson in the 1950's and lately by Weaver
is the way to go. But there seem to be inherent faults in the MECTA that

instrumentation for

.

will be useful in the clinic.
Similarly, the efficacy and applicability of MMECT is so far from demonstrated,
that a text as to how it should be applied clinically may be premature.
need remedying before the instrument

window'

in

ECT.

I look forward to your next report
‘

on

the 'therapeutic

Sincerely yours,
Max

Fink,

M.D.

VWGW’

w

Citations:
R. Abrams.

What have we
McGaugh, J. and

MECT:

learned 2 in Fink, M., Katy, 8.,
Williams, T. (Eds.): Psyyhobiology of

Convulsive Therapy, Washington, V.H. Winston, 197h. T9-8h.

M.Fink.
-

Convulsive Therapy: Theory,and Practice.
306

pp..

1979.

New

York, Raven Press,

M. Clinical experience with multiple electroconvulsive
treatments. gggprehensive Psychiatry 1;: 115—121, 1972.

Abrams, R. and Fink,

�</text>
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                    <text>September 12, 1978

Gerald Sarwer—Foner, M.D.

Professor

&amp;

Chairman

Department of Psychiatry

University of Ottawa
Ottawa, Canada
Dear Gerry,

Enclosed is a draft copy of the report "A History of
Convulsive Therapy" which relates the history of the past forty
years. I felt that to limit the description to a shorter period

did not do Justice to the

men who embarked on

this treatment,

nor did it give a flavor of the continuing process of evaluation
and development that has marked this remarkable treatment of the

mentally

ill.

I hope that you find this acceptable for publication.
I look forward to your critique.
My

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

Max

�</text>
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                    <text>1.1%?

March h, 1978
Dr. Karen Allen
Texas Tech University
El Paso, Texas
Dear Karen,

It was kind of you to send me the pictures of the
participants at the ECT session. It reminded me of a very pleasant
occasion and I do hope we can meet in lilanta.
The Task Force has completed

will be submitted to the Trustees of the

its

APA

work and the

shortly.

It

report

should be

debated at the meeting in may and perhaps it will be out in the
Fall. There has been a brouhaha about the recommendation that
unilateral ECT is to be preferred as effective and safer. Otherwise

the

critics

have been kind.
my

regards to Michael.
Sincerely yours,
Max

Fink,

M.D.

�</text>
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                    <text>March 5, 1979

.

Dr. L. K. George Hsu

St. Getrge's Hospital Medical School
London, England
Dear Dr. Ken,

for your inquiry regarding a position in this
laboratory. At this time, we have no openings, but I will keep your
application on file in the event our situation changes.
Your interest as anorexia nervosa is of-special interest
Dr. Michael
to me, and in this regard, I any suggest that you.write to Chicago
of
Psychiatry,
Department
Taylor,(Chairman and Professor,
medical School, VA Hospital, North Chicago, Illinois ‘6006h). He has
an interest in the same condition and may have a position open.
Thank you

In the recent literature on anorexia nerVOsa,

'

it

has

been unclear whether the vegetative disturbances, particularly the
evidence of hypofunction of the hypothalimo-pituitary axis, are primary
loss. In a recent
to the disease or secondary to the anorexia and weight have
come to the
others
we
ECT,
among
of
analysis of the mode of action
ECT
stimulating
in
much
of
the
is
process
of the thrust
conlcusion that
substances.
hermenal
of
release
axis
to greater
the hypothalmo-pituitary
respond
should
anorexia
nervosa
with
'If this be true, then patients
well to ECT, and the-evidence in the literature are that they do. However,
unable to find any
the reports are clinical and anecdotal and we hare beenanorexia
nervosa. In
ECT
of
the
course
on
of
sytematic study of the effects
the
7
share
can
ECT
you
received
If yes,
your studies, have any patients
schedule,
treatment
hormonal
status,
date with me- state of subject,
outcome, etc . ?'

If this

problem

interests you, perhaps

you could apply

for support for such a project in a center where such cases are available
(as in Chicago or Iowa City)or New York), and defray your support by this
A

mechanism.

I trust these

comments

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

Max

�</text>
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                    <text>:7

par u

'2." 1m!

\vr'ax4

on“

».-

-

n-w

.7

v van

»—~‘ w

y.-

m- mm. rwww

u-w—w~«-mww—mw

March 5. 1979

Dr. John R. Robertsen
Comox,

3.0.,

Canada.

Dear Dr. Robertsen,

It would be difficult fer a suit to be sustained on
the basis of permanent ingury following ECT after a single induced
seizure, unless the record indicated that a particular complication of
the procedure- prolonged apnea, cardiac arrest, laryngeal stridor, for
example-- had supervened and was not corrected. If the treatment
procedures were within the range of the usual, i.e., with anesthesia
which was of reasonable duration, and oxygenation was maintained, it
is unlikely that a seizure induction would induce a prolonged brain
damage.

If the lawyers wiah to send the full record, it is
previous experience to respond to the record, and I would
be willing to do so-— if it were to be of some help.

within
be

my

The Task Force report
helpful to your counsellors.

# 1h

of the

APA

should also

Sincerely yours,
Max

Fink,

M.D.

PRofessor of Psychiatry

�</text>
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                    <text>Mrs. Mbry Winkcls
,4

Health Sciences Library
L—3

—~m~.«-«-~.—7:

..,

:,~v:v

Health Sciences Center
Stony Brook, H. Y.

v-

vf-imzwrv

Deer Mrs. Winkels:

I an pleased tc submit this letter

»-WM

on

behalf or

Miss Jeanne

Galbraith. As you knew. I have completed en extensive review of
convulsive therapy. During the past two years, I have called
upon the library for a great desl of assistance. Throughcut this
time, Miss Gslbreith hes been particularly helpful in satisfying
the needs which developed, including sesrchcs fbr citations,
verification of foreign citsticns, and searches for unccmmcn
documents. In addition. she has been particularly helpful in
assisting me in my teaching sssignments.

I have always found her cooperative, prompt. helpful

relisble. I
1"-

an pleased

to

and
and
continued
recommend her promotion

service in the Health Sciences Library.

Sincerely ycurs,

ladv-ﬁm‘

-

«an-

~

,
a

n-

»,m-gn-g

Fink, M.D.
Professor of Psychiatry

Mix

n!-/ﬁ§{'.¢*-\&gt;-V—n

.

MF:bc

�</text>
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                    <text>ww.~mvmmhr'7Vw'.

erw—Il-‘HW

W

m

February 3. 1978

Professor

Max Hamilton.
Department of Psychiatry
Leeds , England

Dear Max,
We are pleased that you will be able to visit us again.
I have arranged with the Director of Residency Training, Dr.
Lester Shapiro, for you to lecture to the residents on Thursday,
March 2 from 1 to 3 p.m. If agreeable to you, we have provisionally
titled the presentation as "Diagnosis and Treatment of Depression."
It is important. we believe. for these students to have another
point of View with regard to the issues in the identification and class—
ification of depressed patients, the treatments that are available.
and the decisions involved in their care. If possible, it may
be helpful for them to hear about the development and your view of the
present status of the Hamilton Depression scales.

and

Martha and I would be pleased to have you stay with us,
you to the University on Thursday. We

I will arrange to take

can make the

final arrangements in

New

Orleans.

I am processing the letter from your registrar and I
should have an answer from the Department within the week. I have
recommended that an invitation be extended to her, and would like
to have her assistance in the clinical research unit at the VA
Hospital in Northport,

centers.

New

York, one of our

affiliated clinical

.

I think

we

will

have some fun

forward to seeing you there.

My

best.

in

New

Orleans and I look

Sincerely yours,
Max Pink, H.D.
Professor of Psychiatry

cc:

L.

Shapiro,

H.D.

W3 .—..~... ",7. VFW—7m—

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                    <text>March 29. 1979

Robert L. Williams, M.D.
Departmant of Psychiatry
Baylor College of Medicine
Houston, Texas
Dear Bob,

.

is a draft of the requested PESAP- IV Syllabus
have tried to follow the guidelines,
and trust that this submission meets the standards that you have
set. If not, let me know and I will make the necessary adjustments.
Enclosed

for convulsive therapy. I

m

mmwrn.

Thank you
Wm

My

for the opportunity to contribute.

regards.

&lt;

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

Max

�</text>
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                    <text>November 6, 1978

Office of Research Reports

NIGMS

-

NIH

Bethesda, Maryland 2001h
Gentlemen:
We

\

would apprecaite receiving single copies of the following

publications for our use in the teaching of students at this Health
Sciences Center:

Inside the Cell

The New Human Genetics
An

addressed

Thank you

labll is enclosed for

your use.

for your help.
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Mex

�</text>
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                    <text>1v

V$dﬂme

—

a...

November 7, 1978

Lothar Kalinowsky, M.D.
30 East 76 Street

New

York City 10021

Dear Lothar,

It was a pleasure working with you once again in explaining
the progress in convulsive therapy. I was pleased by the presentations
and by the audience response, but was disappointed that the time was
so limited. Nevertheless, I believe the message was clear, and the
discussion indicated that the process of exploration by the Task Force and
the interaction with the community was successful. Thank you for your
contribution.

I also want to take this opportunity to thank you for the
splendid copy of your first edition. It is a welcome addition to my
library of works on convulsive therapy, and I will treasure it.
My

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

Max

�</text>
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                    <text>November 7, 1978

Alice Leeds,

M.D.

PRB- NIMH

5600 Fishers Lane
Rockville, Maryland
Dear

20857

Alice,

I have read the latest issue of the Psychopharmacology Bulletin,
and following your ibvitation on page 3, I am writing to suggest some
additional

titles for

the Recurrent Bibliography.

(Electroencephalography): I sought this item since the
effects sf psychoactive drugs are clearly defined in EEG measures. At
but when I
first I thought there were no such articles to be indexed,
found three among the citations that would clearly be so indexed, I
assumed the class was not in the master index file.
EEG

Convulsive therapy (ECT; Electroshock therapy): It is fairly
clear that the effects of ECT are operative through biochemical mechanisms
that are similar to those which are invoked as explanations for the effects
of antidepressant drugs. The index includes reference to ECS, the animal
equivalent of ECT when doen properly, but not to ECT.
Other items of

interest that

Mianaerin

seem

lacking are:

(GB—9h)

pharmaeokinetics, drug
pharmacodynamics, drug
plasma (blood) levels

I trust these

comments

are of

some

use;

My

regards.

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

Hex

�</text>
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              <elementText elementTextId="62897">
                <text>1978 </text>
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                  <elementText elementTextId="107048">
                    <text>November

7. 1978

Research Resources Information Center
1776 East Jefferson Street

Rockville,

MD

20852

Gentlemen:
We would appreciate a single copy of Biotechnology Resources,
Research Resources Directory, Revised 1978, as described in a recent
issue of NIH Guide to Grants and Contracts.

A

Please send to address on label attached.
Thank you]

Sincerely yours,

Max

Fink,

M.D.

�</text>
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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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                  <elementText elementTextId="104064">
                    <text>;

Been Tania, M.D.

Central

Islip Paychintric

Contrtl 1311p.

New

York

November

8, 1978

Center

Delr Dr. Tania,
confirm

on ward

In response to your latter of October 25, I with to
that projects 5 20, 2h Ind 25, which had been undertaknn
L—6 at CIPC, ha»! been discontinnsd.
Sincerely yours.
x Fink, M.D.
Professor of Paychiatry
M

�</text>
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                    <text>?"
Bbvunbor 20, 1978
Ephraim Friodmnn. M;D.
Donn, Albcrt Einstein College
1300 Morris Park Arman:
Bronx. New York 10h61

at

/

Mbdicine

Dear Dean Friedman,

I am pleased to submit this latter of rueomnrndution on bohglf of
the appointmnnt or Dr. Loo Zach to the rtnk of Associate Clinical Professor
of Duntistry. I harm knowh Dr. Zach since 19ho, when we were classmates at
New York university. Since than, I have follownd his carver in neadcmie
dantistry and bare been an enthusiastic supporter of his practice.
At the time that I ﬁll a resident in neuropayehiatry at
ﬂoatatiore, he was rasidsmt in pathology and my interest in his work
was heightened by the aznallant presantations that ha main in naminsrs
ax thai time. Since than. I have fbllawed his publicaiiano and have
been impressed with tbs gullity of his work and tha calrity of his
thinking. 0n n number of catasions. I discussed his work with monkeys and
fbund the results impresniva,,

is a parsondble and ukillod lecturer and writer. His
mastery of the English language is wall known, and his teaching
anthusialm matehau his rescnrch ability. I have been impressed that
ha ha: been able to use his skills in the office as wall as the leeture
hall and rcaearch theatre.
He

It is with piersuro that I endorse tbs recommandation for
appointmcnt as Associate Clinical Proﬁtssor.
Sincerely yours,
Mt: Fink, M.D.
Profewnor of Psychiatry

�</text>
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                    <text>’2‘-

-w

.«z'

'—y.&lt;- 1v-')vvv}ﬂ£vr ‘z’ibmu—Eﬂ'ﬁ‘vna'.r‘.Jvm'-vvwv—~"

—«.—-—.~r

..—..—.

,.

,-

7,.

.

m'v-r‘

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u;

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.n,/.,.,"_,.,.. in“,

,7” ,,,_

I

v

-.

wnw—ywwmvvwnwmww—a

.W.

November 20, 1978
mm.

Mr.

J. Heller

Efringerstrasse

Basel, Switzerland

Dear Mr.

Heller,

anv-wm-wrww-

m

um.

~v7‘w-w-"rnw'w

w

T3

CH-hOST

We

do not

ordinarily have funds for post-doctoral

candidates in our program, except for physicians who are completing
their psychiatric residency training. I regret that we are unable to
fund a position. We have, however, from time to time, made the facilities
of the laboratory available to candidates interested in examining a
problem for which these laboratories seem particularly well suited.
Our work is exclusively with normal human volunteers, almost always
male, and we are equipped to examine the EEG effects of psychoactive
drugs (or any other perturbation of the central nervous system) both
on acute and long term adminsitrations. While our studies are in
alert subjects, others at this University are exploring similar
problems in the sleeping volunteer. Should any of these facilities
be of use to you, let me know the proJect problem and if we can be
of assistance, we will.
=

Thank you

for your inquiry.

m.

we”.

Sincerely yours,

:xvvjyvvw-

Fink, M.D.
Professor of Psychiatry

Max

..

‘
H

“Tﬁfrvxﬂ'lz‘qr"arw'r‘w‘w-r-yﬂw'.

r9"

.

.._~

..

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v

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c

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7,.

.

�</text>
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                    <text>November 23. 1978
Graham Burrows, M.D.

Department of Psychiatry
University of Melbourne

Victoria, Australia
Dear Graham,

It was kind of you to arrange an invitation to
of the theoretic views of ECT to'a plenary session of
the meetings of the Australian and New Zealand psychiatrists in
October, 1979. Unfortunately, I do not see a way to finance the trip
from this end at this time. There are few places in the world as far
present

some

enticing to us as the Australian/New Zealand islands, and
like someday to make the trip. Perhaps, on another occasion.

away and as

I

would

However, the books on ECT are abOut to come off the
should be possible for these volumes to answer some of
APA Task Force report (#1h) will be issued this
The
the questions.
month. my volume, Cbnvulsive Therapy, Theory and Practice, will be
out in January (Raven Press, New York). I understand the NIMH volume,
ECT: Efficacy and’IMpaat; one issued by Richard Abrams and Walter
Essman; and another by Peter Breggin are scheduled to appear in 1979
or 1980.

presses and

it

Thanks again

for the invitation,

and my

best regards.

