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

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

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

gentleman’

.

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

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

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

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

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

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

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                    <text>Ma

April 3, 1993

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

A-8036 GRAZ, Austria

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

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

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

and Neurology

�Post-It" brand fax transmittal memo 7671 lilo! pages
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“Ca/oy—
February 13, 1993
Barbara Melisch, M.D.
Universitatsklinik fiJr Psychiatrie

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

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

difficult.

recognize that such a delay is frustrating and makes any planning

My

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

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

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

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

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

I

.

'

Have a good holiday.

Sincerely yours,
Max Fink, MD.

Professor of Psuchiatry

the

f’/

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

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

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

July, 1993.

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

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

I

Have a good holiday.

Sincerely yours,
Max Fink, MD.

Professor of Psuchiatry

wW
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�July 3, 1992

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

in

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

We will also need the following information:
-

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

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

would be useful

if

Dr.

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

regards to

Dr.

it will

be useful to support your

Zapotocky.
Sincerely yours,
Max Fink, MD.

PRofessor of Psuchiatry

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                    <text>April 23, 1993

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

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

I

I

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

I

I

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

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

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

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

and Neurology

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                    <text>May 10, 1993

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

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

trained

in

I

Dr. Janowsky at UNC in Chappel Hill is advertising for

ECT. You may wish to write to him.

someone

Good luck with your patient.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

and Neurology

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

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

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

I

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

I

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

I

I

I

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

�American Psychopathological Association

Page 2

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

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

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

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

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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

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

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

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

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

were suitable.

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

Max Fink, MD.
Editor

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

well as the patient.

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

literature.

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

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

�</text>
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m/ﬂ

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

and Neurology

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

Zentrum der Psychiatrie

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

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

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

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

Dr. B. Verﬁey

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

Phone: 516 4442929
516 862-6651

September 21’ 1993

Fax: 516 862-8604

Mr. Marty Madison
Quest Publishing Co.
Brea CA 92621

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

M

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

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

Examiners
'

Gentlemen:

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

without reservation.
I commend him to you
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

A

:7

I”

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,

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

NOTARY

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

516-444-2990

Fax:

516-444-7534

BFOOk

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

Phone: 516 444-2929
516 862—6651

Fax: 516 862-8604

1

September 22, 1993
Dr. Douglas Glover

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

Wide
Sincerely you

,

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

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

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

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

Good luck in your work.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

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School of Medicine
Department of Psychiatry and Behavioral Science

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

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

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

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

�</text>
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                    <text>MM

December 18, 1993
Ms. Lynne Mascarella

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

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

Max Fink, MD.
Professor of Psychiatry
and Neurology

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

F aroukh Maneksha

George Petrides
From:

Max Fink

Subject:

Follow—up

on trimethaphan study

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

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

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

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

�J.

0.

Cole

Pharmaco-EEG

Page 2

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

weak.

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

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

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

with pharmaco-EEG studies.

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

are cited in my report in progress.

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

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

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

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

Abington Memorial Hospital
Abington, PA 19001

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

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

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

published

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

consent was recently

Sincerely yours,
Max Fink, MD.

Editor

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

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

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

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

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

if

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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

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

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

I

I

I

I

i

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

I

MEDLINE.

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

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

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

Nepperhan Avenue
Hastings-on-Hudson

ll

New York 10706

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

I

I

I

I

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

I

am not the man for the job.

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

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

Good luck

in

your efforts.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

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

41 Mall Road
Burlington MA 01851

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

l

I

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

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

it?

My

best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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

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

I

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

I

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

I

My

I

I

best to Titty.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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

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

I

I

I

I

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

the management of patients
geriatric psychiatry.
in

in

high risk ECT and he has a special interest in

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

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

I

I

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                  <elementText elementTextId="107120">
                    <text>January 5, 1992
Michael Taylor, MD.
Department of Psychiatry
UHS/Chicago Medical School
3333 Green Bay Road
No. Chicago, Illinois 60064

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

I

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

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

4O

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

I

I

appreciate the problems with your son. Looking back at our

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

It

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

son is misplaced.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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

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

urge your support of legislation to re-instate payments retroactively

and immediately.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

ﬁg

�</text>
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W

March 14, 1992
Werner Herrmann, MD.

