65
100
6561
-
http://exhibits.library.stonybrook.edu/mfp/files/original/5b9a44fcaf14d7a5f6579449d67bb8df.pdf
96194333c1cc0ec421969075980975ab
PDF Text
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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mfp-05-00-032-2-067
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1990
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701bd50db0d3f035449599a2b1272e94
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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
�
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mfp-05-00-032-2-069
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1991
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http://exhibits.library.stonybrook.edu/mfp/files/original/a6d2c85a62f2ddfdcbdd457e428c348f.pdf
7af53651f7bffdf8904ab4da7b3cf396
PDF Text
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
�
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mfp-05-00-032-2-070
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1991
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-
http://exhibits.library.stonybrook.edu/mfp/files/original/31969d5b591466abeb428fea254b3f4c.pdf
e4afe5776670c3e45537b223973bc8a5
PDF Text
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
�
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mfp-05-00-032-2-071
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1991
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308c6e8aac071c327029396e7f9897df
PDF Text
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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
�
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mfp-05-00-032-3-073
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1991
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PDF Text
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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
�
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mfp-05-00-032-3-078
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1991
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-
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aadd26e7b0cacd17d9b09d16599ee118
PDF Text
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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
�
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mfp-05-00-032-3-079
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1991
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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af7a075c381f1fce4db7ce5c11dbb8af
PDF Text
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
�
Dublin Core
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Correspondence
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Correspondence to: Moynihan, Hon. Daniel
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mfp-05-00-032-3-080
Date
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1991
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/733c030b63de0a9e647b87a85a5b8e33.pdf
64a0d6ea13f3efa021155a2c09c07c5e
PDF Text
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
&
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 & 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
&m4315Lmnmst<H7&)
(516)862-6651
(516)444—2929
July 2, 1991
Davall & 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
�
Dublin Core
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Correspondence to: Ravenhill, Donna
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mfp-05-00-032-3-081
Date
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1991
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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The Max Fink Collection
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/97eeed54a549b6ea00f26c0e806bc4dd.pdf
da064d777aa6686ee9ab2bf99c9d255a
PDF Text
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
�
Dublin Core
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Correspondence to: Neubauer, David
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Text
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mfp-05-00-032-3-084
Date
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1991
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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The Max Fink Collection
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/305b23c89b7e73760bb6280c962dc167.pdf
95728ad9ed01d39823b96f1ec150cfca
PDF Text
Text
«F V/- ?/
["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.
�
Dublin Core
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Dublin Core
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Title
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Correspondence to: Lewis, Robert S.
Type
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Text
Identifier
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mfp-05-00-032-3-091
Date
A point or period of time associated with an event in the lifecycle of the resource
1991
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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Correspondence -- Correspondence
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The Max Fink Collection
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/5e203efc5e8baac48e64f98378f66106.pdf
79a4b1037956d255ee1773713741bc11
PDF Text
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
�
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Title
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Correspondence to: Cowen, Philip J.
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Text
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mfp-05-00-032-3-092
Date
A point or period of time associated with an event in the lifecycle of the resource
1991
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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The Max Fink Collection
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/74bff10770507f790f30c5128f274617.pdf
3be3910d3a49748bf22647e258cfe506
PDF Text
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.
�
Dublin Core
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Dublin Core
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Title
A name given to the resource
Correspondence to: Slavney, Philip
Type
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Text
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mfp-05-00-032-3-095
Date
A point or period of time associated with an event in the lifecycle of the resource
1991
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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Correspondence -- Correspondence
Relation
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The Max Fink Collection
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Information about rights held in and over the resource
<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/2bdf2262a04cdcb4248ecb3a95cf45dc.pdf
f04cb62b824cce5625ace90edddcd154
PDF Text
Text
May
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
�
Dublin Core
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Correspondence to: Sandirer, Myron
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Text
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mfp-05-00-032-3-096
Date
A point or period of time associated with an event in the lifecycle of the resource
1991
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
The topic of the resource
Correspondence -- Correspondence
Relation
A related resource
The Max Fink Collection
Description
An account of the resource
Rights
Information about rights held in and over the resource
<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
Language
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/a9653665c3f153c038d1c9ab4d6a5b10.pdf
42d6955f591c5b7bc9e8d94373831b9f
PDF Text
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.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Correspondence
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Dublin Core
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Correspondence to: Schwartz, John
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Text
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mfp-05-00-032-3-097
Date
A point or period of time associated with an event in the lifecycle of the resource
1991
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
The topic of the resource
Correspondence -- Correspondence
Relation
A related resource
The Max Fink Collection
Description
An account of the resource
Rights
Information about rights held in and over the resource
<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
A related resource from which the described resource is derived
Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
Language
A language of the resource
en-US
Format
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/5ac10e4b67a8d64b27281103119f5aca.pdf
8ee8cb1b5ede8317aa04bc01be7a6714
PDF Text
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
�
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mfp-05-00-032-3-098
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1991
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d8ab9c94924bc120b5d776042f27b880
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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.
�
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mfp-05-00-032-4-099
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1991
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http://exhibits.library.stonybrook.edu/mfp/files/original/258061a07efdd559edb2b45b1ec4402f.pdf
d707bd5b92d0cfa522a6248bb3a2d3be
PDF Text
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
�
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mfp-05-00-032-4-100
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1991
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http://exhibits.library.stonybrook.edu/mfp/files/original/58721fde94f95764bdd7b766dc632e01.pdf
1be326cb863f9c4dd27f8a885e06ec21
PDF Text
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
�
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mfp-05-00-032-4-102
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1991
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b1d80c861e0d6cae32ad896f34646ee4
PDF Text
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December 2, 1991
Wagner Bridger, MD.
Medical College of Pennsylvania
3200 Henry Avenue
Philadelphia PA 19129
Dear Wagner,
am delighted to recommend the faculty appointment of Charles
MD.
as Professor of Psychiatry at MCP.
Shagass,
I
have known Charlie since 1955, when he had developed the sedation
threshold test, the first of the modern biological tests for classification of the
mentally ill. It was my good fortune to undertake confirming studies of this work
which remains an important part of my evaluation of patients.
l
A leader in electrophysiology, Charlie has written numerous books and
articles on EEG and behavior. A leader in the academic world, he has been
instrumental in propelling the Society of Biological Psychiatry to the forefront in
biological psychiatry. A leader in the international scene in biological psychiatry,
he was instrumental in organizing the International congresses of biological
psychiatry.
His record includes all
aspects of professorial activity
-—
pre-eminent
research, active teaching, administrative leadership, and important clinical
contributions.
Charlie is well liked by his peers and his co-workers, as witnessed by
the many honors and appointments that he has had.
recommend his appointment as Professor, with enthusiasm and
without hesitation or reservation.
I
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
�
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mfp-05-00-032-4-104
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1991
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cdcf7b05f070279bd629e54dfc37bcf7
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Text
November 30, 1991
Martin B. Keller, M.D.
Dept. Psychiatry & 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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mfp-05-00-032-4-106
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1991
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035f53b1bab535f7d6773ab99c85d758
PDF Text
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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mfp-05-00-033-1-011
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1991
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5d097620864ebc8a518cb66323eecb8e
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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 & Chairman of the
Department of Psychiatry & 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
�
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mfp-05-00-033-1-013
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1991
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1d14e038c02d9b79c3d2f20b107ad796
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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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mfp-05-00-033-1-014
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1991
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9014ecae082176ee5594eb8da125bde6
PDF Text
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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mfp-05-00-033-1-015
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1991
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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http://exhibits.library.stonybrook.edu/mfp/files/original/6bd1554506f42e88357bfc3053d5464e.pdf
c45c26b3b95254598b1e84de2e9b13ec
PDF Text
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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mfp-05-00-033-1-017
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1991
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http://exhibits.library.stonybrook.edu/mfp/files/original/47521a213c4ebbc9385bb423194a4610.pdf
6cf53a47b6300d8e9e3164dd956a33e2
PDF Text
Text
{if
‘
4!“:
_
I!r“.;,"‘,./"';':’/
May 9, 1992
Wilma Harrison, M.D.
Roerig Division Pfizer Inc.
235 East 42 Street
New York City 10017-5755
Dear Wilma,
Thank you for the invitation to participate in the teaching commitments
am delighted to do so. As you know, am now identified with ECT
and catatonia than in standard antidepressant research. My ’expertise’ is rather
specialized and may, or may not, fit into the Roerig teaching program.
of Roerig.
I
I
ECT is a most effective treatment, which is offered mainly at major
academic hospitals in the U.S. It is hardly available at Veterans Hospitals, state
mental hospital, municipal hospitals mental health services, or the NIMH clinical
center. Despite the confirmed efficacy and safety of modern ECT. Despite the
reports of numerous commissions and study groups. Despite the belief by many
psychopharmacologists that the drugs can do all, for all, if only their knowledge
and skills were applied. [Even Don Klein, however, has begun to refer patients
for ECT.]
What can be done?
ECT, can surely help.
If
you wish to support lectures or conferences on
I
Perhaps Roerig is interested in something more. Each year at the
APA, the industry sponsors large lectures, with food and excellent P.R. Each
year, the topics are focussed on drug treatment for mania or panic disorder or
therapy resistant schizophrenia, each a topic designed to support a defined use
of a specific drug. Roerig could do more. Offer a symposium on the evaluation
and treatment of the severe mentally ill, with a focus on the relative efficacy,
indications, and combined uses of drugs and ECT. By including ECT, you will
capture a large [and growing] group of physicians who feel that their training
has been deficient [it generally has] and who are now asked to use ECT [by
insurers]. A symposium could be organized about a single diagnostic group
[depression, bipolar disorder, psychosis] or about a problem [treatments in
pregnancy, the elderly, or young adults] with a focus on guidelines for the use
of drugs and ECT, in association or sequentially.
�Wilma Harrison, MD.
Page 2
Catatonia is a second topic. A few years ago, Mickey Taylor and
wrote an argument that catatonia should be separated from schizophrenia [it is
only defined as a subtype of schizophrenia in D-SM-lll] into a separate class in
DSM-IV. The DSM-IV committee agreed, in part, and now recommend that
catatonia be a modifier of four conditions.
I
Our interest in catatonia is based on two issues. ls catatonia a part of
schizophrenia or is it something else? Considering the particular efficacy of
ECT, should it not be separated from other conditions so that ECT can be used
early in the treatment? Further, are catatonia and NMS similar or different
disorders?
also enclose an editorial “Pharmacotherapy and ECT” which
expresses my opinion of some present lacks in the education of
psychopharmacologists and clinicians about ECT.
I
Some specific suggestions. For lectures, the following titles are
descriptive:
For whom should ECT be considered?
ECT and pharmacotherapy: Combined and sequential use.
Efficacy and safety of modified ECT.
Catatonia and NMS: Identification and treatment.
Catatonia: Not so rare and very treatable.
For the APA, a conference can be organized on the topic of catatonia, or
therapy resistant depression [psychosis], or the pregnant psychotic. Each topic
can be organized to be rather unique in modern APA annals.
I
enclose some reprints for your review, and a copy of my ’short’ c.v.
My
thanks foryour consideration and my best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
�
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mfp-05-00-033-1-020
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1991
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-
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81ab104222be887ebd14cc70e103fbbf
PDF Text
Text
"
Prim
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.
Emma
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Post-It” brand fax transmittal memo
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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
�
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mfp-05-00-033-1-023
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1991
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47752ea4463fd1d8131cd8f4c49a6ca5
PDF Text
Text
j-
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
,
�
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mfp-05-00-033-1-024
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1991
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4a16a1fcfd87913dcbb26b5ed06a5d1b
PDF Text
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
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Correspondence to: Cuomo, Hon. Mario M.
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1992
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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http://exhibits.library.stonybrook.edu/mfp/files/original/15ebc60ab8a3f574c59bc45bd3bf53dd.pdf
bb75602ff52b7f814a140950e79017a7
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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
�
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mfp-05-00-033-1-026
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/f3e57e4d01002162e34f7d00e78ad33d.pdf
5ce7163a4174ad4dfd9a0d78dda0eabd
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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
�
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1992
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e0df70f47007465689c367a38cc8bdbf
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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
�
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mfp-05-00-033-2-030
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1992
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1ce671ac538d495448b5ea77ffb0632f
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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
�
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/a573f6ce1ca6a3da8e54c62c4e3df499.pdf
169938da1c472c0dfbb44fc875883964
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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
�
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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
�
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1992
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904675e3482cb6fb7ff512bd96250432
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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
�
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0eaf5dd626213bf174bd1db05a396854
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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
�
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mfp-05-00-033-2-045
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/5a628705c7ab5f887f4f2f6203f18171.pdf
1a2060ee4789a32280673bdb05e07f81
PDF Text
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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1992
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401160c57ed4e40fb6ca3419de212b43
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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.
�
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1992
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751be4a627af68a438b7454a90f192aa
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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?
�
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mfp-05-00-033-3-049
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/f5f8ab192d9d22e57a1ce62ed52b521e.pdf
cca0cff7a0d6463ee06676939fad7f4a
PDF Text
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
�
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mfp-05-00-033-3-050
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1992
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629ce2a1d7f006672b98519c049f7721
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Text
Post-It” brand fax transmittal memo
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is
. NYB (I)
Health Sciences Center
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
�
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mfp-05-00-033-3-053
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/cef1ed652e4b2febf9e5da2f51505f5e.pdf
e27878c1985832cdb2335274433936af
PDF Text
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
�
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1992
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7c3d5bee89082eed30b9331e5e534790
PDF Text
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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
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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
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CASELLES
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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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1992
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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 & 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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http://exhibits.library.stonybrook.edu/mfp/files/original/14b075b9edf666c7c155c2e489076550.pdf
802b946ccef9a24803f864c09c1b4540
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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
�
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mfp-05-00-033-3-058
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/af740e98144d028e26e5fec2d40615a4.pdf
afc1227c0db6f6fb5249948d79152e7a
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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
�
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1992
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http://exhibits.library.stonybrook.edu/mfp/files/original/964043eb5c74c880746dacee6aa2e41d.pdf
280f38fdab93d25ae0e7170ee5b995d3
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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
�
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1993
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78533c571fbfffc39d49f8153797e237
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June 16, 1993
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
�
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1993
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191dfe5261fafd5409e7babc426b1215
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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
�
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June 10, 1993
Dr. John Little
H&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.
�
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mfp-05-00-033-3-067
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1993
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http://exhibits.library.stonybrook.edu/mfp/files/original/38f7c751658fa3a5701ae50b2e4576c2.pdf
6b1690a89c0fc5db05f0b8aa5a979ac3
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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
�
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mfp-05-00-033-4-069
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1993
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c61c617f1327d6e809764016f0c600b7
PDF Text
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
�
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mfp-05-00-033-4-071
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1993
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http://exhibits.library.stonybrook.edu/mfp/files/original/3a223603e9b7cb103d77f8052ae5c2a2.pdf
07dff742552ec257bf1dd62cf97cdb89
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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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mfp-05-00-033-4-072
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1993
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http://exhibits.library.stonybrook.edu/mfp/files/original/050f862d88da7566f71759ca325e43dd.pdf
13827b1f21e3deb002a206100a10405b
PDF Text
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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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
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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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-
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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 & 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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mfp-05-00-033-4-073
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1993
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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ea06902a644e0f8b54141ccd93b1c8dc
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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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mfp-05-00-033-4-079
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1993
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2abf4558ee3dd51fa3504ea29b0a8e4f
PDF Text
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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Correspondence to: Graettinger, William
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mfp-05-00-033-5-080
Date
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1993
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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f3b10a0f49d49f21096bdb021fae0899
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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 & 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 & 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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1993
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0f9c40a5d58bade58ae853f52395ba92
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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 & Sons in hard
cover, and re-issued in 1990 in soft cover by Wall & 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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mfp-05-00-033-5-083
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1993
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b2af67b9c3398da391afadae6a2c0b46
PDF Text
Text
November 7, 1994
Fred H. Frankel, M.B.Ch.B., D.P.M.
Department of Psychiatry
Beth Israel Hospital
330 Brookline Avenue
Boston MA 02215
Dear Fred,
I regret your impression that Dick Abrams’ remarks honoring my work in
ECT detracted from the work of the 1978 Task Force. Faced with the task of writing a
note honoring my contributions, he cited a long list, including the experience with our
1975-7 8 committee. I know that he meant no disservice to others.
This note reminds me of your earlier suggestion that the Task Force be
memorialized in 1995, at the 20th anniversary of its inception. Somehow, I think that is
premature, since our product was not available until 1978 -- would a recognition in May,
1998 be more appropriate?
My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-5-085
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1993
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afc5ed12d46f119c9257a072676c999f
PDF Text
Text
Dr. Denise White
July 29, 1994
Department of Psychiatry
Groote Schuur Hospital
Observatory 7925
Cape, South Africa
Dear Dr. White,
Thank you for the recommendationof Dr. Ian Lewis for the position as Fellow in
our Department of Psychiatry. The application needs documented evidence of the completion of
medical training; satisfactory completion of residencytraining in psychiatry; letters of
recommendationfrom three sponsors [he should advise us to whom to write]; and satisfactory
grades in the FMGEM or USMLE examinations. [The last is essential for all trainees in the US]
It is my understanding that the examination schedule can be obtained from the US. Consular
offices. Please ask him to write a letter of appliication addressed to me.
I attach a copy of the letter I recently formulated for another applicant; it will give
Dr. Lewis a better idea of the work that is ongoing and planned.
It was a pleasure to work with you again in Philadelphia. It has taken me more
time than it has taken you, but I am now convincedthat NMS is a variant of catatonia. In talking
to Teri Rummans of the Mayo Clinic who recently described their experience with malignant
catatonia, she added the modification that NMS should be seen as a variant of ‘malignant
catatonia’ -- a correction which I consider reasonable. Such associations lead logically to a
different protocol for the treatment of NMS -- that of‘lorazepam and ECT rather than dantrolene,
bromocriptine, amantadine, and l-dopa.
I am rather pleased with the changes in DSM-IV regarding catatonia, and decided
that since it is most likely that the APA Task Force will get brickbats and complaints, that perhaps
someone should extend a friendly hand. I did so in an editorial for Biological Psychiatry; a copy of
the accepted article is enclosed for your interest.
from him.
Thank you for the recommendationof Dr. Ian Lewis. I look forward to hearing
My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-5-091
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1993
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383e92cec1646eeb388337a9459958b4
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A
State University of New York at Stony Brook
School of Medicine —— Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 11780
/
/4
jail”!
9?
b
'
Phone: 516 444-2929
516 862—6651
Fax: 516 862-8604
July 23, 1994
TO:
Robert Hirschfeld, M.D.
FROM:
Max Fink, MD.
Subject:
Ted Hutchinson’s memorandum14 July 94
M
Ted is a lay-person who was advised that his son needed ECT in California,
and he came up against the community prejudice and legal devices to frustrate its use. He
succeeded in getting treatment which was most helpfiil. Since then, he has read widely in
ECT, developed a unique knowledge of the legal issues, especially those affecting the
FDA, and the role of the anti-psychiatry movement in the US. His ‘alerts’ to members of
the ECT community are respected.
He was instrumental in getting D. P. Devanand, Tom Bolwig, and Harold
Sackeim to compile the data in the reecent review of the pathology of ECT, the review
appeared in the recent number of the Am. J. Psychiatry. [He is a co-author].
I take his advice seriously and respect his knowledge.
The APA Task Force on ECT, headed by Richard Weiner, was establsihed
in response to requests for advice by the FDA in 1981 or 1982. It is still responding to the
FDA, and you may wish to get his advice, to correlate your responses. [Te1: 919-681
8742}
�
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mfp-05-00-033-5-092
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1993
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b55da0d142bca3c48135713618a7231f
PDF Text
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State University of New York at Stony Brook
School of Medicine ~— Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 1780
Phone: 516 444-2929
516 862—6651
Fax: 516 862-8604
1
July 8, 1994
TO:
FAX
FROM
FAX
Dr. Sweeney Pillay
617 855-3754
Max Fink, MD.
516 444-7534
7
The citations you requested are:
Fink, M. :EEG and behavior: Association or dissociation in man? Integrative Psychiatry [in
press, 1994]
Fink, M., Irwin P., Weinhold P.: EEG profile studies of clozapine in volunteers and psychiatric
patients. Neuro-Psychopharmakologie1979; 12: 184-90.
My best regards to Jonathan.
�
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mfp-05-00-033-5-093
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1993
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9540841bb88506d1664767d0a7ffc976
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“State University of New York at Stony Brook
School of Medicine — Department of Psychiatry
Phone: 516 4442929
Max Fink, M.D.
Professor of Psychiatry
PO. Box 457
St. James, New York 1780
516 862-6651
Fax: 516 862-8604
1
April 29, 1994
TO:
FAX:
Greg Fricchione, MD.
617 738-1275
FROM:
Max Fink, MD.
516 862-8604
FAX:
There is no secure literature on ECT in patients with amyotrophic lateral
sclerosis. The closest are the early reports of the successful use of ECT in patients with
multiple sclerosis [Savitsky and Karliner, N YSla/e .1. Med. 1951; 512788] and Alexander
[JNMD 1951; 1 14:283-306]. Others have written about the usefulness ofECT in
Parkinson Disease, general paresis, progressive muscular dystrophy, and intractable
epilepsy, in each case without negative effects on central nervous system fimctions.
While none of these experiences are directly relevant to a case with
amyotrophic lateral sclerosis, I believe the consensus today is that if ECT is compelled,
there are no systemic disorders that would prevent the administration of ECT. I would
anticipate no specific difficulty other than that associated with swallowing and respiration
-— if brainstem signs are present sufficient to compromise these functions, the
anesthesiologist may well decide to intubate.
patient, keep good records and have your
junior write up. While cannot promise the response of my successor as Editor of
Comm/Siva 'l'herapy, I expect that he would look upon such a report with favor.
Ifyou decide to treat such
it
a
I
Good luck, and my best regards.
�
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mfp-05-00-033-5-096
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1994
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April 29, 1994
Donald F. Klein, M.D.
NY State Psychiatric Institute
722 West 168 Street
New York City 10032
Dear Donald,
After your letter about the hunt for the article on an evaluation of
psychoanalysis, I thought of calling Abe Lurie [516 681-5004]. He recalled a similar story,
stated that he had brought the tale to HH afier sitting next to the author on a flight. He
recalled that there was another evaluation done at Hawthorne-Cedar Knolls in the 1960s
The report was critical of psychotherapy, but could not give me any more data.
Perhaps you can jog his memory a bit more.
My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-5-097
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1994
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a09b3e3f9b45f3a6ddd9321b7401b854
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December 27, 1993
Werner Herrmann, MD.
Clinical Psychophysiology
F reie Universitéit Berlin
Eschenalle 3
D—lOOO Berlin 13
FRG
Dear Werner,
I received your Fax regarding your nephew and took it up with Fritz Henn.
He will ask for approval from the Dean’s office and should know within a few weeks.
We have had such scholars previously. Our third-year students have a
clinical course of 6 weeks which is both didactic (lectures) and clinical. It is preferable that
he be assigned to work on 10-North at University Hospital and if possible, should be there
when either I or Fritz Henn are ‘on service’. When approval comes, let me know what
dates he has available and I will advise you how to maximize his experience.
My best wishes for a happy and healthy 1994!
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-5-102
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1994
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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e837c88db593120602ef932be8382bee
PDF Text
Text
February 8, 1994
Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
GENOA
Italy
Dear Walter,
First, the good news that your good fairy deposited a check for $9,980 to your account on
January 10, giving you a balance of $14,335.
As for compiling a book from a meeting, it is a good idea and many publishers will
welcome the opportunity to publish, provided that you can convince them that there is a market.
That is usually done by showing that a society is behind the book, and that the society will ‘sell’
the book to the members by making it part of the annual dues; or by internal advertising; or by
subvention. The latter method is the most secure, since the publisher asks that you assure him of a
set amount [usually enough to cover his direct costs for 500, 1000, or 2000 copies], and he will
then gamble on making some money from additional sales.
It is not the list of speakers, nor their eminence, that will make the book -- but the
eminence of the authors, that is, the actual submissions that you receive to publish. The usual
procedure is to develop a ‘proposal’ for the book, which you can present to science editors of
publishing houses. I have attached the topics for a proposal.
Raven Press is a good bet, and when you have a proposal, send it to me, or bring it when
next you are in New York. Other publishers are Elsevier, Academic, Plenum, Karger, Thieme,
and others.
Having a co-editor is a pain, unless you can find one who is obsessive and wishes to do
the work involved.
Ciao!
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-5-105
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1994
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http://exhibits.library.stonybrook.edu/mfp/files/original/c4b042dc1452c19aaeff3b9499221ac2.pdf
6414feb61423fcd0af8b46caf53b98f8
PDF Text
Text
December 5, 1995
Chittaranjan Andrade, MD.
Department of Psychopharmacology
NIMHANS
Bangalore 560 029
India
Dear Dr. Andrade,
Thank you for sending me your most recent publication which outlines the
research contributions of NIMHANS to our understanding of ECT. It is impressive.
By happenstance, Dr. Sanjay Sandragiri was assigned to work on my
service this month. He is a trainee in our residency training program. He appears to be
talented, enthusiastic, and well trained already, so that it seems a shame for him to spend
the next three years in pedestrian learning activities. I was considering encouraging him to
undertake studies in ECT concurrent with his residency training. I understand that he
spent some time at NIMHAN S. I would be grateful for any remarks that you would share
with me regarding his potential for an academic career and his ability to assume the double
burden of residency training and innovative research.
My regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-6-109
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1994
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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ec086d920872deff90f10525b146ccb5
PDF Text
Text
Directions in Psychopharmacology
Published by
The Hatherleigh Company, Ltd.
420 East513t Street
New York NY 10022-8095
EDITORIAL BOARD RESPONSE FORM
Name Max Fink, MD
IE
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In addition, I would like to write a lesson on:
would like to serve on the Program Advisory Board of Directions in Psychopharmacology.
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A deadline of
El
Thank you for the invitation to serve on the Board, but I must decline at this time.
JW
Signature
is requested for my manuscript.
(576
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4¢¢~2¢90
Telephone number
//F/»\//¢ @ 579.5001. swysa.
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£42—
FAXnumber
(604!
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e-mail address
Please indicate any address correction here:
de 60X
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My
xx/rowe/s?
Please return this form, along with an updated curriculum vitae, and send to:
Steven L. Pessagno
Managing Editor
The Hatherleigh Company
420 East 51 Street
New York NY 10022-8095
Thank you for your time in completing this form.
�
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mfp-05-00-033-6-112
Date
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1994
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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b7e403b1ec397f5c267b544150e64355
PDF Text
Text
November 26, 1995
Lizzie Sand Stromgren, MD.
Department of Biological Psychiatry
Psychiatric Hospital in aarhus
Skovagervej 2
DK-8240 Risskov, Denmark
Dear Lizzie,
I read your essay on ECT in acute delirium with much interest. I marked up
the text, and made suggestions which I believe will clarify the presentation. I also made
marginal numbered notes which are discussed in the attached memorandum.
There is little question about the efficacy of ECT in severe melancholia,
stupor, or acute manic states. The argument which I believe you wish to present is that in
acutely ill patients with histories of psychiatric or systemic disorders, the appearance of an
acute delirium, with or without fever, with or without rigidity, with or without autonomic
signs, is a possible indication for ECT; and if ECT, the use of en bloc [2-?3 ?4] treatments
may be life-saving. The discussion of unilateral and bilateral ECT and cognitive features is
beside the point. I believe we need a follow-up of the Kramp and Bolwig article as an
invitation to others to entertain the possibility of using ECT in this special type of case.
Thank you for the opportunity to read this report. My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-6-113
Date
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1994
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c6bd7111d8b56e812d810c39d4423768
PDF Text
Text
State University of New York at Stony Brook
.
\J
’
9 a
I
School of Medicine — Department of Psychiatry
,
Max F ink, M.D.
Professor of Psychiatry and Neurology
PO. Box 457
St. James, New York 11780
Voice: (am) 516 444-2990
(pm) 516 862-665
Fax: 516 862-8604
E-mail: mfink@epo.som.sunysb.edu
1
November 26, 1995
Dr. Daniel Flores Amargos
Inst. de Psiquatria y Psicologia de Montevideo
Ellauri 1221
Montevideo, Uruguay
Dear Dr. Flores Amargos,
I am indeed flattered by your invitation to particpate in a medical specialty
training program in Montevideo, and whicl I am inclined to accept the invitation, I am
aware that there is no suggestion as to what is expected of me. Do you intend to develop
courses over extended periods in Montevideo, or single day seminars? Or, do you wish a
list of sites to which you can send trainees, much as you did Dr. Savi? I will reserve my
answer until I am apprised of the details of your program.
Meanwhile, I am interested in hearing of any programs developed since Dr.
Savi’s visit here.
My regards to Dr. Lyford-Pike and Dr. Savi.
Si
erely ours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-6-114
Date
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1994
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2b0a91a1c60fa3b3b931936f9ef03f21
PDF Text
Text
July 17, 1995
Worrawat Chanpattana, MD.
Department of Psychiatry
Srinakarinwiroth University
Vajira Hospital, Samsen, Dusit
Bangkok, Thailand
Dear Dr. Chanpattana,
I have read the outline of your proposed study of continuation ECT in
interest. There is a need for a prospective study of ECT contrasted with
with
schizophrenia
neuroleptic drugs in schizophrenia. The basis for this belief is the review, now in press in
Schizophrenia Bulletin, which I recently completed with Dr. Harold Sackeim; a copy is enclosed.
The question which you seek to answer with the design of your study, however, is
not central to our present concerns. Most patients are treated with neuroleptics first, and only
treatment failures are considered for ECT. In such a group, there would be little justification to
continue treatment with a failed compound [such as a neuroleptic]. If you wish to answer the
question which intervention reduces relapse rate for longer periods, and at what cost, then patients
who failed an adequate neuroleptic trial for schizophrenia could be assigned to receive either a
continuation neuroleptic [although an atypical neuroleptic like clozapine would be preferred]
contrasted with those treated with ECT [either alone or combined with the atypical neuroleptic].
Such a study would parallel ongoing US studies comparing the relative efficacy and safety of
continuation ECT, continuation lithium combined with a tricyclic compared, and lithium alone.
It is probably inappropriate to use haloperidol combined with ECT since there are
few studies of this combination. Considering the high risk of haloperidol for inducing dyskinesia, it
is not favored by many psychiatrists.
I am not directly involved in the support by our governmental or private agencies
of mental health research, and so cannot answer your query about support.
My regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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mfp-05-00-033-6-115
Date
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1994
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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PDF Text
Text
Self <PSYCH|ATRYIMFINK>
taylorm@mis.finchcms.edu(Taylor Mickey)
Re: congrats on MEDLINE
From:
To:
Subject:
Date sent:
Wed, 2 Oct 1996 15:48:19 -0500
Dear Mickey,
Monday morning visited the library and the librarian showed me the
list of new journals accepted for indexing by NLM, and l was so
delighted to see ourjournal listed! Then came home and the mail
said the same thing.
I
I
How reassuring! How wonderful! You are to be congratulated on getting
the journal so far.
have decided that the lay-world needs a verbal explanation of ECT,
something akin to the videotape. So have been working on a
'popular' book for the trade market titled ELECROSHOCK!