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

Max

�</text>
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                    <text>F.”

”when

v,“

a.--

.._

m

in

u”.

.WVA.»

9
m

November 28, 1978

Catherine M. Shore
Carrier Clinic
Belle Mead, New Jersey

Ms.

Dear Ms. Shore,

It should be possible to come to the Carrier Clinic on April
19, 1979. As I have been pro-occupied during the past two years with an
assessment of convulsive therapy and phe publication of a book which
will appear in January, I could discuss the clinical issues, indications,
optimal methods of treatment and prevention of complications in a talk
entitled, "Convulsive Therapy: Current Practice and Theories". An
interesting alternative would be a review of the history of Edﬂvulsive
therapy and an emphasis on the theories of its action, how their progression
reflects the changes in psychiatric mythology. "Convxlsive Therapy: A
Perspective on Changes in Psychiatry" would be an appropriate title.

it is best to fly to the local private airport from
airports, thus avoiding the barrier of New York City. If
all reasonable, this would be somewhat more expensive in
travel cost, but less so in time and effort._
Islip or

I think

Republic
the weather is at

most

slides and a Koiaslide carousel projector is
f
,.
In addition to travel expenses,.irpvision should be made for a

I shall use
useful.

lecture fee of

2 x 2

$350.

Thank yOu

for your invitation.”
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

�</text>
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                    <text>3/
._.

~nv....,._--,A

v

”we”.

November 20, 1978

rr.

.,

r
.1»

A,

.

~va

~v.v,u

,rm—y-v

"I...”w—

M.A. Taylor, M.D.
Professor &amp; Chairman
Department of Psychiatry

Chicago Medical School

Illinois

Chicago,

Dear Mickey,

role as searcher for new compounds that any be
across the data file on an orally active testosterone.
Mindful of your findings at Metropolitan Hospital, I thought that there
were two bases for an interost~~ the possibility that the compound could
have antipaychotic activity in its own right (particularly in therapy
resistant psychotic patients), either alone or aynergiatically with
an antipaychotic drug: or, as the analog of the high dose eatrone
studies which have heen reported by Klaiber in Worcester State as
successful in therapy resistant depressed women.
In

useful, I

came

my

I would appreciate your reading the enclosed file. Are you
interested (or stimulated) to follow up your earlier findings at metropolitan
Hospital What do you think is the likelihood of success for the effects
of testosterone as a psychotropic agent ?
Y

I will file an IND and try to
for
the
compound.
profile
It should be possible to carry out
cIinical trials in psychotic patients under the some IND.
find uh

EEG

During the next few months

I received a few anxious calls from NY PI.
site visit on their large application to examine the
,’effecta of lactate on anxiety. From their questions (I have not seen
1the application) it sounded like they were replicating your earlier
A

few weeks ago,

.Ihey anticipated a

application

and study.

I

I've almost completed all my ECT assignments. The book is in
,preea. I hare had to defend the treatment for a number of books and
I'Journala, and almost see the end of the york It is time to get back to
'
science and maybe EEG. I am setting up some studies of GK 78 (de Wied'a
latest peptide gragment) but the possibility of a testosterone study
&amp;

intrigues

me

even more.

One last comment. You will probably hear that your assistant,
Almy had a rough time before the VA merit review board.
you plan
another application, why not send
to me before
goes to the committee ?
Come and visit when you are in Rev York.

it

it

If

�</text>
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                    <text>locamber 6, 1978
Dr. 5. D. Thornton
5r
-

Publishing Editor, Life Sciences
&amp; Sons Ltd.
Chickastcr, Susscx, England

John Wiley

Dear Dr. Thornton,

I am pleased to roxpond to your letter at 27 Novcmbar
rugarding the propascd volume by Drs. Green and'Costain. First off,
thn material sent ma was an outline of a volume and the details are
too skimpy to allcv a dctuiled assessment of this volume's potentials
against othcra in the fielﬁ; but thc material is sufficient to allow a
goncral annuaamcnm.
My initial impraasion of the outline was that the topics
within
veil
the 51:111- 01‘ the anthcrs. In the 39¢.th two years , I have
we
cans ta regard the worker» in fobrd as among the mcrc sophisticatcd in
tho ticld. I regard their knowledge of the role of catecholamﬁnes in
behavior. and tha relations between brain chemistry ana behavior, very
highly. In the culling, I believe that they should have no difficulty
in preicating the chapters in Section 1 (Eeurotransmittcrs) ably and
clearly. I presume that thuy will emphasize the relations between human
and animal stuﬂicn. I! thcy inclnae tables and figures vhich state

altarly what

hunnn

was discerned in animal trials, what was confirmed in
trials. and where thc discrepancies between the two domains ct

inquiry exist, thqy will be diing the science a distinct sorvicc. There
in much confusion among thc Icieutistn who scum psrticularly facile in
Junping tram one domain to another, lccving tho careful listencr and
rcndnr raihnr buolthlcsu from the exnrtion of ncpnrtting thn tun types

of ants.

Thc

actline or the chapters dodicntnd to clinical

paychopmthologic attics pmojocto an important contribution to thc ficld.
Wire thcy to docunnat reliably thn many studies in humans. summarising
the psychiatric, biochcmical and pharmacologie data, again thcy would be
doing an all 3 service. Among the contribuiionn that they citc, they unit

prior ctrcrtu gt thin connclidntion of thy-clinical and ldborutcry
tinﬁingnua thn vnlunos by Baldataarini and by van Praag. Both these author:
has» prancntod simple and atruightfarwnrd summaricn of tha clinicul and
laboratory dutn. Baldnnsarini’u volunn is particularly uaaful fur amdical
ntudanta, fbr when it was insignad. Dr. van Praag's in more technical cud
less readdbln, but nor. datailed.

£19

�Wr-

Dr. S. D. Thornton

rav—mv-

......

December 6, 1978

.............

page

2

In reviewing the list of psychopathologic states, I noted
important omissions: the special problems of children end-adolescents,
the elderly, and the adults with psychoneuroses. There are important
tapics among each of these specialised populations which ought to be
considered. It is probebhy true that the findings among these populations
are particularly sparse, and that may be the reason for the omission, but
e text for studients should include some statements about the special
some

sensitivity among children,
the theories and studies among anxiety cases (ipg., lactate precipitated
anxiety, beta blockers, snti—hypertensives).

problems in metabolism.emong the elderly, the
and

As

to the specific questions.

There

is a need for additional

volumes which can be used in teaching basic psychiatry to medical
students and residents. At this University, I am charged with the

respdnsibility of teaching psychophsrmscology to medical students. In
the past few years I have used Freedman and thlen's Textbook of Psychiatry;
the volumes by Lance Simpson, Beldesserini, and lately, the one edited
by Berchss et s1. I have not been satisfied by any of these texts, and
believe that there is a need for an elementary text of the type proposed
by Green end Costein. For advanced students, I have been pleased this pest
semester with the

Press.

new volume on Psywhophermscology

published by.Raven

The authors' outline is a good one, and would suggest that
them
ask
to flesh out their outline with more details as to the
you
specific approaches which they hope to use, perhaps even going so far
as to ask for a preliminary draft of one section. That should give you and
your reviewers somewhat more to go on.
As I understand their mission, the primary market would be the
medical students in courses in psychobiology and first year medical
post-graduates in psychiatric residency training ppogrsms. The secondary
markets always include the broad range of psychopharmscologists, chemists,

behavioral psychologists and neurologists
behsvior relationships.

who

are interested in brain—

I an only directly acquainted with

I have answered this question earlier.
are

my own

course, and believe

The only volumes which are to be added to the list submitted
those by Beldesserini end by van Press. There are others published

and apparently used (Abel, Vslselli, Clark 3. Del Guidice, Iver-sen a.
Iversen) but none ere in use here. For the most part, these are more
general texts. I have no knowledge of manuscripts in preparation; nor an
I knowledgeable about the market for such ventures.

more

it.

I trust these comments are helpful. Should
detailed outline, I would be pleased to encourage

you obtain a
them and review

«Sincerely yours,
1431

Fink,

MOD-

_Professor of Psychistry

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                    <text>December 7, 1978

Alan

J. Gelenberg,

M.D.

Eerich Lindemann Mental Health Center
Boston, Massachusetts
Dear Dr. Gelenberg,

I enclose

1979-

my

renewal subscription for the Newsletter for

description of the report on the effects of succinylcholine
and ECT sent me to the file of the newsletters and I failed to find any
other reports of the developments in ECT. Since ECT is still regarded
as a biological therapy, perhaps the earlier omissions are to be rectified.
However, there have been and there continue to be many fine reports on
the effects of ECT which contribute to our understanding of brain
chemistry and physiology and clinical psychiatry. I commend some to
of your
you, in the hope that their review will bring to the attention
few
marked
ECT
the
which
has
past
years.
readers the active ferment in
Some interesting articles are those of Meco et a1 (Lancet 1:999,
0"Dea et al (Am. J. Psychiat. 135: 609) and 0"Hman et al (Lancet11:936, 1976)
discussing the changes in prolactin; the comparative study by Freeman
et a1 (Lancet 1: 736, 1978) which raised a storm of letters; the comparison
The

J. Psychiat. 135: 1108, 1978); the failure
bromide
psychosis ( Davis et al. Br. J. Psychiat. 133:
to relieve a
9h-96, 1978) and the use of ECT with pacemakers (Abiouso et a1., JAMA 2h0?
2&amp;59. 1978)-

of
of

TCAD
ECT

and

ECT

by Coryell (Am.

Since the death of Paul Blachly and the suspension of the ECT
Newsletter there has been a lack of coverage of the many studies of ECT
which appear with increasing frequency. Perhaps you and your associates
would

like to
Good

fill

luck

the void.

!

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

Max

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                    <text>am}

August 2, 1978

”gr-per

g
‘

“17;“?

mum”"

,vw,m%m-'

Dr. A. Collins
Department of Psychiatry

Lenox Hill Hospital
York City

New

Dear Dr.

,.
“rte.

who

is

an

Collins,
I am writing this letter on behalf of Dr. Arthur ZAKS,
applicant for admitting privileges at Lenox Hill Hospital.
I

have known Arthur since his days as a resident
in
New York Medical College in 1968. He
was an outstanding
student, a willing and enthusiastic workern and keen observer. He
began his research studies as a resident and thena continued
until the
end of 1972 to lead one of the research teams
in my Division of

psychiatry at the

Biological Psychiatry. He was a major contributor to our studies of
opiate dependence and has contributed much to our understanding of
the usefulness of methadone maintenance, levomethadyl,
challenges,
the interaction of bpioids and narcotic antagonists and heroin
the
specific
properties of naloxone. He was active in the study of naloxone pamoate,
one of a group of long acting opioid antagonists.

is an outstanding clinician and researcher. He is well
his patients and by the staff. My enthusiasm
for his work
was such that when I accepted a position
at
this
university,
I recommended
that he be promoted to take over the responsibility for the narcotic
research program, then running on grants and contracts at a level
of
more than $500,000 a year. I regretted his decision
to
leave
with
me and to enter private practice, but
since then I have continued to
share in his studies and interests.
liked

by

with as

He

I

much

recommend him

skill

and

highly and can think of few other trainees

responsibility as he has demonstrated.
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

�</text>
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                    <text>~

““3‘"

1ywxyr‘

warm—n-

"-1--

a-IIV-."""Aﬁ))"

.

mun-Irv;-

.,
.

Charles B. Wilkinson,
Kansas City, Missouri

M.D.

August 2, 1978

Dear Dr. Wilkinson,

I am pleased to write a letter on behalf of Dr. Oliver
Hikolovski. He washed at New York Medical College in l968~l970
and was involbed in my research efforts for one year.

is

a well trained European psychiatrist with a dedication
for research. He is unimaginative, however, so that
his principal capacity is to carry out protocols carefully. This he
does with enthusiasm and with attention to every detail. He is reliable.
In his interpersonal relations, he is well liked by the staff and the
patients.
He

and enthusiasm

After working with me for a year, he was promoted to be
in charge of the Day Hospital-— a function which he carried out well
and with equal enthusiasm. I think his clinical skills are good and

his reputation in that position was good.
I have no basis for Judging his teaching ability since
was not a member of my teaching team during the time I was at the
York Medical College.

I think he is an excellent team member and should serve
admirably in any clinical position in which dedication, sincerity,
and meticulous attention to detail is required.
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

he

New

�</text>
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                    <text>August 2, 1978

Richard Ries, M.D.
Chief Resident

University of Washington— Department of
Psychiatry &amp; Behavioral Science

Seattle, Washington

Dear Dr. Ries,

letter of July

20 raises an interesting question
in conditions outside the accepted use
in endogenous depression. From your note, I would have to assume that
the patients exhibited symptoms usually described as catatonic, for it
is among such symptoms that the most dramatic responses to ECT have
been described. The other situation in which rapid and favorable
results have been described is in acute mania, where some authors
cite rapid results in one to three days.

of the

mode

Your

of action of

ECT

Unfortunately, in my review of the literature, I have
across any systematic review of the rate of response to ECT
and specific syndromes or symptoms. The references to the response
06 catatonic patients is usually part of a clinicll report; or,
is cited by clinicians in lectures. For example, Professor Max
Hamilton, in lecturing at Stony Brook cited the rapid response of
catatonic patients, particularly those with 'pernicbous catatonia'
and referred us to his revision of Fish's Schizophrenia. But there,
we found no data, only a general reference as to the utility of ECT.
not

come

(Arch gen Psychiat. 33: 579, 1975;
1977) and Taylor and Abrams (Arch gen Psychiat.
Bk: 1223, 1977) have written about catatonia and suggested that the
syndrome was more ubiquitous than generally thought. If your cases
follow their reasoning, then it would be valuable to describe their

Amer.

Recently,

Abrams and Taylor

J. Psychiat. l3h:78,

symptams and present a report of the results with ECT. Possibly, some
patients could be continued in pharmacotherapy for an additional three
weeks and some receive ECT for a comparison of the courses under two

treatment sngimens.

I regret that I

have no

other references to assist your

commend your review of your findings from
view as a start. Let me know what you find.

study, but

this point of

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

�</text>
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                    <text>c

“7",,

vur

7...,—

August 3. 1978

Albert J. Silverman, M.D.
Professor 5 Chairman
Department of Psychiatry
University of Michigan
Ann Arbor, Michigan

Deer Al,

It is

easy to write a letter about Oliver Nikolovski.
New York Medical College in 1968
wozked with me for a year at
or 19 9.
He is a well trained European psychiatrist withlsdediceted
enthusiasm for research. He is reliable and carries out protocols to

He

the letter. He is likeable and friendly. He is also obsequious, sometimes
I think to a fault, and obsessive to a degree that made it difficult
for me to work with him. I recommended he work in the clinic at
NYMC and he did a commendable Job until he became restive for advancement.
When Al Freedman did not promote Oliver, he sought fbr a progessorship
elsewhere, and found it in North Dakota. I suggested that he was paying
a high price for a title which would come in time, but he went anyway,
and is now seeking other employment (he froze in ND last winter).

If

you have a

If

you are seeking a

My

best regards.

clinical position in which you seek a reliable,
methodical, careful, unimaginative worker-- Oliver is your man.
researcher, seek elsewhere.
Sincerely yours,
Max

Fink,

M.D.

�</text>
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                    <text>August h , 1978
Nancy K. Hello, Ph.D.
McLean Hospital

Belmont, Massachusetts

Re: William E. PAIN, M.D.