Clinical Psychophysiology

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

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

�Werner Herrmann, MD.

Page 2

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

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

capture the best papers.

My best regards.
Sincerely yours,

Max Fink, M.D.
Professor of Psychiatry
,

�</text>
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Department of Psychiatry and Behavioral Science

March 21, 1992

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

If

slides or,

if

have

full

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

I

will

be glad to copy the

I

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

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

‘

231 pp.

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

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

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

Max Fink, MD.

Professor of Psychiatry

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

Fax:

516444-7534

�</text>
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‘

4!“:
_

I!r“.;,"‘,./"';':’/

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

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

I

I

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

What can be done?
ECT, can surely help.

If

you wish to support lectures or conferences on

I

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

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

�Wilma Harrison, MD.

Page 2

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

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

disorders?

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

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

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

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

My

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

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

Gretna,

LA

70053

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

I

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

I

I

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

I

believe we are making progress.

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

Good luck

in

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

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                    <text>June

3, 1992

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

Chapel

Hill,

NC 27514

Dear Ms. Froimson,
It

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

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

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

model.

My regards.

Sincerely yours,

Max Fink, M.D.
Edhor

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                    <text>June

3, 1992

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

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

I

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

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

Max Fink, MD.

Professor of Psychiatry

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

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

I

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

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

psychoses.

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

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

�Page 2

Michael Taylor

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

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

variables and comparing various models of genetic transmission of illness.

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

research leaders

and administrative leader.
I

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

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

Boston MA 02115
Dear Carl,

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

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

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

My regards.

Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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

345 Blackstone Blvd.
Providence, RI 02906
Dear Martin,

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

I

l

.

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

in

created the

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

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

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

promotion with enthusiasm.
My regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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

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

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

aspects of professorial activity

-—

pre-eminent

research, active teaching, administrative leadership, and important clinical

contributions.

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

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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                    <text>December 4, 1991

James Ballenger, M.D.

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

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

is with

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

l

l

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

meetings.

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

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

I

�Re: Charles Kellner, MD.

Page 2

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

work;

I

I

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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

England

900

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

I

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

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

your attention.

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

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

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

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

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

Which membership lists would be appropriate to canvass?

research?

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

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

FaX15l6—444—7534

�Sannita—

December 20, 1991

Page 2

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

W

Max Fink, MD.
Professor of Psychiatry

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

�</text>
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                    <text>May

2, 1991

Mrs. Robin Nicol
MECTA

Corporation

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

It

was a

36

Spring Hollow Road

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

associates at the

My

St. James,
regards to all.

New

York 11780

Sincerely yours,
Fink, M.D.
Executive Director

Max

�</text>
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                    <text>May

2, 1991

Dr. John Schwartz

Inc.
Tustin CA 92680
CME,

730 El Camino Way

Dear John,
An

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

the events in

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

Fink, M.D.

�</text>
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Myron

Sandifer,

2, 1991

M.D.

4008 Mayflower Lane
Lexington, KY 40504

Dear Myron,
was

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

painful,

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

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

Fink, M.D.

Editor

�</text>
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                    <text>May

2, 1991

PhiIip SIavney, M.D.
Department of Psychiatry

Johns Hopkins HospitaI
600 N. Woife

BaItimore,

Dear

MD

Street

21205

PhiIip,

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

it.

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

to read

it

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

MAOI,

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

though they admit that our course of

IittIe reIief.
i1] patient

ECT

for their daughter

gave her

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

successfuIIy treated with
Thank you again

ECT.

for thinking of

me.

My

best regards.

Sincerer yours,
Max

Fink,

Editor

M.D.