Two publishers are interested, but before signing a contract l
decided to finish a good part of the book and then see if get a
better deal. So far, 21 chapters are written -- in various stages.
hope to have it done by the winter.
I
I
I
I
Harold Sackeim is the chairman of the SBP meeting in May 1997. He
visited us yeaterday and among topics, asked whether he was
interested in a discussion [debate, symposium, whatever] on the
difference in the US eclectic view of catatonia and the European
classical view that catatonia IS schizophrenia. He seemed interested.
suggested Beckmann and Stoeber of Germany, Taylor and Fink for the
US. Any thoughts? Could you go to California in May if carry
this through?
I
I
I
All my
best.
Max
�
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Correspondence to: Taylor, Michael A.
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mfp-05-00-033-7-121
Date
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1994
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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397ce2f11ec99a1feb4240988e2268dd
PDF Text
Text
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Correspondence
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Title
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Correspondence to: Tennison, Michael B.
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Identifier
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mfp-05-00-033-7-127
Date
A point or period of time associated with an event in the lifecycle of the resource
1995
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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Correspondence -- Correspondence
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The Max Fink Collection
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/d163f8b6823f518ad6587beaf6288182.pdf
24fdb48012a0deb8ea2648540dd879a9
PDF Text
Text
Robert M. Post, M.D.
NIMH
Building 10 Room 3N212
9000 Rockville Pike
Bethesda, MD 20892
May 21, 1996
Dear Bob,
I am pleased to nominate Harold Sackeim of Columbia University for the
NARSAD Selo Prize.
For the past decade, Harold has been the nation’s leading researcher into
the practical issues in electroconvulsive therapy. He has defined the importance of the
seizure threshold, energy dosing, and electrode placement in the eflicacy of ECT for
affective illness. In addition, he has clarified the role of ‘pharmacotherapy-resistance’ in
the efficacy of ECT in affective disorders. Leading from those experiences, he has
organized and is now analyzing the data of the nation’s only study assessing the relative
efficacy of continuation TCA vs continuation lithium plus TCA vs placebo in the aftercare
of patients who complete ECT. He has also made important suggestions as to the
mechanism of action of ECT, and in the present brouhaha about TMS, he is carrying out
the most organized and detailed studies of this possible alternative induction method.
He has been an NIMH scholar, a NARSAD scholar, received an award of
the ACNP, and is now a member of the APA Task Force on ECT.
For the decades of the 19605 to the 19803, it could be said that I led the
ECT research community. In the past decade, that role has surely been taken by Harold
and his leadership should be acknowledged. I am pleased to nominate him for the honor.
My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
Dublin Core
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Dublin Core
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Title
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Correspondence to: Post, Robert M.
Type
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Text
Identifier
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mfp-05-00-033-7-129
Date
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1995
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
The topic of the resource
Correspondence -- Correspondence
Relation
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The Max Fink Collection
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Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/7f15af7a20a4ddaf50e613ab53746fe0.pdf
d2f82701779052e80f3e0a5082ef6db2
PDF Text
Text
Health Sciences Center
School of Medicine
Department ol' Psychiatry and Behavioral Science
April 16, 1996
TO:
Charles Kellner
From:
Max Fink
Subject:
Letter of Mr. Herman
W
I am in receipt of a copy of a letter addressed to you by a Mr. David Herman
regarding the use of CT pages for Szasz.
DH is a chronic psychotic who has latched on to ECT and drugs as the cause of his
difficulties; he is active in writing to everyone about his desire to save the world by stopping ECT
and drugs. He likes Szasz and Breggin.
He has written often; and as often, I have not answered.
My lack of reply is no sign of agreement or acquiescence.
See what being an editor gets you!
State University of New York at Stony Brook
Stony Brook, New York 1 17947810]
5i 6444—2990 Fax: 5 ()7444—7534
I
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Correspondence
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Dublin Core
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Title
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Correspondence to: Kellner, Charles
Type
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Text
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mfp-05-00-033-7-131
Date
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1996
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
The topic of the resource
Correspondence -- Correspondence
Relation
A related resource
The Max Fink Collection
Description
An account of the resource
Rights
Information about rights held in and over the resource
<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/d2452c2f3626ab48ed944da8dec7ac88.pdf
ec0c7866fee35738bc21d19d9655753a
PDF Text
Text
March 19, 1996
Greg Fricchione, MD.
Division of Psychiatry
Brigham & Women’s Hospital
75 Francis Street
Boston MA 02115
Dear Greg,
What a terrible story about Anthony Bouckoms! I liked him very much;
last November I invited him to join me and Charlie Welch in an ECT symposium at the
Boston APA meeting. He did well, and he told us of the changes in progress at Hartford
Hospital. Pity, such an untimely personal and professional loss; more than doubly sad for
his wife and remaining children.
I have read the article on catatonia with interest. My suggestions -- I
cannot read any article without and editorial pen in hand -- are in the text and margins.
Overall, I think the essay presents the experience well. But, if we are to be of service, we
should be more definite about the conclusions which we wish to leave as the ‘messages’.
The first message is to recognize catatonia, and that is done well. Andy and
George will probably wonder why you do not recommend the use of their handiwor -the catatonia rating scale. By the time you get this note, it will be published [it is in the
March number of the Acta]. Instead of tables 4-6, should you not adopt the rating scale
and test method? We will surely have no objection to such use. [There is one small point -both George and Andy saw the scale as their ‘special’ handiwork and in the text of the
article labeled the scale as the ‘Bush-Francis Catatonia Rating scale’ or BFCRS —- a
cumbersome title that will not sell well. I believe you can adopt the scale without the
mnemonic label, as I have done elsewhere]
Similarly, you may wish to amplify the paragraph discussing the Bush et al
experimental findings in incidence of cases and treatment results, much as you do for the
Ungvari and Rosebush data (pg 16).
�The discussion of the theory of the mechanisms in NMS, catatonia, and
malignant hyperthermia deserves a clearer message (pg 23). When NMS was discerned as
an entity in the late 1970s, it was seen as similar to malignant hyperthermia, leading to the
suggestion that dantrolene be tried. But no commonality between MH and NMS has been
demonstrated except the superficial appearance of the syndromes. Further, the evidence
for the efficacy of dantrolene alone in NMS is anecdotal at best. (I am not convinced that
it does anything material in CNS disorders.) It does no good to continue to recommend its
use in NMS.
In the theoretic argument (pg 24), you argue for a specific site for
pathophysiology. Perhaps you would include a statement that one should assess PET with
xxxx as the ligand or SPECT for lesions in yyyy and/or zzzz. Such specificity may bring
you more attention than the more general, non-specific loci recommended now. [I believe
Mickey Taylor did himself a disservice by hsi trepidation in not seeking to argue for more
specificity; as a result his work is usually seen as ‘something happens to the brain, more in
the front than the back, I think . . .]
Finally, the summary argumen -- which is usually the most read- should be
clearer about what you recommend as a course of treatment. The journal is ‘critical care
medicine’, read, I assume by clinicians. What I have learned since we treated our patient
on 16N together is that that all neuroleptics need to be discontinued promptly; that
supportive measures instituted; and that lorazepam needs to be ‘pushed’. My present
dosage range for lorazepam is up to 16mg/day. I see no need to ever consider
bromocn'ptine or dantrolene -- if lorazepam fails, ECT is the definitive treatment. If the
diagnosis of catatonia is secure, such Rx will surely optimize the best for the patient.
I have also pencilled in corrections for some of the citations.
On a more personal level, I do not need to be a co-author of another paper.
I am delighted to help in this effort -- and will gladly review a penultimate drafi -- and all I
warrant is a note of thanks in the acknowledgements.
Many thanks for the opportunity to read this review. My best regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Correspondence
Text
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Dublin Core
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Title
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Correspondence to: Fricchione, Greg
Type
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Text
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mfp-05-00-033-7-137
Date
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1996
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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Correspondence -- Correspondence
Relation
A related resource
The Max Fink Collection
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An account of the resource
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/ed10f1701a537571c4caeef3644623f2.pdf
08f2635fd18f48d6334a3311a165a8b7
PDF Text
Text
DatezFebruary 22, 1996
TO:
D.R. Milne
FAX #
419 382-2378
Total Pages (including this sheet)-1-
Dear Mr. Milne,
I do not participate in public debates except for and with mypeers.
The tragedy in public discussions of electroshock is the anger shown by
many in the laity and some in my profession to the mentally ill. The same persons who
would undergo coronary artery bypass surgery or hysterectomy or other surgery with
alacrity are distressed out of all proportion at the idea of electricity coursing through
their brains, not realizing that their brains are hotbeds of electrical circuits already.
You would do better to ask the question: Why is it that E CT is available at
the leading academic centers in the nation but not in almost all the state and veterans
administrationpublic mental hospitals? Why do we have a two-tier treatment
program? [It is notfinancial since mentally ill patients are equally likely to be
admitted to the academic hospitals in your state as to the publicfacilities.] Try the
professor ofpsychiatry in your [or any] state and its commissioner of mental health.
Max Fink
From:
Max Fink, M.D.
P.O. Box 457
St. James, New York 11780
FAX:
516 862-8604
TEL: 516 862-6651
�Date: Feb 21, 1996
TO:
Mr. D. Milne
L9
FAX # 419 382-23175
Total Pages (including this sheet)-lDear Mr. Milne,
The essay by Gary Figiel is in the nature of ‘Chicken Little’s fears.
The four articles to which he refers find no justification for the routine use of
labetolol or esmolol other than the anxiety of the physicians. ECT is no more
riskful to the heart than climbing a flight of steps -- indeed, less so.
More harm is probably done by routine use of anti-hypertensives
than by unmodified seizures, since severe and persistent hypotension is a
common accompaniment of such use.
If you publish such anxious statements, perhaps at the least you
would ask the author to specify what he means by ‘MAJOR’ and what he
means by “MINOR’ effects. Also, a complication is an unexpected, and
potentially damaging event. You may ask the author what the consequent
‘complications’ were in the unmedicated series.
I will not consider a reply. You do no service by such publication.
Max Fink
From:
Max Fink, M.D.
P.O. Box 457
St. James, New York 11780
FAX:
516 862-8604
TEL: 516 862-6651
�
Dublin Core
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Title
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Correspondence
Text
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Dublin Core
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Title
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Correspondence to: Milne, D.R.
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Text
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mfp-05-00-033-7-141
Date
A point or period of time associated with an event in the lifecycle of the resource
1996
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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Correspondence -- Correspondence
Relation
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The Max Fink Collection
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Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
Format
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/7c5681118ee118e010d81f3d7fcfe975.pdf
930ebd4ced5dd4a2a31514d87d0d3b86
PDF Text
Text
February 17, 1996
Ms. Sarah Lentz
DMS Box 470
Hanover, NH 03755
Dear Ms. Lentz,
Thank you for the opportunity to read you report on ECT and pregnancy.
It is quite good, but as an Editor, I have some suggestions to improve the history and the
practice.
In the history, the introduction of electrical inductions by Cerletti and Bini
was a modification of an established treatment, that of Metrazole convulsive therapy. The
induction of seizures with camphor and then pentylenetetrazol [Metrazole] was introduced
by Ladislas Meduna in 193 4, highlighted in an international conference in Muensingen,
Switzerland in 193 7, accepted throughout the world as a treatment [see the supplement to
the Am J Psychiatry 193 8]. These events preceded and were surely the stimulus to the
Italians [Bini attended the 1937 meeting]. It would be better to state that the introduction
of convulsive therapy by Meduna was the innovation that altered psychiatric practice. He
deserves the credit.
The charge of overuse and inappropriate treatment of ECT is incorrect. All
treatments that are perceived as successful and safe are ‘overused’ as practitioners seek to
extend and define the indications. Think of the present enthusiasm for fluoxetine or the
newer alleged psychotropics; or the extensive overuse of coronary artery bypass surgery;
or of caesarian deliveries. The canard should not be repeated and this section should be
deleted.
Further, ECT like other somatic treatments in use in the 19505, was
replaced by medications, but its renewed interest [in contrast to psychosurgery and insulin
coma] was occasioned by the failures of pharrnacotherapy. Despite the enthusiasm of the
public and the blandishments of the pharmaceutical representatives, many patients fail
modern drug therapies and are later successfiil with ECT.
�In your suggestions about ECT in pregnancy, there are a few that are more
dangerous than you consider. Vaginal examination is not only not necessary but a
dangerous procedure during pregnancy and should not only not be recommended, but
enjoined unless compelled by signs or symptoms that warrant such an examination. There
is nothing about the examination that would alter or affect ECT, if ECT is compelled by
the patient’s mental state.
Anticholinergic medication as part of the ECT procedure is acceptable and
useful. External fetal monitoring during the procedure has been done, and remarkably, the
fetal heart rate is unaffected by the procedure. There is no justification for such monitoring
as a routine procedure because the expense is excessive and the information yield nil.
In patients in the second half of pregnancy, intubation is part of the
standard of anesthetic care, and it is routine for all our cases. The use of antacids is
optional and our anesthesiologists no longer find it usefiil.
I am puzzled by the CME credit questions 2 and 3. ECT is indicated during
because
the patient is so psychotic as to require hospital care and is exhibiting
pregnancy
either suicidality, mania, inanition, or command delusions which threaten the life of the
mother or the fetus. The emphasis on diagnosis does not reflect the compelling indication
for ECT, that is behavior which puts patient or others at risk.It is not the diagnosis that is
the indication; many mentally ill mothers cany to term without medication or treatment.
Question 3 is ambiguous. Each of the modifications of procedure are
relevant to the care of pregnant patients.
Aside'from these quibbles, I commend you on your report. We are now a
main center for treating pregnant psychotic patients and treat at least one a month. Two
are in treatment now, one for severe depression and suicidality and one who was in manic
delirium. The first is continuing in ambulatory treatments and cares for her other child; the
second has just had the delirium erased and is still being treated for mania and psychosis.
Good luck in your career.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Correspondence
Text
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Dublin Core
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Title
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Correspondence to: Lentz, Sarah
Type
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mfp-05-00-033-7-143
Date
A point or period of time associated with an event in the lifecycle of the resource
1996
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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Correspondence -- Correspondence
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The Max Fink Collection
Description
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
Language
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en-US
Format
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application/pdf
Publisher
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http://exhibits.library.stonybrook.edu/mfp/files/original/b19c4e7f59ae6371b281a0cd90f36543.pdf
2ef2a4ec998748b63028de45cff8dda4
PDF Text
Text
February 8, 1996
Dr. Sydney Archer
Rensselaer School of science
Troy, NY 12180-3590
Dear Sydney,
My recollections of the patients are hazy. But I called Dick Resnick and he
seemed more au courant. I have sent him your letter and asked him to call you.
If I can be of help,
let me know.
My regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
cc: Richard Resnick MD.
43 West 94 Street
New York City 10025
�
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889d9d49bf090acf9beea2c8bdf47ffe
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Dr. Richard Horton
February 3, 1996
42 Bedford Square
London WC 1B 3 SL
United Kingdom
Dear Dr. Horton.
I read the essay ‘Revising the research record’ with much interest and
sympathy. As editor of Convulsive Therapy, no problems of scientific error have been
brought to my attention. Our level of error has been at a more trifling level, and so we
have not been faced with the difficult decision as how to alert the readers to scientific
error. I am impressed that the Table ‘Taxonomy of error’ in your essay reflects the best
stande available today.
Since a published report has gone through the journal’s peer review, when
is
found
error
or charged, it seems logical to go through the same procedures to establish
error. Assuming the review concludes that error of fact or procedure occurred, such
conclusions warrant publication. The suggested ‘withdrawal of aegis’ by the journal is a
reasonable and innovative step in maintaining scientific integrity. The principal downside
risk is the assurance that the material presented the readers in the ‘withdrawal of aegis ’ be
complete and able to withstand procedural and legal scrutiny. The guidelines for authors
should reflect the possibility of such review of published material and the possibility of
such published revision.
Should you wish a publisher’s point of View, Dr. Alan Edelson, the founder
of Raven Press and the former President of Lippincott may be able to answer an inquiry
more formally than I [amedelson@aol.com;or 16 Washington Avenue, Irvington NY
10533}
Incidentally, I have stepped down as Editor of Convulsive Therapy, but am
still interested in the problems of editing and editors.
My regards.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry
and Neurology
�
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eff8d749f7b7a5a67cb0b63ef8853f01
PDF Text
Text
Saturday, January 27, 1996
1300 EST
Dear Alan,
Martha and I have just returned fiom a delightful 5-days at the Spice Island
Inn in Grenada. The weather was excellent, the food adequate, the accommodations
among the best we have had in the various islands. The hotel was next door to the offshore medical school in Grenada. I was able to chat with many of the students who were
relaxing and reading on the beach -- their cafeteria and dining tables are on the beach
front. I was saddened by the thought that these -- what seemed to me to be fine young
Americans -- had to get their education in what seemed to be poor facilities [despite a
glorious beach]. I could see little that would distinguish them from our students at Stony
Brook.
Among my mail on my return is the communication from Richard Horton,
Editor of Lancet. I had been in touch with him when I edited CT. I am puzzled by his
inquiry. First, I had to look up the word ‘aegis’ [see ‘egis’] and found that it is a
protective influence, a shield. As I read [and re-read] the article, I come to the conclusion
that the ‘withdrawal of aegis’ is a legitimate editor’s response to an unsatisfactory article
which passed through the review net. What do you think?
I am still pausing in getting to write about ECT on the Internet. I have an
invitation from ‘www. mhsource.com ’, the home page of John Schwartz [CME, Inc., The
Psychiatric Times], and another from Ben Green [Psychiatry On—Line-- www.
cityscape.co. uk/users/ad88/psych.htm]. In addition, Stony Brook has decided to has
invested in a server for the medical school ‘home-pages’ and has invited faculty members
to set up their own. If my work-load decreases, I will think more about it.
It is pouring this afternoon -- why am I here instead of in Grenada? ? ?
My best to Carol.
a.
W
�
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mfp-05-00-033-7-146
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1996
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529c1931185d5aee13ad748dfb9521b4
PDF Text
Text
January 28, 1996
Dr. Lawrence C. Perlmutter
Department of Psychology
Finch University of the Health Sciences
3333 Green Bay Road
North Chicago, IL 60064-3095
Dear Dr. Perlmutter,
Dr. Avi Calev has been a neuropsychologist in our program since 1990, and has
asked me to write a letter on his behalf. I have known Avi for about a decade, first becoming
acquainted with him through his work with Dr. Bernard Lerer at the Hebrew University in
Jerusalem. At the time, Dr. Lerer was studying the electroshock process, and Avi provided most
useful examinations focused on cognition. With Dr. Lerer’s encouragement, he applied and was
appointed in our Department as a member of our electroshock evaluation program. He was well
liked and when an opening appeared in the inpatient clinical services, he was appointed as the
psychologist of my inpatient team. My relationship with Avi is therefore at multiple levels -- as a
co-worker, supervisor, and friend.
Avi is a talented neuropsychologist with an excellent grasp of psychometrics,
projective testing, statistics, and experimental design. He has been an active co-worker and a
leader for various projects, as attested to in his curriculum vitae, where he has a large range of coworkers. In addition to the reports of the cognitive effects of ECT, he has also assumed
responsibility for studies to determine whether pre-treatment with caffeine will influence
therapeutic results and cognitive effects of ECT. He has already published the preliminary results
which argue that the effects are favorable and is now completing the data collection for a random
assignment study.
I have known him also as the team neuropsychologist on our inpatient service. As
he
has
been most helpfiil in assessing patient characteristics, elaborating the techniques for
such,
our residents and medical students, and assuming responsibility for psychotherapy in selected
patients. In the latter instance, he both treated patients and supervised our residents.
�Lately, he developed a relationship with Dr. Lynn DeLisi, an expert in the study of
schizophrenia. Together, they are working on a number of projects with which I am not directly
acquainted.
Avi is a conscientious, interested, intelligent, and well trained psychologist. He is
well liked by his co-workers and I have been delighted to work with him. He is knowledgable
about the literature, is able to document his positions in argument, and is technically skilled. I am
distressed that he has been asked to leave -- a situation which has been occasioned by the
necessary down-sizing of our Department and not associated with any of his defects or actions.
Sincerely yours,
Max Fink, MD.
Professor of Psychiatry & Neurology
Attending Psychiatrist, University Hospital
�
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1996
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94c9268427d9025a4d53c68cbb463619
PDF Text
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August 28 1997
Dr. Valdir Pricoli
Rua Albilio Soares, 639-123
04005-002 Sao Paolo
Brazil
Dear Dr. Pricoli,
Thank you for your letter. I am pleased to have been of help.
I am moving my teachiong and research operations from SUNY at Stony
Brook to the Long Island Jewish-Hillside Hospital complex in Glen Oaks, Long Island. It
is closer to the city. The hospital has a long tradition of ECT research -— back to 1953 -and I have developed a research team there.
We would be pleased to have you visit. Arrangements can be made to stay in
Great Neck, about 10 minutes from the hospital, or in New York City —- about 30
minutes.
You can reach me at my office address as on this letterhead.
My regards.
Sincerely yours,
Max Fink, M.D.
�
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1996
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419fa279ac108e0411b62aa86ca9e868
PDF Text
Text
July 16, 1997
Harold S. Orchow, M.D.
Montevista Hospital
5900 West Rochelle Avenue
Las Vegas NV 89103
Dear Dr. Orchow,
The relationships between number and frequency of seizures, reduction in
mood disorder (efficacy), increase in cognitive symptoms (safety), and electrode
placement are described in an extensive series of reports. The details are well described
by Abrams in his textbook Electroconvulsive Therapy (Oxford U. Press, 3rd Ed., 1997).
The most recent reports are those from Jerusalem by Bernard Lerer and his co-workers.
1.
2.
3.
4.
5.
Efficacy in ECT for mood disorder improves with both frequency and
number of treatments.
Cognitive symptoms worsen as number and frequency of treatments
increase.
Efficacy is greater for bilateral electrode placement, but such efficacy
is associated with greater cognitive symptoms.
Efficacy is less for unilateral electrode placement, and such lesser
efficacy is accompanied by lesser cognitive symptoms.
Twice a week treatments achieve the same efficacy and less cognitive
effects than three times a week treatments; but two weeks after the end
of the treatment series, when efficacy is equivalent, cognitive effects
are not distinguishable.
As a consequence of these syllogisms, practitioners select the parameters
of treatment according to the severity of the symptoms. For severely ill and debitated
patients, where one seeks immediate improvement and is less concerned with cognitive
effects, ECT is given 3x/week with bilateral placement. This assures the best results. [In
severely manic or psychotic patients, this series may begin with two to four treatments
daily.]
For patients who are not too distressed, where cognitive effects are feared,
with unilateral electrode placements, at 3x per week.
treated
patients are
�In the elderly, where cognition is a principal risk, treatments are given
with bilateral placements no more frequently than two times a week.
Some practitioners deliver two seizures in a single setting. This is a relic
of 'multiple monitoered ECT' developed by Blachly and Gowing in 1966. MMECT was
tested and shown to increase risks with limited gains. The practice is no longer endorsed
except in the very severely manic, psychotic, or stuporous patient where an immediate
effect is required.
The practice of giving 12 treatments in four to five days, even with
unilateral electrode placement, sounds like MMECT — a practice which is not generally
recommended. The APA Task Force of 1990 waffled on these data and recommendations
because the members of the panel were aware that many practitioners were still using the
MMECT model. A better review of MMECT is to be found in Abrams' textbook.
I trust these remarks are helpful.
For other opinions, you may want to post a specific case example on the
intemet site of 'convulsive-therapy@psycom.net' and see what others answer.
Sincerely yours,
Max Fink, M.D.
�
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1996
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ef203757347fbc823ee497c8152e31e9
PDF Text
Text
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Dublin Core
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Correspondence to: Wyatt, Richard J.
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mfp-05-00-033-8-156
Date
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1996
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/afbe8b229bbdc7d665a13a4b0dd99df3.pdf
48223f41e34dd5cb920fb4cf2717dffc
PDF Text
Text
State University of New York at Stony Brook
School of Medicine — Department of Psychiatry
.
’oe|
I
Max Fink, M.D.
Professor of Psychiatry and Neurology
PO. Box 457
St. James, New York 11780
Voice: (am) 516 444-2990
(pm) 516 862-6651
Fax: 516 862-8604
E-mail: mfmk@sunysb.edu
.
March 11, 1997
Alan J. Gelenberg, MD.
Department of Psychiatry
University of Arizona HSC
Tucson AZ
85724
Dear Alan,
Your reminder of a failure to review manuscript 4406 “The use of
flumazenil in the anxious and benzodiazepine-dependent ECT patient” sent me to my
desk and files. I have not received the manuscript.
my custom.
Please send it on and I will get a review within a few days of receipt, as is
My regards.
W
Sincerely yours,
Max Fink, M.D.
�
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mfp-05-00-033-8-160
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1996
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1f4c8847787ea1d7dacfe0e07c4ea555
PDF Text
Text
State University of New York at Stony'Brook
School of Medicine — Department of Psychiatry
Max Fink, M.D.
Professor of Psychiatry and Neurology
PO. Box 457
St. James, New York 11780
Faculty Committee on Honorary Degrees
Graduate School
SUNY at Stony Brook
Long Island, New York 11794
Voice: (am) 516 444-2990
(pm) 516 862-6651
Fax: 516 862-8604
E-mail: mfink@epo.som.sunysb.edu
April 25, 1997
Dear Committee Members,
Dr. Dale Deutsch has nominated Dr. Raphael Mechoulam of the Faculty
of Medicine of the Hebrew University of Jerusalem for an Honorary Degree at this year’s
commencement. I endorse his nomination with enthusiasm. Recognition of Professor
Mechoulam’s extraordinary achievements in medicinal chemistry, especially in the most
difficult chemistry of botanicals, is well deserved.
I first met Dr. Mechoulam in 1970 when I was the Principal Investigator in
NIMH
contract on the study of the chronic and acute effects of inhaled cannabinoids in
an
human subjects, both in Athens, Greece and New York. We were asked to examine the
behavioral, psychologic, and electroencephalographic effects of different cannabinoids to
assess which were the most active in altering behavior and their dependence liability. It
was from Dr. Mechoulam that we received large sample amounts of various cannabinoids
derived from special samples of hashish provided by Dr. Costas Miras of Athens and
marijuana from US. government offices. Based on his cooperation, we were able to
demontrate the activity of A9 and A8 cannabinoids, and contrast these with other complex
compounds.
His recent identification of a natural cannabinoid-active compound in the
brain has sustained a good part of the academic research into cannabis, at a time and
under conditions of national and international confusion about its risks.
Such an honor is well deserved and I am delighted to join Dale Deutsch in
this nomination.
Sincerely yours,
Mug/Lac
Max Fink, M.D.
Professor of Psychiatry
and Neurology
�
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Text
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mfp-05-00-033-8-161
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1996
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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http://exhibits.library.stonybrook.edu/mfp/files/original/8be8d6c037a0183a06654c37349a1194.pdf
8e11b4a3f4e89018c4150ad69bec20d0
PDF Text
Text
April 13, 1997
Mrs. Katherine Graham
The Washington Post
1150 15th Street NW.
Washington DC 20071
Dear Mrs. Graham,
Reading the story of Mr. Philip Graham’s death in your Personal History
is a sad reminder that even the best educated in America do not get the best medical care.
The tragedy reflects the failure of the early recognition of manic depressive illness, the
failure to use available medications, and what is most egregious, the failure to use
electroshock. While much has been learned since, the benefits of electroshock, including
its use against suicide, were clearly well known in the profession at the time of the
tragedy.
Why write now? Because your tragedy is still repeated in America. It is
one thing to have a fatal illness for which no remedy has been devised; it is another to
have an available remedy and not use it because of professional bias and incompetence,
encouraged by the bias of the press and the media.
Electroshock, as you hint [pg 329], is different today than what was
available a quarter century ago. But the negative attitudes to electroshock expressed by
your husband’s physicians are as prevalent today. The legislature of the State of Texas is
considering a bill to abolish the use of electroshock in the state; it already has regulations
that proscribe its use in persons under the age of 16. A starting point could well be the
enclosed memorandum from Texas.
The bias against the use of ECT is largely engrained among mental health
professionals and managed care companies where ECT is seen as a ‘last-resort’ therapy -—
to be used only after all other possible treatments have been tried and failed. Dependence
of oft-repeated ineffective trials encourage suicide and death.
�Mrs. Katherine Graham
Page 2
Perhaps you can turn the powerful searchlight of the Washington Post on
national
bias
and hostility against the use of an effective and safe treatment for severe
our
depressive illnesses. Sadly, few of the active psychiatrists at NIMH have experience with
electroshock. The only two names that come to mind are Dr. Richard Wyatt and Dr.
Matthew Rudorfer; the first has an academic knowledge but little clinical experience; the
second a limited clinical experience. But they are knowledgeable.
Thank you for writing such an interesting story and for expressing so
clearly the tragic effects of professional bias against an effective intervention.
Sincerely yours,
Max Fink, M.D.
�
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mfp-05-00-033-8-162
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1996
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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2d7ec677f8818f096f90091183d38871
PDF Text
Text
March 11, 1997
Mr. Philip A. Pardee, Membership Coordinator
American Psychiatric Association
1400 K Street, NW.
Washington DC 20005
Dear Mr. Pardee,
I should like to endorse the application of Guillermo Jose Castrofor
Quintela
membership in the American Psychiatric Association. I met Dr. Castro
during my visits to Montevideo as a consultant and speaker at national meetings over the
past few years. He is an associate of Drs. Alexander Lyford-Pike and Gabriel Savi in their
teaching program and clinical practice. He participated in clinical case conferences and
expressed a good knowledge of clinical practice.
Dr. Castro has attended meetings of the APA and has attended courses
with his co-workers. In one ECT course when I was the instructor, Dr. Castro
participated actively in the program. He is an excellent candidate for Corresponding
Member and I recommend him without reservation.
Sincerely yours,
Max Fink, M.D., F.A.P.A.
Professor of Psychiatry & Neurology
�
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mfp-05-00-033-8-163
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1996
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PDF Text
Text
Date: March 11, 1997
T0:
Dr. Athanasios P. Zis
FAX #
604.822.7922
Total Pages (including this sheet)
-5-
Dear Athanasios,
Sorry for the delay in answering your FAX but I have been on holiday.
A search of the ECT Database finds only a few studies of parkinson’s disease
and ECT. I attach the citations from the file.
I know of no studies in progress on PD and ECT. A few years ago I was told
that Dr. Melvin Yahr at the Mount Sinai Hospital in New York was managing such a
study but I have yet to hear or read an abstract. Richard Abrams had such a study in
progress in Chicago but the intake must have been slow because he retired and I have
heard nothing more of it.
Ray Faber at the VA in San Antonio, Texas told me of his program in ECT in
PD and that he was doing maintenance treatment. Ray was the one who explained our
cases of delirium and advised me to reduce the l-dopa doses. His review with Tn'mble is a
good He would be the one to call for possible experience.
I know of no PET studies published or in progress.
Sounds like you have a good problem in hand. Go
row
Max
From:
Max Fink, M.D.
FAX:
TEL:
516 862-8604
516 862-6651
P.O. Box 457
St. James, New York 11780
Alternate FAX: 516 444-7534
Alternate TEL: 516 444-2990
�
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mfp-05-00-033-8-165
Date
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1996
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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February 6, 1997
Lee C. Miller, MD.