Dear Nancy,

I an pleased to recommend the.proeotion of Dr. Willi-urban
fron.Menber to Fellow of the American College of Neuropeychophernecology.
I heve known of Ed's work since his early publications with Jenowsky
and Davis on a wide range of subsects in psychopharmacology. More
recently, I have participated in a number of conferences which he has
organized and hove come to appreciate his skill as an editor and administrator in getting volumes on the psychopathology end treatment of
different psychiatric states. I particularly appreciated his

volume

on gerentopsychiatry.

is e capable researcher. whose work over the past
reliable. He is clearly among the beet of the young
ho's 'young’ !)
investigetors (to think that one would call someone in theirrecommend
and his contributions are sufficiently well established to
Ed

decade has been
him

for promotion to Fellouohip in the

I an pleased to

commend

ACHP.

his promotion to the College.
Sincerely yours.
Fink, M.D.
Professor of Psychiatry

Max

Fellow,

ACNP, CIR?

�</text>
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                <text>Correspondence to: Mello, Nancy K.</text>
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              <elementText elementTextId="62762">
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              <elementText elementTextId="62763">
                <text>Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).</text>
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              <elementText elementTextId="100161">
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  <item itemId="6275" public="1" featured="0">
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      <file fileId="6439">
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                  <elementText elementTextId="107046">
                    <text>August h, 1978

Lother Kelinovsky,
30 East 76 Street
New York City

M.D.

Dear Lather,
“It,

,,....~,..,_

I have Just returned

the opportunity
reprints regarding our studies of the narcotic untesonists in opiate dependence. I trust these are helpful.

to enclose

some

from Europe and take

A.

Since coming to Stony Brook, I have not carried out

studies of the antagonists. It was one of the surprises
of my move that ve were unable to find a patient population with
opiate dependence in Suffolk County.
any systematic

My

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

1.

"Wm

W”

/

�</text>
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                <text>mfp-05-00-029-3-120</text>
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                    <text>'7’4‘

1“

"meéﬂww‘:

WWWWZ'W'?)U

ﬂaw-u

'u'rw—Vﬂv-‘a ”any

-.

mm... WWW—Wm"

m n-v

max—vmwwmww—wm-w—mw———um.mn

-c

,.

w. . rm .,

..

~ w

-~_,_1,.

,..

.

August 11, 1978

Prof. J.W.

Thompson

Department of Pharmacological Sciences
University of Newcastle upon Tyne
NEL TRU, England
Dear Prof. Thompson,
Having returned from meetings and recovered from the time
warp, I have reviewed your questions. I shall try to answer them as best
I can. You must realize that the answers are not readily available, nor
can I document some of the hunches which I will describe. That is
what has sustained our interest in the problems of EEG and drugs since
1958. The meetings in Basle were the most recent of a long series, and
you should become acquainted with the citations, as well as the latest
publication which Mr. Mateddekkwill issue at the end of the year.

It is clear that there is

no reliable relationship
clinical diagnosis. That is categorical for
all psychiatric states described as 'functional'. The only associations
are those that are well known-— seizure disorders, post-tratmatic states,
mass lesions of the brain, post-infectious states, toxic states. For these,
there are intimate associations between EEG measures and clinical state.
In the toxic states, for example, the association is very high and some

between any

1.

EEG

variable

and

authors have used the EEG measures as an index of decompensation, as in
hepatic and uremic dysfunctions.

difficulty with EEG and depression is based on many
First, the EEG is a measure of the integrity of the CNS at one
moment in time. The diagnosis of depression is a generalization based on
historical, experiential, symptomatic factors as well as the training
and sensitivity of the psychiatrist. It is the most unreliable of diagnoses
with consensual validation less than 50% across cases or studies.It is no
wonder that the sensitive EEG measures with careful quantification bear no
relation to the presnt diagnostid myths.
problems.

The

2. The question of stability of the EEG reflects some
problems with the meaning of EEG measures. The brain is in constant biochemical flux, changing its state for every cell and for the whole basin
in patterns that are related to time of day, waking and sleeping, feeding,
exteroceptive signals, internal changes (anoxia, for example), etc. It is
clear and well demonstrated, that under laboratory conditions, when samples
are taken at the same time of day, with adequate attention to food and sleep,

�. a... ._. .

. .. van...

.. :r'm'ler w.‘&gt;wu
-

,-mn-"-—-an“«aria—n—nquMW'v—u‘gwwv:

.-.—

m»

.7 --

.. -~.—~v--w

-2.
EEG

records are highly stable.

patient's or subject's record
data are derived from the
With

It is possible to identify the individual

when we have a few samples as a base.
many placebo controlled drug studies.

volunteers, the date are excellent.

With

These

patients,

however, since 1958, there has been a dearth of adequate studies in
which placebo controlled EEG records have been taken. We carried out
one such study, 1959—1962, in which patients received on a random basis,
either imipramine, chlorpromazine or placebo therapy for five weeks. The
placebo controlled patient records were remarkably stable, and the data
was feund to be reliable. However, at the time, our principal interest
was in the difference bertwenn the EEG effects of the two active
compounds and the pacebo and so did not assess the placebo trials

independently.

experience, I would have to assume that the EEG for
will remain stable, from day to day, so long as
the behavior, the state of the depression, the feeding and sleep behavior,
remain stable. Instability in any of these factors should elicit a
variability in the EEG. The issue can be turned about. When EEG
From my

a depressed patient

records are repeated, and attention paid to time of day and feeding,
then any changes in the records are likely due to the changes in mood
of the patient.

3. We have not attempted to answer the question about diagnosis,
primarily because I have found diagnostic rubrics to be unstable in time
and

location, highly subjective,

wnd

of

little scientific

value.

Our

emphasis has been on the use of different methods of EEG analysis to
measure drug effects, and here the issue is clear. Any quantitative
method, carefully applied, is capable of reflecting EEG changes induced
by psychoactive drugs. Some methods are more sensitive than others. Thus,
the least sensitive measure is that proposed by Goldstein, that of mean
integrated amplitude. It is an easy measure, widely applied, with some
success in gross studies. The next two methods, period analysis and
power spectral density analysis are almost equivalent in sensitivity,

although period analysis reflects faster (higher) frequencies better than
PWRS, and PWRS is a more accurate reflection of the slower frequencies.
I tend to teach that period analysis is like the low power of my
microscope, and PWRS like the high power. Both are useful and reliable,

for different problems.

h. As to the PWRS, we have used principally the
methods of Tukey using Hanning filter weights.

classic

the present time, it is clear that PWRS examination of
in volunteer subjects is the most sensitive measure of
drug effects in man. Other methods, like sleep EEG, averaged evoked
potential, contingent negative variation, are all less sensitive,
less reliable, and less carefully worked out.
the

alert

5. At

EEG

For

But others claim

clinical diagnosis, I do not believe any are satisfactory.
that the averaged evoked potential (sensory), the CNV, and

�~»

~

,
w.-

rams,

.

,muﬂywrwun.

_

“aw—wr.—.,wn._g. 'r

”we, —,.___,. "a“, ,ijv "mus-WW”.7

.Ww

VarVTW—wmmwnwv-

.

_

.

-3even

the sleep

EEG

this literature

and

are reliable diagnostic tools. I have read
find it unimpressive.

much

of

6. The evidence from Shagass, Itil, Saletu and others on the
for drug assessment indicates that the AEP is an insensitive
measure, unreliable and not easily quantified. For clinical diagnosis,
the issue is far from clear, but as I said above, I am singularly
unimpressed. (In 196h966, Itil and I worked tdgether on the problem
of IEP and drug effects. I found the methods unsatisfactory, and did
not proceed further. He went on with a student, Saletu to study the
problem up to 1973. I suggest you write to him; from the written
evidence, he is unimpressed also.)

merits of

AEP

7. The only recent report concerning slow potentials that
Tecce of Boston, published in the 1978 review of
Psychopharmacology (Raven Press). I was chairman of that session and
heard Dr. Tecce's report-~ it is unimpressive. I have heard that
Dongier has found some diagnostic merit in CNV, but I have not seen

I heard was that of

the published reports.

For the past few years, Fleur—Henry has been publishing

reports that depressive

power of the

of the

and schizophrenic

patients differ in the

data is poorm but a number
of observers have recently confirmed his observations, making is more
important to check his findings. The issue of diagnosis and its
unreliability still remains, but the asymmetry of the brain and its
functional significance will be the subject of a symposium in
Barcelona at the end of August.
EEG

two hemispheres. His

There are also the papers from_your laboratory, asserting
is a realistic and adequate measure of the CNS effects of
compounds. I have read the reports of Dr. Ashton and am impressed with
the careful detention to detail reflected in them. The measure seems to
have the same two—dimensionality of the amplitude integration measure

that the

CNV

of Goldttein. I was surprised that you Ashton was willing to take on
the important issue of EEG dissociation and behavior in a report with
five subjects and in which other methods of measurement of brain function
were not assessed. After all, the principal argument among pharmacologists
regarding brain function measures has been that of 'association' or
'dissociation'. That Dr. Ashton is willing to come out on the side of
the issue with such incomplete and imprecise data is disappointing.
Your record is good and I do hope that you will tackle one
of theiﬂgprtant questions raised by your letter. Good luck !

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

Max

�June 29, 1978

Prof. J. W. Thompson
University of Newcastle upon
Newcastle, England

Time

Deer Prof. Thompson,
'

f
”

Thank you for your letter and the reprints, which
have been very busy trying to complete a
before the summer hiatus and so have not spent enough time manuscript
to answer
your questions directly. I will do so within the next two weeks.

arrived safely. I

reason for writing today, however, is to suggest that
interested in sessions to be held at Basle on the subject
of quantitative EEG, from July 17 to 20. The various students of the
effects of drugs on brain function in man have met on a number of
occasions during the past decage and are constituted in an informal
you may be

The

.

"Pharmaco-BEG Study Group". There are no officers or dues. At the
present time, Mr. M. Mateedek (Pharmaceutical Division, Sandoz

CH-u002, Basie) is the acting executive secretary and has
organized a meeting which will be held at the Hotel International. The ,
sessions are dedicated to methodology and technical issues, the efﬂ‘cts
of drugs, classification, etc. and should interest you.

Ltd.,

1/

F

If you can attend, I think you myy find it most
useful. I suggest to call or write Mr. Hetejcek for further
details.
I‘em glad that you survived our hotels. I trust the ;
accommodation and food is better in EuropI—- at least I hope to find

out again.

My

regards.
Sincerely yours,
Max

Fink,

M.D.

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                    <text>'
‘

Wen'nﬁv’n

was.

r.
-v

August 15, 1978

Docteur Henri Loo
Paris , France
Dear Docteur Loo,

for your inquiry about the report on the
which was presented at the CINP meeting in
Vienna last month. The paper has not yet been prepared or accepted
for publication, and cannot be cited in a review.
mechanism

Thank you

of action of

ECT

However, there are a number of my more recent papers
which you hay not yet have seen, covering the same material. These

include:

Efficacy and Safety of Induced Seizures
Psychiat. l2; 1—18, 1978.

Is

in

(EST)

Man.

ngprehens.

a

Useful Therapy of Schizophrenia ? In: J.P. Brady and H.K.H.
Brodie (Eds.): Controversy in Psychiatry, Philadelphia, v.3.
Sunders Co., 183-193, 1978.
EST

Myths of ﬁahock Therapy". Amer.
EST: A

spldial
Io

Case

235-29“. 1977.

J. Psychiat.

in Pharmacotherapy. In:

ggg; 991-996, 1977.
W.

E. Faun

et al. (Eds.):

inlrnngggnnyof Depression, N.Y., Spectrum Publn.,

:1;.

mu

Wu;

«runaway-“3,“.-

In addition, I have written an extensive review of

"A

Sincerely yours,
away

law-w

17'

‘Wilm:rvml

tamwm

ECT

will be published in January by Raven Press of New York, entitled
"Convulsive Therapy: Theory and Practice". You may wish to refer to this
volume when it is available in a few months.

which

Fink, M.D.
Professor of Psychiatry

Max

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                    <text>August 16, 1978

Prof. Michael Shepherd
Institute of Psychiatry

Denhark Hill
London , England
Dear Michael,

It was kind of you to send me the latest information
additional reviews from the Journal of the Royal
Society. I have used the ECT information in updating my book on ECT,
as I Just completed editing the copy-edited version. The volume will
be out in January and will include citations to July, 1978.
As for Dr. Gildea, I knew him
slightly. When I went
to St. Louis in July of 1962, I had met Dr. Gildea in a number of
on ECT and the

meetings at washington University that spring. He recommended my
appointment ts Research Professor and supported it at the faculty

sessions. Unfortunately, he retired that fall and his successor,
Eli Robins was appointed very promptly. I heard some stories about
Dr. Gildea's stewardship of the Department, but I have no personal
memorabilia. My mentor in St. Louis was Dr. George Ulett and he was
a student of Dr. Gildea's. (He can be reached at Forest Park Hotel
Medical Center, h9l9 Buckingham Court, St. Louis, Missouri 63108).
It was through him that I met Dr. Gildea.
Dr.

now

Professor

The
&amp;

other student of Dr. Gildea's

Chairman of

the Department at

was Sam Guze, who

Washington University.

is

I have not yet seen the review of the hashish book in
Psychological Medicine, but I look forward to it.
My

best regards.
Sincerely yours,

«v
-

gut,

Fink, M.D.
Professor of Psychiatry

Max
_,

\

�</text>
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                    <text>August 16, 1978
Mme.

Dahin Herbillon

Bruxelles, Belgique

Dear MEI. Herbillon,

I regret that the proceedings of the 1978 meeting in
Vienna are not available as yet from the various authors. They are
requested to submit their manuscripts to the editors in Vienna by
the end of September, and I do not have copies from them.
However, you may wish to obtain copies of some recent
on ECT which I have written to start you on your effort. The
following are recent summaries which may be useful.

reports
CNS

Sequellae of

Shagass, C.

N.Y., Raven

EST: Risks

of Therapy and Their Prophylaxis. In:
and Brain Dysfunction,

et al (Eds.): Pszghopathology
Press, 223—239. 1977.

Special Case in Pharmacotherapy. In: !.E. Fann et al. (Eds.):
Phenomenology and Treatment of Depression, N.T., Spectrum Publ.,
285-291., 1977 .

EST: A

Myths of "Shock Therapy". Amer.

J. Psychiat. l3hz991-996, 1977.

Efficacy and Safety of Induced Seizures in

Is

EST

Man. Cogprehens.

Psychiat.

a Useful Therapy 6f Schizophrenia ? In: J.P. Brady and H. Brodie
Controversy in Psychiatry, Phil., W.B. Saunders Co., 183-193, 1978.

(Eds.):

In addition. I have Just completed an extensive review of
convulsive therapy and the volume will appear in Jabuary. It will be
published by Raven Press in New York and will be the most extensive
review available. If you can wait for it, I think you will be satidfied
with the documentation of the facts about convulsive therapy.
My

regards to Dr. Mendlluicz.
Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

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                    <text>September 12, 1978
Daniel L. Crane, M.D.
Ayerst Laboratories
New

York City

Dear Dan,

Yﬁunrletter reminded me that we had put the papers you
requested aside for you in anticipation of your visit en route
to the South Shore. In addition to the records that were
asked for, I am returning the remainder of the drug supplies.

We

have none on hand now.
My

best regards;

Sincerely yours,
Max

Fink,

M.D.