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

Psychopharmacology Research Unit

Littlemore Hospital
Oxford OX4 4XN
United Kingdom

Dear Philip,

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

in

the lists.

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

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

Journal

(April 19, 1991).

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

My regards.

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

�</text>
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["1513

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

�</text>
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                    <text>July 15,

1991

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

Dear Dr. Neubauer,

theory

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

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

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

EEG

signals to numeric

basis of efficiency, not

for

an

on ’meaning’.

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

studies.

Again,

my

thanks and

my

best wishes for success in your
Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

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

457, St.

lames, NY.

I

I780

l5I6I 862—665]
(516) 444-2929

July 12, 1991

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

&amp;

UK

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

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

I

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

I

would be grateful for your help.
Sincerely yours,

ﬂwab‘wc

Max Fink, M.D.
Executive Director

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

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

(516)862-6651
(516)444—2929

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

Gentlemen:
We

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

Report
Royal Commission is available from your
advised that
FAX

it

office.

the charges for
to
as
advise
Please 8604.

this report.

#: 516 862

Thank you.

Sincerely yours,
Fink, M.D.
Executive Director

Max

Our

�</text>
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                    <text>July 24,

1991

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

than 40 years of professional

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

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

than

it is.

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

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

treatment.

Thank you

for your attention.
Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

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

Jacques

M.

Quen, MD.

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

Dear Dr. Quen,
I

responded to your letter of July

and Senators.

11

and wrote to my Congressmen

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

it

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

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

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

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

Professor of Psychiatry

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

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

PO. Box 38

Glen Oaks, NY 11004

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

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

Max Fink, MD.
Professor of Psychiatry

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

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

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

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

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

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

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

FAX: 305 321 8024

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

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

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

Max Fink, M.D.

Attending Psychiatrist

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

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

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

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

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

Professor of Psychiatry
Attending Psychiatrist
University Hospital

�February 16, 1991
To the Editor,

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

part is due to budget cuts. There

is also a failure to take advantage of advances in

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

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

malignant catatonia, and were successfully treated.

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

Hospitals.

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

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

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

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

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

Max Fink, M.D.

Attending Psychiatrist
University Hospital

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

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

Max Fink, MD.

Professor of Psychiatry

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

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

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

PO. Box 591524

San Francisco, CA 94159-1524

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

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                    <text>March 12, 1991
Dear

,

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

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

excellent work,

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

Central Islip Psychiatric Centers.

never recovered.

We,

in Suffolk County,

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

Institute.

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

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

StonyBrook

/

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

Co.

Dept
Fax #

\v

3/3 #2.? If)”;

/

FAX: (516)

444—7534

Co.

Phone#
Fax #

m5;

.

,_

U'lk-a:

L.

wisp/‘3

”or.“I“:
.Vg-«féz F!
(F

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

Sincer

1y

M.“

yours,

Max Fink, MD.
Professor of Psychiatry

Attending Psychiatrist
University Hospital

�</text>
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                    <text>March 18, 1991

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

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

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

support

Therapy in 1989.

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

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

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>April 5, 1991

Ms. Rita Scheman

Raven Press
1185 Avenue of the Americas
New York City 10036

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

I

I

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

editors.

To answer your specific queries:
1.

no comment

2. No.

3. Yes.
4. No.

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

I

I

l

I

�Ms. Rita

Scheman

Page 2

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

such preliminary material

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

A more cynical attitude may also be taken. Since

these articles were

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

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

Max Fink, MD.
Professor of Psychiatry

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

United Kingdom
Dear Dr. Watt,

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

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

Good luck in your studies.
Sincerely yours,

Max Fink, MD.

Professor of Psychiatry

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                  <elementText elementTextId="104341">
                    <text>gm
January 20, 1990
Dear Stan,

I enclose copies of the

and

my

reply.

He

letter

plans to attend the

APA

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

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

him.

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

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

for

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

Thank you

dedicated orthodox Israeli

an

excellent
My

best regards.
Sincerely yours,
Max

Fink,

M.D.