Northwood Office Center, Suite 9
2201 Forest Hills Drive
Harrisburg PA 17112
Dear Dr. Miller,
You inquire about a 39-year old man with a ‘life-long’ depression who has
been sensitive to the side-effects of medications and is considered a treatment failure to
psychotherapy and medications. He began ECT on September 6, 1996, showing
improvement after 6-8 treatments ‘and then curiously the gains seemed to recede.’
Treatments continued and then ‘switched over to maintenance treatments.’ Treatments
have had to be given weekly, and any attempts at lengthening the interval between
treatments is followed ‘by a drop in mood’ [and presumably a request to continue].
The benefits of ECT usually persist alter the course has ended. But
some patient’s benefits are limited to a few days after each treatment and it was for such
patients that continuation therapy, either medication or ECT, has been recommended.
1.
How to explain it? The benefits of ECT arise from our ability to stimulate
the hypothalamic-pituitary axis to liberate, in greater quantities over a persistent period,
of those hormones [labeled by me as ‘antidepressin’] which regulate mood. In some
patients, ECT ‘j ump-starts’ the process and further stimulation is not required. In others,
the change is transient and repeated stimulation is required. The best analogy is our
experience with insulin -- in some patients, diabetes can be controlled by diet; in others,
oral agents; and yet others, daily and mullti-daily dosing of insulin is necessary.
To get around it -- treat more intensively and hope to get the system
working again. At times, we have re-admitted patients to hospital and given a new course.
2. ‘Indefinite’ courses of treatment are occasionally required. At UH we
have records of patients with 40, 140, and 180 treatments over periods as long as 10
years. In some, the period between treatments was lengthened by concurrent treatments -lithium and then lorazepam in one case, clozapine in another.
�Given these facts, I have no concern about continuation treatment. I
would, however, do the following.
a. Assess by careful inquiry to the family whether unprescribed
medications are being taken out of your ken. Specifically, alcohol, benzodiazepines, or
even barbiturates muck up a treatment series. I would surely enquire what is meant by ‘a
small dose ofXanax at bedtime ’. Self-restraint is not a feature in benzodiazepine use.
b. I would next entertain a series of treatment trials —- lithium at levels of
0.4-0.6 mEq/l; lorazepam at 0.5mg bid; and if well tolerated, lorazepam at 1mg tid.
c. Perhaps, an independent consultation as to diagnosis is warranted. If the
underlying pathology is that of a dysthymic disorder [a lifelong atypical depression] or an
Axis 11 character pathology, perhaps the best course is to forego ECT before any damage
is done. Prolonged courses of ECT are the basis for legal suits, the plaintiffs arguing that
the treatments incapacited their ability to survive and work in society and their claims for
damages achieve credibility with insurers and juries.
Your question is interesting. I will be out of the country until February 26.
If you want to discuss this fin'ther, try me late afternoons at the numbers above.
Sincerely yours,
Max Fink, M.D.
�
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mfp-05-00-033-8-167
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1997
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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February 5, 1997
Henry Pechstein, MD.
145 Cathedral avenue
Hempstead, New York 11550-1125
Dear Henry,
What a lovely surprise! It was a pleasure to look through that Newsletter
of 1959 and to realize that it was almost 40 years ago. The names alone -- Lenzner, Nord,
Shapiro, Zuger, Bauer, Whittier, and the speakers Nate Klein and Harvey Tompkins-brought back images. I remember almost all of them. It was a much freer time in
psychiatry; our battles with the psychologists seem like the battles of Neanderthals today.
archives.
I am delighted that you are sending the old numbers to the Society
I am still teaching at Stony Brook. I have maintained an active research
interest, and seem to have made a name in keeping electroshock alive. My book in 1979
was useful; my student Richard Abrams took it over in 1988 and is now issuing his third
edition. Not to compete with him, I decided that a ‘popular’ book on electroshock was
needed and I have just signed a contract with Oxford University Press for a ‘trade’ [read=
popular] book which I hope to have done by June.
All in all, life has been good to me. I trust the same for you. My thanks for
thinking of me.
Sincerely yours,
Max Fink, M.D.
�
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mfp-05-00-033-8-168
Date
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1997
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
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http://exhibits.library.stonybrook.edu/mfp/files/original/61c33925791b5d54df352aaeb8e8f263.pdf
0409434e3bdb6db1fdf603492858b4f1
PDF Text
Text
Walter Sannita, M.D.
Institute for Neurophysiopathology
University Hospital San Martino
1 6 1 32
GENOA,
ITALY
February 4, 1997
Dear Walter,
Thanks for your recent notes. I worked on the IPEG Artiles of Association and enclose
my pencilled comments. I think that some members would be shocked to think that the residual
money -- even if there will not be any -- was committed to the German EEG Society. Better to
have the officers decide what to do at the end. It is usual to give a party and spend all the money
when a society dissolves. Good times and good memories should be had by all.
As for Dr. Valducci, it is a tragedy. But, electroshock is a surgical procedure and even if
someone has given more than one-million treatments, the same care must be given to the one—
millionth-and-one. The patient’s death, as described, is the result of a doctor’s error. It happens,
but that does not excuse the physician. The family deserves recompense. The reason is simple —if there is a question about eating before ECT, the treatment is either passed over; or if the
treatment is compelled by the state of the patient, it can be given, provided that the patient is
intubated. [Hence, our insistence in the US. on an anesthesiologist for every treatment]
Tell Dr. Valducci we are sympathetic, but he seems to have erred.
I am off to Astralia for two weeks. It seems that they want an American ‘course’ in ECT
and Martha agreed to go with me.
My best regards to Titty.
Sincerely yours,
Max Fink, M.D.
�
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Correspondence to: Sannita, Walter
Type
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Identifier
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mfp-05-00-033-8-169
Date
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1997
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/1230f9c4f00d73be1d469b9abdd26496.pdf
8e349e2582d217a5d7b01049fe29f056
PDF Text
Text
January 12, 1997
Dear Jack,
It was good to hear from you again; I also received a card from Sophie and
her family on holiday. All is well here. Martha has just returned from a short visit to our
two grandchildren in Phoenix. The are growing well and the reports were glowing. My
son, as a Department chairman, is in that phase of his life that he is dealing with ‘movers
and shakers’ -- deans, university presidents, and corporate executives. He likes the power.
At the same time, he is at a pinnacle of his research career, with much research money
and many students, and has to decide which effort -- the academic or the political -- to
follow. Martha reminds me that I was in the same phase when I was in Missouri as the
head of an institute. I am glad I chose the research.
On the topic of research, a few years ago I urged some leaders in ECT to
organize a study comparing the efficacy of continuation ECT to that of continuation
medications [lithium and a tricyclic]. After three years of bargaining, the Government has
awarded grants to four hospitals in a collaborative effort. Unfortunately, the federal funds
are inadequate to do the study properly. In the past, universities were willing to support
the research effort, seeing such work as part of their academic responsibility. No longer.
The issue now is wholly -— how much money do you bring in as a clinician; how much
are we paying you; and if we cannot make a profit, maybe it is time to go. So, I am in the
process of returning the money to NIMH.
The process has become ugly. The Dean has asked whether I am willing to
retire now. After all, he says, he can hire two psychiatrists for my salary. When I noted
that I have been accorded all sorts of honors as a teacher and as a leader in research, he
smiled and said that the school had paid me for such efforts in the past, but for me to ‘get
with it’ -- the times have changed. Martha and I have begun the necessary dialogue to
retire later this year, after I have completed my present assignments. These end in June
and after some months of terminal leave, I should be free.
My book ELECTROSHOCK is coming along nicely. I have written a
for
the laity. I have a good publisher [Oxford University Press]. All the main
description
chapters are written; I am busy with the end-notes and appendices. While it will not lead
many to this useful treatment, it will serve to answer some questions.
�As with my university, a similar immediate return seems to have affected
old
your
company. Earlier in the year, when mirtazepine [ORG 3770] was about to be
marketed, I reached the research director at Organon USA and suggested that we
undertake a clinical trial of mirtazepine in delusional depressed patients, with an eye to
defining its efficacy in hospitalized patients. I noted that the filing data in the US. [which
he had sent me] was limited to out—patients. In return, he said that they were not at all
interested in testing mirtazepine in in—patients. [I do miss the days when it was possible to
talk directly to Organon’s leaders]
I replied that I ran a clinic of depressed patients and I offered to examine
mirtazepine in either our depressed patients after a course of ECT [was it as effective as a
tricyclic in continuation treatrnent?] or in those who were not so ill, and for whom we
could define the clinical efficacy at the same time as its effects on adrenal functions.
Again, he wrote to say that they were not interested. Too bad. The competition for
attention in modern psychopharmacology is based wholly on hiring ‘names’ to give
‘talks’ about new drugs and to ‘testify’ as to their effects. Most of my peers are already
on the do g-leash for other compounds [of which there are about eight]. I fear that
mirtazepine will have no better fate than mianserin in this country.
Martha continues her supervision of student teachers; our daughter Rachel
in Massachusetts has adopted a lovely, bright, and intelligent Chinese girl whom we love.
And Linda has convinced her husband to take a position in Virginia -- they are building
their home on almost 200 acres of mountain-top nearby to her college.
I continue to give courses in ECT and lecture on my new-found interest,
the syndrome of catatonia. Martha and I are off to Melbourne in late February. That will
be our first trip to Australia.
So, we move on from one phase to another. When I step down, it should
be possible to travel more freely. We will see. Meanwhile, Martha joins me in thanking
you for your kind note, and we wish you and your family continuing health in 1997.
�
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Title
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Correspondence
Text
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Title
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Correspondence to: ?, Jack
Type
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Text
Identifier
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mfp-05-00-033-8-170
Date
A point or period of time associated with an event in the lifecycle of the resource
1997
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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Correspondence -- Correspondence
Relation
A related resource
The Max Fink Collection
Description
An account of the resource
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Information about rights held in and over the resource
<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
Language
A language of the resource
en-US
Format
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application/pdf
Publisher
An entity responsible for making the resource available
Contributor
An entity responsible for making contributions to the resource
Correspondence
-
http://exhibits.library.stonybrook.edu/mfp/files/original/4b34d77a93adfdf543aae63a1ead5831.pdf
9a3d77013a79d7057f02f224ed583aa6
PDF Text
Text
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�October h
, 195“
Interin Report
Dear Dr. Miller,
requested I wish to report that the following projects have been in progress this summer in this
department.
1. Effect of electroshock on memory func»
tion tests. Twenty-four patients are now fully studied;
the data is beingA collected; and a report is planned
for the 1955 A P meetings.
2. Effect of Lysergic Acid on perceptual
functions, including Rorschach; and on blood chemistry.
These experiments are now in progress and will be completed by the end of the year.
‘E3iy Under the terms of the U.S.P.H.S. grant
a continuing study of perceptual changes in insuli n,
and EST patients is now in planning.
a. A psychiatric rating scale, modified
after Malamud, is in use. As soon as it is standardized
in this population, it will be presented to the Research
Eonmittee.
£5. The Funkenstein test (Hecholyl) in EST
and insulin therapy is being checked in our pop—
As you
ulation.
Sincerely,
HF33RB
�Obtober
Projects in Progress
as.
1954
/
,2-\
Relation of mental changes to behavior f‘
1'
(1) Effect of organic mental syndrOme on results of EST.
(3) Changes in perception with I92.
\
(3) Can ACTH. cortisone alter brain function and thereby
(a)
l
;
i
results of
(b)
EC!
or ICT?
\
\
Psychophysical measurements of Psychiatric terms - an operational
approach to terms of diagnosis.
(1) Denial: Relation to improvement in electroshock
Relation of premorbid character to change in
behavior in electroshock.
(2) Ambivalence:
Is
it possible
to measure ambivalence by
psychophysicel menad and relate to the past history of
the patient in choice of neurosis?
Relation of chemical agents to psychoses. psychological.
(o)
biochemical and behavioral aspects.
(d)
9
Rating Scale'
�October 1?, 195b
Dear Dr. Rachlin,
requested I wish to report the following
projects have been i n progress this summer.
(1) Effect of electroshock on memory f unction,
FRO, Amytal tests and nerceptual tests. Twenty
four patients have been fully shielded. The
first revert on the relation between the
response to treatment and the occonotal test is being
submitted to the A E A. The observat ion support
As you
the thesis that there is
a
relation between t
development of an organ.
he
Mental syndrome and
improvement.
Effect of lysergiv acid on perce ptual
functions. Rorschack and blood chemistry. The
psychiatric and psychologic tests are being
prepared for presentetnion at the American
Psychopathological Association.
(3) Under the terms of the U.S.P.H.S. gr ant
a continuing study of perceptual changes in
insulin and EST patient a is now i n planning.
(3) A psychiatric re.ing scale, modified after
Halemud, is i n use. As soon as it is standardized
in this population, it will be presented to the
(2)
Research Committee.
(5)
The Punkenetein
test (neohom) in
EST
and
__
�nsulin the rapy
population.
1
18
being checked
Since rely,
1
n our
�
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Research Files and Unpublished Works
Dublin Core
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Progress and annual reports; research activities (folder title).
Type
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Text
Identifier
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mfp-03-01-001-0-001
Date
A point or period of time associated with an event in the lifecycle of the resource
1953-1954
Creator
An entity primarily responsible for making the resource
<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
The topic of the resource
<a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965
Relation
A related resource
The Max Fink Collection
Description
An account of the resource
Annual report - department of neurology; Interim report to Dr. Miller; Progress Report; Letter to Dr. Rachlin;
Rights
Information about rights held in and over the resource
<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
Source
A related resource from which the described resource is derived
Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
Language
A language of the resource
en-US
Format
The file format, physical medium, or dimensions of the resource
application/pdf
Publisher
An entity responsible for making the resource available
Contributor
An entity responsible for making contributions to the resource
Research
-
http://exhibits.library.stonybrook.edu/mfp/files/original/e5d103cbe3dc9cd93159ddec488b3ecc.pdf
022eaace568b7d0816980adc5ccaa74c
PDF Text
Text
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��Dr. Fink
January 18, 1955
To:
All Department Heads
'Re:
Annual Report
Please prepare
Report
all
-
l95h
of your data for the 195h Annual
at the earliest possible date.
All tables and other information should be turned in
to Mrs. Bailey, Office Manager, on or before February 10.
uith your statistical data, Dr. Miller requests
that in addition to any tables or general statistics
which you will furnish, that you write a succinct out—
line of the'work of your department for the calendar
which
comments
in
appeared
the
to
similar
l9Sh,
year
Along
the last Annual Report for your department. Please
submit
all
data in three copies.
I think that will be
Report in.March of this
With everyone's cooperation,
able to publish the Annual
year.
a report of
I
vities of the hospital similar to the
would
like you to
Janua RY 19 meeting.
make
all
research'acti—
one given
Maurice Bachrach
Administrator.
Mled
at the
�(33L
Biochemical Research
Material assistance was offered the laboratories during 1954
in the form of enlarged quarters, and by the award of a two-year
grant from the National Institutes of Health. The program initiated
the previous year by Dr. Harry Goldenberg, Director of Laboratories,
was continued along the following lines:
Clinical
Methodoloww
It
has become abundantly clear that the clinical laboratory can
no longer cope with the special problems of mental disease using ther
standard chemical tests carried out in general hospitals. Consequently
increased attention has been directed towards providing the clinical
laboratory with procedures for testing adrenal and carbohydrate
metabolic function as well as for determining the course of drug
and shock therapy. Reference has previously been made to ketosteroid
and corticoid analyses. A new direct colorimetric test for hormone
conjugates is nearing completion. Rapid micromethods have alib been
perfected for two standard analyses, viz. blood phosphorus and
which have hitherto been subject to large experimental
phosphatase,
A
simple technique is also being investigated for following
errors.
the course of chlorpromazine excretion in urine.
Metabolism of Steroid Sulfate Conjugates
Impetus to our earlier studies on the metabolism of sulfuric
acid—bound steroid hormones has been furnished by an InStitute of
Health Grant which makes provision for much needed equipment and
simple
personnel. At the outset of the grant period a remarkably
method was discovered for the colorimetric assay of steroid sulfates,
based on the use of basic dyes. Further inquiry shows that, aside
from its use in enzyme research, the method offers great promise for
the assay of bound steroids in blood and urine as an index of
these
lines.
Studies
along
continuing
are
stress.
physiological
Mechanism of Action of Lysergic Acid Diethylamide
and
from
drawn
have
been
vitro
conclusions
inc preliminary
ig
which
induces
LSD
mode
25,
a
of
of
drug
action
on
the
vivo
studies
in
a—transient psychotic state:
(l) LSD 25 is a powerful inhibitor of human serum cholinesterase.
(2) Parallel with a definitive response by the individual receiving
LSD 25 there is a rise 11),..38rum alpha keto acids.
Hormone Assay with Enzyme Systems
There appears to be little doubt but that hormones are implicated
The
in
establishing
deterrent
prime
mental
aberrations.
and
emotional
in
of
for
of
assay
suitable
procedures
this relationship is the lack
.
�function. Were such procedures available it should be possible
to catalog mental illness on a chemical basis and suggest corrective
action as an adjunct to the psychiatric services.
Since the effect of hormones on various organs is mediated via
enzyme systems, an extended study has been undertaken into the
The
hormone
for
systems
isolated
enzyme
of‘using
assay.
possibilitywould
involve incubating the test fluid with the appropriate
procedure
enzyme system in a test tube, and then determining the degree to
which the enzymes are altered by the hormone in question by measuring
conditions
the release of a colored product. To determine the choice of makuxx
been necessary to
for carrying out these measurements it has The
on
two
mathematical
studies.
papers
out
detailed
first
carry
in
Several
manuScripts
are
more
been
have
published.
this'subject of
preparation.
various stages
hormone
Bibliography
Goldenberg, Harry
"Rectification of Nonlinear Beer's
690 (1954).
Goldenberg, Harry
Law
Plots”, Anal. Chem., gg,
"Rectification of Nonlinear Enzyme Activity Curves.
Arch. Ricchem. and Biophys., §§, 288 (1954).
I. Preliminary"
�.;
and
Research
of
the
of
Publications
Department
Psychology
;/
Research in the Department of Psychology was oriented around several themes including: Refinement of psychological tests, the persis—
tent problem of schizophrenia, and the effect of maturation and agang as
measured by objective
criteria.
Certain aspects of the Rorschach test were dealt with more objectively
by a series of papers by Dr. Gurvitz and Mr. Eichler and Mr. Feinberg.
These set up for the first time objective adult standards for evaluating
many Rorschach criteria which were not available previously. Further
data was made available to experimenters illustrating the normal process
of aging and maturation to further extend the cancept that if people grow
older there are decrements in intellectual functioning and personality
ingegration.
In two new papers to be presented at the Eastern Psychological Association meeting, further progress was made in diagnosing schizophrenia by
teens of psychological tests.
The past and current research in psychology at Hillside has continued
to attract attention both in terms of the acceptability of papers in both
scientific meetings and professional journals, and also in terms of the
many hundreds of requests for reprints sent in by psychiatrists, psychologists and social workers.
These papers and research projects have also served as a training
medium for psychological internes in the Department of Psychology and the
past year was noteworthy for the fact that each one of the psychological
internes or staff members presented at least once at a psychological convention or participated in some published research.project.
��RESEARCH
During the calendar year l9Sh two projects were
in process. their families pay for hospitalization
a) Study of rates which patients and
as correlated with time Spent in the hospital.
b) The adjustment of applicants referred by psychiatrists found unsuitable
for admission to Hillside Hospital during period 1951/1953.
This latter study is a series of studies which is being done to determine the
adjustments in the community and the use of community resources for applicants
who have applied for admission to Hillside HOSpital but were found unsuitable.
It is planned to continue this series during the year 1955.
In addition, the joint project with the Jewish Community Services of long
Island concerning the placement of discharged patients in private residence
continues.
W3
research project is being set up at the Altro'work Shop to which patients
discharged from Hillside Hespital go in order to learn work habits.
A
Publications:
)/
<3'“>(
'21”
,~
63‘”
7
s====r
;)
Vocational Adjustment for the Emotionally Disturbed
Authors: Roland Baxt, Abraham.Lurie, and Joseph .A. Miller,
.
-
M.D.
Presentations at conferences:
a)
[pulse Pinsky presented a paper at the National Conference of Jewish Communal Service in May, 1951;, called, "The Impact of Medical Crisis on the
Family".
b)
AL:hd
‘
Abraham Lurie Spoke at the National Conference of Social‘Wbrk in may, 195h,
"The Implications for Psychiatric Social‘work of Team‘work Relationship
Between Social'workers and Psychologists".
�MEMORANDUM FROM THE
CREATIVE THERAPY DEPARTMENT
WWW
1955
Study on the constructive and/or
destructive use of passive and active aggression as a differential test for determining
schizophrenic responses.
Data for this research project had
been gathered for the past three years. Their
sifting and clinical evaluation is planned in
the near future.
The test is carried out within the
C.T. program and consists of 16 specific proand
number of
jects
EZ/r
#290
a
sub-tests.
“a
707
Ernest Zierer
�Fsbmary 2, 1955
Memorandum
from: Dr.
To:
Subject:
Fink
M.
Bondsr,
M. D.
24.1).
Anmsl Report of Hillsids Hospitals
and
medical
services
with
other
Coordination md cooperation
with the psydxiatrio staff
past you. With
in.
slsotmoncsphalogmm,
for
the
of
laboratory
sstsblishnsnt
tho
crossed use of this facility and of the consultation faoilitin m
was
incrsssed during
the:
ands by members of the resident and attsndim staff.
the
answered
attending
by
19
consultations
ssrs
the
yes“:
hiring
neurology oer-vies, and
1:0
consultations in addition vsrs anmrsd by
the rssidaxt neurologist. In the slootrosnoophahgramio laboratory
111:8
this nun":- 75 constituted consultstion
taken
rsoords
wars
the
0!
records.
maindsr,
follow-up
”cords vars taken.
rsqnssts and
01'
in tho oourss of two invsstigations
-
one
in tho effects of electro-
shosk on brain function; and the second on the
relationship between
treatinsulin
the
of
and
the
rssults
can
function
brain
in
changes
mt.
Evaluation of the organic mental mamas provided the major
with
three
Thurs
were
patients
consultations.
nourologio
Icons for
the
clinic.
followed
in
sud
who
controlled
wars
disordsrs
leisurs
Four
logic
nonrafurther
for
another
institution
to
transfsrod
sore
pstiants
work—up and
troatmnt.
when
direction
another
in
The neurologic service
nto
consultation
prior
for
aimissions
olinis
nods
tbs
tron
qussts ms
was extended
hospital admission.
your and
Sm
such
oomltstions
were dons during the
svnlustion
butts:for
s
an
upper-unity
ssrvioo
providsd
this
�of the patients problems before autumn“.
introduced to you in 1953
to evaluate organic
m
natal
The "
mail
test"
which was
mm richly used during the put year,
syndmmlg
.
�Fobmary 15', 1955
modem
Annual Report
of
Wt
of Neurology, 11111:“. Hospital
—
moperation with the psychiatric star! and other mdical gen-ion
by when of the neurology
was increased during the year.
63th
Fortyunino «nomination: by the attending neurologists, and
«agitation:
1:0
additionfl
were answered by the supervising neuropaychiatriut.
the eiootroenmphalographie laboratory
111:8
ream-ch
mm
m.
In
this
01'
lumber, 75 constim‘bod consultation requests and follow-up rewards.
Evaluation of the organic mantel syndrome provided the major
focus for ammlog‘io consultations. more were three patients with
mime
disorders
who
were controlled and followed in the
patients mm tranatemd to
work-up and treatment.
Hillsido in
1953 was
The
«3111116.
Four
guard hospitals for further nonmlogie
«um»; first“ which to: introduced at
mm widely used to evaluate organic mental and»
must.
{the
mmlogic service uni also
extended when rogue“; worn
man from the admissions clinic for consultation prior to hospital
admission.
such consultations were answer-ad during the your and
Sm
this service provided
boron admission.
Under
tom
an
opporhnity for a batter evaluation of patients
of a U.S.P.H.S. grant, the electroencephalographic
laboratory was swarmed for taohirboscopy, and a number of basic nouns.
physiological problems were smdiod.
f
’13:“
��_
my}-
1955
Neurology
hmommmwumammmwumh
mes
in the visiting
a...
was noon
almond by
mm.
Wynn».
tndmtharrfi
m supervising
mailman
In th. metro-n
mphdographic laboratory, 210 mom an am, of which 7!; war;
consultaticn "quests. For the most put, the consultations in!" on)»
momentum
(6); pain syndma (3) and axiom cum
tit-onion (7); men-1
wt:
>nenrnlng1c mum (10). 'th wk). test for organic bran dim”
Wmtinflpt’dnnu.
activities
mar-aura:
”sued
mm...
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aerial
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N,
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m
as: u.-
momma!
Dr. H1110?
TO:
Dr. H. Fink
RESEARCH SERVICE,
smcrmmmya-pm-m.
Dummmtharmmhthemmamanumwmume
.
in organizing an mom nhctmshook
2mm,
the
and the
mam,
the
mm
m
Scrpuil project. Considerable mm
electron-Museum laboratczy,
and
sum
Public Health Bunion for adds!
lamb
Grant
“97.
penis“ w
mm
in
project with Dr.
spout in letting up
WMar
by the
equipment
mud
thu
no
,
Fonoving discussion with Dr. Embers and Dr.
known,
Dr. LnQuor
Wimudtoviaitiflllgidumdmmmm..Dr.LIQm15mchup
of the Luann unit at Grandma: State Hospital.
a: March 9th, Dr's. numbers,
mum and melt mum cm:- to as Dr. hQuor'I mam unit.
m
intended in his
that. Vinita, the
use or
split
mm mm: to induce com.
mm.
This '11]. be
mm
RobertluhnandnvaeuvisiudDr. hulfloehandnr.
thhtric Imtituto chitin-$133M. Wflaittonr. WWW
Dr.
undue for the
nut
Following
Med research emanate. at. Dr. Blmbarga suggestion din-
mud a similar project ban, and the protocol was
prumtod at the nut numb can-dun mating.
nth»
w.
purponoracqmmuthmmaentnumh
with Dr. Ismail
m
most helpful as
m.
second
Our
b. has had dmidunbla experience
in psychoplvaicq. tachniquu.
SW8 ut his ham and dime.“
withhmthemdforimmudmndsforthocmmm. Iupmssodtohiu
(h
March 17th
I Visited Dr.
Ismail
thodllinbflityofhlvingmummeo that Dr. filmmldbo
thoDuunPoundntionorthoPnaidcntamifm Public
mppomw
‘19de
that
��mm:
Glon om, no: Ia-k
KEPITAI.
April 28, 1955
to,
Dr. Josoph S.A.Hillor,llodioal Dix-sates
M8
Dr. Kl! Pink
8i:
subJoot:
'
hospital,
Honth
Promos Ropu-t and Room-noun".
Atthsondstthofirstsixnouthsasbirootorotnosoomhatth
1 should
libs to dosoribo tho prosont stoto of our rosoaroh program,
thhnsfathofluturo,anitonkowonoouasndationsforsrosm
asparagus.
I:
Prosoat
m
dotinitivo report of tho rosooroh aotivitioo of tho dspsrtnsnts of
tho hospital was prooontod to tho nsdioal Board on April It, 1955. by tho chairman
of tho Itososroh Omittoo.
A
tho prosont tins, tho staff assisting tho Dirootor inoludos two
it
psychologists and a part-tins sscrotary ( supportod by norm and
Dausn Foundation
grants); and o half-tins no toohnioian. Port-tins roooorch ootivitios aro
cox-riot! out in tho various sorvicod sports-onto. In tho Doportuont at Ioborotorios,
two toohnioians oro assisting Dr.Goldonborg, undo:- tho tons of a noon-oh
grant
of tho USPRS. Of tho psychiatric staff, two supss‘visim psyohiatrists and two
rosidonts aro ootivoly oncogod in part-tins rosoaroh. Of tho ottonding staff,
tour labors of tho Hodicol Board as in diroct collaboration with hospital
psrsonnol in spocitio projects.
is octivo in tho following projootst
a. Following on tho sumoay of tho 1951; proJoot on thorolotion of altsrod
brain mnotion to
following olootroohook thorapy, a oooond
projoot has boon undsrtoksn to asaosa tho chorootomlogioal and bioehonioal factors in impromnt.
b. An snluotion of sorposil so a thoropoutio ogont hao boon undortakon
as an intomopsrtaontal projsot, with tho sotivo oooporotion of tho
.diool dopu-tmnt, onporvisim psychiatrist and a rosidont psychiatrist.
has Dinotor
imam.
o.
dosslopuont of moan-so of abivolonoo, both as a chorootonologiosl
factor and a symptom of psychiatric choc-ponsation. “his study is in
conjunction with a lambs: of tho Hodiool Board.
d.
and taoMstoooopio
”physiological
of tho new, is now noaring oonplotian.
Dnfiont
Tho
'l'ho
laboratory, built with funds
Tho
hm m'ass stimlata's,
nocosoary for tachis-
mt.
mublod.
oscilloooops, and roloy and lons
tosoopy havo boon dolivorsd, on?! are being
boon outlinoo and will begin by slid-Mu.
Projects hovs
�4-2Bimltonoomly with thou motto, I havo boon participant in a
nunbor of tho dopartnontol projocto at the hoopitalp oooporatod with tho fibcultun Study Omittoo in tho dmlop-ont of its protocol; and havo mlnatod
throo protocola which uoro oubnittod to tho Roaoaroh Conittoo from outoido
loot-coo, and out. opooifio roommdationa on oooh.
now
mum
problou of mohiatry involvo all aopooto of tho moo, oonroo,
for thoo'pocitio tonic
tron-int and provontion of tho Nor poyohoooo.
an! innmatory poychoooo, nothing is known of tho otioloy of ochioophronia,
involutional paycheck or antic-domain illnooo. Itch duoription of tho
oouroo of thooo illnooooo io availablo, but thio haa boon of littlo bola": in
troatnont or promotion moot in ioolatod inotonooo. mutant io omit-idol;
and
W
at boot, poi-ital".
'
"
control roam for hospitalisation in loot pationto in tho dmlomontvo! owning tonsion and anxiow, and pmhotio thoughto. lutorporoonal
rolaticnohipo havo boom diotortod, culmination blurrod, and otfootivo activity
oo to throotod oolf-prooorvation. rho vat-1m porchiotric thorapioo
oo
availablo today attack difforont aopoota of thooo problouo. A prion-y goal io
tho doovoaoo in tonoion and musty, and tho ovum-o of mohotio idoation. hob
offal-t in «pound ot chaining intorporoonalxolatimohipo and oodoo of omnioation; and nontual ”education and oupport d tho pationt in dirootim his
ootivitioo along «room ohannolo that lood to
on! meiot- prooorvotim.
Tho
m1
alto
0'thMom.
“ti-toot“: intho njority or
ma‘ont nothoda
portion.- in at loaot town-11y atomim tho poyohotio
rollovine tonnion
and indnoim a roturn to non offoctivo
In this prooooo, tho following nothodo are pennant at tho hoopitoln
Ont
1.
W.
By
2.
By
3.