�</text>
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                    <text>September 25 , 1978

St. Clair, M.D.
Fincastle Building
Louisville, Kentucky l$0202

Harvey
319

Dear Harvey,

‘

ECT at this
in a number of reports
available to you in the
next few months. The Task Force of the APA completed its report in
the spring and it will be published in November, edited by Fred
Frankel. The NIMH held its conferenece in February and its report
is due early next year. And I have written an extensive review of
my experience with ECT and this will be published in January by

It is

funny you should ask about

time. The answer has recently been written
which are now in press and which should be

Raven Press under the

Practice".

title:

unilateral

"Convulsive Therapy: Theory and

In each of these reviews, the conclusions are the same.
efficacy of ECT is related to the frequency and number of
seizures induced in the brain, and not to the mode of induction.
Thus, there is good evidence that the clinical efficacy for unilateral
and bilateral ECT is the sine. There is one problem with unilateral
ECT, however, and that is that missed seizures are more frequent.
The amount of current necessary to induce a seizure with unilateral
electrodes is significantly higher; high enough for some therapists
not to elicit a seizure for each application. Since many present day
therapisys use barbiturate-suecinylcholine anesthesia, the seizure is
masked and there is a mistake possible when the therapist does not
monitor the duration of the seizure using one of the estabilshed
monitoring methods: blood pressure cuff inflated befbre Anectine,
EEG or EMG.
The

indicated, there is excellent evidence that memory
effects are significantly less after ECT with unilateral nonOdominat
As you

ECT

than after

remains

bilateral ECT. Therefore, the treatment of choice

unilateral non-dominat

ECT.

If

you wish a recent published review before the new ones
you see the chapter by d'Elia in "Psychobiology of
Convulsive Therapy" edited by Fink Kety, McGaugh and Williams,
Washington, D.C., V.H. Winston &amp; Sons, lQTh.

appear, I suggest

I trust this is helpful.

My

regards.

�</text>
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                    <text>3%;
September 25, 1978
Robert

G.

Professor

Heath, M.D.
&amp;

Chairman

Tulane university School of Medicine

New

Orleans, La.

70122

Dear Bdb,
Thank you for sending me a copy of the preprint describing
recent
findings in primates smoking marijuana, and the kind
your
comments on the 1961 discussion of your work. I thought then, and

still

most

believe, that you and your associates
original and intrepid investigators in

then are

still

the

same

today.

have been among the
America. My kind views

However, in some issues, the data that you present is
inconsistent with those produced by other observers and the
source of the inconsistency has to be found. I have stated in
the past, and still believe, that the principal findings of the
toxicity of cannabis smoking is to be found in examinations of
the users. They, alone, have the experience from which we can derive

a

realistic estimate of toxicity.

artificial

The smoking by primates, under
conditions can, at best, provide clues as to what systems

should be examined.

I have dedicated six years of effort to examine the effects
of cannabis in volunteers in New York and chronic users in Athens.
My experience is extensive, probably as extensive as any of the
younger invetigators writing today, and as I wrote in a number of
reports, including the final section of the volume Hashish- Studies
of’Longhterm 033, published by Raven Press. I commend the section
to you for the best opinion that I have on the subject.
As your

letter reflects, the issue is

no longer one of

fact or science, but of emotion and politics. I regret that you have
seen fit to allow your name and work to be used in the public press
and that you have sought to enjoin in public argument. I have not
followed this road, as you well know.
Indeed, I have stopped my

work in cannabis since leaving the New York Medical College (1973).

�Robert

Heahh, M.D.

G.

controls

.......

September 25, 1978

.......

page 2

I have read your report and remain unconvinced. What
for the readings in these monkeys ? Is there

do you have

a population of monkeys that have smoked tobacco under the same
conditions ? That seems to me to be an obvious control. Another,

what of monkeys that have smoked THC free material ? If the
slides are mixed between control monkeys and those exposed to
cannabis, what is the frequency of identification that an
observer can make of the effects that you cite as the result of
cannabis smoking 7 What evidence is there from studies in man

of these findings

of

some

you.

?

In any case, I am honored that you think my opinion is
It is kind of you to send me the reports and I thank

merit.

As a matter of record, I have spent the past few years
reviewing my studies of ECT and have Just written an extensive
review of the problem, which will be published by Raven Press
of New York in January as convulsive Therapy: Theory and Practice.

In reviewing the extensive literature and assessing the data,

it

has been possible to develop a reasonable theory of the mode of
action of ECT; It is clear that this major treatment is an analog
of pharmacotherapy and that its action is not dependent on any of
the physical elements of the treatment but purely on the biochemical
changes induced in the brain. It has been a surprise to me that the
leaders of the Society of Biological Psychiatry and other august
societies have shunned this treatment. I have learned much from
the assessment and I hope that you will have a chance to look at

the volume

when

My

it

appears.

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

Max

�</text>
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                    <text>W5
I—»

¥1

,’

v-

("

MWwW

September 26, 1978
TO:

HON.

Mr.

Justice

Royal Commission
New South Wales
FROM:

Woodward, Commissioner

into

Drug Trafficking

Fink, M. D.
Professor of Psychiatry
School of Medicine, State University of

Max

I

am

New

York

at Stony

pleased to respond to the invitation to discuss

with dependence producing drugs to assist the Commission in
regarding the trafficking of proscribed drugs.

My

its

my

Brook

experience

recommendations

experience is based on

a six year study of the pharmacologic effects of cannabis and cannabis

derivatives, both in volunteers in the U.S.

and

in chronic users in

Athens, Greece. I have also studied the efficacy of narcotic antagonists

in the treatment of opiate dependence. In these studies, begun in

1966

and continued to 1973, I have administered heroin, methadone and levomethadyl

to opiate dependent subjects;

and examined the pharmacologic

interactions of the narcotic antagonists cyclazocine

effects

and

and naloxone with

opioids.

I am.Professor of Psychiatry ate the School of Medicine at the
State University of

New

York

at Stony

Brook. At the time of the

studies

discussed today, I was Professor of Psychiatry and Director, Division of
Biological Psychiatry at the

to the National

New

York Medical College; and a consultant

Commission on Marihuana and Drug Abuse,

the Veterans

Administration, and the National Institute on Drug Abuse.

‘

�this time permit

At

me

to

make

a number of generalizations

about the pharmacology of these compounds. There

distinction between opioids
apparent in the studies.

administration of the opioids, even under

controlled conditions, is fraught with risk.
into stupor

Our

and evinced grand mal convulsions

which we deemed safe

an important

is immediately

and cannabis which

The

is

subjects have fallen

after dosages of heroin

for the individual. Seizures occurred in three

suffiently striking for us to report it
in the scientific literature. In my clinicial experience, three patients
subjects, a finding that

was

died on our wards after opiate overdoses. In two instances,

antagonist.
and

and administered naloxone, a proper

the proper diagnosis

made

But our dosages were not sustained with

the subjects died during the night.

on our ward. He was
some

A

Such

programs in

tales are

New

common. There was a

still

new,

city, It

was

York were

almost every day in the

a young addict achieviaggthe age of

that

A

we

young man

visitor passed

The dose was

anticipated (or his tolerance had been reduced
died during the night, on a medical service.

narcotic

methadone was drug-free

to be discharged the next day.

heroin which he injected that night.

had

sufficient frequency

third instance, a

detoxified by decreasing doses of

who had been

we

him

higher than he

by our treatment) and he

time, when the methadone
read of a methadone death

said then that the likelihood of
30

if he were taking

opioids at the

age of 21 was less than ﬁne in ten.
By
We

contrast,

we

have found cannabis to be

relatively benign.

have reported the central nervous system effects in

as well as the development of

its administration

tissue tolerance; but the principal effects

�-3in_the cardiovascular and nervous systems are well tolerated, well
within the ability of most subjects to accept and survive.
For

this difference alone, the response of Society to cannabis

ought to be different than the response to opioids.

In the studies of long term users of hashish in Athens,
were

struck by their focussed interest

on cannabis (hashish). Despite

the fact that they had used hashish for more than

interest in
smoke

we

and experimentation with opioids was

20

years, their

insignificant.

They did

tobacco in large quantities and did use alcohol. In no instance

to

were we able

document

the

combined use of hashish and opioids. While

such obserbations are not compelling, they do suggest

that the connection

is probably not inherent in the pharmacology
of the drugs, but in the propinquity of the distribution systems. If one
is looking for a synergistic use of drugs, we can suggest that cannabis
between opioids and cannabis

'and tobacco are

clearly used together

Perhaps the most

antagonists.

3

When

/

I

first

by long-term

users.

interesting studies are those with narcotic
became acquainted with

the subuect of opiate

dependence, four competing theories of treatment were current: abstinence

after detoxification, abstinence in the

framework of group therapy,

cross tolerance to methadone, and blockade by narcotic anttgonists,

chiefly cyclazocine. Abstinence after detoxification

was a temporary e

expedient with an unacceptable relapse rate; abstinence in a group therapy

setting

was

helpful to a very small

to implement.

The

sample of users and very expensive

principal treatments

antagonists. working with

were methadone and

methadone and

its

the narcotic

long acting analog, levomethadyl,

I found these regimens of limited usefulness. Proper use of

methadone did

not preclude the use of other drugs such as opiates, barbiturates, alcohol,

�and cocaine, and
methadone

these drugs

into the

some

find

extensively. Spillage of

additional source of opioid deaths

community was an

and dependence. we did

in

were used

substitution useful

methadone and levomethadyl

patients, but our successes were

few

--- too

few

or to be considered a success in relation to our costs.

to be gratifying

Our

greatest

energy was dedicated to cyclasocine therapy, which I thought was a

logical treatment
detoxified

and

this regimen, patients are first
in a drug-free state, are gradually

and prophylaxis. In

after a

few days

introduced to single daily doses of cyclazocine. This narcotic antagonist
has a long duration of action and after a few weeks, single doses of
four to five

mg

are sufficient to block the effects of

heroin for more than

2h

hours. Thus, patients

who

up

to

are on a maintenance

dose of cyclazocine have no euphoria or sense of well being

heroin and

we

25 mg

after

believed that this negative reenforcement would lead

to disuse of heroin

and eventually

to

an end of dependence. But we

found many problems with the treatment, the principal one being the
5

2

.;

need for voluntary comjliance by the subject

daily for a

number of

years,

and few

---

he must take the medication

patients are so cooperative as

to complete a satisfactory treatment course. Lately, other antagonists have
been studied, the best known being naltrexone, which is safer and easier
to use than cyclazocine. The reason for raising the question of the
antagonists is the perspective they give to the medical management of

opiate dependence -— there are

ways

to treat dependent subjects but

each method ultimately depends on the cooperation of the subject,
something

that is difficult to achieve.
These experiences with users have made me

our

ability to solve the opiate dependence problems

pessimistic about
by

present medical

or legal means. Opiates are dangerous substances and they should be

�-5controlled in their distribution.

One wonders, however, whether

driving

users to the streets has been successful, and whether relaxing controls for

greater medical usage

may

not have

some

benefits. I

am

acquainted by

reading only with the mixed picture presented by the English regulations

for the use of opioids, and despite their difficulty, on balance I think
that they are more sensible than the laws in New York, where phsyicians
are enjoined from using opioids other than for methadone maintenance in

established clinics. I think the present rules
away from any

the

illicit

experience with opioids and

have driven most

made most

ptactitioners

users dependent on

marketplace.

Finally, the

most extensive experience

I have had is with

chronic users of hashish in Athens. There, a team of scientists from the
New

York Medical College and

to study a group of
The

worked

together

h? hashish users and a matched sample of

controls.

users were the survivors of a larger sample of chronic users of

hashish which
‘

the University of Athens

at the

was known

to the scientists at the University of Athens

end of the second World War.

We

found

that the users

showed

little

toxicity -- they were no different from controls in medical
or neurologic status, or in tests of brain function. There were some
differences in psychologic tests which seemed related to their education.
evidence of

individuals

classify as psychopaths -they were willing to flaunt the law for gratification of their senses.
We did find that they had developed a tolerance to the pharmacologic
But they were

effects of cannabis.
150

mg

we

would probably

They could smoke hashish containing more than

THC-delta—9 and develop

greater than the effects of
doses (over 100

mg

in naive subjects.

10

euphoria and cardiovascular responses no

to

20 mg doses

in our volunteers.

Such

THC-delta-9) are known to cause vascular collapse
we

attempted to demonstrate withdrawal symptoms, but

�-6the subjects were willing only to remain under our care for three days
without smoking cannabis. In this time, we could not demonstrate the

classic signs of physiologic withdrawal, but then, perhaps, their

inability to cooperate was in itself a symptom of withdrawal.
The conclusions of that study were many, but the principal
one was that we had failed to find evidence of toxicity for cannabis use.
Similar dindings in CostarRica and Jamaica reassure us that our
very

observations were not spurious. Further studies of this nature were
reported at the conference on chronic hashish use held in 1976 at
the

New

York Academy of Sciences (volume 282).

These are

my

experiences. I have lectured often on the

problems of cannabis use, and I have come to believe

that the greatest
risk in my community from the use of cannabis is the risk of legal
penalties and imprisonment. There is also a risk of other substance use,
since the present distributors of cannabis are acting in defiance of
the law, and they seem as willing to

sell

cocaine, and other abuse substances as to
which

legalized alcohol

and medical

risks

-—

and tobacco

same

on

distribute opioids,

sell cannabis.

A

society

substances with well defined toxicity

should legalize cannabis as well. For consistency,

prescription of cannabis should be
and alcohol;

-—

and

accompanied by

legalization of the latter

proscription of tobacco

two drugs should lead

to the

treatment for cannabis. There is no other rational position based

the available evidence.

�</text>
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                    <text>‘

ﬁé/ﬁm‘hm

”September 28 , 1978
Dear Gunther,

I regret that

did not find the time in Vienna or Sasle
to go over your program in detail, so I have had to write a more general
letter than perhaps is needed to convince a committee to give its
support. However, I have written the recommendation as strongly as
I could, and I hope it is helpful.
As

I

we

have been on the grant giving end of

things for a

number

not sure that such testimonials are very helpful. It is
still best for the commission to enquire of consultants, on a confidential
basis, for the advice of consultants. Perhaps they have already done that.
of years, I

My

am

best regards.
Sincerely yours,
.Max Fink, M.D.

Professor of Psychiatry

~

24'-

“am-“V

rm::v-'mwv.-,-v.-»-v.vm—

:
&lt;

r,"-

urn-w

swat

"-

70*“

a,~
farm

/

�</text>
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                    <text>Fix

October 1h, 1978
Michael L. Grozier, M.D.
Knoll Pharmaceutical Co.
30 N.

Jefferson

Road

Whippany, NJ 07981
Dear Mike,

Thank you for sending me the copy of the therapeutic notes
on Metrazol and the reference list. In checking with my files, I find
that I have quoted and referenced most of the articles dealing with
my forthcoming book. It was helpful to
as an independent check on my scholarship.

psychiatric treatment in
have the

list

It is of interest that this publication fails to cite the
seizure therapy use of Metrazol. The citations are up to l9h6, so I
estimate that by that time this use of the drug had ceased, reflecting
the greater ease and safety of ECT.
The volume "Convulsive Therapy? Theory and

Practice" will appear

after the first of the new year, from Raven Press in New York. I
think you will be pleased with the Metrazol citations and discussion.
soon

There are some suggestions as to the usage of Metrazol in the treatment

of

some

patients today.
My

regards.
Sincerely yours,

'::'u;.,.;

a:

WN-Mg.

92"".