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

Dear Mort,

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

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

Fink, M.D.

Professor of Psychiatry

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

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

I

I

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

I

While

it

is not usual for ’scholarly’ journals to include

pieces by the

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

(occasionally more than) the straight science.

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

My

best regards.
Sincerely yours,

Max Fink, MD.
Fellow Editor

A

I

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

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

I

John

is a dedicated clinical and theoretic

researcher with special

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

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

My

best regards.
Sincerely yours,

Max Fink, MD.
Professor of Psychiatry

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                    <text>May 8, 1990

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

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

I

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

man.

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

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

I

I

expeﬁence)

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

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

These views are outside the mainstream. That

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

experience

If

in

the clinic.

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

review by Taylor in NNPBN.

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

Sincerely yours,
Max Fink, MD.
Professor of Psychiatry

l

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                    <text>/

32f gé;;$ﬁxf

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

&amp;

Psychiatry

Institute of the Pennsylvania Hospital
Street

111 N. 49

Philadelphia,

PA

19139

Dear Dr. McCurdy,
Like many of

my

peers,

I am

writing with regard to the proposed

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

electrophysiology complement those of their neurologic peers.

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

certified both in neurology

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

am

and

psychiatric assessments.

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

unfolding.

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

limiting the

Thank you for your consideration.

Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

ABPN

(P54) (N52)

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

Box 0208, M-181
San Francisco, CA 94143

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

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

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

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

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

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

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                    <text>«~/

August 5, 1990

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

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

Max Fink, MD.

Professor of Psychiatry

�</text>
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                    <text>Department of Psychiatry and Behavioral Science
Health Sciences Center
State University of New York at Stony Brook
Stony Brook, New York 11794-8101

StOﬂYBrOOk

telephone: (516) 444-2929

August 23, 1990

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

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

�</text>
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                    <text>December 12, 1990

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

I-l6l32

Italy

GENOA

Dear Walter,

that

we

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

First, congratulations

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

of

interest.

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

letter

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

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

My

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

My

best regards.

York?)

Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

all

to

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

Italy

Dear Dr. Gherardini,

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

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

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

picture

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

and

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

attention.

Sincerely yours,
Max

Fink,

M.D.

Professor of Psychiatry

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

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

NC

27710

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

Chongcheng in 1985 on
been intrigued by its

failed to teII

needs

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

best wishes for

a happy and

me

untiI his

Ietters of invitation,

visit, either

healthy 1991.

Sincerer yours,
Max

Fink,

M.D.

Professor of Psychiatry

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

Chongcheng, M.D.

Institute of Acupuncture

3

Haiyuacang

Beijing

and Moxibustion

100700 China

Dear Dr. Xue,

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

University.

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

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

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

in practice.
My

be

able to demonstrate your
every effort to see

wiTT make

regards.
SincereTy yours,

Max

Fink,

M.D.

Professor of Psychiatry

�</text>
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    <fileContainer>
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                  <elementText elementTextId="104330">
                    <text>StOﬂYBIOOk

Department of Psychiatry and Behavioral Science
Health Sciences Center
State University of New York at Stony Brook
Stony Brook, New York 11794-8101
telephone: (516)

444—2929

June 15, 1989
Mr. Wolfgang Kudrnofsky
ORF
ORF

Centrum

Vienna, Austria
Dear Mr Kudrnofsky,

It is clearly difficult to

communicate

at this distance.

While

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

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

made

Singzzzjy

.4 Fink,

yours,
M.D.

Professor of Psychiatry

�7..

_

-

I

[-

'

"

‘

"W“

7

mw‘l‘w‘wmvv'nw-mm”m‘

r..me

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.

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.

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//

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

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

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

—-

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

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

Thank you for your inquiry.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

�May 23, 1939

Dr. Wolfgang Kudrnofsky

Osterreichischer Rundfunk
Wiirzburggasse 30

1136 VIENNA
AUSTRIA

Dear Dr. Kudrnofsky,

it is not clear

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

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

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

that we can try

Since rely yours,

Max Fink, M.D.