By
hoopitolilation,
thoe pationt
'
is ”poo-om
pm,
and ioolatod
'
tron bio
»
.diootion,
barbitnratoo, oorpooil, and chlorpronaoino,
and by olootz-oohook and ubnlatory insulin trootnonto, ton-ion and
anxioty
are roduood.
dmg
W
oo
olootroohock, olootz-onaroooio and inmlin cola thorapy pontwtio
idoation in omod by altoring brain function.
It. By group and social
aotivitioa, om group thong, in a poniooivo
onvironoont, bottor communication io footorod.
5.
individual poyohothorapy intorporoonal rolationahipo oro tootorod
alom nan-tic line.
6.
onvironnmtal “Isolation, sob ”causation, and oooial oorvioo
bolp, offootivo mnotioning is
By
By
Onrnaoaroh
prom
W.
io dovotod to ltudyingthooo
Miovnda-otamthomwmt
moo.
diooiplimo aro omtmotivoly appliod at tho hoopital,
tho offootivonooo of aw hao not boen mftioiontly some»; nor hao tho undo
While thooo
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I955.
�HILLSIDE HOSPITAL
Glen Oaks,
New
York
April 28, 1955
Tb:
Dr. Joseph S.A. Miller, Medical Director
From:
Dr.
Max
Fink
Six Month Progress Report and Recommendations.
Subject:
At the end of the
first six
months as Director of Research
at the
hospital, I should like to describe the present state of our research program,
our plans for the future, and to make specific recommendations for a research
department.
I: Present
'A
Proggam
definitive report of the research activities of the departments of
the hospital was presented to the Medical Board on April h, 1955, by the chairman
of the Research Committee.
At the present time, the staff assisting the Director includes two
psychologists and a part-time secretary (supported by USPHS and Dazian Foundation
grants); and a half~time EEG technician. Part-time research activities are
carried out in the various service departments. In the Department of Laboratories,
two technicians are assisting Dr. Goldenberg, under the terms of a research grant
of the USPHS. Of the psychiatric staff, two supervising psychiatrists and two
residents are actively engaged in part-time research. Of the attending staff,
four members of the medical Board are in direct collaboration with hospital
personnel in Specific projects.
The
Director is active in the following projects:
a. Following on the summary of the l95h project on the relation of altered
brain function to improvement following electroshock therapy, a second
project has been undertaken to assess the characterological and biochemical factors in improvement.
evaluation of serpasil as a therapeutic agent has been undertaken
as an interdepartmental project, with the active cooperation of the
medical department, supervising psychiatrist and a resident psychiatrist.
b.
An
c.
development of measures of ambivalence, both as a characterological
factor and a symptom of psychiatric decompensation. This study is in
conjunction with a member of the Medical Board.
d.
neurophysiological and-tachistoscopic laboratory, built with funds
of the USPHS, is now nearing completion. The two Grass stimulators,
DuMont oscilloscope, and relay and lens systems necessary for tachistoscopy have been delivered, and are being assembled. Projects have
been outlined and will begin by mid-May.
The
The
v'
/
�-2...
Simultaneously with these efforts, I have been a participant in a
number of the departmental projects at the hospital; cooperated with the Subculture Study Committee in the development of its protocol; and have evaluated
three protocols which were submitted to the Research Committee from outside
sources, and made specific recommendations on each.
II.
Future Programs
Present problems of psychiatry involve all aspects of the cause, course,
treatment and prevention of the major psychoses. Except for the specific toxic
and inflammatory psychoses, nothing is known of the etiology of schizophrenia,
involutional psychosis or manic-depressive illness. Much description of the
course of these illnesses is available, but this has been of little help in
treatment or prevention except in isolated instances. Treatment is empirical,
and
at best, primitive.
central reason for hospitalization in most patients is the devel~
opment of overwhelming tension and anxiety, and psychotic thoughts. Interpersonal
relationships have become distorted, communication blurred, and effective activity
so minimal as to threaten self-preservation. The various psychiatric therapies
available today attack different aspects of these problems. A primary goal is
the decrease in tension and anxiety, and the erasure of psychotic ideation. Much
effort is expended at clarifying interpersonal relationships and modes of communication; and eventual reeducation and support of the patient in directing his
activities along effective channels that lead to self- and social- preservation.
The
present methods are apparently satisfactory in the majority of
patients in at least temporarily stemming the psychotic process, relieving tension
and inducing a return to more effective functioning. In this process, the following methods are prominent at the hospital:
Our
1.
By
hospitalization, the patient is separated
environment.
and
isolated from his
2. By drug medication, as barbiturates, serpasil, and chlorpromaline,
and by electroshock and ambulatory insulin treatments, tension and
anxiety symptoms are reduced.
3. By electroshock, electronarcosis and insulin coma therapy psychotic
ideation is erased by altering brain function.
b.
By group and
5.
By
social activities,
environment, better
and group therapy
communication is fostered.
in a permissive
individual psychotherapy interpersonal relationships are fostered
along
realistic lines.
6. By environmental manipulation, job reeducation, and
help, effective functioning is strengthened.
Our
social service
research program is devoted to studying these processes.
A. To Understand
the'flay Therapy'Horks:
disciplines are constructively applied at the hospital,
the effectiveness of any has not been sufficiently assessed, nor has the mode
While these
�.3mode
of
of
the
lhe
study
evaluated.r
present
been
adequately
of operation
has
Electroshock
of
our
interest.
example
an
electroshock
of
is
operation
By
assessing
in
many
from
patients.
depression
psychotic
resulted in improvement
be
works
will
electroshock
the various possibilities it
understood. If this is accomplished, then some ideas about the mental and
The understanding of
become
clear.
may
in
depression
physiological processes
A plan for a
of
service.
research
the
electroshock treatment is the first goal
similar study of insulin coma therapy is now in preparation; and others at the
environment
as a therapeutic
of
the
hospital
a
study
planning
hospital are
is
hoped
that the
way
mechanism.
B.
Relationship of Character Structure to Diagnosis:
child—
of
the
the
demonstrate
importance
to
devoted
been
study has
hood environment in the development of character, behaviour patterns under stress
conditions and the neuroses. Other investigators are actively involved in assess—
of
adult
in
the
variety
result
that
childhood
relationships
the
in
the
factors
ing
behaviour patterns. It is not possible to carry out such studies at Hillside,
but the important relationship between character and the type of mental illness
of
behavioural
to
of
the
character
patterns
the
relation
the patient shows;
change which we call 'improvement'; and the aspects of character that resist
treatment methods can be assessed. A prototype of such studies is now in progresselectroshock
in
therapy.
improvement
to
basic
of
character
the
in
aspects
much
C.
Biochemical and Physiological Factors in Mental
Illness:
ill
for long periods, appear to take on a stereoPersons who have been
and
chemistry
in
their
reflected
which
is ultimately
typed behaviour pattern,
by
neurologic,
'non—reactor'
and
patterns
such
of
'reactor'
Study
physiology.
the
failures
in
assessing
methods
important
and
are
drug
biochemical
physiologic,
and
physical
illness
between
psychiatric
the
relations
of present therapies;
Such
and
a
improvement.
between
therapies
'organic'
and
the relation
illness;
to
drugs
EST
and
reaction
where
second
project,
the
in
incorporated
study is
and
of
long
short
terms
in
be
assessed
will
electroencephalogram
changes in the
term improvement rates.
(Follow—up):
Results
Treatment
of
D. Continuing Evaluations
suffer
treatment
of
generally
of
present
the
results
studies
Follow-up
of
the
evaluation
done
an
without
are
only;
one
therapy
because they assess
control
to
standard
and
compared
not
are
improvement;
for
subject‘s potentialities
followcontinuing
a
be
to
organize
possible
With
may
active support, it
groups.
evaluated
on
admission;
assessed
are
the
in
hospital
which
patients
up program, in
followed
a
and
over
then
methods
at
discharge;
and
psychiatric
by psychologic
number of years with an evaluation as to sustained change and reasons for failure.
much
would
have
at
discharge,
the
to
predictions
Such an evaluation, if compared
base—line
for
and
a
provide
of
choice
therapies,
present
merit in assessing the
the evaluation of any future therapeutic methods.
III.
Recommendation
of
problems
the
methods
in
attacking
of
suggested
In this outline
the
treatment
best;
as
one
made
to
specific
specify
no
effort
have
I
psychiatry,
is
that
fragmentary
so
it
knowledge
is
Present
the
specific.
or one etiology as
of
psychoses.
the
major
to
the
eticlogy
make
as
only
a
to
poor guess
possible
A multidisciplinary approach with full freedom to follow many leads is the best
of
a
establishment
recommend
the
would
For
I
be
this
offered.
reason,
that can
�-
u
-
Research Service, with full-time personnel devoted to such studies. I would
suggest that such a service have "research" as its function; that it be independent of the service departments of the hospital; and that it have a basic
budget which would assure continuation regardless of the availability of outside
research funds.
A.
The
Research Service should have the following organization:
1. Director of Research -- Responsible to the Medical Director.
2. Research Associates in Psychiatry and Psychology.
3. Research Assistants:
a.
b.
c.
d.
Psychology
Neurophysiology
Psychiatry
Social Service
h. Secretarial and clinical personnel.
5. Technicians.
B.
Annual Budget recommendations
for the Research Service:
1. Director
2. Associate in Psychiatry
"
in Psychology
b. Assistant in Psychiatry
"
5.
in Psychology
“
6.
in Neurophysiology
"
7.
in Social Service
8. Secretary
9. Technician
n
10.
-
Lab
EEG
(1/2 time)
$20,000
12,000
8,000
6,000
5,200
5,200
h,000
2,760
h,000
1,300
Equipment: As warranted
Consumable Supplies
Travel
Overhead:
As
decided by Administrator.
- $25,000.
- 20,000.
- 10,000.
- 10,000.
—
-
-
8,h00.
10,000.
6,000.
3,300.
6,000.
1,800.
2,h00.
1,000.
available as a continuing commitment to
the Medical Director for long range planning of the Research Service.
These funds should be made
For the budget year 1955-1956. I should like to make the specific
recommendation that the following are the minimum requirements:
1.
2.
3.
h.
5.
Director
Research Assistant
"
"
Secretary
Consumable Supplies
6. Travel
7. Overhead
8.
EEG
- Psychiatry
- Psychology
&
Equipment
Technician (in Operating budget)
$15,000.
7,500.
7,200.
3,000.
2,h00.
1,0000
-
$36,100.
1,600.
$37,700.
�0. Space:
Problems of space at the hospital are acute, and will provide an increasing measure of difficulty as the service is developed. It is suggested
that in the next capital outlay by the hospital for construction, some allowances
be made.
for the Research Service
‘
D.
Relation with Other Departments:
activities of the Research Service are to be those designated by
the Director. Interdepartmental projects will be carried out by the Research
Service, or in those instances where approval of the Research Committee is obtained, by the departments involved. Supervision of such interdepartmental
projects will lie with the Research Director.
The
Interdepartmental projects are to be fostered by the Director. Prior
approval by the Research Committee and the Medical Director is required. Such
projects as are consistent with the service functions of the departments involved
W111 be fostered. Presentations and reports are to be approved by the Research
Committee prior to publication.
E.
Job Description:
1. Director of Research:
objectives of the Director of Research will be to: (l) Organize
and maintain an active program of research and a Research Service; (2) Promote,
supervise and integrate research activities at the Hospital; (3) Educate hospital
personnel in research methods and progress; and (h) Administer research funds.
The
The
director of research will:
a. Organize a central project or series of projects appropriate to the
unique character of the Hospital and integrate this into the activities
(therapeutic) of the Hospital. Progress reports will be submitted to the Medical
Director and to each meeting of the Research Committee of the Medical Board; and
such data as is approved for presentation will be submitted by the Director or
his delegate at the appropriate scientific society.
all
staff to plan and carry out individual
research projects. Third year residents in psychiatry are to be specifically
encouraged to undertake research projects under his direct supervision, or that
of an attending psychiatrist. For these residents, and any other professional
members of the staff, the director of research is to assist in the planning of
b. Encourage
members
of the
the project; in its integration into the hospital program; and in
both technically and financially.
its
support
0. Carry on such educational activities as the supervision of third year
residents in research; monthly seminars in research problems and progress; and
periodical reports of important psychiatric meetings. The director will maintain
a calendar of meetings and lectures; stimulate attendance thereto; and foster the
He
such
of
is also to invite such
meetings.
at
Hospital
activities
presentation
guest lecturers and seminar leaders as are available.
d. Administer all research funds with the approval of the Medical Director.
This includes the stimulation of fund sources; the application for funds; and their
allocation to hospital projects.
�2. Research Associate:
Director in all projects at the hospital; to
assume responsibility for specified projects; and to carry on such independent
investigations as his training and experience dictate.
Tb
work with the
Associate in Psychiatry is to be a qualified diplomats in
psychiatry, with extensive experience both in psychoanalytic psychiatry and in
descriptive psychiatry. By training or experience, the associate should have
teaching qualifications; and some training in research methods.
A. Such an
assume responsibility for that portion of the functions of
the service assigned to him by the director; assume responsibility in the director's
absence; attend conferences, meetings and assume teaching functions as recommended
by the director.
He
range
—
will
Salary to be determined by qualification and experience. Probable
$12,000 to 20,000.
B. Such an Associate in Psychology is to be a qualified psychologist
with at least 10 years experience. Psychoanalytic experience is preferable.
The equivalent in academic standing of Associate Professor is the guide line.
research associate in psychology is to assume responsibility
for those functions of the Research Service assigned to him by the director.
An evaluation of testing methods. statistical evaluation of results. and a
of
the research
of
of
aspects
contr0l
the.functioning
procedure
in
all
rigorous
service are his responsibility.
The research associate in psychology may be chosen from the research
assistants. Salary range - $8,000 to 10,000.
The
will: organize and supervise projects
in the department; supervise projects of the resident psychiatric staff; assist
such department heads as request aid in organizing departmental projects; advise
the director of new research possibilities; attend conferences, write reports and
papers, and carry on such administrative activities as the Director may require.
Both Research Associates
Board
at
Appointments to Research Associate are to be made by the Medical
the recommendation of the Medical Director and the Director of Research.
3. Research Assistants:
assist the director in his research activities and carry on
the work of the department. Each assistant is to be responsible to the director,
and will carry on such tests, procedures, write such reports, and present those
To
papers designated by the Director. Assistants are to be qualified by training
and experience for the specified jobs named. They are to be appointed by the
Medical Director at the nomination of the Director of Research.
a. Assistant in Psychiatry: For such psychiatristswho have had three
or more years of formal psychiatric training but not yet certified, the opportunity to work for one or more years on a Research Service may provide the
stimulation for continuation in research and also provide the director with the
assistance of personnel intermediate in experience between the resident and the
associate. The assistant in psychiatry can assume responsibility for the selection
�-7of the patients for the various projects; evaluate changes in behaviour with
treatment; assess the importance of intrapsychic and environmental factors in
the present behaviour of the patient. the assistant.vill assume responsibility
for those aspects of the problems under investigation as are within his scope,
and assigned by the director. He will write such reports, papers and make such
presentations as the director may suggest. He will make such tests, learn such
technics and work with those members of the research service or the service departments of the hospital as his projects permit.
Salary is dependent on experience. Probable range $6,000 to 1C,000.
b. Assistant in Psychology: Graduate in psychology with a minimum
of doctorate. Preferable experience in research methods and publication experience
with some specialization in laboratory methods. Equivalent academic status of
assistant professor. The assistant in psychology is to carry on such psychologic
and laboratory tests, and make such statistical and methodological evaluations
as the projects of the service require; and to make such reports and presentations
as the director may suggest. He is to direct the laboratory technicians, organize
their work and assume responsibility for the maintenance of all testing equipment
and materials. In the design of projects, he is to assume responsibility for the
application of the best methods and design commensurate with the goals of the
project.
Salary range
~
$5,200 to 8,h00.
c. Assistant in Neurophysiology: M.D. or Ph.D., with a minimum of
three years experience in electroencephalography or neurophysiology. To supervise
and coordinate all neurophysiological studies, now being organized; develop and
build electrophysiological equipment; assume responsibility fer such animal studies
as are organized; cooperate with the psychologist in coordinated neuropsychological
investigations; and supervise technicians in electrical methods.
This position can be filled only if the laboratory is expanded to
include more basic studies. Personnel can then be recruited from medical school
training centers. Salary range - $5,200 to 10,000.
d. Assistant ~ Social Service: B.S. (Soc. Work) with minimum of five
years experience in field or administrative work. Emphasis on interviewing
technics and assessing family relationships. Personal analysis recommended.
If previous research experience with psychiatrists or psychiatric clinics is
noted, it should be heavily weighted.
Assistant is to assume responsibility for interviewing relatives
of patients and develop technics of assessing premorbid characteristics based
on history and interview; to obtain histories from relatives and patient relevant
to the early years of development; to cooperate with the psychologist in assessing
the personality of the subjects; and to coordinate research testing in the various
projects. Patients seen during their hospitalization in any of the research
service projects are to be seen by the social worker prior to discharge, and eVery
effort at follow up contact made. For all follOWbup testing and evaluation, the
assistant will make the necessary contacts and arrangements for the director.
The social worker assigned to the research service will, if time is available,
cooperate with the Director of Social Service in those interdepartmental projects
which he may have organized with the approval of the director of research.
Assistant is to be selected by the Director of Social Service.
Salary range proportionate to experience in research. Range - $h,000 to 6,000.
�e. Technicians:
EEG -~ High
l.
fundamentals
school graduate, although two years college preferred.
To learn the
of electroencephalography; make the necessary measurements and place electrodes; obtain artefact free records; maintain card files;
type reports; keep records in systematic way; and maintain equipment. Technician
is to be responsible to the assistant in neurophysiology or the director.
Salary
-- if
untrained,
$52,600;
if trained,
$33,060
to 353,600.
2. Lab. Technicianp-Neurophysiology. College graduate, preferably
with some engineering or physics experience. To assist the assistant in neurophysiology and/or the assistant in psychology, in the development and maintenance
of electrical equipment; to assist in the handling of animals; to cooperate in
the experimental procedures; to build, adjust and design special equipment.
Salary range dependent on training-- Rangefi .000 to 6,000.
IV.
Summary:
Research Director is actively involved in a number of studies of
the mechanism of treatment. To maintain a continuing function and make long term
planning feasible, it is recommended that a Research Service be established; that
be an integral part of hospital organization with a continuing annual budget.
it
A proposed organization is included in this report, with a projected annual budget
of $60,000 ~ $70,000; and with a minimum budget 1955-56 of $36,100.
The
This report approved by the Research Committee April 27, 1955.
Respectfully submitted,
Max
Fink,
MoDo
Director of Research
�HILLSIDE HOSPITAL
Glen Oaks,
New
York
April 28, 1955
Th:
Dr. Joseph S.A. Miller, Medical Director
From:
Dr.
Max
subject: Six
Fink
Month
Progress Report and Recommendations.
first
six months as Director of Research at the
hospital, I should like to describe the present state of our research program,
our plans for the future, and to make specific recommendations for a research
At the end of the
department.
I: Present
A
Program
definitive report of the research activities of the departments of
the hospital was presented to the Medical Board on April 5, 1955, by the chairman
of the Research Committee.
At the present time, the staff assisting the Director includes two
psychologists and a part-time secretary (supported by USPHS and Dazian Foundation
grants); and a half-time EEG technician. Part-time research activities are
carried out in the various service departments. In the Department of Laboratories,
two technicians are assisting Dr. Goldenberg, under the terms of a research grant
of the USPHS. Of the psychiatric staff, two supervising psychiatrists and two
residents are actively engaged in part—time research. Of the attending staff,
four members of the l"ledical Board are in direct collaboration with hospital
personnel in specific projects.
The
Director is active in the following projects:
a. Following on the summary of the l9Sh project on the relation of altered
brain function to improvement following electroshock therapy, a second
project has been undertaken to assess the characterological and biochemical factors in improvement.
b.
evaluation of serpasil as a therapeutic agent has been undertaken
as an interdepartmental project, with the active cooperation of the
medical department, supervising psychiatrist and a resident psychiatrist.
c.
development of measures of ambivalence, both as a characterological
factor and a symptom of psychiatric decompensation. This study is in
Dmedical
member
of
the
with
Board.
a
conjunction
d.
neurophysiological and tachistoscopic laboratory, built with funds
of the USPHS, is now nearing completion. The two Grass stimulators,
DuMont oscilloscope, and relay and lens systems necessary for tachistoscopy have been delivered, and are being assembled. Projects have
been outlined and will begin by mid-May.
An
The
The
�-2...
Simultaneously with these efforts, I have been a participant in a
number of the departmental projects at the hospital; cooperated with the Subculture Study Committee in the development of its protocol; and have evaluated
three protocols which were submitted to the Research Committee from outside
sources, and made specific recommendations on each.
II.
Future Programs
Present problems of psychiatry involve all aspects of the cause, course,
treatment and prevention of the major psychoses. Except for the specific toxic
and inflammatory psychoses, nothing is known of the etiology of schizophrenia,
involutional psychosis or manic-depressive illness. Much description of the
course of these illnesses is available, but this has been of little help in
treatment or prevention except in isolated instances. Treatment is empirical,
and at best, primitive.
The
central reason for hospitalization in most patients is the devel-
opment of overwhelming tension and anxiety, and psychotic thoughts. Interpersonal
relationships have become distorted, communication blurred, and effective activity
so minimal as to threaten self-preservation. The various psychiatric therapies
available today attack different aspects of these problems. A primary goal is
the decrease in tension and anxiety, and the erasure of psychotic ideation. Much
effort is expended at clarifying interpersonal relationships and modes of commun—
ication; and eventual reeducation and support of the patient in directing his
activities along effective channels that lead to self- and social- preservation.
present methods are apparently satisfactory in the majority of
patients in at least temporarily stemming the psychotic process, relieving tension
and inducing a return to more effective functioning. In this process, the following methods are prominent at the hospital:
Our
1.
By
hOSpitalization, the patient is separated and isolated from his
environment.
2. By drug medication, as barbiturates, serpasil, and chlorpromaaine,
and by electroshock and ambulatory insulin treatments, tension and
anxiety symptoms are reduced.
'
3. By electroshock, electronarcosis and insulin coma therapy psychotic
ideation is erased by altering brain function.
'
b. By group and social activities, and group therapy in a permissive
environment, better communication is fostered.
5.
By
individual psychotherapy interpersonal relationships are fostered
along
realistic lines.
6. By environmental manipulation, job reeducation, and social service
help, effective functioning is strengthened.
Our
A. To
research program is devoted to studying these processes.
Understand the Hay Therapy Vorks:
disciplines are constructively applied at the hospital,
the effectiveness of any has not been sufficiently assessed; nor has the mode
While these
�.3mode
of
of
The
the
study
evaluated.
present
been
adequately
of operation
has
Electroshock
of
interest.
our
example
an
electroshock
of
is
operation
By
assessing
in
many
from
patients.
depression
psychotic
improvement
resulted in
be
works
will
electroshock
the
way
that
hoped
is
the various possibilities
and
mental
about
the
ideas
some
then
accomplished,
understood. If this is
it
The
of
become
understanding
clear.
may
in
depression
physiological processes
A plan for a
of
service.
the
research
electroshock treatment is the first goal
similar study of insulin coma therapy is now in preparation; and others at the
environment
as a therapeutic
of
the
hospital
study
a
planning
hospital are
mechanism.
B.
Relationship of Character Structure to Diagnosis:
study has been devoted to demonstrate the importance of the childhood environment in the development of character, behaviour patterns under stress
involved
in
assessOther
actively
are
and
investigators
the
neuroses.
conditions
of
adult
the
in
variety
result
that
childhood
relationships
the
in
factors
the
ing
behaviour patterns. It is not pOSSible to carry out such studies at Hillside,
mental
of
illness
and
the
between
type
character
the
but
important relationship
of
behavioural
to
of
the
patterns
character
the
relation
shows;
the patient
of
character that resist
and
the
aspects
'improvement‘;
we
which
call
change
A
be
prototype of such studies is now in progressmethods
assessed.
can
treatment
electroshock
therapy.
in
improvement
to
basic
of
character
the
in
aspects
Much
C.
Biochemical and Physiological Factors in Mental
Illness:
ill
for long periods, appear to take on a stereoPersons who have been
and
chemistry
in
their
reflected
which
is ultimately
typed behaviour pattern,
by
'non—reactor‘
neurologic,
and
patterns
of
such
'reactor'
Study
physiology.
the
failures
in
assessing
methods
important
and
are
drug
biochemical
physiologic,
and
physical
illness
between
psychiatric
the
relations
of present therapies;
Such
a
and
improvement.
between
therapies
'organic'
and
the relation
illness;
and
to
drugs
EST
reaction
where
second
project,
study is incorporated in the
and
of
long
short
terms
in
be
assessed
will
electroencephalogram
the
changes in
term improvement rates.
D. Continuing Evaluations of Treatment Results (Follow~up):
suffer
treatment
generally
of
of
present
the
results
studies
Follow-up
of
the
evaluation
done
an
without
because they assess one therapy only; are
control
standard
to
compared
and
not
are
improvement;
subject's potentialities for
followa
continuing
be
to
organize
possible
may
With
active support, it
groups.
evaluated
on
admission;
assessed
the
are
in
which
hospital
patients
up program, in
followed
a
and
over
then
methods
at
discharge;
and
psychiatric
by psychologic
number of years with an evaluation as to sustained change and reasons for failure.
much
would
have
at
discharge,
Such an evaluation, if compared to the predictions
for
base-line
and
a
provide
of
therapies,
choice
present
merit in assessing the
the evaluation of any future therapeutic methods.
III.
Recommendation
of
problems
the
methods
in
attacking
of
suggested
In this outline
the
treatment
best;
as
one
made
to
specific
specify
no
effort
have
I
psychiatry,
is
that
fragmentary
so
it
knowledge
is
Present
the
specific.
or one etiology as
of
the
psychoses.
major
to
the
etiology
make
as
only
a
to
guess
poor
possible
A multidisciplinary approach with full freedom to follow many leads is the best
of
a
establishment
recommend
the
would
For
I
this reason,
that can be offered.
�-
h
-
Research Service, with full-time personnel devoted to such studies. I would
be indesuggest that such a service have "research" as its function; that
have a basic
pendent of the service departments of the hospital; and that
budget which would assure continuation regardless of the availability of outside
it
it
research funds.
A.
The
Research Service should have the following organization:
1. Director of Research -- Responsible to the Medical Director.
2. Research Associates in Psychiatry and Psychology.
3. Research Assistants:
a. Psychology
b. Neurophysiology
c. Psychiatry
d. Social Service
h. Secretarial and clinical personnel.
5. Technicians.
B.
Annual Budget recommendations
for the Research Service:
1. Director
2. Associate in Psychiatry
"
3.
in Psychology
b. Assistant in Psychiatry
"
5.
in Psychology
"
6.
in Neurophysiology
"
7.
in Social Service
8. Secretary
9. Technician
"
10.
—
Lab
EEG
$20,000 - $25,000.
12,000 - 20,000.
8,000 - 10,000.
6,000 - 10,000.
5,200 - 8,h00.
5,200 - 10,000.
h,000 - 6,000.
2,760 - 3,300.
h,000 - 6,000.
1,300 - 1,800.
(1/2 time)
warranted
Consumable Supplies
Travel
Overhead: As decided by Administrator.
Equipment:
As
2,h00.
1,000.
available as a continuing commitment to
the Medical Director for long range planning of the Research Service.
For the budget year 1955-1956. I should like to make the specific
These funds should be made
recommendation
1.
2.
3.
h.
5.
6.
that the following are the
Director
Research Assistant
"
"
Secretary
Consumable Supplies
Travel
minimum
- Psychiatry
Psychology
~
&
Equipment
7. Overhead
8.
EEG
Technician (in Operating budget)
requirements:
$15,000.
7,500.
7,200.
3,000.
2,h00.
1,000.
-
$36,100.
1,600.
$37,700.
�C.
Space:
Problems of space at the hospital are acute, and will provide an increasing measure of difficulty as the service is developed. It is suggested
that in the next capital outlay by the hospital for construction, some allowances
be made.
for the Research Service
'
D.
Relation with Other Departments:
activities of the Research Service are to be those designated by
the Director. Interdepartmental projects will be carried out by the Research
Service, or in those instances where approval of the Research Committee is obtained, by the departments involved. Supervision of such interdepartmental
projects will lie with the Research Director.
The
Interdepartmental projects are to be fostered by the Director. Prior
approval by the Research Committee and the Medical Director is required. Such
projects as are consistent with the service functions of the departments involved
will be fostered. Presentations and reports are to be approved by the Research
Committee prior to publication.
E.
Job Description:
1. Director of Research:
objectives of the Director of Research will be to: (l) Organize
and maintain an active program of research and a Research Service; (2) Promote,
supervise and integrate research activities at the Hospital; (3) Educate hospital
personnel in research methods and progress; and (h) Administer research funds.
The
The
director of research will:
a. Organize a central project or series of projects appropriate to the
unique character of the Hospital and integrate this into the activities
(therapeutic) of the Hospital. Progress reports will be submitted to the Medical
Director and to each meeting of the Research Committee of the Medical Board; and
such data as is approved for presentation will be submitted by the Director or
his delegate at the appropriate scientific society.
staff to plan and carry out individual
research projects. Third year residents in psychiatry are to be specifically
encouraged to undertake research projects under his direct supervision, or that
of an attending psychiatrist. For these residents, and any other professional
members of the staff, the director of research is to assist in the planning of
b. Encourage
all
members
of the
the project; in its integration into the hospital program; and in
both technically and financially.
its
support
c. Carry on such educational activities as the supervision of third year
residents in research; monthly seminars in research problems and progress; and
The
director will maintain
of
meetings.
important
psychiatric
periodical reports
a calendar of meetings and lectures; stimulate attendance thereto; and foster the
He
such
of
is also to invite such
meetings.
at
Hospital
activities
presentation
guest lecturers and seminar leaders as are available.
d. Administer all research funds with the approval of the Medical Director.
This includes the stimulation of fund sources; the application for funds; and their
allocation to hospital projects.
�2. Research Associate:
Director in all projects at the hospital; to
assume responsibility for specified projects; and to carry on such independent
investigations as his training and experience dictate.
Tb
work with the
Associate in Psychiatry is to be a qualified diplomats in
psychiatry, with extensive experience both in psychoanalytic psychiatry and in
descriptive psychiatry. By training or experience, the associate should have
teaching qualifications; and some training in research methods.
A. Such an
assume responsibility for that portion of the functions of
the service assigned to him by the director; assume responsibility in the director‘s
absence; attend conferences, meetings and assume teaching functions as recommended
by the director.
will
He
Salary to be determined by qualification and experience. Probable
range - $12,000 to 20,000.
‘
B. Such an Associate in Psychology is to be a qualified psychologist
with at least 10 years experience. Psychoanalytic experience is preferable.
The equivalent in academic standing of Associate Professor is the guide line.
research associate in psychology is to assume responsibility
for those functions of the Research Service assigned to him by the director.
An evaluation of testing methods, statistical evaluation of results. and a
rigorous control of procedure in all aspects of the functioning of the research
service are his responsibility.
The research associate in psychology may be chosen from the research
assistants. Salary range - b8,000 to 10,000.