M1,!

v-1351Flh9;“§_lﬂ2m;w¥“jﬂ"~“I“

n.9,,”

q

wen“

A»

‘An-viwﬁf—lv

V»
.«rﬂ

Fink, M.D.
Professor of Psychiatry

Max

�</text>
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                    <text>r W;
October 20, 1978

Alick Elithorn, M.D.
Royal Free Hospital
Pond Street
London NW 3

FRCP

2QG

Dear Alick,

It

was good to hear from you, and especially that you are
putting together some work on ECT. I have spent the last few years
previewing the studies which I first began in 1953. and have completed a
book, called "Convulaive Therepy— Theory and Practise" which will be
published in January by Raven Press in New York. I enclose s reprint that
you requested end some preprints from other reports that have either been
published or are in press on the same subject.

I

most pleased with the progress made in our understanding of
and
I an optimistic that many improvements in the treatment
process.
are both feasible and will surely be seen in the next few years.

ECT

am

also wish to look for the report of the APA Task Force
report of the group, chaired by Fred Frankel,
will be issued later this year by the APA in Whahington.
You may

on Eonvulsive Therapy. The
My

best regards.
Sincerely yours,

‘

Fink, M.D.
Professor of Psychiatry
Max

the

�</text>
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                    <text>r W;
October 20, 1978

Alick Elithorn, M.D.
Royal Free Hospital
Pond Street
London NW 3

FRCP

2QG

Dear Alick,

It

was good to hear from you, and especially that you are
putting together some work on ECT. I have spent the last few years
previewing the studies which I first began in 1953. and have completed a
book, called "Convulaive Therepy— Theory and Practise" which will be
published in January by Raven Press in New York. I enclose s reprint that
you requested end some preprints from other reports that have either been
published or are in press on the same subject.

I

most pleased with the progress made in our understanding of
and
I an optimistic that many improvements in the treatment
process.
are both feasible and will surely be seen in the next few years.

ECT

am

also wish to look for the report of the APA Task Force
report of the group, chaired by Fred Frankel,
will be issued later this year by the APA in Whahington.
You may

on Eonvulsive Therapy. The
My

best regards.
Sincerely yours,

‘

Fink, M.D.
Professor of Psychiatry
Max

the

�</text>
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                    <text>mrm-wmnn-mmmr

October 28, 1978
Mr. Milan Matejcek

Sandoz Ltd.
h002 Basle, Switzerland
Dear Milan,

I received your letter dated September 22, I arranged
redrafted and I believe I have followed each of
to
the instructions but one. I would appreciate your translation of
the abstract into German, to meet the standards of scientific
When

have the paper

translation.

The only question from your second letter that is confusing
of
is that the designation of left occipital-vertex leads according
to the International (10-20) placement. I enclose a copy of the
drawing which we have used for a number of years, which indicates
that 01-02 is correct for left occipital—vertex leads.

Please excuse the delay which
during the past month which have taken
Atlantic a number of times.

was occasioned by my
me

travels

cross contry and cross

I look forward to the publication. In the meanwhile, I
have put my hand to a draft of a report on clozapine which still needs
much work. I will send you a draft when it is available. I am becoming
convinced that our EEG profiles are more compelling, in the light of
the ancillary clinical and pharamacologic evidence, that the clinical
Judgements that clozapine is an 'antipsychotic' are probably wrong.
It is indeed unfortunate that clozapine has been withdrawn for in
the clinical marketplace, it is likely (I believe) that the practitioners
would have rejected its antipsychotic designation and found its utility,
which was seen
if at all, in depression.andThat was the fate of doxepin
of
experience, was
the
marketplace
only in
first as an anxiolytic,
EEG
had
designation
determined
the
(after
its antidepressant activity
been made, I must add.)
My

regards.
.

x

Sincerehy yours,
\

\
1

\

Fink, M.D.
Professor of Psychiatry

Max

�</text>
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                    <text>May

Merrill T. Eaton.
Nebraska

1, 1978

M.D.

Psychiatric Institute

University of Nebraska Medical Center
602 South 45th

mm.
Dear

Nebraska

Street

68106

Merrill:

Don Swanson-Joined our facllty about l974 as a psychiatrist
in the Research Unit at the V.A. Hospital at Northport. He
exhibited skills of a well trained psychiatrist and assumed
responsibilities for the patients and the projects then ongoing.
He was interested and did a commendable Job. At the time however
the V.A., in one of its periodic episodes of conscience, restricted
the activity of all physicians who did not have a state license.
Dr. Swanson found that his activities were so severely restricted
that both he and I agreed that he would do better for his good to
process licensure immediately. He correctly felt that the demands
were excessive and returned to South Africa.

that he worked very well, and that his skills were
suitable to our needs. I regretted his decision and recommended
his reappointment when and if he decided to return. I believe he
is a skilled physician and should do well in any position requiring
clinical ability both in-patient and out-patient. we had no
opportunity to determine his skills as a teacher, but I would be
willing to take a chance on that score as well.
I found

I am

r

pleased to

recommend him

to your.
Sincerely yours.

i
§

Max

Fink. M.D.

Professor of Psychiatry

Mszac

�</text>
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                    <text>I

35M

May

Lorrin

r

Koren. M.D.

Acting Associate Professor
E

,’
iii

M;

4. 1978

;»

g

A

Stanford University Medical Center
Dept. of Psychiatry 5 Beheviorai Sciences
Stanford. Ceiif. 94305

Dear Larry:
I have not heard from the Ad Hoc Committee appointed to
review your eppiicetion for appointment. Are you sure that
you
don't want me to write a letter on your request?

If yes, send

me

appropriate committee.

the

name

of the

dean or chairmen of the
My

best regards,

Fink, M.D.
Professor of Psychiatry

Mex

Mszec

�</text>
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                    <text>rnw-V=—‘

r.

«cw

vw-M».

”Q.

_

..,.._.

:"‘-,Q;w,ug~w’m4I“V-‘VIV\

w.” w

H...

,.

- M”, .nz-n—r- m-L'r
.

.. ~

,

.

.

——.~w-mw—.~v am

“7"?"—

3.8%”

May

n, 1978

Werner Herrmann, M.D.

Schering

Berlin,

AG

Germany

Dear Werner,
The two

citations in your recent letter are not

available as reprints.

The report in the Drug Information Bulletin was published
in the volume Pharmacokinetics, Blood Levels and Clinical Response,
edited by L. Gottschalk and S. Merlis, Spectrum Publications.
New York (2u3—2so), 1976. A summary of the findings was also
presented in the 1976 volume edited by Matejcek and Schenk of the
proceedings of the second Vevey conference.

report by Glasser et al.
and has not been published.

The

satisfaction
other in

Good

was

never completed to

luck in your studies. I hope that

Vienna and perhaps in Basle.
My

we

will see each

regards.
Sincerely yours,
Max

Pink,

M.D.

my

Professor of Psychiatry

�</text>
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                    <text>1-.

May

51”“

5, 1978

Nancy K. Hello, Ph.D.
McLean Hospital

Belmont, Massachusetts

Ref: Jovan Someon,

Dear Nancy,
Simeon

to

I

am

M.D.

pleased to recommend the 'promotion' of Dr. Jovan
of the ACNP.

Member

I have

known

of Jovan's work since 1965

when he came

to

at the Missouri Institute of Psychiatry. His early training
was dedicated to the problems of adult psychopharmacology and he
carried out numerous studies of the clinical and laboratory effects
of compounds. His interests soon focussed on the problems of
join

me

pediatric psychopharmacology and since 1970, his emphasis has been
in the assessment of the effects of compounds in children.
He

has made some important methodologic additions to

the usual assessment, defining the importance of videotape recording
and analysis, and of the evoked potential in assessing drug effects.
His recent interest has been in the effects of cromolyn sodium on
hyperkinesis-— an innovative and novel approach to the problem of
the definition and treatment of this commpn disorder.
He has assumed responsibility for the clinical and
research programs in pediatric psyuhopharmacology in Ottawa. In a
recent visit to his center, I was impressed with the variety of
studies underway, and the enthusiasm and training of his associates.
His contributions to date are listed in his c.v.; his future contributions

should be most helpful in this difficult
and I recommend him highly for promotion

area of psychopharmacology,
to Membership status.

Sincerely yours,
2.
v

.r.

,a-VWl-D-Ilmr‘ﬂtlinw

Pink, M.D.
Professor of Psychiatry
Max

Fellow,

ACNP

�</text>
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                    <text>.v,w...1.vAw..-u.--~v-

a.

w.

,

.wv

«,

;

\w~

3M w van-p m_-‘“u- rum-mv‘m

4nn-.V-Iv'--

V-

v

,-

~

_.‘~‘ may
»m,-mmu.w.m—w—r--,

._

.

.....~,- ~.

.

v...

“7“", r

.,..,.

.

....

Ely 5, 1978

Neil

B. Schofield, H.D.
Flaker Drive
Wykoff, N.J. o7u31
M16

Dear Dr. Schofield,
The question of fractures after ECT has not been
assessed recently. Neither in the Task Force Report nor in the many
recent reviews, has the issue been raised. Perhaps. because the
problem seems to have been solved by the introduction of succinylcholine. There are a number of studies assessing the impact of
succinylcholine on practice, but these appeared soon after the
first papers on the drug, about 1963. The ninth meeting of the
Electroshock Research Association in 1953 discussed the effects
in some deeail (Confinia Neurologica 132313 ff, 1953). Some reports
are cited by Kalinowsky and Hippius, but these are not well

documented.

The

best reports comparing modified

and unmodified ECT

are those of Havens (1958) and Huggins, Sandifer and Pearson (1969).
I would start with those as the baseefor any studies now.
I

am

sorry that I cannot be of more help, but the topic

has not been covered recently.
Good

luck.
Sincerely yours,
Fink, H.D.
Professor of Psychiatry
Max

3‘:

.wnz;

w.»

.

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                    <text>May

11, 1978

Paul Satz, Ph.D.
Department of Psychology

University of Florida
Gainesville, Blorida
Dear Paul,

I have had the time to read your interesting report
it should be published. While I would consider the
standard neuropsychological journals, I will suggest that you may
want to place it in a journal dedicated to drug problems such as
"Contemporary Drug Problems". The audience is the legal profession and
those sophisticated drug research specialists who have an interest in
behavioral variables. I have published in the journal on a number of
occasions and know the editors, who would (I think) be interested in
the review. (Laurence London, 2” West Terrace Road, Great Neck, NY
and do

believe

11021).

I found the summaries of the studies well done and
the report interesting. If I were to critique the Greek summary (since
I know it best), it would be to indicate that we dedicated a lot more
effort to the EEG testing and it was this component which complements
the other brain tests in other studies. The translation of the EEG
data is not too difficult—— we found that the resting BEG records
of users and controls were the same; that the effects of cannabis,
even in high doses, altered the EEG patterns transiently; that the
patterns were similar to the effects of acute use in lower doses, but
lasted longer. However, when the EEG records were examined after a few
days of abstinence, no abnormalities or drug effects were left. In sum,
cannabis produced a transient CNS effect (toxic psychdsis in a technical
sense) whcih had no long lasting component. Similar to the psychologic
tests. The very absence of the findings in our study, and in the other
studies is the remarkable fact. Like the stony by Conan Doyle, the
significance of the dog's not barking was the critical clue-- the
absence of neurologic and neuropsychologic effects is the important clue.
You could emphasize these more.
Thanks

for the chance to read the review.

Good

Sincerely yours,
Max

Pink,

M.D.

lucﬁ.

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                    <text>*W‘awm"r'wvacwmww ‘13Wm”? menu—w:

,

May

13, 1978

Niroo Gupta, M.D.

Bndo

Laboratories

Garden City,

New

York

Dear Dr. Gupta,

recollection, the studies with
prior to 1973. When I left the
New York Medical College, at that time, there were no supplies
available and all the publications were completed.

naloxone

in

my

tablets

hands

naloxone.

To

the best of

my

were completed

In any case, there are no supplies of naloxone

at this time; nor in I carrying out

any

tablets

studies of

»

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�</text>
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.w»....

‘/'

1;-

.W.

._W,

,—
&lt;

-.

x»

”we

—m-,n..y

W

‘z'n'vw

WWI-curv-

mmm

“W

May

”WW

r"

13, 1978

Edward Hanin, M.D.

St. Vincent's Hospital
Harrison, New York
Dear Ed,

I am pleased to write this letter in support of the
application for hospital privileges by Arthur Zaks, M.D.
Arthur was a resident in psychiatry at the New York
Medical College about 1968-70. He undertook clinical research into

the mode of action and utilization of narcotic antagonists and
opioids in the treatment of opiate dependdnce, and following the
completion of his training continued as a member of the Department
staff. His research included the assessment of methadone and
levomethadyl in opiate dependence, the use of heroin challenges,
and the use of naloxone in the management of opiate overdose and
as a possible treatment method. He has published extensively.
In this work, he was diligent, responsible and a most
capable clinician. After entering private practice, he continued to
carry out research projects with NIMH support, the last continuing

to

my

knowledge

until

1976.

is an able teacher and an outstanding clinician. I
without reservation.

He

recommend him

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

Max

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                    <text>mku‘vynwu

u

,
,...-wdw_m.__:,,wjr—_.(raw—r...k,V-.—-v.‘,-,w
_

V

rwsaqmm—n—mm

alum

”aw :g-w

1""

W"

wer'&lt;"'ﬁ~'

“we

I'r-QJI-

May

v
1

15, 1978

'12-:

Roger Meyer, H.D.
WWI/"'37

University of Connecticut
75 West Uplands Drive

Hartford West, Eonn.
Dear Roger,
my

It

best wishes

was a

pleasure to speak to you in Atlanta, and

on the success of your

clinical center.

Enclosed is the report on DH-52u, an interesting
compound which has CNS activity in our screen, and which seems
to us to have some special merit in studies of alcoholism. The

by Mendelson is cited, and it is the only negative report.
the least, trials in patients will tell us whether tolerance to
the cardiovascular effects occur and if sow other applications
could be sought.

report

At

My

regards.
Sincerely yours,
Max_Fink, M.D.

�</text>
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                    <text>q».

Mew

25. 1978

Dr. Margo Nedien

Social Seienoes Division

Fordhsm

university et Lincoln Center

Lincoln Center,

N.

Y., N.Y. 10023

Dear Dr. Nedien:
Mr. Gillespie, e student at S.U.N.Y at Stony Brook. is
scheduled to receive his Ph.D. this week. His work here has
been exemplary end he has completed his studies with skill.
-

My

acquaintance

is limited to hie-pertioipetion in

my

seminar on "Brain end Behevior". end his work Iith e peptide,
ACTH h-lo.
In the seminar, he was an interested and active
participant, and completed his assignments well. In the study
of ACTH 3—10, he examined the effects on attention and learning
in monkeys. Again. the work was done with care but the results
failed to show e drug offset.
.

He

V

is a skilled experimenter and I

position in which his

skills

may be

recommend him

useful.

for a

Sincerely yours,

MFahec

M31

Fink,

M.D.