Professor of Psychiatry

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

June 25, 1989
Mr. Bruce Williams
Associate Product Manager

Asendin amoxapine

Lederle Laboratories
Plaza

One Cyanamid

Wayne, New

Jersey 07470

Dear Mr. Williams,

I

am

a

supervising psychiatrist at University Hospital at

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

the combination of an antipsychotic and an antidepressant drug in

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

for your cooperation and help.
Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�</text>
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                  <elementText elementTextId="104329">
                    <text>July 31,

1989

Muriel Young, M.D.
E-43

SK-Beecham
1500 Spring Garden

Philadelphia,

PA

Street

19101

Dear Dr. Young,

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

session).

The animal model

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

effects

on

ECT

induced amnesia have been modest.

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

better

on improvement

scores.

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

report

is

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

to its

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

basis for deciding whether the

ECT

and

clin.

editors of
Culling the 4500
specific drugs

These should give you
model may be useful in the

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

Sincerely yours,
Max

Fink,

Editor

cc: J.0. Cole

M.D.

�</text>
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                  <elementText elementTextId="104328">
                    <text>August 11, 1989
Dr. K. Stephan

Arzneimittelforschung
Kurfurstendamm 217
1000 Berlin 15

AFB

GmbH

in Berlin

West Germany

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

interests.

My

regards.
Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�August 11, 1989

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

Schottenring

24

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

Max

Fink,

M.D.

Professor of Psychiatry

�July 28,

1989

Werner Herrmann, M.D.

Kurfurstendamm 217
1000

Berlin

West Germany

15

Dear Werner,

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

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

We

are looking forward to your

My

best regards

August. Except
visit in the
house, we

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

my

thanks.
Sincerely yours,
Max

Fink, M.D.

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

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

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

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

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

ECT?

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

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

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

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

Max Fink, MD.

Editor

�</text>
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                  <elementText elementTextId="104325">
                    <text>November 28, 1989
Prof. Oded Abramsky

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

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

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

opportunity to support important research.

Sincerely yours,
Max Fink, MD.

Professor of Psychiatry
Editor, CONVULSIVE THERAPY

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

November 27, 1989

Prof. Bernard Lerer

Yaacov Herzog Center
Ezrath Nashim
P.O. Box 140

for Brain

&amp;

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

Psychiatry Research

Jerusalem, Israel
Dear Beni,

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

establish

announcement.

THERAPY

If

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

helpful, send it on.
My best to Ziona,

who

must be

especially proud.

Sincerely yours,
Max

Fink, M.D.

Professor of Psychiatry

�</text>
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                    <text>m: ww-n-a"m.1li wwwvw-y-rra-H van—spew

W‘

.-...—-

-

'

'

:amrm'w

-.

vmﬂmnrmv

WWW

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

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

...

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

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

Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

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

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

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

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

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

Professor of Psychiatry

�</text>
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.; m.-

5,2,4... ... “an.

,

.. (h

February 15, 1989
Dr. Steven Bressler

EEG Systems Laboratory
51

Federal Street

San Francisco, CA 94107

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

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

Since rely yours,

Max Fink, M.D.

Professor of Psychiatry
IRS 11-2133166

�</text>
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wu—u-wwmw-w-u-w

WWW

"aw—V...

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February 15, 1989

wry-v:

vaw

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

Street, N.W.

Washington, D.C. 20005

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

best regards.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

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                    <text>March

‘13,

1989

Lothar Kalinowsky, M.D.
Klinik Dr. Dohrn

Driesenstr.

10

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

1

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

Institute.

L “M”
i

a

1

i
i.

i

i

1

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

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

It

My

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

Max Fink, M.D.

Professor of Psychiatry

�V'-

v

“w‘mﬂw~

‘

-

--

v

wimww ~MYwW—vuy

.77

‘VVWV. w... r~._—..—. "WW—”w

wruva—‘mw—wv._._.._r

7—- ,,

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

Bad Wiessee am Tegernsee

West Germany

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

&lt;

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

later this year.