The
will: organize and supervise projects
in the department; supervise projects of the resident psychiatric staff; assist
such department heads as request aid in organizing departmental projects; advise
the director of new research possibilities; attend conferences, write reports and
papers, and carry on such administrative activities as the Director may require.
Both Research Associates
Board
at
Appointments to Research Associate are to be made by the Medical
the recommendation of the Medical Director and the Director of Research.
3. Research Assistants:
assist the director in his research activities and carry on
the work of the department. Each assistant is to be responsible to the director,
and will carry on such tests, procedures, write such reports, and present those
To
papers designated by the Director. Assistants are to be qualified by training
and experience for the specified jobs named. They are to be appointed by the
Medical Director at the nomination of the Director of Research.
a. Assistant in Psychiatry: For such psychiatristswho have had three
or more years of formal psychiatric training but not yet certified, the opportunity to work for one or more years on a Research Service may provide the
stimulation for continuation in research and also provide the director with the
assistance of personnel intermediate in experience between the resident and the
associate. The assistant in psychiatry can assume responsibility for the selection
�-7of the patients for the various projects; evaluate changes in behaviour with
treatment; assess the importance of intrapsychic and environmental factors in
the present behaviour of the patient. the assistant will assume responsibility
for those aspects of the problems under investigation as are within his scope,
and assigned by the director. He will write such reports, papers and make such
presentations as the director may suggest. He will make such tests, learn such
technics and work with those members of the research service or the service departments of the hospital as his projects permit.
Salary is dependent on experience. Probable range $6,000 to 10,000.
b. Assistant in Psychology: Graduate in psychology with a minimum
of doctorate. Preferable experience in research methods and publication experience
with some specialization in laboratory methods. Equivalent academic status of
assistant professor. The assistant in psychology is to carry on such psychologic
and laboratory tests, and make such statistical and methodological evaluations
as the projects of the service require; and to make such reports and presentations
as the director may suggest. He is to direct the laboratory technicians, organize
their work and assume responsibility for the maintenance of all testing equipment
and materials. In the design of projects, he is to assume responsibility for the
application of the best methods and design commensurate with the goals of the
project.
Salary range - $5,200 to
8,hOO.
minimum
M.D.
of
with
a
Ph.D.,
or
Assistant
in
Neurophvsiology:
c.
three years experience in electroencephalography or neurophysiology. To supervise
and coordinate all neurophysiological studies, now being organized; develop and
build electrophysiological equipment; assume responsibility for such animal studies
as are organized; cooperate with the psychologist in coordinated neuropsychological
investigations; and supervise technicians in electrical methods.
This position can be filled only if the laboratory is expanded to
include more basic studies. Personnel can then be recruited from medical school
training centers. Salary range - $5,200 to 10,000.
d. Assistant - Social Service: B.S. (Soc. Work) with minimum of five
years experience in field or administrative work. Emphasis on interviewing
technics and assessing family relationships. Personal analysis recommended.
If previous research experience with psychiatrists or psychiatric clinics is
noted, it should be heavily weighted.
Assistant is to assume reaponsibility for interviewing relatives
of patients and develop technics of assessing premorbid characteristics based
on history and interview; to obtain histories from relatives and patient relevant
to the early years of development; to cooparate with the psychologist in assessing
the personality of the subjects; and to coordinate research testing in the various
projects, Patients seen during their hospitalization in any of the research
service projects are to be seen by the social worker prior to discharge, and every
effort at follow up contact made. For all followbup testing and evaluation, the
assistant will make the necessary contacts and arrangements for the director.
The social worker assigned to the research service will, if time is available,
cooperate with the Director of Social Service in those interdepartmental projects
which he may have organized with the approval of the director of research.
Assistant is to be selected by the Director of Social Service.
Salary range proportionate to experience in research. Range - th,000 to 6,000.
�e. Technicians:
l.
EEG
--
High school graduate, although two years college
preferred.
learn the fundamentals of electroencephalography; make the necessary measure—
ments and place electrodes; obtain artefact free records; maintain card files;
type reports; keep records in systematic way; and maintain equipment. Technician
is to be responsible to the assistant in neurophysiology or the director.
To
Salary --
if
untrained, $2,600;
if trained,
$3,000 to $3,600.
2. Lab. Technician--Neurophysiology. College graduate, preferably
with some engineering or physics experience. To assist the assistant in neurophysiology and/or the assistant in psychology, in the development and maintenance
of electrical equipment; to assist in the handling of animals; to cooperate in
the experimental procedures; to build, adjust and design special equipment.
Salary range dependent on training-~ Range$h,000 to 6,000.
IV.
Summary:
Research Director is actively involved in a number of studies of
the mechanism of treatment. To maintain a continuing function and make long term
planning feasible, it is recommended that a Research Service be established; that
be an integral part of hospital organization with a continuing annual budget.
it
A proposed organization is included in this report, with a projected annual budget
of 3,560,000 - $570,000; and with a minimum budget 1955—56 of $536,100.
The
This report approved by the Research Committee April 27, 1955.
Respectfully submitted,
Max
Fink,
M.D.
Director of Research
�Viva—v Wu'I-v-r
“IV 11; 1955
mom
DR. M. FINE
SUBJECT:
MOW
REPORT, RESEARCH SERVICE «- APRIL
1. My louder ectiviw this month has been the planning and preeentim to
the Director, the Research Committee end to the Medical Affairs
a
plan for a research department. This was discussed at length at the hoepdtel.
and then presented to the Research Omittee, April 27th and approved. It
was later presented on May 3rd to the Medical Affairs Oomittee.
2. Research pro cots underm:
a. BM 2: theetndy ienowinmllewingendueam followingconoeoutive patients with all our indiciee of change.
(30th
"
b. Ambivilence: Our equipment for techietoecopy hue been set
up. Correlations between clinical evaluations between embivilunce made by Dr.
Tmohow and tween, and the laboratory studies using the techietoecope and
the TAT test, are new in pmgmee.
\
electrouetimuletore and oscilloscope have been coordineted and preliminary measurements are being made in the alteration in tactile
perception in electnoehock patients.
(I. Serpaeil project continues despite some difficulties in the
choice of patients.
c.
The
'
e. Subculture: This comittee has continued ite work despite
a number of hwering developments. This eppointment of Dr. Navarro to the
adolescent pavilion hue limited the amount or time available for this project.
Simlteneouely, Dr. Outwits announced that because of the pressure of other
activities, he would be unable to devote the mountfl‘ time previously outin-
eted to the project. For the meanwhile, the committee
elucidating a protocol.
is
continuing and in
Projects begun: Dr's Ledemn end Emberg have begun a study or
the use of divided insulin doses and their effect on come levels.
3‘.
attended: Dr. Knhn attended the Eastern Psychological Asediction nee
e in Philedelphin, Ind participated in a panel and presented a
paper based npm his work at the hunt Sinai Hoepital. I attended the April
meeting of the New York Neurologic Society.
1;.
'
p
3
"
5. Pipers published: In the Joumel or the Hillside Hospital, the
”th1
Test
in
Mental Petientc' by Dr. Kuhn, Weinetein and myself.
.
�MEMORANDUM
Dr. Joseph so A. Miller, Mono
FROM: Dr. Max Fink
SUBJECT; Monthly report, Reaearoh Service
T08
1. Activities of
- Boy
of the Research Service during the month
have been attendance at various psychiatric matings; the presentation of
papers; and tho continuation of ongoing projects.
members
2. Papers Presented: (c)
The paper entitled "RelatiOn of
want in Eleotroshockfl was read,
~
Kwalwasser.
To
.
and Learning to Improve»
the Electroahcck Rosearoh Association
Changes in Memory
hy title, by Mr. Karin, Dr. Fink, and Dr.
This paper received the Annual Prize Award of the association.
(b) To the American Psychiatric Association, the paper entitled
"Relationship Betucon Altered Brain Function and Denial in Electroshook
Therapy“ was presented by Dr. Kahn and Dr. ?ink.
‘(c)
the resident's meeting of tho New York Neurologic Socioty,
Dr. Grnubert road the paper 'Daluaional Rodnplication of Parts of the Body
After Insulin Coma Thorapygfi
To
final manuscripts of these three paperc
Committee, at the end of the month.
The
3. Meetings uttendod:
were sent
to the Resoarch
or the Research Service attended the
following meetings: Amorican Psychosomatic Society, American Psychiatric
Association, Electroshock Ecuooroh Association - all at Atlantic City.
Also the
Nowhers
York Neurologic Society and the American Psychopathological
Association in New York City.
‘
How
h. Notes regarding ongoing projects: a. Further data has been con
llected for the two projects - EST # 2 and Ambivalence.
b. Serposil: Some difficulties in the selection were cleared
in conferences with Dr. Loderman and Dr; Blumberg. Later on in the month
Dr. Laderman requcsted that he be relieved of working on this project except in the aupervisony role since he has to many other activities. The
project will continue with Dr; chhspress assuming the major psychiatric
role.
0. Subculture: Furthor work in preparing a protocol has continued
during the month despite the hampering difficulty of the nooignaticn of
Dr. Gurvito and the increased activities of Dr. Navarre. It is my anticipaticn that a satisfactony protocol may be available by the and of the
month.
up
�S. New Projects: Following an initial meeting with Dr. Loon Helium:
of the Sloan Kettering Institute on April 25th further dismsions were
held at the hospital between Dr. Goldenberg and myself and a second visit
to the institute was made on May 23rd. With the elucidation of their
program, our own protocol is being prepared and will be submitted to the
Research Committee and Medical Dimctor within the next few days.
‘
The Annual Prim Award of
$100.00 was donated to the
the Electmshock Research
urea]. Strauss Research Fund,
Association for
also renewal mquest for tho grant. of the 0.3. Public Health Service were
submitted on May 3rd.
6. Funds:
7. Papers Published: None.
�DOW
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drugesnd
rented elheloidel compounds in blood end urine. The procedure involves extinction
orthe buiriedi‘luidwith heptsneendreextraetionottheecupoundfromthe
heptsne leyer with hydrochloric acid. an mixing the acid solution with methyl
orange e complex is formed which dissolved in ethyl.” dichloride to give I: soln.
whose color in directly proportionel to the amount of chlorpromssine, eerpcsil,
or other elkeloid origindqureeent intheteettluid. Adeteiled etudyhes
eleo bean nude or the specificity of the melytiecl method.
Prelim-:7 results
obtained with serum of petiente indicate an «trench
rapid rate of dieeppesrsnee or the mister-ed meterinl. Studies are being
mderteken to determine whether this 1e due to repid elimination, detonticetion,
or both, and whether the degree or retention of the drugs can be correlated in
em we: with their clinical effectiveneee.
2. Inhibition of Sena Cholinestereee by Hallucinogen»
stub wee reemd or en intereeting observation that had been made in
our lobe. lest Sept... 195:. but not subsequmtly followed up became of leek of
personnel. it that time it was noted that LSD 25 is e potmt inhibitor of mm
11;.
The
cholinesterese.
question eroee as to whether thie phenomenon correlates
in may we; with the echisogenic ection of LSD 25, end whether hallucinogenic in
general have 1 eimer effect on cholineetereee from serum, cells, end brain.
serum
Prelilinery results with serum cholineetereee indicate a perelleliem between
hallucinogenic eetivity of the 3 druge teeted, listed in the order or decreasing
activity, '13., lysergic acid diethylenide > lyeergie seid monoethylamide >
mecsline, end their ability to inhibit the anyone.
3. Steroid
3mm. Conjugate
Studies.
einple method hec been found for eliminating the protein and alkaloid
interference with steroid sulfate cnelyeis or biological fluids. Procedure
involves eddition of alkali to diesoeiete steroid sulfate bound to protein,
followed by extraction with lipid oolvente end treatment with e eulronie eeid
resin to remove excess bees as well a: tree alkaloid. Progreee along theee
lines has been extremely rapid and fruitful. It hes also been discovered that
the home sulfates ere synthesized by the liver. Chromtomphic end paper
electrophoretio methods are being adopted ee companion tools to our dye teehnie
in order to establish the identity or the component hormone conjugates.
A
�mm
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tor urinary “mid studios hy Slow-Kauai.“
mend
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Research Files and Unpublished Works
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mfp-03-01-001-0-002
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1955
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
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<a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965
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The Max Fink Collection
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Annual report - research; Biochemical research; Research and pUblications of the Department of Psychology; Annual Report of Department of Neurology, Hillside Hospital; Letters to Dr. Miller (Budget); Research Progress Report
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-
http://exhibits.library.stonybrook.edu/mfp/files/original/6d5d109f552158de5a99360da32ba4a2.pdf
cbe6f09f352080376a08471f0e47212a
PDF Text
Text
HILLSIDE HOSPITAL
FOR PSYCHIATRIC TREATMENT. TRAINING AND RESEARCH
75-59 263RD
GLEN OAKS. N. Y.
STREET
FIELDSTONE
3-7300
JOSEPH S. A. MILLER. M. D.
MAURICE BACHRACH
MEDICAL DIRECTOR
ADMINISTRATOR
SIMON KWALWASSER. M. D.
Assoc.
June 27’ 1955
MEDICAL DIR.
Dear Dr. Fink:
This
is to
I
sure that there
acknowledge,
with thanks, the receipt of $100
for the Research Fund, from
yourself and your Associates,
Hyman Karin and Simon Kwalwasser.
no need
am
for us to
tell
you
is
of the
importance of our research program.
The Directors are appreciative of
the sentiment underlying your gift
of this $100. to Hillside Hospital.
Very
sincerely yours
Maurice Bachrach
MBzhm
cc: Dr. Kwalwasser
Dr. Miller
Mr. Korin
AN AFFILIATE OF FEDERATION OF JEWISH PHILANTHROPIES OF NEW YORK
�June 30, 1955
Somatic Therapy'fbsearch Program 1955-57
From the Research
Service of the Hillside Hospital
mode
of
action
the
to
investigate
A. AIMS: It is the purpose of this study
We
do
by
this
to
plan
mental
illness.
of somatic therapies in
and
personality
behavioral
of
physiological,
the systematic investigation
factors which
B.
may
be involved.
mechanism
conc‘eming
the
therapeutic
Although many theories
BACKGROUND:
been
have
they
advanced,
been
have
of the somatic therapies
cannot
validity
their
that
either empirically disproved, or, are so vague
be
and
hypothesis,
meaningful
more
of
a
development
the
More
recently,
tested.
new methods of study have provided the opportunity
ion. In l952,'fleinstein
and Kahn (Amer.
for a fruitful investigat-
Journal Psychiatry l923 22-26) sug-
of
milieu
a
creating
by
improvement
to
gested that the somatic therapies lead
Some
could
of
denial
operate.
anisms
mec
in.which
function
brain
altered
support for this
hypothesis has been found in the
literature. Carter
(Am.
earlier work of Janis,
unpleasant life memories after
the
of
some
confirmed
1953)
has
§5
330,
Psychologist
of
selective
forgetting
there
is
showing that
electroshock.
non—emotional
and
emotional
of
Using tachistoscopic presentation
demonstrated
1953)
hhS,
§5
(Am.
Psychologist
words, Teicher
that
of repression" to emotional stimuli occur in the post-shock
state.
For the past year and a half preliminary studies
"mechanisms
investigating this
done
been
have
hypothesis
at these laboratories at Hillside Hospital.
results to date
striking.
have been
patients were followed.with serial
taneous
tactile
Twenty—four
The
consecutive electroshock
electroencephalograms and amytal, simul-
perceptual and memory
tests.
A
marked
correlation between
�.02.
improvement and
early, persistent
alogram, and in the amytal
tests
was observed.
appear, improvement did not occur.
sistent
and severe changes on the electroenceph-
It is
If
such changes did not
our conclusion that early and per-
sufficient, prepossible to predict
changes in these indices are a necessary, though not
make
These
observations
improvement.
for
it
requisite
the short term response to therapy during the second and third
week of
treat-
ment.
A
report
on
the amytal test results was presented at the recent meet-
ing of the American Psychiatric Association (May 1955) and submitted fer public-
Electroshock
the
At
of
of
meeting
American
Journal
a
Psychiatry.
the
to
ation
Research Association on
May
8th, a report of the changes in
memory and
learn-
This
was
treatment
presented.
electroshock
of
the
course
ing occurring during
he
Award
citation
Association.
the
of
Annual
Prize
awarded
the
was
report
noted the methodology as exemplary, and offering a
fruitful
method of study-
ing electroshock.
Concomitant with these
studies,t7e
have followed
patients
on
insulin
therapy. Recent reports onthe value of prolonged coma as the basis for
improvement (Kwalwasser and Caplan: J. Hillside Hospital l; 1&5, 1952; Revitch,
coma
E.
:
Neurol.
Arch
A.M.A.
Rowsell:
and
195h;
shagass
72,
Quart.
fig;
Psychiat.
and Psychiat. 225 705, l95h; and Yeager
195h)
In one
gt 3;; J.
Nerv.
&
Ment. Dis. llgg h35,
2
the
over
studies
past
in
years.
in our patients
unusual case report the direct relationship between altered brain fun-
have been confirmed
(Delusional
demonstrated
Reduplication
been
has
and
improvement
denial
ction,
of Parts of the Body After Insulin Coma Therapy, J. Hillside Hospital, 1955,
in press).
C.
METHOD:
1.
we
plan to verify and amplify our preliminary observations on
the relation of changes in behavior to altered brain function after
somatic treatment.
�-3”
E.A. and Kahn,
sease,
Am.
electroshock will be given amytal tests (heinstein,
DiBrain
Sodium
In
Organic
Use
Amobarbital
of
Diagnostic
Patients
(a)
3.:
on
J. Psychiatlggf
Test" for Brain Disease:
889—89h, 1953;
Its
Serial Administration of the
"Amytal
Arch
A.M.A.
Value,
and
Prognostic
Diagnostic
and
before
and
electroencephalograms
l95h)
Neurol. and Psychiat. 1;; 217-226,
treatment.
make
be
a
used
to
This
will
data
preat stated intervals during
diction of the short term response to treatment.
(b)
Double simultaneous
tactile perceptual tests will
using threshold electrical stimulation.
be
carried out
Using two Grass Sh-B stimulators,
to
be
his
for
tested
ability
the
will
patient
monitored by an oscillograph,
of
his
body.
different
parts
to
simultaneously
two
stimuli
applied
perceive
shown
to
been
previously
has
stimulation
simultaneous
double
of
technique
hé-SB,
g}
Neurology,
(Fink
function
3},
be a good index of altered brain
at
The
January, 1952).
By
applying this highly refined technique
it is hoped that
elicited.
be
will
patients
tests,
changes in brain function which are not otherwise apparent
will
be
and
amytal
of
electroencephalognmn
the
case
in
tested before and at stated intervals during treatment.
As
2.
Other Physiological procedures will be carried out in con-
junction with the tests above.
(a) Each patient will be given the mecholyl-epinephrine
cribed by Funkenstein and associates
The
results will
(J. Nerv.
(b)
sulin
coma
as des-
Ment. Dis. Egg: h09, Nov. 19h8).
be compared with the work of previous
as with the results of our other physiological
test
investigators as well
tests.
and
electroshock
of
undergoing
Biochemical testing
patients
treatment have been in progress for
some time
in-
in these laboratories.
In this series of patients, estimates of urinary ketosteroid excretionxates
Simultaneously
esexcretion
rate.
be
post-treatment
to
compared
their
will
timates of steroid sulphates; phosphatase; and blood levels of steroid sulphate,
�«hphosphorus, phosphatase and
total alkaloid will
be done.
of
many
that
investigation
3. It has been evident in our preliminary
months.
within
six
treatment
somatic
relapse
the patients tm.t improve after
imp
of
duration
the
to
involved
in
regard
The critical problem of the factors
provement
is also to
be
studied.
One
hypothesis
now
under investigation
is
related to the premorbid personality.
denial"
verbal
of
the
"explicit
characteristics
the
with
patients
Specifically,
Denial
Factors
in
Personality
R.L.:
and
Kahn,
personality (Mainstein, E.A.
that sustained improvement
may be
1953)
March,
1-13,
fig:
Psychiat.
Illness, A.H.A. Arch. Neurol.
more likely to maintain improvement, than patients
&
of
who do
will
be
not have this pre-
morbid personality makeup.
(a)
two
with
interviews
by
personality
of
premorbid
the
Evaluation
close relatives will
airre will
be used to
be made
elicit
dictive value such as need to
for each patient.
A
standardized question-
characterological factors, which
be
at least
may
have
pre-
right, prestige-consciousness, sensitivity
toczfiticismand compulsive drive.
words:
and
of
pictures
(b) Tachistoscopic presentation
The
threshold
material
be
compared.with
will
illness
to
related
levels of subject matter
characterological
for
be
evaluated
data
This
will
of more indifferent nature.
assessed
be
as
quantwill
in
response
alterations
In
addition,
indications.
itative indices of denial.
(c)
and
be
Rorschach
given
will
and
the
Test
The Thematic Appereeption
evaluated for the
same
factors as the personality interviews.
to
of
response
predictions
material,
the
of
personality
(d)
the basis
of
treatment
the
to
start
Prior
made
at different periods..
treatment will be
1)
those
unthree
to
possibilities:
according
be
classified
patients will
On
and
temporarily;
moderately
or
to
improve
2)
those
likely
to
improve;
likely
3) those
improvement
and
sustained
marked
maintain
to
likely
(for at least
6
�.5.
Prediction will also be
months).
made
during the course of treatment (the
third weekfbr the electroshock patients) taking into account the physiological
At
the
of
factors.
the
premorbid
personality
well
analysis
indices as
as
conclusion of treatment patients will be evaluated for actual immediate response to the treatment. Those
who showed some improvement
ified again according to whether or not improvement will
will then
be
be
class-
sustained.
h. Evaluation of the change in behavior of patients undergoing treatment
will
Such
ratings will be
be made on the
basis of a modification of the
made
independently of
all
Malamud
the other
rating scales.
test results
by a
supervising psychiatrist.
D.
FACILITIES AVAILABLE:
l.
Hillside Hospital is a
200 bed
voluntary hospital
for psychiatric care. All patients subjected to phy—
siological therapies are available for study. Periods of hospitalization.are
2-8 months; and a h-6 week observation period is generally available prior to
the
institution
A
of physical therapy.
Research Service has been established, with a
full
time professional
staff of a Director (neuropsychiatrist); assistant in psychiatry; biochemist
EEG
and
technician
(Ph.D.)
research
and assistant chemist;
neurophysiologist
and secretary. A full time psychologist and two chemists are associated on a
project basis.
Laboratory
a Medcraft D-8,
two
S—hB
8
facilities include:
(a) Electroencephalographic unit with
channel instrument; (b) Neurophysiological laboratory with
Grass stimulators,
Du Mont
# 3&0
R
oscillograph; two synchronized tach-
Biochemical
(0)
laband
equipment;
electronic
auxiliary
projectors
istoscopic
the
followwith
and
of
equipped
1000
with
feet
laboratory
space
square
oratory
ing major items:
Beckman
spectrophotometer,'Warburg respirator, Coleman Spect-
rophotometer, and radioisotope unit following the basic specifications of the
A.E.C.
�2. Personnel:
(a) Dr.
Max
Fink, M.D., Director of Research: After undergrad-
uate studies at the University College of
his
D-A.
New
York University where he received
cunllaude with Honors in Biology in l9h2, he attended the
New
York
University College of Medicine, graduating in 19h5. After a rotating interneship he served in the
U.SL Army, where he
attended the School of Military
Neuropsychiatry.
training
Formal neurologic
York
(19h8-l9h9) and
was
received at Montefiore Hospital in
at Bellevue Hospital
(
l9h9-1951). Formal psychiatric
training received at Bellevue Psychiatric HOSpital (6
Hillside Hospital (1952).
and
During 1951,
again
in 1953,
New
at
months 1950) and then
he was a research fellow of the Nat-
ional Foundation for Infantile Paralysis,
first at
of Medicine and then at Mount Sinai Hospital in
New
New
York University College
York.
Both periods of
study were under the supervision of Dr. Iorris B. Bender.
In 1952 he was certified in Neurology by the Amer. Board of Psychiatry
and Neurology, and was granted complementary
May
certification in Psychiatry in
l95h. Simultaneously he attended and.gsunnfindfrom the William Alanson
Institute of Psychoanalysis, Psychiatry
Certificate for Physicians in January 1953.
White
and Psychology, receiving
(b) Dr. Jeseph Jeffe, M.D., Assistant in Psychiatry:
undergraduate studies
at
their
Following
Columbia College (B.A., l9hh), Dr. Jaffe attended the
New
York University College of Medicine, and was granted
was
elected to Alpha
Omega
Alpha.
He was
an interne
his
M.D.
in 19h7.
He
at the Morrisania City
Hospital, and then began three years intensive study at the Bellevue Psychiatric
Hospital. First as a resident in psychiatry, theniizneurology, and he
com»
pleted his studies as a U.S.P.H.3. post-doctoral research fellow under the
supervision of Dr. Morris B. Bender.
�~7—
From 1951
to
1953 he was
in the United States Air Force.
He
graduated from
the School of Aviation Medicine and was Chief Psychiatrist at the Mitchell
Air Force Base Hospital.
Since discharge from the military service he has been in the private
practice of psychiatry.
He
was
certified in psychiatry
by the American Board
of Psychiatry and Neurology in 1953. Since 19h? he has been a candidate in
White
Psyof
Psychoanalysis,
Alanson
Institute
William
the
at
psychoanalysis
in
Research
Assistant
two
and
the
and
for
past
years
Peychology;
chiatry
Neurology at the Mount Sinai Hospital of
(0)
New
York.
Dr. Robert L. Kahn, Fh.D.: Assistant in Neurophysiology:
After graduation from Brooklyn College
Columbia University which was
United States Army.
in l9h0, he started graduate
interrupted
by
work
at
four years of service in the
In the army he went to Clinical Psychology School and
served as psychologist in various hOSpitals within this country and overseas.
On leaving the army he became a Research Psychologist in the Department of
Neurology of the Mount Sinai Hospital in
the supervision of Dr.
time.
To
date,
M. B.
New
York, where he has worked under
Bender and Dr. E. A. Weinstein up to the present
he has been an author of more than twenty
co-author of the monograph.
"Denial of Illness:
ASpects" which was published
in
Symbolic and Physiological
May, 1955.
received his Ph. D. from the
He
publications, and is
New
York University School of Graduate
Arts and Sciences in 1953, and was an instructor of psychology
and Hunter Colleges
sultant to the
New
for
York
at
Brooklyn
For the past two years he has been a con-
years.
State Department of Mental Hygiene and has conducted
two
training programs in several of thé mental hospitals.
(d)
Chemist:
A
Dr. Harry Goldenberg, Ph.D.: Director of Laboratories and Chief
Trethe
of
he
where
was
a
C.C.N.Y.
l9hh,
of
recipient
in
graduate
maine Scholarship and graduated cum laude, Dr. Goldenberg received
his Ph.D. in
�~8l9h9 from the Polytechnic Institute of Brooklyn.
(who-ll?)
Institute
the
Polytechnic
at
biochemistry
He
(1951 to date).' In l9h7-h9
National Institute
U.S.P.H.S. project
he was a Research Fellow
an
been
has
and
in
instructor in
at Brooklyn College
enzymology of the
of Health, and from 1950 to 1952 he was a chemist to a
at
Jewish Hospital of Broeklyn studying enzyme methods in
clinical chemistry.
(e)
Mr. Hyman Korin, Research
Assistant (Psychology): Following four
College of the City of
military service, he matriculated at
and received his B.S. in 19h? and his M.S. in 1950. During
years of
New
York
1951-52 he was
Ph.D.
his
for
and
matriculated
Sinai
Hospital
psychology interns at the
in
Research
Assistant
been
1953
has
he
June
Since
New
York
University.
at
thesis
doctoral
his
completed
and
has
recently
Psychology at Hillside Hospital
Mount
on "The
Effects of Electroshock on Retroactive Inhibaticn."
3. Publications:
Recent publications of the Research Service include:
The Amytal
Test in Patients with Mental Illness,
1955.
3-13,
ii:
Hospital,
Hillside
J.
Electroshock,
in
Improvement
and
to
Memory
Learning
of
in
Changes
Relation
press).
Conf. Neurologica, 1955 (In
Delusional reduplication of Parts of the Body After Insulin
J. Hillside Hospital,
1955
(
Therapy,
In press).
Relation Between Altered Brain Function and Denial
Amer.
Coma
in Electroshock Therapy,
J. Psychiatry (submitted).
Rectification of Nonlinear Beer's
Law
Plots, Anal.
Chem.
gé: 690, l9Sh.
Bioand
Biochem.
Arch
Curves,
Enzyme
Non-Linear
Activity
Rectification on
phys., fig;
288, l95h.
�July 1, 1955
BUDGET
l.
-.
RESEARCH SERVICE,
PERSOM'EL
1955-56
EFF—ES.
Director of Research
15,000
-
BD OF DIRECTORS
15,000
in Psychiatry
7,200
Research Assistant in Neurophys.
7,500
Chief Chemist
8,200
Assistant Chemist
2,800
Research Assistant in Psychology
h,000
h,000
-
Assistant Chemist
h,000
h,000
~
Assistant Chemist
1,800
1,800
-
2,520
960
150
150
3,810
2,1uo
1,670
1,000
200
800
$ 57,980
$20,750
$37,230
Research Assistant
Secretary -
EEG
Technician
2.
EQUIPMENT
3.
CONSUMABLE
)4.
TMWBL-CONFERENCES
TOTAL
SUPPLIES
7,200
7,500
-
8,200
2,800
1,560
��your grant for the biochemm and neuroplvsiologiul
approved. A mpplamuzy grunt request fer $7992.00
apprum!
by the Public Health Serum for the 24—927 pmaeem This may will amt thsalary or Dr. R. him.
6.
grants were
A.
,
3
The ascend
In sdditionk protoccla were submitted thmgh Hr.
medatim.
m
Calm ta
the Hofheimr
�Department of Biochemistry
.................................
RESEARCH PROGRESS REPORT, JULY-AUGUST
A. Major work
Dr. H. Goldenberg
1955
in Progress
1. Determination of Chlorpromazine in Blood and Urine
procedure for the colorimetric estimation of chlorpromazine and related
alkaloids, described in the June 1955 progress report, has been further refined
to permit detection of the extremely small amounts of drug circulating in blood.
The method is based on two new features: (1) The finding that drugs can be
quantitatively extracted from biological fluids with a single portion of an
ethylene dichloride-ether solvent mixture, and (2) The use of a three—phase solvent
dye partition system of analysis.
The
Clinical data are also being obtained on bound as well as free circulating
promazine, based on the use of hot acid to liberate the conjugated drug.
2. Inhibition of Cholinesterase by Hallucinogens
These studies are being continued as indicated
in the prior report.
3. Steroid Sulfate Conjugates
All but one of the major problems involved in the assay of steroid sulfate
metabolism.in mental disease have now been solved. A novel device has been
introduced for eliminating the interference with our test due to phenol sulfates
in blood and urine. A two-phase system incorporating dicyclohexylamine (DCHA) as
a complexing agent effectively separates the steroid from the phenol sulfates,
permitting their unequivocal determination. The procedure for serum is now as
follows:
is treated with alkali to release the hormone conjugates.
b. A lipid solvent is added to precipitate the proteins and simultaneously
extract the hormones.
DCHA
The
and
between
to
brought
is
dryness
supernate
partitioned
c.
lipid
a.