�</text>
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                    <text>May

19, 1978

Alfred
New
New

M. Freedman, H.D.
York Medical College
York City

Dear Al,

I

trust the

food and wine.

meetings in Paris were as good as the

While you were away. Dr. Tai (? sp) called from Stamfbrd
with
an interesting question. What criteria should be
Hospital
who on the staff is accredited to administer
decide
applied to
ECT ? The same question was asked a few weeks earlier by the
physitian in charge of New Rochelle Hospital.
The Task Force report does not make a specific recommendation.
consider a request to the American Board of Psychiatry
did
but
and Neurology to establish accreditation criteria. As I recall the
discussion (as told by Fred Frankel) of the first Trustee review,
we

this item

deleted.

was

personal suggestions to Dr. Tai, indicating
standards of accreditation that were applied at his
hospital for physicians carrying out similar difficult skills in
treatments that carried similar risks (e.g., anesthesia, surgery)
should be applied for physicians requesting approval for BOT:
evidence of preceptorship, a number of treatments,given under his
control, knowledge of the principles of BCT, and skills at treating
Since criteria of this kind have
the emergincies of the treatment.
not been applied heretofore, I suggested he may want the umbrella of
your Departmental recommendation. If he should get in touch with
you, this note will explain the basis for his seemingly odd request.

that the

I

made some

same

My

regards.
Sincerely yours,
Pink, M.D.
Professor of Psychiatry

Max

�</text>
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                    <text>I:
May

/

26, 1978

Dear Ms. Lamb,

I have read the responses to the letter of Dr. Kaiser.
In the juxtaposition and editing, I found a few places where the
meaning has been altered and I commend some corrections to your

attention,

which I assume you

will accept.

I have also indicated some questions raised by the
Dr. Claghorn. I believe
is filled with errors and
I do hope that you will check the questions with him. It would
be unfortunate if your journal, afar a useful beginning, were
to give voice to unproven and undocumented allegations, opinions
and experiences. I am sure that Dr. Claghorn knows better, and
a little encouragement will get him to clean up his sections,

letter of

it

I hope.

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

Max

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                    <text>M,

—,r.

“WW",

..

_...

war-w

June 6, 1978
Donald F. Klein, M. D.
York State Psychiatric
722 West 168 Street N
New York City

New

Dear Don,

w...,.,...e..

Wow,

Thank you

for the corrections of the Hillside data.

this juncture, I cannot recall for sure what the question was
to which the answer was incorrect, but I do recall the data, more
or less, as you note in your letter. Whatever the effects were,
and we were impressed with the antidepressant activity of
At

chlorpromazine plus procyclidine, the marketplace, and our own
we were not that impressed with
the effects. I think what I tried to say was that if antipsycotic
drugs are active as antidepressants they must do so on some subset

activities since, indicate that

if at all.

of patients,

As you note, our failure to find a difference between
imipramine and CPZ was interepreted as an antidepressant action for
CP!. I guess we would be more cautious about that interpretation

now.

In any case, I thank you. I do believe that on toxicity
alone, mianserin deserves a rapid and determined appraisal in this
country. If it is true that it is antidepressant and if its cardiac
and anticholinergic effects are indeed lower, we should use it in
preference to the present TCAD. Good luck in your study.

I

Awe,

——-v._v-",_,..‘m"--

Institute

am

commiteed to writing a summary for Psychopharm.
done.
30, so will send you a copy as soon as

it

Bulletin before June
especially

Take good care of Geeg Asnis. He may be a
nurture him.

if you

Sincerely yours,

”(w

i-

pawn-v,

‘I-v'lv!

cm-‘r‘rﬂlﬂ

w-

n-

1

wwuwvw

scientist yet,

Max

Fink,

M.D.

.

�</text>
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                    <text>"nu-Ink"

7m:

WW

June 7, 1978

mmuﬁm,mm

Department of Psychiatry

Vanderbilt University
Nashville, Tennessee
Dear Tom,

Thank you for the copy of the Psychopharmacolqu of
Thiothixene, which arrived today. I had some time to go through
it and it seems like a complete review of the pharmacology of
this interesting compound. I am sure that it will be distributed
widely and should do much to help in the assessment of this

compound.

My

regards.
Sincerely yours,

Fink, M.D.
Professor of Psychiatry
Max

�</text>
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                    <text>«"w-‘u‘. a. «m.

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May

31, 1978

Baron Shopsin, M.D.

Department of Psychiatry
York University College of Medicine

New

550

New

First
York

Avenue

City 10016

Dear Berry,

Enclosed is a revised and up-dated version of my
oh the effects of ECT in mania.for your volume.
The citations and some parts of the text have been edited to reflect
the latest findings and discussions, both at the Task Force of the
APA and the NIMH conference.

contribution

last year.

I trust that this version
My

may

replace the one submitted

regards.
Sincerely yours,
Max

Fink,

M.D.

Professor of PSychiatry

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July 11,

1977

Baron Shopsin, M.D.
New York University College of Medicine
550

New

First

Avenue

York City

Dear Baron,

Enclosed is a revised draft of the paper, Mania and
Electrvseizure Therapy (EST). Please replace the one formerly

submitted by this

latest draft.

are principally on page 7 where I have
citation to a new, important paper on the subject
written by HuCabe and Norris which just appeared. Rather than
make the changes in the galley, I send this draft at this time.
added a

The changes

My

regards.
Sincerely yours,
Fink, M.D.
Professor of PSychiatry
Max

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April 21, 1977
Baron Shopsin, M.D.

Department of Psychiatry
York University College of Medicine

New

550

New

First

York

Avenue

City 10016

Dear Barry,

Enclosed

Electroseizure

is the draft of the report,

Therapy (EST)

Mania and

for inclusion in your forthcoming

volume niviewing the informiation regarding mania.

your comments.

I
My

trust it meets your standards. I

would appreciate

best regards.
Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

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�depressed patients

Some

drugs do respond to EST.

who do

not respond to antidepressant

In a recent report, Glassman, Kantor and

Shostak (73) found that depressed patients with delusions were markedly

unresponsive to tricyclic drugs-—lO of 13 so treated failed.

re-treated with

EST,

sustained response to

EST.

were

EST

action of

EST

is often used to reduce excitement

its effects

found

greater

EST

nine of the ten failures had a dramatic-and

is also effective in the treatment of mania.

where

may be prompt and

lifesaving.

improvement in follow—up

compared to psychotherapy

of patients treated with

EST

for

controls.

manic

and

The

sedating

agitated states,

Ziskind §t_al, (18h)

patients treated with

McCabe (129) reviewed

the records

in l9h5 e 19h9 and found shorter hospitaliza—

tion, greater percent improvement,
than for controls.

these

When

better follow-up results for

and

EST

Kalinowsky (105), Epstein (53), and Bianchi and Chiari

(l9) found-the improvements rates for

EST

treated manic—depressive patients

to be equivalent in the depressed and the manic phases. ‘Ebaugh and
Johnson (h9) reported

100%

social recovery for five

manic

patients treated

with pentelenetetrazole; and Thorpe (171, 116) described the efficacy of
multiple daily treatments in acute mania. Comparisons of the clinical

efficacy of lithium
and

recurrent

mania

The

and EST, alone or combined,in the treatment of acute

are not available.

efficacy of seizure therapies in depressive illnesses

may

also be seen in clinical comparisons of different methods of inducing the

seizure. Studies

comparing EST using

unilateral or bilateral electrode

placements find the two methods effective in reducing symptoms and

shortening hospitalization (3,
29

studies in

which the

M3,

uh).

D'El ia and Raotma (hh) examined

results of unilateral electrode placements

were

�b»

i415

�De _F¢'r\ \C

Proposed Outline of Book Entitled:
A PROFILE IN PSYCHOBIOLOGICAL RESEARCH:

MANIC ILLNESS

Editor: Baron Shopsin, M.D.

\/

Preface - Introduction ------- §B. Shopsin, M.D.
What is Mania

5

—————————————

W

Wot-sen,

Ginsburg,

G.

Longitudinal Review Starting with the term "Folie Circulaire
by Bairget and Falret ------—) Kraepelin
----------of'9 Bipolar and unipolar illness
Description a dynamic or descriptive nature

/

before schizophrenia?

Analytic Concepts

Other

III

IV

Diagnostic Considerations: Clinical Aspects:
D.D. with schizo-affective illness
B. Shopsin, M. D.

E‘P'DEMIOLOﬁq

3—.

Blamm/
V

Epidemiology-mad Genetics—————— J. Mendlewicz

V‘

Neuropharmacology

VI\

Treatments
1.

Biological

Selzer, B. Shopsin andv
S. Gershon

-------------J.

&lt;
,

2 .

VIII

V

ECT - Max Fink

/

92*

Psychoactive Drugs - B. Sh0psin

Wm.

/

Other (e.g. analytic, behavioral, family therapy, etc.)
Ginsberg

Concluding Remarks

V

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                    <text>June 16, 1978
Dr. Julian Lieb
Yale University School of Medicine
New Haven, Uonnecticut
Dear Dr. Lieb,
Mr. Guillermo Paz was seen

at

my

office

was in no distress, presenting his story well.
and appeared his stated age of 30.

on June 15. He

He was

neatly dressed

principal complaints are emotional instability, depression,
tension, working up to 18 hours a day, lack cf concentration, poor
memory and inability to enjoy life. The symptoms have been present
since early adolescence. At one time, he was classified as suffereing
from hypothyroidism and took Cytomel for more than four years until
a re-analysis found that he was no longer suffering from hypothyroidism
His

'

and no longer required the medication.

Dr. Paz describes himself as a hard driving and exuberant

is in his success rates in reducing death in
cardiac resuscitation units, in maintining life for terminal patients
and his stated work time of 33,500 hours during the three years of
his training. (On calculation, this averages 214 hours a week or

worker. His pride
30 hours a day).»

His marriage

to a pathologist

and schoolmate ended

recently

in divorce, without children. He asserts that his wife failed to
understand his drive or to encourage his need for success.

has been under medication for a number of years for the
of anxiety and tension. The range of compounds is extensive
and he asserts that he has taken the medications at the recommended
dosages. For the MAOI and diphenylhydantoin, the drugs that might
be logically used in his condition, his dosages were adequate for
He

symptoms

trials.

principal quation is the suitability of BCT for his
condition. In reviewing his symptoms, there is no insomnia, anorexia,
weight loss, or dry mouth. Libido has been diminished byt his work
activity has been maintained at a high level—- averaging 16-18 hours
a day. He is of above average intelligence, critical in his
perceptions, and exhibits a low score on the California F Scale (2n).
The

�"hp—www.—

w.

I have not received the history and other medical records
at this time, the basis for the following recommendations is the history
as presented by the patient without verifying documentation.
As

It is clear that he does not exhibit the principal symptoms
of an endogenous depression; rather the syndrome seems
more like
a personality disorder of the obsessive—compulsive type.
For a number of reasons-- the absence of endogenous features,
the continued performance at work, the critical thought processes
and
the low California F Scale; the presence of anxiety and the investment
that he has in memory functions, this patient is a poor candidate for
HOT. The principal result would be
an exaggeration of the memory complaints and no relief of symptoms. Indeed, it is quite likely that
he will have more complaints.

it

While
is clear that ECT is not indicated, it is not
what
clear
measures would be more helpful. In talking to him, and
reviewing the symptoms, I enquired as to the type of psychotherapy
which hashes experienced. Is it possible that he may do better with
an approach that follows the rea-ity npﬁels used by Sullivanian
therapists ? I am struck by his drive and wonder whether his
interests could not be harnessed for his welfare by discussions of
the immediate problems in living and the realtion these problems have
to his attitudes to his family and the expectations that they seem
to have for him.
»

Thank you for the opportunity to see Dr. Paz. If the
review of the records alters the recommendation, I will write again.
Otherwise, please accept this opinion as definitive.

Sincerely yours,
,Max

Fink,

M.D.

Professor of Psychiatry

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�Appendix

Social Attitude Questionnaire (F Scale)*
are a number of statements. For each statement we want you to
give us your personal opinion of whether you agree or disagree. Answer
each statement according to one of the following:
Below

A

/

I

AGREE A

b

I

AGREE PRETTY MUCH

I

AGREE VERY MUCH

1
/&amp;/VV-9

LITTLE

1.

No

I

DISAGREE

5?

I

DISAGREE PRETTY

/ I

I

"“

5

A

LITTLE

DISAGREE VERY

MUCH

MUCH

.
.
of hurting
a close
sane, normal, decent person could ever think

125

friend or relation.

2. Science has its place, but there are many important
must always be beyond human understanding.

If people

3.

off.

would

talk less

and work more, everybody would be

better

a person has a problem or worry, it is best for him not
think about
but to keep busy with more cheerful things.

4.

5.

tion,

When

What

it,

the youth needs most is

and the

will to

work and

strict discipline,

fight for family

8. The best
be done and how

teacher or boss is the
to go about it.

to

21
A

{3/

rugged determina-

and country.

6. Nowadays when so many different kinds of people mix
much, a person has to protect himself especially carefully
an infection or disease from them.
7. Sex crimes, such as rape and attack on
mere imprisonment; such criminals ought to be

/

things that

é;

together so
against catching

children, deserve more than
publicly whipped, or worse.

tells

one who

us exactly what

is to

23’

1/

/

9. Young people sometimes get rebellious ideas, but as they grow up theyé;
[ought to get over them and settle down.
10.

strong.

M0

. .
.
People can be diVided
ten
into

.
.
classes: the
distinct

.

* From

weak and

the ’9

’////////////,
/‘.
/1ﬁ}4

Gallagher, Levinson and Erlich (l957).
Agreement is scored as +7 (agree very much), +6 (agree pretty much),
and +5 (agree a little); +4 for no response or uncertain; +3
(diagreee a little), +2 (disagree pretty much), and +1 (disagree
very much). The ten items are summed for a single F—Scale Score

Scoring:

�</text>
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                    <text>3‘.

w

June 20, 1978

Paul

Schyve, M.D.
Illinois Mental Health
Chicago, Illinois
H.

Institute

Dear Paul,
Thank you for the fine review of the relation between
prolactin elevation and breast cancer. I found it thorough and
rather disconcerting.
During the past half year I have been working on the
review of BCT which will be published later this year by Raven Press.
In trying to assess the relative efficacy and safety of ECT and
drugs in depression, mania and schizophrenia, I became more and
more aware of the many risks that our patients run in taking
medication. Now, I have added a citation to your review. On balance,
it is clear that drugs are safer and more effective than ECT in
schizophrenia and mania, but the issue is far from clear fer
depressive disorders. In fact, if one had to write an opinion today,
PCT is safer and more effective than any of the trecyclics. That is
the reason I was so interested in the review of mianserin.

In any case, thank you again. I am sure the review will
meet the standards of the Archives and look forward to its publication.
My

regards.
Sincerely yours,
Max

rm,

24.13.

Professor of Psychiatry

�</text>
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                    <text>'

June 30, 1978

Gilbert Honigfeld,
Sandoz, Inc .
East Hanover, N.J.
Dear

Ph.D.
07936

Gil,

In 1971, when I first became acquainted with the pre-clinical
data on mianserin, I found that the first human trial had been done
in volunteers, and as part of a Ph.D. thesis, a young investigator
had used the OFF procedure and had found a marked decrement in fusion
threshold with low doses of mianserin. It was 13% data, more than any
animal data, which led to the EEG trials and the finding that mianserin
did, indeed, have a specific EEG profile. The rest is history.
Since 1973. I have included OFF data in every EEG study. So far,
using rather simple procedures, we have been impressed that CF? rates
change in a dosearelated manner whenever we are studying active compounds.
The mianserin data was published in our pharmacodynamic report in
Psychopharmacology (2&amp;z2h9-25h, 1977). We use a simple monocular
fusion procedure with three determinations of the ascending and
the descending flicker threshold, averaging the results of the six

trials.