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

'

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

That is all for now.

My

best regards and wishes for continued improvement.
Sincerely yours,

Max Fink, M.D.

Professor of Psychiatry

.

_

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                    <text>October 25, 1988
Mr.

Peter Alexis, Executive Director

Psychiatric Institute, Fort Worth

815 Eighth Avenue
Fort Worth, TX 7610‘}

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

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

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

trust these remarks are

helpful.gG.ooEiM-luck in

your efforts.

Sincerely yours,
J

ﬁx.“
~

V,»

r;

'

‘_

'

Max Fink, M.D.

Professor of Psychiatry

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

‘

'

,

w“.

,

S

e»

c",

,

“mum -;~hw;'vyw7——wa' m-wamm.

u

—-——

;.‘m'

,

,

.

-s—v—u

March 20, 1989
Ms. Amanda Hopkins-Alexiadis

Psychiatric Institute, Fort Worth

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

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

mid-June.

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

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

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

�Psychiatric Institute of Fort Worth

Page 2

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

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

institutions.

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

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

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

Sincerely yours,
Max Fink, M.D.

Professor of Psychiatry

�1

Psychiatric Institute of Fort Worth

“w

Page

PROPOSED COURSE: CLINICAL ASPECTS OF ECT

w»

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

Yewwm—uy.

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

coordinator.
Day

i:

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

l?

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

a.m. Treatment demonstrations (MP, LG)

w

wvn

pm.

mm—

~.-

—.-

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

m-w—n-

-

4

-—w—-

ymvw

y.

Do! 3:

am.

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

pan.

Concurrent sessions:

a...

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

Consent procedures
Group therapy for patients

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

WWW.

3

...

v...-4v.w-u».r.-~.-,. ..-,

.1

_,

.7...“

�Psychiatric Institute of Fort Worth

Page a

Training Materials

BOOKS:

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

1979.

‘

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

D.C., 1978.

Abrams, R. ELECTROCONVULSIVE THERAPY. Oxford University press,

1988.

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

Bluff,

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

11.,

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

SUPPLEMENTARY READINGS IN EC?

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

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

Street

Santa Barbara, California 93105
.v—

-

"

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

-._w;,.v~——..—.—-—

W.

V,

.,
&lt;

”w...”—

—w-mw—r—---

-.

"nu-v!"

Dear Dr. Ackerman,

'

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

‘

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

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

ww.

'Wumv

‘vw'qm'wwwimmm

A

”m—

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

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

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

demonstrate a difference.

�Dr. John Ackerman

EACT vs ECT

-

Page 2

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

demonstration.

'

"

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

Max Fink, MAD.

�</text>
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                    <text>May 25, 1989

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

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

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

analysis of modern political leadership.
My

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

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

1

�</text>
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                    <text>May 28, 1988

Mr. Jess Buckelew
NDMDA

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

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

Hour.mtreportwasqm‘tesuocesstul,andledmetoworkwiththesamevideo

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

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

booth

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

50th

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

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

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

the intromction of the treatment.

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

CONVULSIVE THERAPY for your use.

Thank you for your inquiry.

Sincerely yours,
Max Pitt, M.D.

Editor

�</text>
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                    <text>u—n

&lt;"1“"-anr-

"v—AVWWn

'—'

v.

«w»

.v

-W

-,

~«r.A~———

‘
m-

vaewr.»

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"1."

August 15, 1988

'
"

l
""

"
c

Mr. Ronald B. Schwartz
4916 Conrad Street

Skokie, IL 60077

""

.

"—"'"‘

‘7

Dear Mr. Schwartz,

.—

‘7

‘

A

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

‘

WWWMMW-

‘-

Good luck in your efforts.

Sincerely yours,

_—

v.1—

«mm

Max Fink, M.D.

Professor of Psychiatry

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

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

Wrwwww

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

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

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

Professor of Psychiatry

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