Serum
and chloroform.
free steroid sulfates are released by shaking the chloroform extracts
with acidic resin.
e. Final assay of the sulfate conjugates is effected by adding dye and reading
the color.
d.
The
considerable amount of clinical data have already been obtained on normal
people and on patients selected for independent studies by the Sloan-Kettering
Institute. An immediate correlation has been established in our laboratory
between urinary conjugate levels and sex, males excreting about twice as much
conjugate as females. This ties in well with what is known of steroid metabolism
A
�and tends to confirm the
validity of the method.
Attention is now being devoted to fractionation of the steroid hormones in
conjugate form. Paper electrophoresis has proven inadequate for the purpose.
Paper chromatography is more successful and is under continuing study.
B. Papers, Lectures and Conferences
following papers are in preparation: (1) "Colorimetric Determination of
Alkaloids, with Particular Reference to Chlorpromazine", and (2) "Steroid Sulfate
Conjugates. II. Colorimetric Microestimation".
The
C. Funds and Personnel Changes
1. Research Grant #A-675 from the National Institutes of Health
the fiscal period Sept. 1955 - Aug. 1956.
2. Messrs. Michael Miller and Spencer Parness terminated
in the laboratory at the end of August.
cc. to: Dr. Fink
Dr. Miller
their
was renewed
for
summer employment
�Department of Biochemistry
.................................
RESEARCH PROGRESS REPORTI SEPTEMBER
-
A. Major werk
Dr. H. Goldenberg
12§§
in Progress
1. Determination of Chlorpromazine in Biological Fluids
As a result of repeated analyses of blood drawn from patients receiving
chlorpromazine, the circulating blood level has been established as less than
1 microgram per ml. serum. The three-phase solvent dye partition scheme of
analysis mentioned in the previous report has therefore been adopted as the only
method capable of detecting the extremely minute amounts of drug in peripheral
blood. A new shaking machine has just been obtained from the A.H. Thomas 60.,
Philadelphia, to permit application of the method on a broad scale.
question naturally arises as to the metabolic fate of chlorpromazine
in humans. We have recently detected in patients! urine an ether-soluble carboxylic acid which reacts with ferric chloride and appears to be an oxidative
byhproduct of chlorpromazine metabolism.
The
2. Inhibition of Cholinesterase by Hallucinogens
three-phase system mentioned above has been found applicable to the
analysis of LSD 25 as well as chlorpromazine and serpasil. By combining this
observation with the earlier discovery of the inhibitory effect of LSD 25 on
human serum cholinesterase, it is now possible to relate the enzyme inhibitory
action to the alkaloid concentration in "unknown" samples of fluid and so deter—
mine the specific molar inhibitory action at the 0.1 microgram level. This
amounts, in effectI to the first sensitive chemical test ever reported for the
detection of LSD 25 and related hallucinogens.
The
3. Steroid Sulfate Conjugates
work progressing
cc. to: Dr.
essentially as described in JulyhAugust report.
Fink
Dr. Joe. S.A. Miller
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October 20, 1955
MEMORAEDUM
TO:
Dr. Joseph S. A. Miller
mom: Max Fink, 14.1).
SUBJECT:
Six Months Report of Research Activities at Hillside Hospital
At the request of the Chairman of the Medical Affairs Committee,
I am submitting this six month report of the activities of the Research
Service and associated research activities at the hospital. During this
period, numerous projects have been under investigation, our staff has expanded, and our space requirements were met. Two projects are being completed, and one project has just been instituted.
A.
PROGRESS
l.
hmw2:
In
ONGOIfiG PROJECTS:
ELECT§9§§QQK #
Our second electroshock project was undertaken in March
project had clearly demon-
in September. Our first
strated that cerebral changes were essential to improvement and that these
1955, and completed
could be measured by the electroencephalogram and by amytal tests. 'Ue
also concluded that memory tests were a poor index of improvement and believed that there were specific psychological patterns indicative of denial
which were more prominent in the improved group than in the unimproved.
Following this study, the second project was undertaken and was designed
to demonstrate the reliability of the electroencephalogram and the amytal
tests for prognostic purposes; and to ascertain the characterological as‘fle
term
be
term
the
short
which
and
in
results.
long
factors
might
pects
have studied.twenty-seven patients to date. The data of this project is
now being processed, and will be available following our six month follow
up
period, (which is from November to January).
data from the first study was pres nted at various meetings,
including the American Psychiatric Association, the Electroshock Research
Association, and the Eastern Association of Electroencephalographers. The
memory data, presented by Mr. Korin at the Electroshocx Research Association
The
in
May, was awarded
The
their
annual prize.
electroshock project #
3
is
below), and will be instituted November 15.
now
in the planning stage (see
This project, which has been undertaken with Dr. Sidney Tarachow of
the Medical Board, has accomplished a considerable amount of its basic work.
Three approaches to the problem of measuring ambivalence have been accepted.
These include an interview evaluation; the thematic apperception test, and
tachistoscopic presentation of pictures. During this period of evaluating
methods, twenty-three patients have been studied. Dr. Tarachow has been
attending to this work, and the testing has been undertaken by dr. Korin.
2.
AMBIVALcNCE:
‘
�~2-
Serpasil evaluation study, undertaken at the end of last year, is com~
double
blind
a
by
been
have
studied
intensively
Seventeen
patients
pleted.
Blumberg
Drs.
andeachspress.
evaluated
by
The
now
data
being
is
technique.
To date, the clinical results are disappointing. Patients who were depressed,
who
were over-active
Patients
symptom.
of
this
manifested an efiag ration
disturbed/EnogIIeviation
of this activity but the psychotic ideation genand
of
secondary
induced
a
The
variety
intramuscular
dosages
erally persisted.
complaints. In the evaluation of'the mecholyl responses following serpasil,
The
blood
in
pressure response
all
subjects.
effect
consistent
was
a
there
of
this
presentation
considering
Dr.
and
Blumberg
is
lower
was significantly
data at the next meeting of the American Psychosomatic Society.
3.
SQRPASLL:
The
}
Preliminary studies by Dr. Laderman in
20 patients in a series of clinical
not
was
but
significant
this
alterations
and
behavioral
showed
symptom
studies
of
Shaw
evaluation
undertook
an
Dr.
In
mid-September,
in the doses used.
A
protocol
coma
therapy.
Thorazine as a possible substitute for insulin
French
and
Kline
submitted
Smith,
to
was
The
Research
Committee,
approved by
and approved, assuring us of adequate supplies for the duration of our proof
8,to
a
medication
for
period
receive
will
In
this
study,
patients
ject.
12 weeks, comparable to the insulin coma period. During this time, very
have
been
To
be
used.
patients
eight
date,
will
thorazine
of
doses
large
The
obser3600
1500
initial
from
to
The
daily.
mg.
dosages range
studied.
three
had
clinical
response;
a
show
significant
three
the
patients
vations
h.
THORAZINE:
and
one
symptoms,
toxic
developed
one
minimal
had
patient
changes;
patients
medthe
of
Cohen
and
Blumberg
Drs.
medication.
the
patient has just begun
our
using
to
permit
controls
the
have
contributed
necessary
ical department
such large doses of this potent drug.
Since June, Drs. Goldenberg
and Royce have been coopof
a
in
study
Sloan—Kettering
Institute
the
chemists
the
at
with
erating
the possible alteration in the keto-steroid excretion patterns in our patSince
June.
Committee
Research
in
by
our
This
was
approved
study
ients.
then five patients have been under investigation. The initial data is not
in
Dr.
Goldenberg
by
studied
Each
of
being
the
is
patients
available.
yet
his laboratory as well as by the chemists at the Institute.
5.
SLOAN KETTERIDG STUDY:
Dr. Goldenberg has been
occupied in studies measurand
acid
of
devising
the
effects
lysergic
estimating
ing chlorpromazine,
methods to measure steroid sulphate conjugates. This basic research is
to
which
to
we
apply
measurement
plan
of
methods
the
to
provide
necessary
our patients.
(a) Chlorpromazine: An ultra~sensitive technics has been
of
amounts
this drug.
microgram)
minute
(0.1
which
measure
can
developed
Golden—
Dr.
Thorazine,
of
number
By applying this to a
patients receiving
bloodstream.
the
amounts
in
small
appear
demonstrated
only
that
has
very
berg
LSD
has been
by
cholinesterase
The
LSD:
of
serum
(b)
inhibition
A
compounds.
demonstrated, and this test applied to other hallucinogenic
correlation between hallucinogenic activity and cholestestcrase inhibition
was found.
6.
BIOCHEMICAL RESEARCH:
�*3“
a
(c) Steroid Sulphate Conjugates: ‘Nith the grant support from the
USIHS, methods to estimate these compounds have been devised. By studying
hormone
demonstrated
sulphates are synthat
Dr.
Goldenberg
liver slices,
of
the
level
in
difference
and
a
there
sex
is
that
the
thesized by
liver,
steroid excretion. Both these observations are of fundamental significance,
and will be presented to various societies this winter.
In the Department of Medicine, hrs.
Cohen and Blumberg have continued
Durand
the
electroshock
of
the
patients.
serpasil
studies
their Mocholyl
and
than
more
been
have
studied
to
additional
an
patients
this
period
ing
half have had more than one such evaluation. The serpasil group demonstrated
a significant alteration in their blood pressure patterns following this
done
be
and
been
will
has
The
correlated
not
data
electroshock
yet
drug.
as soon .8 our electroshock # 2 data is available.
7.
MECHOLYL:
Following the approval of this project
by the Research Committee last spring,
Drs. Navarre and Graubert had a number of meetings with members of the
Medical Board. Following these discussions, they have begun a pilot study
of one patient, and intend to evaluate those factors in the hospital environment which may be contributory to the patient's improvement. This
satisfactory
pilot study was udertaken in an effort to clarify a protocol
to the Ibsearch Conmittee and of sufficient quality to be submitted for
8.
SUBCULTURE:
To
some extent, this project
outside
to
organizations.
financial support
was hampered by the multiple duties of members of the committee and by
the resignation of Dr. Gurvitz. Since September, however, the committee has
been working very actively and it is anticipated that a satisfactory protocol will be available by the end of the year.
In June, following some
discussions concerning the
Laderman
and
Drs.
coma
of
insulin
doses
for
insulin
treatment,
correct
doses
between
the
multiple
relation
into
undertook
an
Blumberg
investigation
05 insulin and the blood glucose level. lt was anticipated that multiple
small doses of insulin might reduce blood sugar significantly earlier and
large dose. It was quickly determined,
for longer periods than a single
.)
however, that multiple small doses, even if the sum total was equal to a
This
and
of
depth.
coma
degree
a
not
did
satisfactory
produce
dose,
single
project is now being prepared for publication.
9.
B.
DIVERE'
I
SULIN
D
SE8:
PROJECTS PLANI‘IED:
November
#
the
third
Electroshock
3:
Beginning
let,
l.
electroshock project will be
undertaken. This study is designed to extend our experience with the factors
which may be relevant in both the long and short term clinical reSponses
following electroshock. Also, in this study specific emphasis is placed on
the psychiatric and language changes which follow electroshock treatment
and which we have been accustomed to calling "improvement." Dr. Joseph
Jaffe has prepared a number of specific studies, including detailed interviews with patients prior to and during treatment, in which specific aspects
of behavior and language will be assessed.
�a...
In this study, also, a basic problem in the perception of multiple
simultaneous tacti e stimuli will be undertaken. Under our original grant
from the United States Public Health Service, we were given funds to study
the problem of Satisfactorily delivering single and multiple independent
and
The
completed
was
designed
equipment
wave
impulses.
electrical square
in Septemler and for the past few weeks has been undergoing rigorous clindur«
be
and
will
applied
found
been
has
satisfactory
highly
ical tests. It
between
changes
the
of
relation
the
with
question
specific
ing this project
the
in
and
in
behavior,
changes
stimulation
tests
simultaneous
double
in
electroencephalogram and in amytal tests following electroshock.
2.
EIOC
‘thAL
APPLICATION OF
HEM
TESTS:
’
Dr. Golden—
berg has
completed.the pilot studies necessary to devise measures of Specific compounds. He believes these should be applied to our clinical population over
the next year. A specific protocol for this application is being prepared.
3.
For more
than a year,
has been interested in form-
EEQQNOSTIC IdDIGATQE§flIfl ELECTROSHOCK:
'
‘
Dr. Karliner of the attending psychiatric staff
electroshock.
would
be
in
which
helpful
factors
some
prognostic
ulating
Discussions were held in June and at the suggestion of Dr. Miller, Dr. Karlbe
This
scale
will
evaluate
scale
to
prognosis.
iner prepared a special
months.
next
the
six
and
Committee
assessed
over
Research
the
to
presented
C.
STAFF CHANGES:
Dr. Joseph daffe, a practicing peychoanalyst, was
and
in
research
psychiatry,
assistant
Service
Research
as
appointed to the
behavioral
the
in
is
Dr.
interest
Jaffe's
work
on
September
began
lst. induced altered brain function and the
by
and language changes which are
relation between such changes and premorbid personality.
were resolved effectively
Lowenstein
of
the
floor
the
on
the
of
first
extension
the
laboratory
by
The
reduced.
been
tachistoscopic
have
also
Our
problems
equipment
building.
be
able
now
to
works
and
well.
are
into
alignment
was
brought
equipment
During
this period our space problem
simultaneously.
two
or
individually
pictures
tachistoscopically
present
The electric stimulatorsale functioning satisfactoraly so that we are now
able to produce isolated simultaneous square wave stimuli with the ability
to vary any of the essential parameters.
D.
FUNDS:
In May, we submitted an application to the United
Sept—
In
of
Dr.
Jaffe's
Service
Health
program.
for
support
Public
States
an
in
the
and
staff
interviewed
the
Frank
Jerome
came
to
hospital
Dr.
ember,
USPHS
the
from
in
we
anticipate a response
evaluation of our program.
mid—December. In June, we also submitted the necessary forms for second
renewals
and
both
and
Dr.
Goldenberg
myself,
both
renewal
for
grants
year
the
these
both
renewals,
note
for
that
to
were approved. It is important
overhead allowances were increased to 15%.
At the suggestion of Mr. Coleman, specific protocols of our re»
search program were submitted to the Kaufman, hoffheimer, and lttleson
Foundations during this period.
�-5the
been
for
has
Service
writing
Research
the
which
The protocol
of
Committee
Research
the
submitted
to
was
Ford Foundation grant pr gram
was
the
protocol
that
the
consensus
was
the Medical Board in September. It
suggestions,
their
Following
be
submitted.
not
and
that it
unsatisfactory
of
Drs.
the
with
cooperation
Service
Research
made
the
by
changes are being
Lenzer and Luttrell.
another
submit
application
to
am
planning
I
present time,
re—
March
for
meetings
their
to the USth in January for consideration at
to
an
application
am
contemplating
also
I
newal of our present program.
ambivalence
study,
the
for
for
Fund
support
for
Psychiatry
Foundation
the
as soon as the basic work is completed.
At the
E.
Q?HER.ACTIJITIES:
l.
ISRAEL 5T3§p?§nF9§E§Ei9F THE JOURNLL QEWEELEEERE
HOSPITAL: Following diScussion with Dr. Tarachow,
the Research Service has undertaken the
Tarachow
issuin
Dr.
work
in
and
ssisting
editorial
necessary secretarial
Journal.
Volume
of
Hillside
the
Commemorative
the
special
ing
2. ISRAEL STRAUSS LECTURE: Consideration is being
given by members of the
at
Discussion
is
next
the
lecture.
Committee
for
Lecture
Strauss
Israel
should
decision
and
a
final
candidates
of
number
present centered about a
be available by the end of November.
Respectfully submitted,
.
i
"’ -,"
’-
4
H7
”.51
‘
‘)
{I
1
«I
g.“
,--‘or
,.
‘
j
.
If
‘f‘ \
Fink, M.D.
Director of Research
Max
.
.
�Department of Biochemistry
.................................
Research Pro ress Re
Major werk
l.
rt,
Dr. H. Goldenberg
November l9§§
in Pregress
Chlorpromazine Studies
previous work has been summarized in the report for the 6 month period
ending Oct. 1955. We have subsequently learned from two representatives of the
Smith, Kline and French Laboratories that Drs. Salzman and Brodie, working at
the National Institutes_of Health, have identified chlorpromazine sulfoxide in
the urine of dogs and men after treatment with chlorpromazine. A sample of the
sulfoxide was requested from Smith, Kline and French and arrived the end of Nov.
Our
ultraviolet absorption spectrum of the sulfoxide was determined in
aqueous solution and compared to the Spectrum obtained with extracts from
patients! urine. A remarkable similarity was noted. On the basis of this and
other data accumulated in our lab., there can be no doubt but that urine from
mental patients receiving chlorpromazine contains: (1) chlorpromazine, (2) the
sulfoxide, (3) one or two other alkaloids of related structure, and (A) at least
one break-down product which yields a violet color with sulfuric acid, as contrasted to the pink colors typical of chlorpromazine and its sulfoxide.
The
Using our dye—partition scheme, the sulfoxide yields a color which is
roughly 1/5 the value given by chlorpromazine in equimolar concentrations.
Hence our dye scheme is not applicable as such to the analysis of fluids con~
taining both derivatives, unless some additional information is available on
the relative amounts present.‘ Fortunately the relative proportions can be
estimated from the extent to which the color is depressed by the addition of
ether. Nonetheless, we are withholding a manuscript dealing with chlorpromazine
analysis until this question is completely resolved.
Ultraviolet and chromatographic studies are to be undertaken soon to
establish the various chlorpromazine derivatives in urine and their clinical
significance.
2. Role of Toxic Agents in Mental Diseas
:
An Enzyme
Test for
LSD
first draft
of a manuscript entitled "Inhibition of Serum Cholinesterase
by Lysergic Acid Derivatives. Submicro Detection of LSD 25" has been completed.
Copies are to be forwarded to the Research Committee on Dec. 8th.
The
3. Steroid
Hormone Conjugates
Little progress has been made in this area in the last 6 weeks because of
a delay in construction of our chromatography cabinet and unavailability of
electrical parts needed for the circuit. This situation should be remedied by
the middle of December.
cc. to:
Dr. M. Fink
Dr. Jos. S.A. Miller
�ELECTROSHOCK THERAPY EVALUATION PROGRAM
from the
Research Service of the Hillside Hospital
Glen Oaks,
New
York
December 20, 1955
Alvin E. Coleman, President
Joseph S.A. Miller,
M. D.
Iiedical Director
�Electroshock Therapy Evaluation Program
em
I.
Aim
II. Background
III. Previous Studies
Development
and
Progress
in
Studies
IV.
Tests of Altered Brain Function
Premorbid Personality
of
Adaptation
Patterns
NonAVerbal
Verbal,
Evaluation of Improvement
Steroid Excretion Studies
Autonomic Studies
V.
Program Summary
Method
Significance
VI. Facilities Available
Laboratories
Personnel
VII. Budget
Present Budget
Requested Support
VIII. Appendix
References
Bibliography of Personnel
Page
�I.
E:
During the past few decades there has been an
of various
new somatic
intensified development
therapies for mental illness. Jhile
some have
even-
been
an
has
established
as
electroshock
therapy
into
fallen
disrepute,
tually
important and successful method for both immediate and long term results (1).
Despite
its
empirical usefulness, the
many
theories concerning the
mechanism
of this therapy have been either disproven or are so vague that their validity
tested. In a comprehensive review, Kalinowsky and Koch (2) emphasize the lack of information in this regard stating: ".......the theoretical
cannot be
aspects of the various somatic treatments
in the case of the shock treatments,
still
.....
are poorly understood, or, as
entirely obscure in their
mode
of
action."
The aim
of this program is to study the therapeutic mechanisms in electro-
convulsive therapy by the systematic investigation of behavioral, personality,
physiological and biochemical factors. Thile the program has electroconvulsive
therapy as its focus, considerable theoretical and experimental information can
be derived
to relate the
phenomena observed
in this therapy to other somatic
treatments such as lobotomy, electronarcosis and insulin coma.
�II.
BACKGROUND:
of
abundance
has
stimulated
an
electroconvulsive
therapy
of
use
and
the
Both
kind
theories
of
the
much
and
research.
exper(3)
hypotheses
The
of
interest
the
reflect
however,
particular
undertaken,
imental investigations
the
origin
frame
reference
of
regarding
and
theoretical
his
the investigator
of mental disorders.
Thus, each has been usually limited to one aspect of the
problem. In general, these theories
may be
differentiated between those that
emphasize physiological, biochemical, or psychological constructs.
A
who
classical physiological construct is exemplified
suggests that the various
by Gellhorn (h)
forms of shock therapy "act on the centers of
the autonomic system, produce intensive and prolonged sympathetico-adrenal
mental
activity,
hypothalamic-cortical
augmented
and
alter, through
discharges
processes and behavior."
psychogalvanic reflex,
The
varying responses of blood pressure, heart rate,
and other physiological indices to chemical
stresses are
obtained
been
has
data
huch
of
sympathetic reactivity.
interpreted as indices
to
and
Show
autonomic
reactivity,
in
this
induces
change
a
electroshock
therapy
that
(5)
coaworkers
and
support this
his
Funkenstein
by
studies
recent
conclusion.
Much
illness
and
biochemical study has been devoted to the relation between mental
steroid metabolism.
between ketosteroid excretion
Numerous
rates
instances (6) in which a relation
and change
in mental state following
electroshock therapy are reported, but the clinical difficulties in the
measurement of steroids have left this issue unresolved. Kore recent studies
excretion
to
the
total
steroids
between
individual
the
relationship
exploring
rate (7) utilize elaborate chromatographic separation technics.
�In a good review of the biochemical and neurophysiological hypotheses,
mode
the
view
the
that
evidence
to
justify
Ashby (8) presents experimental
of action of electroconvulsive therapy
is
through effects on the adrenal
cortex mediated by direct stimulation of the hypothysis.
Psychologic constructs generally fall into three designs
- studies
of
the psychic significance of the loss of consciousness; the relative importance of
ities
memory
loss;
and an estimate of the
subject's re-integrating abil-
the
Numerous
unemphasize
studies
of
confusion.
following a period
conscious significance of the treatment as a “rebirth which eliminates reand
exneed
punishment
for
of
a
satisfaction
narcissism"
a
(9);
or
gressed
piation for committed sins (10).
Amnesic effects are a common concomitant of treatment but most studies
of
these
The
significance
of
impairment.
the
nature
emphasize the temporary
defects for therapeutic results is
emphasized by numerous authors.
Data
is
the
on
emotional
charge
patreduces
the
treatment
that
presented to
emotionallyfor
of
induces
familiarity
loss
a
associations
(ll),
ient's
show
toned associations (12), or a selective forgetting of unpleasant
life
memories (13).
These constructs are
further elaborated by authors
who
believe that the
as
behavioral
responses
confusionalemate
including
of
an organic
induction
im»
electroshock
the
for
basis
is
over-reacting
euphoria, impulsiveness or
provement (1h).
A
more
umerated by Weinstein
&
recent elaboration of this explanation is that enKahn
(15), described subsequently.
�-h-
adaptive
in
changes
proregard
explanations
of
psychologic
Another group
describe
(16)
and
Frosch
Impastato
mechanism.
cesses as the basic therapeutic
on
a
which
then
re-integrates
the
of
ego
electroshock as causing a dissolution
suggestopinion
similar
has
a
Alexander
of
adaptation.
previous or higher level
ing that
defensive
operations.
enhances
active
and
electroshock arouses
For
this
in'whii1
conditions
those
in
effective
such
is
therapy
that
he
asserts
reason
conp
in
ineffective
but
are
low
ebb, as in depressions,
such operations are at a
(17).
alerted
highly
already
ditions in which defensive operations are
most
two
in.which
Kahn
(15)
and
Another hypothesis was developed by weinstein
were
the
process
of
therapeutic
aspects
related.
They
asserted that the thera-
of
altered
milieu
of
a
creation
the
in
convulsions
lay
induced
of
action
peutic
is
of
problems
his
expression
symbolic
brain function in which the patient's
Their
them.
studies,
denying
of
form
the
explicitly
altered, particularly in
cerebral
with
with
patients
documented by an extensive neurologic experience
behavior.
in
adaptive
of
changes
a
function, amply demonstrate great variety
dys—
attention
(l9),
orientation
(18),
They describe altered patterns in language
manifestations
(21)
as
defect
of
and
awareness
(15b)
(20), sexual behavior
the
patient's
constitute
mechanisms
these
conclude
that
and
of adaptive behavior
attempt to deny his illness or
striking
and enduring in those
its
meanings.
patients
Such
who had
most
were
denial
at
attempts
habitually used the defenses
with
their
of
coping
means
a
as
and
rationalization
of verbal denial
of
indicative
these
patterns
that
problems (22). They also demonstrated
administraintravenous
the
following
interview
"denial" could be elicited in an
interview
the
clinical
manifest
in
not
when
were
they
tion of sodium amytal
(23)-*
followdenial
and
explicit
disorientation
of
* This appearance of patterns
with
associated
so
clearly
sodium
is
amytal
ing the administration of
authors
these
by
described
been
has
diffuse cerebral dysfunction, that it
test."
named
"amytal
the
been
has
This
(23).
as a test for such dysfunction
�-5of
denial
between
a
patient's
noted
direct
relationship
a
they
cere—
of
the
of
and
signs
the
electroshock
appearance
therapy
pain following
test)
of
mechanism
the
that
suggested
they
amytal
bral dysfunction (positive
Thus, when
electroshock therapy
may be
the facilitation of patterns of denial by altered
brain function (15).
and
psychophysiological
at
integrating
This hypothesis is an attempt
which
terms
in
View
it
of
the
and
As
operational
in
such,
factors.
logical
have
which
studies
base
our
theoretical
upon
a
has
provided
is stated, it
been elaborated.
�III
PREVIOUS STUDIES:
of
altered
manifestations
studies
investigating
For the past three years,
cerebral function in psychiatric patients, have been in progress at Hillside
Hospital.
In 1952, the application of the amytal
was asseSSed
(2h).
test to psychiatric subjects
Positive responses were found only
in patients
who had had
electroshock therapy or had other indications of organic brain disease.
in order to test the relationship between altered brain
referred
consecutive
patients
electroshock
to
therapy,
and
the
function
response
electroencephalograms,
with
serial
intervals
weekly
at
tested
treatment
were
for
During 1953-195h%
amytal
tests,
simultaneous
tactile
perception%%
tests,
and
tests of recall
function.
A
marked
correlation
was found between improvement
therapy and early, persistent
the electroencephalograms.
following electroshock
and severe changes in both the amytal
If
no such
tests
such changes did not appear, improvement
and
failed
correlations were manifest between improvement
to occur. In contrast,
and tests of recall function or changes in simultaneous tactile tests.
WM
TWenty—four subjects were
tested in this first study, and were classified
improved
markedly
as
psychiatrist
the
supervising
by
independently
ately
improved (6) and unimproved (7)
at the
(ll),
moder-
end of one month post-treatment.
Paralysis
Infantile
for
Foundation
National
from
the
Aided
Fellowship
a
by
*
(Dr. Fink, 1953) and Grant K—927, National Institute of Fental Health,
National Institutes of Health lQSh-Sé.
stimuli
two
simultaneous
tactile
of
the
of
perception
as Previous studies
one
localize
to
or
of
perceive
failure
demonstrated characteristic patterns
of the stimuli in patients with diffuse cerebral dysfunction (25).
�-7Of
the markedly improved patients, every one had at least one positive amytal
reaction during treatment.
Of
the
50
tests
given to
this group,
38 (765) were
positive. In contrast, of the unimproved patients, five of the seven never
showed a
positive result,
positive.
6 (13%) were
and of the
The
LS
tests administered to this
group, only
moderately improved group showed more positive re-
sponses than the unimproved patients, but
fell far short
of the
much improved
group.
In addition, there were consistent changes in language and non-verbal as-
pects of behavior indicating alterations in adaptive mechanisms in the
in interviews not employing amytal. These alterations
improved group, even
were
much
either minimally or only transiently manifest in the
unimproved group and
then only under the influence of sodium amytal.*
Concomitant studies of the electroencephalograms taken on a day pre-
ceding the amytal
first
measured
test indicate
for per~cent time
a similar
31 w wave
relationship.
The 160
records were
(delta) activity, the extent of
burst activity and the amplitude and frequency of the slowest waves present.
They were then placed in a rank serial order. Those falling in the upper third
were
labelled "high abnormality"
abnormality."
ality after
Of
the
and those in the lower
much improved
patients,
one week of treatment; 80%
after
25% showed
third as "low
a high degree abnormp
two weeks and over 90%
after three
In the unimproved patients, however, none had a high degree abnormality
record during the first three weeks and only one had such a record by the fourth
weeks.
week of
treatment.
The
records of the moderately improved patients
fell
between
these two groups.*%
* Presented at the Annual Meeting of the American Psychiatric Association,
Kay 10, 1955.
** Presented at the joint meeting of the Eastern and Southern Electroencephalographic Societies, Bethesda, September 30, 1955.
�Changes
in
memory and
learning were tested in these subjects by using
the principle of retroactive inhibition.
3-letter originally learned
By
the serial testing of recall of
words following the
interpolated learning of nonsense
syllables, patterns of decrement in learning and recall
were
elicited.
As
a
week
of treatthe
showed
to
third
impairment
the
increasing
up
patients
group,
ment, and a rapid improvement after the cessation of treatment. No relation-
ship, however, could be established between impairment and reSponse to treatment.*
The
responses of these subjects to simultaneous
tactile tests using touch
stimuli were also assessed. While an increasing impairment in the ability to
be
two
demonstrated with increasing
could
and
stimuli
the
localize
identify
treatment, no relation to improvement was noted.
however, and
in anticipation that
more meaningful
The
tests
were extremely gross,
correlation for this index
of altered brain function could be obtained, a study using threshold electrical
stimuli has been undertaken (pg. 10).
As
ent and
result of these studies, it was our conclusion that early, persistsevere changes in both the electroencephalogram and in the amytal tests
a
are a necessary, though not sufficient pre—requisite for improvement following
electroshock therapy. These observations make it possible to predict the short
term response to electroshock, and such a study was undertaken
earlier this
year (pg.ll).
Concomitant with these studies,
we
have made some preliminary observations
in patients undergoing insulin coma therapy. Recent reports of the value of
prolonged coma as the basis for improvement (26) have been confirmed in our
patients. In
one unusual case
report
we
noted a direct relationship between
* Presented before the Electroshock Research Association,1;ay 8, 1955 and
awarded
their
Annual Prize award
for excellence in research design.
�altered brain function, altered patterns of adaptation in language and behavior,
clinical
and
improvement (27).
Concurrent with these psychologic investigations, basic studies have been
done
in
in biochemistry.
1950* with an
The
initial
biochemical research laboratory was established
program of study of the
relationship between steroid
excretion patterns and states of mental illness.
studies, utilizing alumina column chromatography, demonstrated atypical
The
number
excretion
of
a
levels
in
psychotic
ketosteroid
patients.
urinary
The
of B—steroids (particularly dehydroisoandrosterone) was found to be elevated,
and the etiocholanolone was depressed (7a). The ll-ketoetiocholanolone
values appeared to be sex-dependent: male patients excreted the steroid
metabolite in normal amounts, while the several female patients studied had
markedly elevated values.