I was impressed with your elegant procedure and would like to
replicate it. I am confident that active drugs will show their effects
on the more sensitive procedures, like CFF, if they affect brain
function. However, the determination can only be gross for classification
purposes, since discrdminations are only possible in two directions. But
as another index for pharmacodynamic studies, we have been impressed.
The mianserin report is not yet does for NIMH. The data are
derived largely from the 1977 meeting on mianserin held in Amsterdam

in October and published as a supplement to Brit. J. Clin. Pharm.,
supplement 1 to volume 5.
My

regards.

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

Max

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                    <text>rm-w-wW‘W'N-r."

"WJII‘xv'h-Ilﬂw"

‘ww'-';

.vrnm

..-.

my»,

-

"w";

v

.

..,.

W‘TWWMIW,'w‘m-uwnruvrtwruyv

July 2,
Richard

D.

Durham,

NC

Durham V.A.

1978

weiner, M.D., Ph.D.
Hospital

Dear Dr. Weiner,

It was kind of you to spend so much time with me on
Thursday and to share your recent experiences with me. I very much
enjoyed the oppdrtunity to get to know pdur work better and I do
hope that you will continue your studies into ECT. It would be
nice to work on a collaborative study program at the V.A.
I have read your report on the elctrodes for ECT and an
answering your request for comments. I am puzzled by the thrust of

It describes the theoretical basis for the difficulties
occasionally seen in the induction of seizures. Since most therapists
are successful in inducing seizures without detailed attention to the
issues that you describe, it is likely that these npoblems are of
small magnitude in clinical practice. They are of considerable magnitude
in research programs, particularly those which attempt to dissect the
factors in the setsure which may be important.
the paper.

The recommendations on page

ll

are really research recommendations.

Clinicians can safely ignore these details if they monitor the seizure.
Ultimately, no clinician is going to be concerned with the details of
the induction. He will be satisfied (as will you and I) that he has
induced a therapeutic event. The simplest way of guaranteeing this is
the use of a blood pressure cuff.
The article is an excellent introduction to your research
protocol and as the basis for understanding the differences in
observations between different observers. I do not see it as a
publishable paper in its present form without additional observations

and

data.

Again, my thanks for your time. I hope you write the V.A. about
the collaborative studies. Let me know what happens.

Sincerely yours,
Max

Fink,

M.D.

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                    <text>July 7.

1978

Dr. Gunther Schenk
Essen, Germany
Dear Gunther,

I received your letter this afternoon, Just as I was preparing
to leave for Vienna for the CINP meetings and for Deals. I am writing
this note now to tell you that, in principal, I am sympathetic to your
project and.will do what I can to encourage you. But before I write
a letter about the project, I really must know more about it. I already
know about your ability (which is very high) but a letter in general
terms can do little to help.
In any case, to do the project Justice, I would like to discuss
with you in Basle. We should have some time together,apdrticularly
to discuss the nature of the work you propose.

it

ﬁbula it be possible to have an official request for a review
of the proposal 7 In the U.S., we often send proposals to gg,hgg ’expert'
reviewers for their opinions, particularly when committees may not have
the necessary expertise to give the application a satisfaetory review.
(I have done this often). The advantage of an official request would
be that the reply would be confidential to the committee and would

therefore be given

much more weight

in their deliberations.

I look forward to seeing you in Basle.

My

best.

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

�</text>
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                    <text>Danuary

l,

1978

Melvin Muroff, Ph.D.

l2 Harcourt

Scarsdale ,

Road

NY

Ref: Hayden Harman, age

Dear Mel,

8

Wwv-m-wrwv-mr

wwm

“war-war—

m

w

vw-.mwm;.u..

Wu

sum—7:»:

I

have read the

(dated 12/6/77) of the patient,

file

and reviewed the
Hayden Harman.

EEG

record

The EEG record is well done and includes alert, photic
and
stimulation
hyperventilation sections. These show mell modulated
dominant
alpha
activity of relatively low voltage. Slow frequencies
are not prominent, nor are they stimulated by hyperventilation in undue
amounts. I concur in hhe report by Dr. Scheinberg that this record does
not show any abnormality inconsistent with the patient's age. We should
note, however, that an important part of the EEG capability was not
used, that of sleep recording. Numerous authors, notably Gibbs and
his students, have repeatedly emphasized thp significance of such
recording particularly in young patients in whom one is seeking

evidence of dysrhythmia.

rest of the file is replete with evidence of cerebral
dysfunction, particularly the report of the observations by Dr. Ballweg.
These data, combined with the behavior and the reports in the psychological
tests (see particularly the figure drawn by the child) are evidence of
dysfunction. Unfortunatley, it is not possible to determine from these
data whether the dysfunction is episodic.
The most conservative approach to problems of this
dimension is the conbined pharmacologic~psychologic. The former provides
The

an opportunity to alter
one may be fortunate in

cerebral functions, and with proper manipulation,
affecting the functions favorably. Two courses
are available: a trial of an anticonvulsant, such as diphenylhydantoin
(Dialantin) in doses up to 300 mg/day; or a psychostimulant, either
methylphenidate (Ritalin) or dextroamphetamine (Dexedrine). I favor the
use of methylphenydate as it has a better safety margin. The use of these
drugs should be combined with sessions with the child and on occasion, with
the parents, to assist in the adjustments necessary in helping a child whose

�mm

[Jp—
n...

‘vw

“r

Dr. Melvin Muroff

........

January 1, 1978

.............

page 2

..mww.aw-nw.w&lt;~wu,

achievements may not be as good as his or his family's aspirations.

If there is

a choice in the sequence of drugs to be

tried,

would depend on the clinical findings as your best guide. Since you
already have noted the similarity of this boy's problems to those
seen in others helped by diphenylhydantoin, I would encourage its

I

trial first.

If there is a special need to verify the possibility
of dysrhythmia further, then a sleep EEG could be obtained. If the
laboratory at Lawrence Hospital is reluctant to carry this out, I
would suggest you enquire whether Dr. Fred Struve of the Hillside
Hospital is willing to do the test for you. He is a Gibbs' student
and one of the best analysts of clinical sleep EEG records in the
region. The other is Dr. Eli Goldenson at the New York Neurological
Institute.

I trust these

are helpful.
for the success of this child'd treatment.
comments

My

best wishes

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

Max

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                    <text>4

January 9, 1978
The American Journal of Psychiatry
1700 Eighteenth Street, H.H.
Washington, D. C. 20009

Boar Miss wright:

enclose the original corrected manuscript and a new procia and
seasons-sheet. we have acecptad your corrections and mad. the
nocnasary modifications in the text and table.

W6

Thank you

for your hnlp.

Sincerely,
Max

Fink. u.

Mrtbc

Encl.

D.

�</text>
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                    <text>January 11. 1978

Dr. Austin H. Kutscher, President
Foundation of Thanatology
630 ﬂoat 168th Street
*

New

York, N. Y. 10032

Dear Dr. Kuraehar:

for your kind invitation to prepare a position
second
conference. I ragret that I cannot accept
for
the
paper
Thank you

‘8

my

prior comitments are

Good luck

too: heavy.

in the conféronco.
Sincerely yours,
ﬂax Fink. H. D.

�</text>
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*5/15"

January 27, 1978

to:

Dr. Al-Chalabi

From:

Max

Subject:

Attached

Fink,

H.D.
5

reports

on

clinical subjects.

five reports you submitted are interesting
what the immediate question may be, but I
unclear
It is
assume you have two: are these items publishable, and are they a
reasonable basis for clinical studies. Since they differ. very
much, I shall try to discuss each one separately. Overall, the
reports are interesting case records and reflect the variety of
the experiences at L-u -- indeed the wealth of case material is
documents.

The

astonishing.

'

study of temporal lobe psychomotor
epilepsy masquerading as psychosis is quite good. Two of the‘
cases are convincing; two are fragments. As a case report, the
introduction is inadequate. The EEG records need samples and
the report of a neurological expert. There is a special issue,
however, which cannot be answered retrospectively: the patients
were receiving antipaychotic medication at the time the EEG records
were taken. These compounds were in doses high enough to alter the
EEG. How are we to separate the EEG effects of drugs from the
natural effects of disease ?
A case report, to be publishable today, should be
a clear example of the problem, and should enlighten the reader
under what conditions he may hope to find the same problem. The
discussion fails to do this~~ it should explicate the symptoms that
alerted you, and should alert others, to the significance of the
EEG and the diagnosis (and treatment) of epilepsy.
B!

The

'

to your comment that few reports are in the recent
literature—- probably so, but that may be because the syndrome has
passed into the textbooks. I suggest you read the writings of Dania
Hill, Ajmoneonarsan, Gibbs, Gastaut, to name a few who have described
these syndromes. I would particularly urge you to look at Gastaut
and the French literature, where this syndrome has been dissected
As

microspopically..

�Al'Chalabi

.OOO‘UOOIODOOODOD January

«.
--

2

2. The combination of lithium and a diuretic has
been discussed at length recently by scientists at the University
of Pittsburgh: Kupfer comes to mind. but there are others in the
same laboratory. see Clinical Pharmacology 8 Therapeuticsg‘1976—77.
3. Low serum lithium. This is an interesting reason
for low levels. It could be the basis for a letter to the editor
in one of the journals. like the JANA or Lancet, when there is
an article describing problems with lithium levels. If the author
omits this reason, it would be useful to write then, explaining

your epperience.

that

would make

,

.

n. This report is unclear. I cannot find a

it

the basis for

a study.

theme

5. The issue of hypothyroidism in lithium therapy
is well defined in the literaturen- as you have noted. While
is clinically important, it is not clear what you propose to
add to the solution of the problem. It is commundable that you
should propose to assess thyroid function in the patients under
your care and that such study will be to their benefit is
net disputed. But what do you wish to do to add to our knowledge

it

w-m

"N'Hw‘zv

27. 1978 psool‘obeoobsrojo‘ipage

of the reports
fame

From

this review, I

am

not optomistic that any

is publishabls except the
I

trust these

one noted in

letter

comments are of some help.

?

�</text>
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                    <text>av-u. w.-

rﬁww—vlwir"

v-mq-

..».-.p»wv—W'

~

-:v

'v-I:

W'xY'wvvr.7\I-m
‘Wmvrﬁwsv‘r'w-W‘vumaa-I;

-.-

,.., u- c-‘vrs'v—. —-

“.w-I—e—yn

mm

my.

7"".

February 18, 1978
William R. Barclay, H.D.

Editor,

JAIA
535 North Dearborn

Chicago,

Illinois

Street

60610

Dear Dr. Barclay,

I have just read the February 6 and 13 issues of the
writing to suggest that the senior editor, Dr.
Z. Danilevicius, has done the readers a disservice in his selection
of abstracts from the American Journal of Psychiatry (pg. 657, February

Journal,

and I an

13, 1978).

In 1976, the American Psychiatric Association held a
symposium on electroconvulsive therapy and invited an outspoken and
brash critic, Dr. J. Friedherg to tpreeent a report. His report was
shown to be dated and biased (see critique by Fred Frankel, Amer. J.
Psychiat. laulelu-lOlQ, 1977). Indeed, the Editor of the American
Journal of Psychiatry, Dr. F. Braceland initially rejected the article

as unfit for publication. but agreed to publish the article in the
context of the symposium. Yet, he added a disclaineu that the articles
had not received the usual criticism.

It is unfortunate the the readers of the JANA will read only
the abstract of this biased and prejudiced report, without recognition
of the critique of Dr. Frankel or the comments from the other reports.
It was of some interest the same evening to read Dr. D.X. Freedman's
review of the interesting issues of the immediate past and to see that
he considered EC? to have some merit and that he cited the report by
Dr. Frankel. (see JANA, 2/6/78. pg 510).
1
va.

,-

mcwml-wu-

m-

It

seems

that

you may wish

his bias and selection criteria.
citation of the literature.

on

to challenge your senior editor

The

readership deserves a better
Sincerely yours,

NWWW

Imus—arm

.
.awv§-§'_,V'

u.
A
m

Hex Fink, M.D.
Professor of Psychiatry

,n-

:wn'rw' H.

.mm &gt;Vuv'-’ .~—

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                    <text>February 3. 1977
Daniel X. Freedman,
Chief Editor

M.

D.

4;;

Arehivas of General Psychiatry
Department of Psychiatry

/

Box 2011

University of Chicago
Chicago.

Illinois

60637

Dear Dan:

It is

to be forgotten in a
check
the status of
busy office! Evy I ask you to
91:02:; (Revised): “Efficacy and Safety of. Induced
Seizures

Many

so easy for u report

(EST)

in

thanks.

Min“?

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

MF:fg

M
(iii;//w

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                    <text>STATE UNIVERSITY OF N!

EV

Health Sciences Center

YORK AT S'I'ONY BROOK
-

School of Medicine

Department of Psychiatry and Behavioral Science
Psychophzlrmzlcology— EEG

Stony Brook. N. Y. 11794

Laborauny

lummc:516444a447

April 26, 1977

Fritz

A. Freyhan, M.D.

Street,

2015

R

Dear

Fritz:

Washington,

N.W.
D. C. 20099

Enclosed is the original typescript of "Efficacy and
Safety of Induced Seizures (EST) in Man" for your consideration for Comprehensive Psychiatry. I understand that you will
not publish the citation list, and I have added a footnote to
the effect that references can be obtained from the author.

I enclose the reference list as well. If I can afford
I would like to print the citations using the
I
think
it,
standard citation format of C.P., and to have complete re—
prints made up. I think 300, with covers will be useful. Can
you get me a quotation on this arrangement?
Thank you for your consideration.

Sincerely,
Fink, M.D.
Professor of Psychiatry

Max

Mszg

enels.

�14.1).
”it!
mm,
2015 B Street K.W.

Washington, D.C.
Dear

20009

Fritz,

Enclosed ere draft copies or the report, ”Efficacy and
Safety of Induced Seizures (as?) in Men” for your review for

mnrehensive qughiatgz.
many

thanks for your consideration.

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

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                  <elementText elementTextId="107028">
                    <text>Juno 8, 1977

Fritz Freyhan,
2015 R Street,

M.D.
N.W.

Washington, D.C.
Dear

20009

Fritz,

editor of

whether

few weeks ago I received a call from the managing
Comprehensive Psychiatry, Mr. Michael Aronson, asking
A

itHewas

possible to reduce the text of the EST review
reluctant to publish the text without the citations,
and agreed with your determination that the text and citations were
too hing. He asked whether 6 pages of the manuscript could be deleted.

article.

was

I examined the text and by reducing the discussion,
clarifying some paragraphs and simplifying
sentences, I reduced the text from 35 to 24 pages. I did, however, add

deleting

some redundancy,

seven additional

citations.

I enclose a copy of the revised text, as well as the
latter is sent
to give you an idea what hadd been deleted. If the paper still
meets your approval, please let Mr. Aronson know. I have sent him
a copy of the revised text.
working copy from which the text was retyped. The

Many

thanks for your cooperation.

My

very best regards.

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

�U

@

[ﬁgW
M

WM,

’M'V' 7lf/r 9‘75 3

Z95”
M

W

Mam

�</text>
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                    <text>June 8, 1977
Mr. Michael Aronson

Journal Dppartment

Stratton
Fifth Avenue

Grune
111

New

8

York City 10003

Dear Mr. Aronson,

Enclosed is a revised verséon of the report, "Eff3cacy
and Safety of Induced Seizures (EST) in Man". Following your
suggestion, the text has been reduced from 35 to 24 pages. To the
citation list, we have added seven citations. I believe the text
and citations now meet the suggested length and may be considered

for publication in

its entirety.

Thank you

for your suggestion

and

assistance.

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

Max

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                    <text>r—vm-rmme

,

WWI—“3:!

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envsosta v93 is

deem

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33

March 9, 1978

George Simpson, M.D.