During the past year, a collaborative study was
chemical department of the Sloan-Lettering
initiated with the
Institute of
new York.
bio~
Similar
steroid excretion pattern studies were undertaken utilizing paper chromatographic technics.
In the
first
phase of the study recently completed, the
elevated excretion of ll-ketoetiocholanolone was confirmed, with a severe
reduction in the excretion of this
when
compound
prior to discharge, at a time
the patient had shown considerable improvement from her
* Supported by grants from the Dazian Foundation
illness.
for Hedical Research.
�.10...
IV. §EUDIES IN PROGRESS
1.
Relation 2f
AND
Tests
IN DEVEILEEENT:
Improvement:
Function
Brain
33
Altered
3;
altered
between
relationship
direct
Our earlier studies
this
that
however,
apparent,
is
treatment.
It
to
and
function
response
brain
and
not
only
function
brain
altered
of
indices
certain
holds
for
relationship
and
elabconfirm
to
undertaken
been
has
for others. Further study, therefore,
have shown a
methods of measuring
orate these findings, as well as to investigate
improvement.
clinical
to
related
function which are more reliably
a.
cerebral
Amytal Test and Electroencephalogram:
Amytal
tests
and electroencephalograms are done
and
second
the
and
during
subjects before,
third
in all
weeks of electroshock treat—
make
a
used
predicto
data
is
the
findings
ment. On the basis of our earlier
those
that
predicted
is
treatment.
It
to
term
short
response
the
of
tion
and
with
positive
abnormality
electroencephalographic
patients with a high degree
amytal
test findings will
be most
likely to
show improvement;
while those with
amytal
and
with
negative
abnormality
a low degree electroencephalographic
results are considered unlikely to improve.
b. Tactile Perceptual Tests:
perceptual
tactile
simultaneous
the
As described before,
was
planned
inconclusive.
It
were
of
test results in our first series patients
conditions
under
stimulation,
electrical
to repeat this study using threshold
terms
Under
controlled.
be
could
rigidly
wherein the various stimulus parameters
two
of
consisting
assembly
instrument
(M—927)
an
USPHS
grant
of an existing
dewhich
can
devised
was
oscillograph
monitored
by
an
Grass Sh-B stimulators
the
assembly,
this
Using
stimuli.
electrical
wave
independent
square
liver
stimuli applied simul-
to
perceive
their
ability
for
tested
patients are
technique
refined
this
By
applying
body.
taneously to different parts of the
two
�.11be
may
otherwise
not
apparent
function
brain
in
it is anticipated that changes
and
of
improvement
the
be
to
degree
compared
will
observations
These
elicited.
to our other test~results.
As
in the case of the electroencephalogram and
the
and
intervals
during
stated
before
at
tested
are
amytal tests, patients
course of treatment.
c.
Hemory
Tests:
imp
and
loss
of
memory
of
relation
the
Numerous theories
provement have been described.
Our own
data to date
shows no
significant re-
and
words
and
simple
nonsense
syllables
for
lationship
forselective
a
there
is
evidence
that
considerable
But
there
is
improvement.
For
memories.
and
situations
of
life
significant
getting, during treatment,
between the memory loss
a record
this purpose,
may be
is
made
of events during the preceding six months which
of emotional significance to the patient. During treatment, inquiries
records
verbatim
of
these
events,
recollection
patient's
are
and these compared to the pre-treatment reports.
made
of the
2. Relation gf’Premorbid Personality
to Duration 3;
made,
Response:
has also been apparent that the relationship between altered
It
brain function and clinical response is valid only for the short term response
When
six
followed
a
for
treatment.
weeks
several
after
to treatment, ite.,
return
a
had
showing
relapsed,
the
of
improved
several
patients
period,
of their former symptoms, and in some instances requiring further hospital-
month
ization.
thesis
To
account for the varying duration of
was advanced
that the difference
personality patterns. Specifically,
it
was
clinical response, the
hypo-
related to differences in premorbid
was suggested
that patients
who showed
would
(22)
denial
verbal
personality"
the
of
"explicit
the characteristics
likely to maintain improvement.
premorbid personality of each patient is assessed
be those more
The
an interview with family members, psychologic
and
psychiatric interviews.
by
four procedures
tests, tachistoscopic tests
-
�a. Family Interviews:
At least two close relatives are seen in independent
interviews. A standardized questionnaire has been devised to elicit characterological factors indicative of the "explicit verbal denial" personality. For
this study fifteen characteristics defined as typically present or absent in
conscious—
Such
include
items
prestige
selected.
were
of
this type
personality
and
and
to
sex
attitudes
temper
to
imagination,
criticism,
ness, sensitivity
illness. Each patient is rated on a scale of 0 to 2 for each item - the higher
score signifying a greater tendency to denial.
b. Psychologic Tests:
Each
patient is tested
on a
standard psychologic eval-
uation battery including the Rorschach and Thematic Apperception TEStS. These
adap—
defense
of
and
usual
or
types
structure
character
assessed
for
tests are
tation.
Such
tests are repeated at the termination of the treatment
program and
again prior to discharge, to obtain additional information as to changes in
behavior in the course of treatment.
-
c. Tachistoscopic Tests:
tachistoscopic study has been devised; in which pairs
of emotional and non-emotional words are flashed on a screen at 10, 20, 50,
100, and 250 millisecond periods. The patient's ability to identify the words,
A
the reaction time, and the distortions are ascertained. This pre-treatment
data is
now
being explored as to
defense patterns.
The
its ability
to clarify the patient's usual
tests are repeated at the
end of greatment and again
prior to discharge for the possibility that characteristic changes in perception
develop with altered modes of adaptation..
�-13..
d. Psychiatric Interviews:
In the course of estimating changes in behavior, patients
are seen prior to treatment, and at intervals during treatment. In a clinical
interview setting, an assessment is made of the patient's symptoms, and usual
of adaptation. Changes in symptoms, behavior, language and modes of adap-
modes
tation are noted.
By
interviews with the patient's therapist, judgment as to
the significance of such changes and
bral states can
ment
their relation to treatment, or altered cere-
be made.
On
the basis of the data in a-d above a prediction of response to
is
made.
treat-
Prior to the start of treatment the patients are classified as:
1) those unlikely to improve;
2)
those likely to improve moderately or temporarily;
3)
those likely to maintain marked and sustained improvement (for at least
six months).
During the
third
week of
treatment, (after the patients have had
ments), a second prediction of the short term response
change
is
made
7—9
treat-
according to the
in the physiological indices.
3. Altered Patterns g£.Adaptation Kanifested in‘Verbal and NonéVerbal
Behavior:
In the earlier study on the amytal test
it
had been noted
that
specific changes in language and behavior indicative of altered adaptive responses occurred in the improved patients to a significantly greater degree than
in the unimproved patients. Further experimental procedures were
necessary to clarify the nature and significance of these changes.
deemed
�alb-
a.
The
is
a highly structured interview
of the patterns of language.
made
ients
who show
language
will
in émytgl Tests:
amytal test procedure is recorded. This
Language Changes Induced
situation,
The
and systematic observations are
hypothesis tested
is that those pat-
consistent, increasing use of the following types of adaptive
be more
likely
improve:
1) The use of the second or
to
third
person. In such instances the patient reports his main trouble as "the Doctors
say I'm depressed", or state the wish that "my family should be well." 2) The
selective response to questions, as answering readily questions about date and
location but failing to answer,
illness.
tive
mumbling or using neologisms when asked about
3) The use of conditional or qualifying expressions, or the subjunc-
mood which has
the effect of vitiating the patientis committment to the
is
I feel kind of dBpressed", in w hich
"sometimes" qualifies the temporal degree of illness, and "feel" and "kind of"
statement.
An example
"sometimes
‘qualify the intensity of the illness. Committment would be indicated by
the direct, unconditional statement of "I
am
depressed". h)
or stereotyped expressions in discussing illness, as "to
or "well, in a manner of speaking..." or "I didn't keep
wheel". 5) Language
antic statements. 6)
problems.
tell
my
The use
of cliches
you the
shoulder to the
filled with nonpsequiturs, circumlocution, ornate
The use
or pedp
of humor when talking about their illness or other
7) The use of metonymy or paraphasia, as
Dr. as a "recorder". 8 )The various forms of
ulation about the main problem
truth..."
referring to the examining
explicit denial including confab-
and temporal displacement.
9) changing the sym-
bolic frame of reference in response to questions, as replying to the question,
feel?", by stating, "with my hands." 10) The use of hyperbole, as
"you're the best Dr. in the whole eastern Atlantic seaboard area."
"how do you
�.15-
State:
Confusional
the
PostaShock
b. Language Changes in
Each
orientation
for
tested
is
patient
and awareness of
treatment.
a
following
immediately
awakening
of
the
period
in
his main problem
such
At
intervals.
weekly
and
then
at
treatment
the
initial
done after
@his
is
most severe, and a
defects
are
cerebral
neurologic
the
times,
These
of
language
appear.
tive changes in the pattern
variety of
may be comparable
adap—
to the
records
are
and
the
situations,
interview
other
the
in
noted
changes
language
and
changes
language
the
later
to
both
as
indications
assessed for prognostic
the degree of improvement.
Study:
Sentence
Completion
0.
in
language
in
and
changes
A way of studying the patterns
technique.
completion
sentence
a
devised
using
been
has
fashion
a quantitative
accordstructured
been
have
which
complete,
to
sentences
to
given
The patient is
the
in
first
been
have
put
sentences
the
of
Ten
different
patterns.
ing to four
when....",
criticized
am
"I
Wish that......",
such
"I
as
unconditional,
person,
the
in
expressed
are
they
that
except
meaning
in
identical
Ten others are
etc.
sometimes
"people
as
aspect,
qualifying
or
conditional
third person and with a
the
In
reetc.
When.....,"
criticized
wish that.....", "people are usually
these
of
senten
In
indicated.
maining twenty items no person is specifically
or
occurrence
exact
an
to
refers
or
direct
is
sentence
the
tences, however,
event as "every
time....",
”when the
doctor
comes
in.....",
etc.
The remainp
"at
times....",
as
aspect,
indefinite
or
qualifying
conditional,
have
a
ten
ing
etc.
when.....",
better
"things usually seem a little
for
analyzed
not
in
sentences
The response of patients to the incomplete
rated
is
each
response
Instead,
manner.
psychologic
content in the traditional
�16
the
whether
include
ratings
for its grammatical or syntactical structure.
or
conditional,
direct
or
is
second
third
person,
or
response is in the first,
The
1h).
(page
above
described
of
language
manifests aspects
1)
assumptions:
following
the
on
This study is based
begins in
the
to
most
obviously
applicable
a manner
A
sentence which
patient (e.g.,
first
person,
adaptive
reto
elicit
likely
unconditional) creates
conditional
is
or
the
third
in
person
A sentence which is expressed
2)
sponses.
and
least
minimal
is
stress
creates
is less applicable to the patient. It
complete
used
to
The
3)
person
syntactical
likely to elicit adaptive responses.
maximum
stress
and
is
most
of
indicative
is
to
person
in
regard
indeterminate
is
whose
beginning
sentence
a
shows
less
of
the
person
first
the
use
the degree of stress experienced (e.g.,
third
second
or
the
of
the
use
defensiveness,
person shows
greater defensive—
ness).
d. Attitude Interviews:
In
this
part of the study an attempt
the
of
mechanisms
ego.
adaptive
the
tionally
Two
is
made
to define
opera—
structured interviews
followed. The attitude of the
questionnaire is
interone
In
next.
the
to
interview
from
one
examiner, however, is reversed
and
the
in
concerned,
view the examiner is empathetic, pessimistic,
minimize
to
and
tends
insensitive
non-empathetic,
he
brusque,
is
other interview
are held, in which the
the patient's
same
difficulties.
In general, the
first attitude
produces good
a
in
grossly
results
latter
the
while
rapport with these disturbed patients,
each
asked
in
are
non-communicative situation. Although the same questions
to be appropriate to the examiner‘s
attitude.
interview, the wording is altered
"YOu
must
today?",
poorly
"feeling
as
such
he
questions
asks
In one interview
worse?.“
been
getting
"has
and
it
consider your condition pretty serious?",
don't
"you
today?",
well
While in another interview he asks, "feeling pretty
consider your condition serious,
do you?" and "have you been improving?".
�.11.:
The two structured.interviews are performed
just prior to electroshock
interviews
All
are
treatment.
of
treatment and repeated following the course
of
the
patient's
1)
alteration
the
study:
in
recorded. There are two variables
The
four
attitude.
examiner's
the
in
behavior by treatment, and 2) alteration
recordings are studied for
and
changes.
language
vocal
changes,
content,
The
it
defensive mechanisms of the patient
both
out
be
carried
can
that
transactions
of
the
of
terms
range
in
ationally,
and any changes
in
can be defined, oper-
be
commmay
patient
depressed
For
a
example,
very
treatment.
and
after
before
he
whereas
interview,
empathetic
concerned,
the
in
treatment
before
unicative
jovial,
mood
is
the
when
latter
examiner's
the
in
will be unable to participate
of
one
is
treatment
to
his
response
However,
if
and
minimizing.
bantering
becomes
he
sustreatment
Following
reversed.
be
euphoria, the situation may
and
empathetic,
concerned
examiner
is
when
the
anxious
or
hostile,
picious,
Thus
the
interview.
the
optimistic
in
stressful
less
communication
is
whereas
terms,
objective
in
be
stated
the defensive system of the patient can
change
i.e.,
in
of
interpersonal
standardized
range
to
a
in terms of his reactions
uations.
in
sit-
M
h. Clinical Ratings 2: "Improvement":
changes
evaluating
of
methods
and
test
These various experimental
ratthe
psychiatric
in
significance
further
have
may
and
behavior
language
considerable
experienced
we
studies
revious
In
our
:
rovement."
"im
of
P
ing
Or,
be
guide?
the
to
relief
symptomatic
Is
our
patients.
difficulty in rating
to
recovery
Is
be
the
goal?.
to
improvement"
"social
recovery"
or
is a "social
relief?
Agreement by
symptomatic
well
as
as
of
insight
be judged by the degree
"unimproved"
and
improved"
"much
"recovered",
of
definition
the
in
psychiatrists
is not available,
investigations,
to
further
crucial
is
issue
and yet, this
We
�they
terms
as
these
of
assessing
task
further
the
undertaken
have therefore
apply to the electroshock population.
of
incapacity
and
type
the
degree
are
Central to this problem of evaluation
and
the
the
of
therapist,
the
goal
personality,
of the patient, his premorbid
capacity
events,
intercurrent
as
Other
aspects,
therapy.
to
attitudes
patient's
environmental
the
patient's
of
therapy,
suitability
of the therapist, temporal
present.
at
encompassed
not
but
are
assessment,
to
important
also
assets are
To
are
studies
evaluation
following
the
"improvement",
of
meaning
clarify the
in progress.
Evaluation:
Pre-treatment
a.
the
by
therapy
electroshock
Patients are referred for
and
resident therapist.
supervising psychiatrist
evaluation is made by the research psychiatrist.
An
Two
independent psychiatric
aspects are specifically
decompensation
of
signs
clinical
encompassed in this study:
of
sympdegree
for
and
rated
mental
status
descriptive
a
recorded
in
which are
of
the
patient‘s
estimate
2)
an
(28);
scale
tomatology on a Kalamrd rating
1) the symptoms and
operations.
defensive
usual
his
of
with
description
a
develOpment
of
ego
level
Relationship:
Therapist—Patient
the
in
Changes
b.
to
held
prior
therapist
resident
the
with
interviews
In
and
the
therapist
between
relationship
the
therapy,
electroshock
of
the onset
recomp
the
for
the
reason
on
emphasis
with
specific
explored
the patient are
and
the
patient's
treatment,
the
of
the
goals
mendation for this form of therapy,
mental
of
treatment
of
method
Since the primary
attitude to the treatment.
electroshock
for
recommendation
the
disorders at this hospital is psychotherapy,
the
between
patient
communication
that
assumption
the
with
carries
it
generally
deis
the
exploration
For
this
reason,
meaningful.
no
longer
was
and therapist
and
recommendation,
the
led
to
that
relationship
the
in
voted to those changes
�19
and
symptoms that it is
behavior
of
of
those
aspects
statement
a definitive
We
the
in
interested
also
therapist's
affect.
treatment
are
may
the
anticipated
attitude to this
may
form of treatment, and attempt to assess the
role this attitude
play in the eventual results.
of
the
the
results
theories
relating
numerous
there
are
Furthermore,
made
being
are
attempts
and
in
our
inquiries,
therapy to its punitive aspects,
to assess the significance of this factor in the outcome. During the interviews with the resident therapist and with the patient, the patient's attitude
behavior)
and
against
(both
language
defensive
operations
to the treatment, his
his
in
and
alterations
the
electroshock
represents,
the reality threat that
attitude
during the weeks of treatment are
studied. Further information regard—
of
our
the
in
course
be
ascertained
will
of
factor
this
ing the significance
control study (page 21).
c.
Follow—up Study:
Crucial to the evaluation of "improvement" is the
oppor—
treatment
of
the
period
following
various
periods
tunity to repeat evaluations at
from
hosthis
discharged
of
the
patients
follow—up
report
Recently, a four-year
between
customary
the
disparity
indicated
and
(1)
this
pital was made available
of
inthis
the
In
course
illness.
discharge ratings
at
out
carried
being
observers
is
same
the
vestigation, repeat evaluations by
As
check
a
treatment.
months
after
and
six
various times during hospitalization
and eventual course of the
and
the
physiological
of
the
personality
basis
the
on the predictions
two—week
the
for
recorded
factors studied, specific follow—up evaluations are
(long-term
months
period
and
the
result)
six
post-treatment period (short-term
made on
ther—
the
resident
of
the
to
ratings
result). These evaluations are compared
each
In
instance,
medical
director.
and
the
apist, supervising psychiatrist
and
the
of
terms
projected
formulated
in
the ratings made in this study are
and
interpersonal
language
of
behavior,
those
noted
aspects
in
actual changes
�Excretion
23 Improvement:
5. Relation of Steroid
and
their
reof
steroids
excretion
patterns
of
The studies of the
More
recently
continuing.
is
9,
on
described
page
mental
to
states,
lation
of
measurement
the
for
of
techniques
development
the
on
been
has
emphasis
colorimetric
and
*
new
separative
steroid conjugates. During the past year
sulfate
steroid
measure
to
(29)
devised
techniques have been
these
for
patterns
excretion
blood and urine. Daily urinary
compounds
in
compounds
are
and
prior
again
electroshock
of
the
course
assayed prior to treatment, during
resolve
to
is
of
this
program
The
object
selected
patients.
in
to discharge
individual
total
the
with
values
these
and
compare
bound
steroids,
the sulfate excretion
hormone
between
relationship
the
elucidating
Besides
hormone levels.
which
to
extent
the
indicate
of mental illness, such studies
and
rates
states
hormones.
steroid
of
metabolism
the
the liver (30) participates in
Electroshock
Therapy:
Results
Functions
of
on
6. Effect of Autonomic
behas
studies,
it
electroencephalographic
of
our
In the course
alterations
the
typical
fail
of
number
patients
that
a
apparent
come
to
also
fail
These
patients
treatment.
extensive
in cerebral rhythms despite
and
frequently
tactile
tests,
in the amytal tests, simultaneous
to
show
show changes
reactivity
the
studies,
these
with
Simultaneous
periods.
confusional
evince no
mecholyl
of
administration
the
to
rate
and
the
pulse
blood
of the
pressure
to
done
was
prior
too,
This,
out.
carried
been
have
"Funkenstein—test")
(the
Marked
ended.
had
treatment
of
the
course
after
immediately
treatment and
two
test
these
found
in
were
medication
this
to
variations in the responses
the
of
earlier
the
reports
way
general
a
in
followed
observations
These
periods.
between
relationship
the
of
exploration
the
undertaking
workers, but we are now
tests.
physiological
and
these
function
brain
altered
of
tests
in
the alteration
* Aided by a grant (A-6YSC)
Public Health Service.
States
United
Health,
of
from the National Institutes
�v.
THE PROJECTED PROGRAM: SUMMARY
1.
3
21 -
Method:
the
along
and
development
continuation
The projected program is a
Our
ultimate
of
this
two
report.
sections
lines indicated in the preceding
the
systematic
by
therapy
electroshock
of
mechanism
goal is to clarify the
of
behavioral,
inter-relationship
the
of
and integrated investigation
biochemical
factors.
and
physiological
sonality,
This program
is
per—
rev
interdisciplinary
full-time
a
by
undertaken
being
neurophysiolpgist,
psychoanalyst,
of
psychiatrists,
search staff consisting
help.
technical
and
allied
biochemist
physiologist, experimental psychologist,
Some
in
scope
clear
already
are
the
in
program
of the specific studies
and
new
continues
the
program
as
become
apparent
Others
will
and outline.
Two new basic
develop.
leads
promising
further
or
problems
appear
critical
decided
been
upon.
already
have
methodological aspects
date
work
to
our
in
1. Control group:0ne of the major deficiencies
starting
Accordingly,
control
group.
has been the absence of an adequate
two
into
divided
be
will
electroshock
for
referred
January 1, 1956, patients
of
conusual
course
the
receive
will
One
group
fashion.
random
a
in
groups
treatments.
sub-convulsive
be
given
vulsive therapy; the other group will
Ulett
of
study
instructive
recommendation follows the recently reported
This
et a1. (31).
In other respects the two groups will
be
treated in the
same
will
each
group
in
are
patients
who
will
The
only
person
fashion.
of
The
purpose
treatments.
the
administering
be the supervising psychiatrist
in—
of
the
effects
physiological
the
differentiate
to
is
such a control group
know which
outcome.
therapeutic
the
affecting
Some
duced convulsions from other factors
disease
process,
the
of
particular
1)
nature
the
of these factors might include
2) the
attitude
and symbolic
etc.;
depression,
involutional
or
as schizophrenia
of
a
large
attention
3)
the
special
the
patient;
to
treatment
of
the
meaning
�~22:
numbers of observers
h) the
incident to being placed
on
the treatment program;
attitude of the patient's therapist toward the patient
and toward
electroshock therapy, including the expected goals in each case; and S) the
relative effectiveness of other forms of therapy provided for these patients
in the hospital milieu. The use of a control group will also clarify the
nature of "Spontaneous recovery" and
may
aid in the understanding of
"atypical" results in the patients actually receiving convulsive therapy.
2. Insulin
Coma:
It is
planned to extend the present methods of study
to an investigation of those patients receiving insulin
coma
therapy.
�~23.-
2. Significance
This program of study has both applied and theoretical significance.
there
since
electroshock
of
therapy
use
clinical
It can lead to the improved
be
mechanism.
will
It
the
of
therapeutic
will be a greater understanding
to
who
better
improve,
will
those
patients
more
skillfully
select
to
possible
and
to
predict
the
involved
therapeutic
in
process,
factors
other
manipulate
more
accurately future management problems.
of
the
psychounderstanding
to
a
greater
however,
also
This study
leads,
pathology of mental
picture
which
illness.
Through the various methods of study a
clearer
will be obtained
meaningful criteria for
of the mechanism of defense and modes of communication
may
contribute
more
operationally accurate and
"improvement".
of
determination
the
for
diagnostic classification
techtherapeutic
other
on
throw
light
may
Finally, the investigation
and
and
obserthe
function
cerebral
in
niques. The studies of the alteration
have
signifi—
damage
and
cerebral
behavior
between
vations on the relationship
also
is
It
electrocoagulation.
and
cerebral
cance for the studies in Ibbotomy
modes
of
and
in
language
the
changes
into
here
gained
the
insights
that
likely
of
psychotherapy.
study
eventual
significant
make
an
possible
adaptation may
�VI. FACILITIES
AVAILABLE:
1. Hillside Hespital is a
200 bed
non-profit psychiatric hospital.
All admissions are voluntary, with periods of hospitalization varying from
h-lZ months. All patients are available for study.
The
hospital
was
established in 1927, for the purpose of treating
ulatory psychiatric patients.
A
amb-
residency training program.was instituted
earxy, under the supervision of an active staff of psychoanalytic psychiatrists.
In 1950 the research biochemical laboratory was established, to be followed
in
1953 by
the neurophysiological research laboratory.
In 19Sh these laboratories were combined and expanded, and a Research
Service established as a:full-time operation of the hospital.
Research Director was appointed to integrate
program.
At this time, the
staff consists
all
A
full-time
the studies into a basic
of the Director, research assis—
tants in psychiatry and psychology, biochemist and assistant biochemist,
siologist,
and
EEG
technician. In addition, a psychologist and
phyb
two chemists
are associated on a project basis.
Laboratory
Medcraft D-8,
two S-hB Grass
8
facilities include:
(a) Electroencephalographic unit with a
channel instrument; (b) Neurophysiological laboratory with
stimulators,
tachistoscopic projectors
ical laboratory with
Du Mont # 3&0 R
and
feet of laboratory space
Beckman
Coleman Spectrophotometer, and
ifications of the A.E.C.
two synchronized
auxiliary electronic equipment; (c)
1000 square
the following major items:
oscillograph;
Biochemp
and equipped with
Spectrophotometer,'Warburg respirator,
radioisotope unit following the basic spec-
�£2 5..
fl
2. Personnel:*
studies
Undergraduate
Research:
of
(a) Dr. Max Fink, H.D., Director
the
and
degree
New
Yorn
College
University,
of
Universitv
were undertaken at the
{e
the
attended
l9h2.
in
was
granted
of B.A. cum laude with Honors in Biology
New
l9h5.
in
graduating
of
Hedicine,
York University College
interneship he served in
School
of
the
from
he
where
graduated
U.S.
Army,
the
Military Heuropsychiatry in
Knox
After a rotating
19h7, and was Chief of the
Psychiatric Section, Fort
Station Hospital during 1947.
Formal neurologic
training
was
received at hontefiore Hospital in
York
New
Formal
psychiatric
(l9h9«1951).
Hosoital
Bellevue
Dsychiatric
and
at
(l9h8-l9h9)
and
than
(1950)
at
Hospital
Bellevue
?svchiatric
undertaken
at
training was
Hillside Hoscital (1952).
During 1951, and again
in
1953, he
and then
at
Mount
In 1952, he was
American Board of
first at
Sinai Hospital in
a research fellow of the Hational
Both periods of study were under the
Foundation for Infantile Paralysis.
ection of Ur. horris 3. Bender,
Was
flew York
dir-
University College of fledicine
flew York.
the
by
in
l95h,
and
Psychiatry,
in
Feurology,
in
certified
‘sychiatry and Neurology.
Simultaneously he attended and gradof Psychoanalysis, Psychiatry and
Institute
1953.
In
January,
in
Physicians
for
Psychology, receiving their Certificate
Mental
of
Institute
National
the
of
June, l9Sh, he was granted a research grant
uated from the ”illiam
Alanson Fhite
Health for a 2-vear study of electroshock processes.
In September, l95h, he was
Fink
Dr.
Hillside
Hospital.
Service
at
Research
appointed Director of the
is
33, married and has one son.
_____._.__.___.___________.___.____________.._._____._______._____________.______.
38.
apaended,
page
of
is
personnel
* Bibliography
�7-20Collowing
Psvcuiatry:
in
Assistant
(b) Dr. Joseph Jaffe, h.D.,
the
attended
Jaffe
Dr.
l9hh),
(B.A.,
Columbia
College
at
studies
undergraduate
Then
19b7.
M.D.
in
his
and.was
granted
of
hedicine,
College
New vorlr. University
he
began
interneship,
rotating
a
he was elected to Alpha Omega Alpha. Followinr
resident
a
as
First
Hospital.
DelleVue
Psychiatric
the
at
of
study
three years
U.S.P.H.S.
posta
as
studies
his
he
completed
in psychiatry, then in neurology,
lender.
3.
Morris
Dr.
of
doctoral research fellow under the supervision
from
graduating
Air
Force,
States
United
the
in
he
was
1953,
From 1951, to
Air
Eitchell
the
at
Psychiatrist
Chief
He
was
fiedicine.
Aviation
the School of
Force Base Hospital.
prac—
the
private
been
in
has
he
service
Since discharge from the military
of
Board
American
the
by
psychiatry
in
He
certified
was
tice of psychiatry.
psychoin
candidate
been
he
a
has
Since
l9h9,
1953.
in
and
Neurology
Psychiatry
Psychiatry
Psychoanalysis,
of
Institute
'hite
Alanson
analysis at the William
the
at
Assistant
Research
been
has
a
two
years
the
and
past
for
and Psychology
in
position
present
to
his
He
was appointed
Mount Sinai Hospital of New York.
September, 1955.
Chemist:
Chief
Ph.D.,
Goldenberg,
(0) Dr. Harry
A
graduate of the
Tremaine
of
a
recipient
York
New
in
of
the
City
of
College
D.
in
”h.
his
received
Goldenberg
Dr.
Scholarship and graduated cum laude.
in
instructor
He
been
has
an
Brooklyn.
of
Institute
from
‘olytechnic
the
l9h9
l9hh, he was the
College
Brooklyn
and
at
(l9h6-h7)
biochemistry at the Dolytechnic Institute
Natthe
of
enzymology
Fellow
in
Research
he
l9h7~h9
was
a
In
(1951 to date).
ional Institute
of Health, and from 1950
the
to
chemist
he
was
a
1952,
to
methods
enzyme
studying
of
Brooklyn
Hospital
Jewish
the
at
U.S.D.H.S. project
in clinical chemistry.
�...27..
Dr. Robert L. Iahn, Ph.D., Assistant in Psychology:
(d)
After
graduation from Brooklyn College in l9h0, he undertook graduate studies at
Columbia University. These studies were interrupted by four years of service
and
School
Dsyc‘hology
went
he
Clinical
to
where
United
Army,
States
in the
On
and
overseas.
country
in
this
various
hospitals
served as psychologist in
of
Neurology
the
Department
in
Research
T’syc‘iologist
became
he
the
army
leaving
of the
Mount
of Dr.
horris
Sinai Hospital in
New
York, where he wormed under the supervision
B. Bender and Dr. E. A.
"einstein until January, 1955.
is
He
of
monograph,
the
and
co-author
is
studies,
experimental
of
numerous
the author
"Denial of Illness:
He
Symbolic and Physiological Aspects" published
received his Ph.D. from the
New
in
May, 1955.
York University School of Graduate Arts
instructor of psychology at Brooklyn and Huntto
been
he
a.consultant
has
two
two
For
the
past
fbr
years
years.
er Colleges
conducted
and
has
training proMental
of
Hygiene
New
York
Department
State
the
and Sciences in 1953, and
was an
he
been
has
1955,
a
Since
January,
mental
the
of
several
hospitals.
in
grams
member
of this
staff.
(e) Dr.
Hyman
years of military service,
received his 3.8. in
ogy
interns at
York
four
Following
Psychology:
in
Assistant
Ph.D.,
Korin,
he matriculated
l9h9, and
at College of the City of
his H.S. in 1950. During 1951-52 he
the Hount Sinai Hospital and
University.
New
was
York and
psychol-
matriculated for his Ph.D. at
New
Since June, 1953, he has been Research Assistant in Psychology
at Hillside Hospital.
He
recently completed his doctoral thesis on
"The
Effects
of filectroshock on Retroactive Inhibition," and received his Ph.D. in October,
1955.
his'L.
F.
(f) Dr. Arnold Blumberg, H.D., Internist: Dr. Blumberg received
from the University of Pennsylvania in l9h2, for studies in physiology,
and in l9h5, received his E.D. from
the
Mew
York
University College of Medicine.
continued
he
two
of
and
service,
military
years
interneship
Following a rotating
1952.
l9h8
First
from
to
Memorial
Goldwater
Hospital
at
his residency training
�-28he
completed
Fellow
Medicine,
in
then
a
as
as a resident in neuropsychiatry,
He
has
1950-1952.
Division
Research
the
his studies as a Research Fellow in
been a Fellow in
Medicine
at the
New York
University College of Medicine,
1951-Sh.
He was
is
an
certified
Internal Medicine in l95h and
of Physicians. He is the associate
by the American Board of
associate of the American
Attending Internist at Hillside
Academy
Hospital and has'been
directly responsible fa'
of
coordinator
well
as
as
Research
Service,
the physiological studies of the
the biochemical programs.
3. Function of Research Service:
the
Research
Service,
the
of
research
programs
In addition to the
with
actively
They
cooperate
functions.
staff is active in two additional
research
who
on
part-time
carrying
are
those members of the hospital staff
In such instances, aid
nature.
of
clinical
a
chiefly
projects,
the
planning
of
goals,
project
clarification
the
is given in
and design of programs, and
is needed.
and
during
in
is
progress,
program
Secondly, an active resident training
independon
an
to
opportunity
carry
an
given
is
the third year, each resident
been
have
two
service
projects
of
this
ent project. Since the development
such technical assistance as
the
include
projects
completed, and three are
testosterone
of
and
the
use
states
anxiety
in
of
reserpine
clinical evaluation
include
resident
At
projects
present,
coma
therapy.
insulin
to
adjuvant
an
as
now
active.
The completed
a
factor,
therapeutic
milieu
a
as
the
of
hospital
a study
clinical evaluation
and
clinical,
coma
therapy
insulin
for
substitute
a
of chlorpromazine as
aMbivalence.
of
measures
and
tachistoscopic
psychologic
�-29In
May, 1955,
the Research Service established
a.
liason with the Sloan-
York
of
steroid
New
out
study
to
cooperative
a
of
Institute
carry
Kettering
excretion rates in psychotic patients, with emphasis on the patterns altered
during and following electroshock thefapy.
�-30..
VII,
M
PRESENT BUDGET AND REQUESTED SUPYOR :
Budget and Present Support:
1. Present anus—“u
The following is the full budget of the Research Service
for the fiscal year l9SSmS6. The major Share of the program is supported
by the Board of Directors, supplemented by grants of the United States Public Health Service. Under Grant M—927 of the National Institute of Mental
Health, $1h,807 of direct costs and $2221 of overhead costs was granted
for the year September 1, 1955 to August 31, 1956. This grant is the second
year of a 2-year grant for neurophysiological studies including the present
Electroshock Evaluation Study.
awarded $6500
The
National Institute of Arthritis has
for the second year of a twoayear grant for biochemical studies.
�~31-
1.
w.-
'
Board of Directors
U.S.P.H.S.
15,000‘
15,000
-——-
Psychiatry*
7,200
7,200
--—
Research Assistant in
Psychology
8,000
-——-—
8,000
Research Assistant in
Psychology
5,000
-—-—-
5,000
2,520
2,520
-————
Chief Chemist
8,600
8,600
-—-—-
Assistant
Chemist
h,000
__—-
h,000
Assistant Chemist
2,800
2,800
-——-
Assistant in Chemistry
1,800
-——-
1,800
h50
-—-—
h50
3,810
2,253
1,557
1,200
1,000
200
Personnel
Director of Research
Psychiatgz:
Research Assistant in
7E0 Technician
-
Secretary
Biochemistgz:
2.
Equipment
3. Consumable supplies
h. Travel - Conferences
Total
Overhead
TOTAL
* 3/5 time to September 1956.
60,380
39,373
21,007
2,521
______
2,521
62,901
39,373
23,528
�.32..
2. Requestegjg‘udgetagr Support:
A.
include
requirements of the Electroshock Therapy Evaluation Project
The
two
two
of
other
modification
the
to
professional staff,
additions
specific allocations of equipment funds.
(1) Psychiatrist: The cooperation of an additional full time psycoma
insulin
include
of
to
the
study
the
needed
to enlarge
scope
chiatrist is
positions,
and
of
evaluations
the
in
to
assist
control
the
study;
therapy; to supervise
diange in patients
and carry out follow-up
studies.
For
this position, an-
alytic experience is essential.
(2)
Physiologist or Heurophysiologist:
Present physiological studies
of
Further
physiostudy
and
the
Internist.
Director
the
out
by
carried
are
by
full-time
a
of
studies
these
coordination
the
changes
requires
logical
physiologist,
(3)
M.D.
or Ph.D.
Equipment:
and physiology.
For
Present needs are focused in two areas
-
biochemistry
further refined studies of the steroid sulfate patterns
mechanical
and
a
Beckman.Spectrophotometer
the
attachment
for
a recording
carry out the anticipated physiological
studies modifications and attachments to the electroencephalograph are
shaker (Dubnoff) are requested.
To
suggested.
following budget is one suggested to continue the present proneeded
completo
the
of
1956
personnel
addition
the
with
July
1,
gnmn after
ment the present staff. The budget is divided into three categories, followB.
The
Research
Serthe
coordinated
in
which
divisions
are
the
three
laboratory
ing
and
five
period,
a
for
the
for
year
Estimates
listed
first
year,
are
vice.
including projected salary increments.
�M
First
1. Psvchiatqz:
a. Director
Secretary
Conferences
13
Year
Five Year Total
(20,-25,000)
20,000
112,500
(2,6-3,100)
2,600
1,200
11,220
(15,-18,000)
(15,-18,000)
15,000
15,000
9,000
5,500
82,500
82,500
52,500
35,000
1,200
3,600
. Personnel
1. Psychiatrist
2. Psychiatrist
3. Eeychologist
13.. Psychologist
c. Supplies
Subtotal
-
&
(
9"12:OOO)
(5’5' 8,500)
Equipment
388,820
69,500
Psychiatry
2. Neurophysiologx:
a. Personnel
9,000
3,600
52,500
12,000
b. Equipment
1,000
1,000
c. Supplies
1,200
6,000
1. Physiologist
2. Technician
(9,-12,000)
(3 : 641-31400)
71,500
10,800
Subtotal - Neurophysiology
3. Biochemistry:
a. Personnel
Chief Chemist (9,-11,000)
9,000
6,000
0,000
1,800
36,000
25,000
11,200
b . Equipment
7,000
7,000
0. Supplies
1,500
7,500
1.
2.
3.
h.
Chemist
Chemist
issistant
Subtotal - Biochemistry
(6,-8,h00)
(bu-6,000)
(1,8—2,600)
29,300
137,700
�Total
First
-
All Programs
..
All Programs
113,600
598,020
17,0h0
89,700
130,6h0
687,720
Overhead Allowance\(15%)
TOTAL
Five Year Total
Year
C. Budget Reconciliation:
1. Salaries:
The
salary range for each item is consistent with pre-
sent positions established at the hospital, or for
new
positions, with neighbor-
for supervising psychiatrists is
$12,-15,000, with a projected revision to the stated scale in 1956.
ing
institutions. Present salary
2. Equipment:
ment expenditure
ance
range
For psychiatry, the
initial year
includes the equip-
for tape recording system (#600) and an annual
for expenses.
The
$600 allow—
physiological equipment expense (51000) is to allow
modification of present electroencephalographic equipment to
record other physiological indices.
The
expenditure for supplies includes
allowances for consumable items and the provision for the building of specialIized equipment.
In biochemistry, the
a recording attachment for the
Beckman
intiial
expenditure includes $7,200 for
spectrophotometer and 9800 for a Dubnoff
shaker.
3. Conferences:
Present budgetary items include this
of the Director or members of the
sum
for the use
staff to attend appropriate scientific
meet-
ings.
h. Overhead: Consistent with hospital policy and recent administrative
changes in other
grants, a
15%
allowance
is requested.
This amount includes
hospital allocations for Social Security coverage; and for such contingencies
in the expenses of the program as not reg iring a significant alteration in the
budget.
5. Subtotals and Total: The budget is presented in three sections,
representing natural subdivisions of the program, thereby allowing for modifications in support.
�VII.
APPENDIX
A. REFERENCES:
from
Discharged
317
Patients
of
Study
Follow-up
H.L.
RACHLIN,
2E.§i:
1.
in
Hosp.,
Hillside
press.
l?50,
J.
in
Hillside Hospital
and
other
Psychosurgery
Shock
Treatment,
2. KALINOWSKY, L.B. and HOCH, P.H.:
New
York,
Grune
Stratton,
(2nd
a
ed.),
Somatic Treatment in Psychiatry
1952.
19h8.
397,
Mil.
Surg.
$92:
Theories,
Shock
Therapy
Fifth
GORDON,
H.L.:
3.
and
Dsvchiatry,
Neurology
of
Foundations
h. GELLHORN, E.' Physiological
1953.
Minneopblis,
Hinnesota
Press,
University of
Nervous
Autonomic
H.C.:
S.a FNNKENSTEIN, D.H.,
Ment.
3
Nerv.
J.
Shock
Treatment,
System Changes Following Electric
GREENBLATT, M.
Dis.
329%.: 2109,
and
SOLOMON,
19,480
Which
PreA
Test
H.C.:
5.b FUNKENSTEIN, D.H., GREENBLATT, M.,
Schizophrenic
on
Treatment
Shock
Electric
of
dicts the Clinical Effects
1950.
889,
Am.
199:
Psychiat.
J.
Patients,
AND SOLOMON,
5.0.
Autonomic
Changes
H.C.:
SOLOMON,
and
M.,
FUNKENSTEIN, D.H.,
&
Nerv.
J.
Patients,
in
Mentally
Changes
Psychologic
Paralleling
GREENBLATT,
Ment. Dis.
6.a.
11;: 1, 1951.
Ill
Exthe
and
in
HOAGLAND, H. et al: Changes in the Electroencephalogram
of
AgitTherapy
Electro-shock
Accompanying
cretion of T7-Ketosteroids
19h6.
Med.
§32h6,
Psychosom.
ated Depression,
Excretion
on
Treatment
of
Effect
B.H.:
6.b. ALTSCHULE, N.D. and
&
Neurol.
Arch.
Mental
Disease,
with
Patients
in
of l7-Ketosteroids
1950.
516,
éfi:
Psychiat.
Cortins
of
Excretion
the
on
Convulsive
Therapy
6.c. ASHBY,‘W. 1.: Effects of
19h9.
275,
Ment.
Sci.
23:
and Ketosteroids, J.
PARKHURST,
Excretl7-Ketosteroid
the
of
Studies
Chromatographic
H.
WERBIN,
7.a.
gt El:
Hosp.,
Hillside
Normal
J.
Individuals,
and
ion Datterns of Psychotic
195,40
2011,
2:
l7~
Neutral
of
Urinary
The
Fractionation
S.
R.:
M.
STITCH,
and
REISS,
7.b.
Ment.
$99:
Sci.,
J.
Male
Schizophrenics,
Chronic
from
Ketosteroids
7011, 195,40
8.
ASHBY, W.
R.:
Mode
22: 202, 1952.
of Action of Electro-Convulsive Therapy,
J.
Ment. Sci.
�.36...
9.
Shock
Therapy,
Hypoglycemic
and
JELLIFFE, S. E.: Discussion on Insulin
1937.
200,
&
2Q:
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Arch. Neurol.
of
Aspects
Psychologic
Certain
0n
E.
MOSSE,
9.:
and
J.A.B.
10. MILLETT,
l9hh.
226,
Med.
6:
Electroshock Therapy, Psychosom.
Shock
Electric
with
Treated
Patients
in
Functioning
Memory
ZUBIN,
J.:
lla.
l9h8.
33,
Dersonality
Therapy, J.
ll:
on
Therapy
Convulsive
Electric
of
Effect
S.E.:
BARRERA,
and
ZUBIN,
11b.
J.,
596,
l9hl.
fig:
Biol.
Soc.
Exper.
Hemory, Proc.
Assoword
the
on
Performance
on
Shock
Therapy
of
:
Effects
ZEAEAN,
J.
12,
19h7.
Association,
Psychological
Eastern
the
at
Presented
ciation Test.
J.
Treatments,
Convulsive
Electric
Following
Loss
Memory
JANIS,
I.L.:
13.
191.18.
Personality
1.1: 29,
der
mit
Erfabrungen
Psychopathologische
GROBE,’W.:
and
W.
BAEYER,
von,
lha.
l9h7.
163,
Psychiat.
$12:
Elektrokrampfmethode, Arch. f.
after
Patients
Mental
on
Observations
E.
STAINBROOK,
J.:
H.
and
LOWENBACH,
lhbg
l9h2.
828,
Am.
2g:
Psychiat.
J.
Electroshock,
Post—Convulsive
of
Immediate
Description
Rorschach
STAINBROOK,
E.J.:
Ibo.
19AM.
302,
&
Personality'lg:
Mental Function, Char.
Electroshock
During
Psychosis
KAHN,
and
R.L.:
LIEN,
L.,
WEIWSTFIN,
E.A.,
15a.
Am.
Psychiat.
J.
Shock
Therapy,
of
the
Theory
to
Relation
Its
Therapy:
1952.
22,
$92:
and
PhysioSymbolic
of
Illness:
Denial
KAI-1H,
R.L.:
15b. mnrsmm, F..A and
1955.
Illinois,
C.
Springfield,
Thomas,
Charles
Aspects,
logical
Ego,
the
on
Treatment
Shock
of
Effects
D.:
IMPASTATO,
and
FROSCH,
J.
16.
Psychoan. Quart. I]; 226, l9h8.
l7.
18.
19.
20.
Recent
Under
"Normal"
Person
of Electroshock on a
L.: Effect
1953.
696,
Am.
J. Psychiat. $92:
Stress,
in
(Paraphasia)
Misnaming
Non—aphasic
UEINSTEIN, E.A. and KAHN, R.L.:
1959.
72,
61:
a
Psychiat.
Neurol.
Arch.
A.M.A.
Brain
Disease,
Organic
Organic
in
Disorientation
of
Patterns
KAHN,
R.L.:
WEINSTEIN, E. A. and
1951.
21h,
&
Neurol.
I:
Brain Disease, J. Neuropath. Clin.
"47.1%.: 7-iithdrawal, Inattention,
310133,
and
mms'mm, E.A., ram-I, R.L.,
1955.
235,
&
IA:
Psychiat.
and Pain Asymbolia, A.M.A. Arch. Neurol.
ALEXANDER,
�-3721.
T‘JEII‘YST‘EIN,
&
E.
nsychiat.
A.
_6_L_l:
and mm,
772, 1950.
D.
Neurol.
Arch.
Anosognosia,
of
L.: Syndrome
"
of
Denial
Illness,
in
Factors
Personality
R.L.:
MEN,
and
22. IEINSTEIN, E.A.
1953.
§_9_:
355,
&
T.‘Ieurol.
Psychiat.
11.14.11. Arch.
23.
L.A. and LINN,
R.L., SUGABI'JIAN,
Brain
Disease,
Sodium
Organic
in
Amobarbital
of
“IEINS'I'Em, 33.11., MEN,
Am.
Use
Diagnostic
1.:
J. Psychiat.
112:
889, 1953.
21;.
Test"
"Amytal
E.A.:
H.
and
vmmsmm,
KAI-1N, R.L., PINK,
1955.
3,
Hosp.
3:
Hillside
Mental Illness, J.
in Patients with
Differential
the
in
Tests
Perceptual
NJ: Tactile
25a. DEF-HER, MB. and
1952.
21,
Hosp.,
Hillside
1:
J.
Disorders,
Psvchiatric
of
Diagnosis
Sign
8.
Diagnostic
Test
as
Face-Hand
1.1.3.:
25b. PINK, M. GREEN, M. and BINDER,
1952.
h6,
2:
Neurology,
of Organic Mental Syndrome,
ImproveClinical
and
Damage
Brain
26a. REVITCE-I, 13.: Observations on Organic
195h.
§_8_:
72,
Quart.
ment Following Protracted Insulin Coma, Psychiat.
Coma:
TreatInsulin
A
Prolonged
Case
of
M.:
26b. IC-“IALEJASSER, S. and CAPLAN,
1952.
1115,
Hosp.
1:
ment, J. Hillside
and
ClinicElectroencephalographic
26c. SHAGASS, C. and ROFSML, P."T.: Serial
&
Neurol.
A.Z"T.A.
Arch.
Coma,
Insulin
Prolonged
of
Case
al Studies in a
195b,.
705,
Psychiat. 12.:
Posthypoglycemic
in
Studies
26d. TRACER, C.L. at £1: Electroencephalographic
19530
1135,
1.32%:
Dis.
l‘ient.
Coma, Jo NerV.
Parts
of
1-5.:
Reduplication
Delusional
and
N.
FINE,
27. KAHN, R. L., GRAUBTE’ET, D.
1955.
13h,
Hosp.
g:
Hillside
Coma
Therapy, J.
Insulin
After
1Jody
the
of
Scale,
Rating
the
A
Psychiatric
of
Revision
28. MALAI‘EUD, 'T. and SANDS, S.L.:
Am. J. Psychiat. _l_9_l_l: 231, ram.
Colorimetric
Quantitative
the
for
Dyes
Basic
Use
of
29. GOLDENBERG, H.:
Chemical
Society
American
Conjugates,
Sulfate
Estimation of Steroid
1955.
'Iarch
31,
200,
Abstract,
Highspeed
by
Synthesis
Sulfate
Steriod
:
T4..
REIL’IANN,
J.
and
30. GOLDEHBERG,
Chem.
Soc.
in
Am.
press.
J.
,
Liver Supernates,
Convulof
Evaluation
the
in
Matched
Groups
Use
The
of
G.
A.
313
31.:
31. ULE'IT,
195h.
128.:
138,
July,
Menn.
Clin.
Bull.
Photoshock,
Subconvulsive
and
sive
F11 K,
(31‘.
�B.
Publications of Personnel:
Dr.
N
l.
x Fink:
Subdural Hematoma Developing during Hospitalization, Amer. J.
Psychiat., 191: 381-383, 1950 (with Dr. M. Green).
2. Patterns in Perception of Simultaneous Tests of Face and Hand,
Trans. Amer. Neurol. Assoc., 22; 250, 1950 (with Drs. M.B. Bender
and
M.
...,
Green).
ibid,
Arch. Neurol.
&
Psychiat., éé: 355-362, 1951.
Test as a Diagnostic Sign of Organic Mental Syndrome,
Neurology, 2: hé-58, 1952 (with Drs. M. B. Bender and M. Green).
The Face-Hand
Tactile Perceptual Tests in the Differential IJiagnosis of Psychiatric Disorders, J. Hillside Hosp., 1; 21—31, 1952 (with Dr. M. B.
Bender).
A
Clinical Evaluation of Carotid Angiography, Conf. Neurol., 13:
Exosomesthesia, or Displacement of Cutaneous Sensation into Extrapersonal Space, Trans. Amer. Neurol. Assoc., lg; 1952 (with Drs.
M. F. Shapiro and M. B. Bender).
....
ibid, Arch. Neurol.
&
Psychiat., éfi: h8l-h90 1952.
9. Order of Dominance in Cutaneous Perception, Trans. Amer. Neurol.
Assoc. 2E3 238~h0, 1952 (with Drs. M.B. Bender and M. Green).
10. Development of Perception of Simultaneous Tactile Stimuli in
Normal Uhildren, Neurology, 2; 27-3h, 1953 (with Dr. M. B. Bender).
11.
Perception of Simultaneous Tactile Stimuli by Mentally Retarded
Adults, J. Nerv. Ment. Dis. 111; h3-h9, 1953 (with Drs. M. B.
Bender and M. Green).
l2. Spinal Fluid Findings
2: 137, 1953 (I-rit‘n Dr.
13.
Following Cerebral Angiography, Neurology,
M.
Stein).
Statistical
Study of a Psychoanalytic Hypothesis; Absence of a
Parent as a Specific Factor Determining Choice of Neurosis, J.
Hillside Hospital, a; 67-71, 1953 (with Dr. S. Tarachow).
A
Effects of Barbiturates
15: 1953 (with Drs.
on Perception, Trans. Amer.
M. B. Bender, P. Bergman and M.
Neurol. Assoc.,
Nathanson).
Homosexuality with Panic and Paranoid States (Case Report)
Hillside Hosp., _2_: 16h-9o, 1953.
J.
16. Standardization of the Face-Hand Test, Neurology a; 211-217, 195h
(with Dr. M. Green).
�.3917.
Patterns of Perceptual Organization with Simultaneous Stimuli, Arch.
Neurol. & Psychiat., 12: 233-255, 195A (with Drs. M. B. Bender and
H. Green).
18. The Amytal Test in Patients with Mental Illness, J. Hillside Hospital,
g; 3-13, 1955 (with R. L. Kahn and E. A. Heinstein).
l9. Delusional Reduplication of Parts of
Body
After Insulin
Coma
Therapy,
Dr. Joseeh Jafiig:
1.
Perceptual Patterns During Recovery From General Anesthesia, Jour. of
Neurol. Neurosurg. & Psychiat., 1%; 316-321, 195l (with M. B. Bender).
2.
Factor of Symmetry in Tests of Double Simultaneous Stimulation, Brain,
15: 167-176, 1952 (with M.B. Bender).
Dr. Rdbert Kahn:
1. Toxicity of Quinacrine (atabrine) for Central Nervous System: Experimental
&
Human
Neurol.
Arch.
on
Psychiat., 5g: 28h—299, l9h6
Study
Subjects,
(with Dr. T. Lidz).
2. After-Imagery in Defective Fields of Vision, J. Neurol., Neurosurg. and
Psychiat., lg: 196-20h, l9h9 (with Dr. M. B. Bender).
3. A Hereditary Syndrome Characterized by Mirror Movements, Left Handedness and Organic Mental Defect, Trans. Am. Neurol. A., ZS? 22h—226,
1919 (with Drs. I. Freiman and L. Michaels).
Tumors and Vascular
15: 277-278, 1950 (with
h. Correlation of Clinical and EEG-Abnormalities in
Disease of the Brain, Trans. Am. Neurol. A.,
Drs. E. A. ieinstein and H. Strauss).
5.
Syndrome of Anosognosia, Arch. Neurol.
(with Dr. E. A. Heinstein).
&
Psychiat., ég: 772-791, 1950
6. Patterns of Disorientation in Organic Brain Bisease, J. Neuropath.
Clin. Neurol. 1; 21h-226, 1951 (with Dr. E. A. heinstein)
&
7. Nonaphasic Misnaming (Paraphasia) in Organic Brain Disease, A.M.A. Arch.
Neurol. & Psychiat., él: 72-79, 1952 (with Dr. E. A. Neinstein).
8. Preoperative and Postoperative Personality Changes Accompanying Frontal
Lobe Heningioma,
B. Schlesinger).
9.
J. Nerv.
&
Hent. Bis.,
llh;
h92-510, 1952 (with Dr.
Phenomena of Reduplication, A.M.A. Arch. Neurol. & Psychiat.,
81h, 1952 (with Drs. E. A.'Heinstein and L. A. Sugarman).
él:
808-
�uhO-
Shock Therapy, Am. J. Psychiat.,
heinstein and L. Linn).
Its Relation to the
Theory of
222; 22-26, 1952 (with Drs. E. A.
10. IBychosis During Electroshock Therhpy:
'
Brain
Sodium")
Sodium
("Amytal
Organic
in
Amobarbital
of
Diagnostic
Disease, Am. J. Psychiat., 109: 12, 889-89h, 1953 (with Drs. E. A.
Ueinstein, L. A. Sugarman and L. Linn).
Use
Neurol.
Arch.
of
Denial
Factors
in
Illness,
Personality
Q2: 355—367, 1953 (with E. A. Heinstein, M.D.).
&
Psychiat.,
Behavior Disturbances Following Cataract Extraction, Am. J. Psychiat.,
and
L.
Linn).
E.
1953
A.‘
einstein
(with
Drs.
281—289,
219}
Delusional Reduplication of Parts of the Body, Brain, 7?: h5-60, l95h
(with Drs. s. A. deinstein, s. Halitz, and J. hozanshiT:
Serial Administration of the "Amytal Test" for Brain Disease: Its Diag195h
&
217-226,
Neurol.
Arch.
and
Psychiat.,
Value,
Prognostic
nostic
ll:
(with Drs. E. A. Heinstein and S. Malitz).
16. Ludic Behavior in Patients with :rain Disease, J. Hillside Hospital,
A.
Sugarman).
and
L.
B.
A.'Heinstein
l95h
(with
Drs.
98-106,
2:
17.
Test in Mental Illness, J. Hillsifie Hospital.,
(with Drs. M. Fink and E. A. fleinstein).
The Amytal
Q;
3-13, 1955
Amer.
"Irritative"
Lesions,
in
of
Functioning
Intellectual
Patterns
18.
PSychologist, 25 h02, l95h (with Dr. E. A. Meinstein).
19.
"Spatial inattention" in Patients with Localized Lesions of the CereN.
S.
l95h
(with
327-328,
Drs.
Psychologist, 2:
Pollack and M. B. Bender).
brum, Amer.
M.
Batteery,
20. The Adaptive Role of Behavior Accompanying Brain Disease as Exemplified
by the Phenomena of Reduplication, Amer. Peychologist, 2; h90, l95h (with
Dr. E. A. ieinstein).
21.
Denial of Illness: Symbolic and Physiological ASpects, Springfield, I11.,
Charles C. Thomas, 1955 (with Dr. E. A. ;einstein).
22.
Coma
Therapy,
Insulin
Body
After
of
of
Parts
the
Jelusional [@dnplication
M.
and
Fink).
D.
Graubert
1955
(with
lBh—lh7,
Drs.
J. Hillside Hosp., g:
and Pain Asymbolia, A.M.A. Arch. Neurol.
23. ’kithdrawal, Inattention,
Psychiat., 1h: 235—2h8, 1955 (with Drs.
s.
A.
neinstein ana'h.
H.
&
Slote).
Spatial Inattention in Focal Cerebral Lesions, Brain, in press (with
Drs. C. S. Battersby,
M. B.
Bender and.M. Pollack).
�25. Autokinetic Movement in Patients with Sensory and.Motor Disturbances, J.
M.
M.
and
B.
Pollack
S.
(with
Drs.
H.
Battersby,
Exp. Psychol., in press
Bender).
26. Relation Between Altered Brain thction and Denial in Electroshock Ther& Peychiat., in press (with Drs. M. Fink and
A.M.A.
Meurol.
Arch.
apy,
E. A. heinstein).
27.
Mount
Sinai
of
J.
With
Picture
Schizophrenia,
Clinical
a
Encephalitis
Hosp., a1; 1955 (with Drs. E. A. Heinstein and L. Linn).
Korin:
Dr.
.1.
The
New
Effects of Electroshock
York University, 1955.
on
Retroactive Inhibition, Ph.D. Thesis,
Dr. Hargz Goldenberg:
and
of
Amino
Acid
Esterase
Trypsin
Activities
of
the
1.
Chymotrypsin, Arch. Biochem., 22; 15h, 1950 (with V. Goldenberg).
pH Depenfience
2.
Several Derivatives of Acetyl-dl-phenylalanine, J.
5317, 1950 (with V. Goldenberg and A. McLaren).
Am. Chem.
Soc., lg:
3. Effect of Ultraviolet Light on the Specific Activity of Chymotrypsin
and Trypsin, J. Am. Chem. Soc., 72: 1131, 1951 (with A. D. McLaren).
h.
An
Ester
Leucine
of
Ethyl
Hydrolysis
the
Enzyme-Catalyzed
Into
Inquiry
Gold1951
V.
(with
Biochem.
110,
Acta,
Biophys.
1;
et
Chymotrypsin,
by
enberg and A. D. McLaren).
5. Report D-12, April 1, l9h6; cf. pp. 117-119, concerning 8-Hydroxyquinoline Method (Alcohol Extraction), in C.J. Rodden's "Analytical Chemistry
of the Manhattan Project", (with J. Greenspan, M. J. Sohuler, D. Taub,
and A. S. Carlson).
6. Calcification. V. Influence of Fluoride and Cyanide Ions in the Presence
and Absence of Magnesium, Proc. Soc. Exp.
A. L. Sobel).
Biol., 19:
719, 1951 (with
kaline Earths on Survival of the Calcify1952
(with A. E. Sobel).
695,
Exp.
Soc.
Proc.
g1:
Mechanism,
Biol.,
ing
7. Calcification. IX.Inf1uence of
A
8. Calcification. IV. Influence of Strontium and Magnesium Ions on Calcification in vitro, Proc. Soc. Exp. Biol., IQ: 716, 1951 (with A. E.
Sobel and A. Hanok5.
9. Calcification. XI. Studies of the Incorporation of Citrate in Calcification in vitro J. Dent. Res., 3;: L97, 19Sh (with A. E. Sobel
and E. Schmeriler).
�~h2§
Ions
and
Cyanide
Fluride
by
Inhibition
10. Calcification. XII. Cation-Linked
& Hed., éé: 27S,
Biol.
Soc.
Exp.
Proc.
in B-GlycerophOSphate Medium,
l9Sh (with A. E. Sobel).
19Sh.
26:
690,
Chem.,
Anal.
Plots,
ll.
Rectification of Nonlinear Beer's
12.
Curves.
Nonlinear
Activity
of
Rectification
Biochem. & Biophys., ég; 288, 195h.
Enzyme
Law
I.
Preliminary, Arch.
�Studs.“
'1
tho room.
L
01‘
91‘
the
“mum
Width.
01‘
tn:
1::
Win
A
man}:
Wm
Wtm «mum,
01’
khanm tar claatraoncophflampw
W!
«mum “W
studying 01-min manta].
with
WW
in brain
during tin
mmmd.
m
and
Wm M
wt yaw.
W
method.
for
YMMMW
mmmmno
at Madam ta
stimulation
mm
W
m,mmmmuhhmmmmmmmmpumm
thew. m
Wu.
Mitmun.
mental
W
«mum
int-mm:
um
M m
huts, ham
gatima or tho
hymn
dam-uni"
affect: of
inn-ms,
and
human
um
cum-a.
tannin; haloahraaanmkin
acid (mp-was) an anal:
and
In tho
mm-
5:
yaw, a
my at tho was in brain function during mmmuw mm «I
Mpmholamu. Dre WWW”. Kmmlwomm
and
the
Pink
to
Dr.
fellow
of
tha
a
«mm.
m
mum
«mm.
Mutilation tar Inna“): Win an imam to sup-mu that kbonhary work.
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on
with a
Main: 1.
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1953
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a alumni
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tum-Ind.
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Research Files and Unpublished Works
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Progress and annual reports; research activities (folder title 2/2).
Type
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Text
Identifier
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mfp-03-01-001-0-003
Date
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1955
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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<a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965
Relation
A related resource
The Max Fink Collection
Description
An account of the resource
Letter to Fink; Somatic Therapy Research Program; Monthly report; Research Progress reports - Department of Biochemistry; Letters to Dr. Miller; Electroshock Therapy Evaluation Program; Annual Report - Department of Neurology;
Rights
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Research