Metropolitan State Hospital
Norwalk,

California

90650

.G.M

,ﬁulﬁ

st

Dear Geore¢3sidomaq lo 10389301?

left the wintry East for the
have had a hard time of it, the
snow is still about two feet high on my lawn and the passage for my
car looks like a trench from the first World War.
You must be

sunny west before

._.w.w,_,,‘,..__.

pleased to have

this winter

I We

It was good of you to write. I was sorry to have missed
the session in Louisville but I thought that Hy's solution was
worthy of a trial and I am glad that it went well. The meeting in
New Orleans was a good one, if late in coming. I suggested it about
four years ago, and now that the Task Force of the APA has done all
the work, it was useful to bring some of the clinicians together and
review the data. It became clear as the days wore on that there is
much that is known by the researchers about ECT, but that little of
the information has percolated through to the practitioners or to
the University professors who have interests outside of clinical
studies. Papers by Salsman, Davis, Frankel, and Squire were particularly
outstanding. Some of the analyses were newly done and commendable.
All in all, I think the meeting report will be complementary to the
APA Task Force report and my own volume on ECT, both of which will

r”

..

,..,

appear

this year.

As to Grimm, he is one of the many over-emotional pseudo~
scientists who have an opinion based on limited data, and then re-

interplet the findings of others to suit their preconveived notions.
too strong, it does reflect my opinion. He has made a

If that is

big deal of the concept of kindling, based on animal data, and then
alleged that the dame phenomenon occurs in ECT. It does not since
the parameters of ECT are distinctly different, as I noted in my
report to the APPA and published in the volume edited by Shagass,
Gershon and Friedhoff,on "Psychopathology and Brain Dysfunction".
You have a better scientist at LaJolla, Larry Squire, whose data
should be used in preference to the opnions of Grimm.

x

2'8"

-

A”,

A

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th only did you leave at the right time for the winter, but
the DMH is undergoing re-organisation again; Donald Oken has been around
at the Governor's request to find out why we do so much research and to
find all the 'fat' in the research budget; and we have already been told
that the 1978-79 budget will have a 17.8% reduction across the board.
Do you know of a good Job for a middle-aged psychiatrist in sunny Cal ?

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                    <text>March 22, 1978

William R. Tabor, M.D.
A. H. Robins Co.

Richmond, Virginia 23220
Dear

Bill,

I was saddened by your note of March 13 indicating that
further study of lenperone was suspended. Having followed the
progress of the development of this drug from its early clinical
trials, I know how much effort (and dollars) have been expended.
I do not know where lenperone would have fallen in the therapeutic
spectrum, but we are all losers ~- patients and physicians alike -in losing the opportunity to test the compound in the clinical
marketplace, where so many of the applications have been discovered.
I

do hope

that

you have a replacement on the way.

no longer have any supplies on hand, and will
follow your admonition regarding our records.
we

My

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

Max

�</text>
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                    <text>r

v-

.7

cw “I'v‘w'v‘ «v7

-

-_...—u-—.—w".

~ﬁV—wr&gt;l_—IWWW'MV'¢

y

”we.“

&gt;W'wnvw

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n..-

'ﬂmmwt"ﬁvw—

4w»~«-

"ﬁ-‘va‘ ~r-v——. cums...“ ... .wmw—wnwan-rm...—

"WW”...

v.

w."

A.—.—_.v.._

JM)?

rﬁ

March 28, 1978

Jack Ewalt,

M.D.

Department of Medicine &amp; Surgery
Veterans Administration
20h20
washington, D.C.
Dear Jack,

Enclosed is a copy of a letter I recently received
from Dr. James A. Hagans, denying my request for an exception

to the regulations regarding 5/8 to full time for sponsors of
collaborative studies. I have notified the other VIA.
physicians who have indicated an interest in participating in the
study or the letter and suggested, as did Dr. Hagans, that if
one of them is interested, he should carry on.
V.A.

At the recent meeting of the V.A. Behavioral Sciences
Committee, I had the occasion to talk to Dr. Hayes about the
letter, and she endorsed its conclusions.
Thank you

for your advice.

My

regards.

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

Max

P.S.

From time to time, positions open up at the V.A. in direct
association with schools of medicine. Perhaps the problem could

be solved by such an appointment.

let

me know.

If you

hear of any openings,

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'm

1%

New—T

-

mm

Merch 28, 1978
Mr. Jacob R.

Schlenger, Secretary

Research Foundation for Mental Hygiene, Inc.
hh Holland Avenue
Albany, New York 12229
Dear Hr. Schlesinger,
Thank you for the notice of election of March 6, 1978.
I regret that my committments for the coming year preclude my
active participation in this worthy effort, and I am writing to

decline the election.

Sincerely yours,

Fink, M.D.
Professor of Psychiatry

Mex

cc: 8. F. Yollee,

M.D.

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April 5, 1973

a...

"W

Ms.

Carolyn

Patient

Care

Lamb

Darien, Connecticut
Dear Ms. Lamb,
Dr. Kaiser makes an important complaint; one that is
shared by many other professionals, the-laity and the media. Are
the presentations in the 197a New Yorker article with its emphasis
on permanent brain damage, or the 1976 article in Psychology today
which suggested that BCT 'burns the brain', or the image in "One
Flew over the Cuckoo's Nest" correct ? Does ECT cause permanent

brain

damage ?

Dr. Kaiser also laments its unequal use in populations, its
alleged overuse and abuse, and the thorny issues of consent. In raising
these questions he is not alone, for since 1972 there have been numerous
individual assessments of BCT, conferences and symposia, and at least
three international task forces reviewing the questions. There are
some answers.

has been shown to be the most effective treatment
for severe depressive illnesses and for catatonia. The results in these
conditions are consistently better than alternate treatments. ECT is
also useful in mania, but the comparisonnwith lithium therapy is
lacking. In schizophrenia, the evidence is also clear, that ECT is no
ECT

better than pharmacotherapy,

and should only be considered a secondary
treatment. In the neuroses, adolescents and children, cases of
psychopathy and addiction, ECT is of no value.

As to safety, it is surely as safe and often more so than
other treatments for the mentally ill. Suicide rates and death rates
are consistently lower for ECT treated samples. The old complications
of panic, fear, fracture need not occur under modern regimens. The
principal complaint is still amnesia, but even this can be reduced
markedly by the properttreatment which should include anesthesia,
muscle relaxation, oxygenation, and proper attention to the use of
minimal currents and unilateral non-dominant placement of electrodes.
Under these conditions, the incidence of persistent amnesia should be
less than 1/200 cases, and even when the complaint persists for some
weeks, should be reversible within six months.

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is a question about training in ECT. Host physicians
entered psychiatry in the last two decades received little
training in HOT; and the older clinicians, many of whom learhed the
techniques in the 1940's and early 1950's, may still be using techniques
that are clearly outmoded. It is important that ECT training sessions
There

who

be made a regular feature of medical review courses and that only
physicians with recent experience be encouraged to use ECT.

Contrary to Dr. Kaiser's opinion, BCT is a treatment of
and
the middle
upper classes. In the APA survey and our own in
New York City, we found that university private hospitals treated

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about 5% of their patients with ECT; private for profit hospitals,
with middle and upper class clientele, about 30%; while public
(minicipal, State and VA) hospitals used ECT in less than 1% of
patients. If anything, the complaint should be that because of the
expense of HOT, and the prevailing reimbursement policies, ECT is
a treatment that is reserved to the insured and the self-payeing

public.

Consent is an important issue. There is little reason not
to treat the voluntary hospitalized patient who is willing to be treated,
after a reasonable explanation of the risks and benefits of the
treatment. Also, there is no problem in NOT treating the voluntary
patient who refuses ECT. The issue in involuntary patients is more
complex and I would refer the reader to the APA Task Force report
for a better discussion of the issues and the recommendations.

of the technical questions would require a
text—book or manual, and I am pleased to tell him that two excellent
manuals are in press, and should be available by the end of the
year (see below).
The remainder

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Dr. Kaiser is to be commended for raising the question. He
fortunate to do so at a time when the assessments have been made and

are available. He should also know that the mode of action of BCT has
received much intensive study, and that so much is known about the
process, that it is likely that a biochemical equivalent of the
BCT process should beiin the clinic before the end of this decade.
I

commend

the following articles to him:

R. and Prange, A. Convulsive therapy and other biological
treatments. In Flash, FF and Draghi, SC (Eds): The Nature and

Ilaria,

Tﬁeatment of Depression, New York, John Wiley

Efficacy and Safety of Induced Seizures
Comprehens. Psychiat. 19: 1—18, 1978.

Pink,

H.

8

Sons, 1975, pp 271-308.

(EST)

in

Man.

Frankel, F. Report of the Task Force on Convulsive Therapy, American
Psychiatric Association, Washington, D.C., in press.
Asnis,

Saferstein, S. ECT in Metropolitan New York
survey of Practice, 1975—1976. Amer. J. Psychiat.

6., Pink,

Hospitals:

A

M.

and

135: u79-u82, 1978.

,

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.

,

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v.7,

a-

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Psychiatrists Memorandum on the Use of Electroconvulsive
therapy. Brit. J. Paychiat. 131:2II-272, 1977.

Royal College of

Pink, M., Kety, 8., McGaugh, J. and Williams, T. The Psychobiologz_
of Convulsive Therapy. Washington, 0.0., V. H. Winston 5 Sons.
197u, 312 pp.

Convulsive Therapy: Theory and Practice.
Press. (late 1978).

Fink,

ECT

M.

is alive

Perhaps the

New

York, Raven

citations alone should convince

and well in academia.

him

that

Sincerely yours,

Max

Fink,

M.D.

Professor of Psychiatry

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                    <text>April 5, 1978

Peter

Crown, Ph.D.
Hampshire College

Amherst, Massachusetts
Dear

Oln02

Peter,

It was good to hear from you, and while I do not
understand the design of your study, we will be pleased to
cooperate if we can. I have told Peter and he expects your call
and visit. I enclose a cost sheet which gives the hourly charges
for grant supported studies.
I am sorry that you did not get your copy of the
book from the published. I have sent you another to this same
address.

As

to

my

regards.

how

I

knew

the

ZIP code,

it

was

easy.

My

daughter,

Amherst College -- one of the first wowed at
the school. She remembered you well and if you get to her campus,
she would be pleased to get re~acquainted.(5u2 3231).

Linda

is a student at

Sincerely yours.
Max

Fink,

M.D.

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                    <text>m

r.» r-T”
7

-

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. -WW~—r-.wsm—wmvn‘wu-w
,

.

.

.

n.-

v

guru.

\

I'a-W'VW

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wwv»

April 5, 1978

E

Margarito T. Hays, H.D.
Medical Research Service
Veterans Administration
Washington, D.C. 2ou20
Dear Dr. Hays,
work

of

I

am

pleased to respond to your invitation to assess the
is being considered for an appointment

Dr. Larry Squire, who

as a Research Career Scientist.

;

My association with Dr.
Squire began about four
ago when I noted his reports on the effects of BCT on memory.years
heard him speak at Rockefeller University and at the Winter I
for Brain Research, and then joined him on a panel on ECT at Conference
the Society
for Neuroscience. On each of these occasions, I learned much and
was
impressed with his knowledge of brain function and memory. When asked
fer recommendations for a panel being organized NIMH assess the
status of ECT, I recommended Larry and he becamebya paneltomember.
Later,
when asked to recommend a scientific
consultant to the Task Force on
Convulsive Therapy of the American Psychiatric Association, I
again
recommended Larry. In both positions I have worked
with
him, and shared
the task of assessing the effects of seizures on brain function.

wwwuum'w

.n

.
a:

“vuwum

Tm."

'

~w.-M“

~urzr

Dr. Squire was trained at H.I.T. with my former
teacher,
Hans Lukas Teuber —- a critical thinker and
I
teacher.
believe
Larry learned much there, and came away with a keen

Prof.

problem of memory,

its retention

interest in the

its loss. I think it is to his
studies
and

individual credit (since such
were not in Dr.
repertoire) that he saw the merit in examining memory Teuber's
and
amnesia in the one reversible paradigm in man which is functiond
ethical
to
examine, that of convulsive therapy where amnesia is a
regular
of the treatment. Further, since the amnesia is reversible, Dr. feature
quire
had the advantage of examining its development and
in the
its
recovery,
same patient, within a time span of weeks to months
-- surely finite
enough to be credible.
The techniques for the study of
function in ECT are
the standard psychological paradigms. Since memory
became interested in
Larry
the long term effects of BCT, he developed novel
of memory based
on TV exposure during different decades. His teststests novel
and
are
sensitive, and have become accepted not only in ECT research, but seemingly
in

�——~

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«umnw r—‘W‘r—“mzxw:

-

wur

.

.i—n-

m.VWW——rmrwmmmwﬂwom

W,

.v... nwn ~

2.

studigs of

memory

in drug assessment and neurosurgical interventions.

While most of his emphasis in the past few years has been
in the EC? process, I think his interest is broader, in the memory
process itself. To this end, he has undertaken studies of amnesia
fellowing surgery, trauma, and in systematic studies in animal
experiments. His work has consistently been well designed, carefully
done, statistically sound, and with the most reasonable controls. His
evaluation of the differences between unilateral and bilateral ECT
are among the most compelling new data in this field, and his assessment was an important feature of the recommendation by the APA
Task Force that unilateral ECT be considered the primary mode of treatment in depressive illnesses.

I believe his work to be sound.

skill to deal

He

has shown the necessary

attracted bright young
clinicians,
researchers to his laboratory. My assessment is best expressed by
the fact that when the Long Island Research Institute, a research
arm of this Department of Psychiatry, was seeking young talent fer
its staff, I recommended him highly and sought him out. Unfortunathly,
Long Island did not seem as attractive as Southern California. Nevertheless, my offer remains.
with

and he has

His work at the APA TAsk Force and the NIHH evaluation
to have good political skills. His presentations were well
documented, and I have every reason to be pleased with my
show him

recommendations.

While he is young in years (37), his experience since his
doctorate (1968), and his record of publications and presentations
support the recommendation for his appointment as an Associate
Professor.

I

am

pleased to

recommend him

to you.

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

W mm..mw
W

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                    <text>"Iw—W mun

-w—-m.,_....

.

_ amu—rn

-.mm...__..uwmw..w.e...,..-_m_n..._

.

v

_.V_._,.. ...t

...

.7

..

”aw“.

April 11, 1978
Robert Gerber,

M.D.

Carrier Clinic Foundation

Belle

Jersey

Mead, New

Dear Bob,

I regret that the dates that you have suggested for
Mead are the most difficult in the year for me.
My principal teaching committment to the medical studiits is in
May/June, and there is no Thursday that I can dedicate for the

a

visit to Belle

trip.

we

can

find

Perhaps,

when you make up

an occasion

for a visit.

the

1978—1979

schedule,

By now you know that the A.P.A. Task Force on Convulsive
Therapy has submitted its report to Trustees and we are awaiting their
decision as to its acceptability as an A.P.A. position paper. You should
be able to get a preliminary draft by writing to Dr. Work.
My

regards.
Sincerely yours,

Fink, M.D.
Professor of Psychiatry
Max

�</text>
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Dr. Peter Crown
Hampshire College

Amherst, Massachusetts
Dear

Peter,

Enclosed is a set of notes describing the easiest way
to record EEG records on tape for analysis. The details of the actual
recording will vary with the recorder, but the principles should be of
interest to your consultants.
Good

luck.
Sincerely yours,

Max

Fink,

M.D.

�</text>
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