http://exhibits.library.stonybrook.edu/mfp/files/original/ad349d5951296913e2318475b59825b4.pdf cf794749634e525d25b732c78d778039 PDF Text Text September 2h, 197h Mr. Berton Roueehe The New Yorker 2h west h3rd Street New York, N. Y. Dear Mr. gouache: are sure to write about your article, "As Empty as Eve”, to sympathise with Mrs. Parker and to praise your presentation. Some will write to criticize the errors of fact and of experience. I am writing to express my sadness that you have chosen the public press to air a single medical case report, without the leavening of clinical experience, which would permit this case to he ’eeen in the context of the goals, successess and failures of this therapy. I do not understand what service you uere attempting to offer, but surely you .ghaVe added.your powerful voice to the many who fear that vh1ch they do I_not Understand, thus making_it more difficult for patient 5 Who may be helped to receive treatment.- YQn are encouraging many patients to I.veehs and months of the unnecessary hell of a severe depression; and even some to a suicide that may have been prevented. Many _ ‘ ' I am sad that the New Yorker and particularly you. with your a.record of fine writing, have choSen this topic to attack.. It is easy easy to damn "to find the single case which hes not done veil; it 'vith innuendo, error, misquotation, and selective quotation,balance it is hard to stay one' a voice when we are ignorant, and to speak with ~ is V when we have an urge to speak. Some specifics. Free the record given, it is probable that _. curs. Parker was a poor choice for this therapy. I anticipate that she is a person who is critical in her perception of her environment —- in :.psychological terns, she has a low California F-Scale, makes few errors c;on figure-ground tests, and is unusually accurate in the perception of *the visual upright. Such individuals, when they become depressed, do so gradually, and characterize their depression not in mood or affective terms, but in body symptoms (often termed hypochondriacal) and are , : ' , �Page 2 Berton Rousche September 2h, 197h generally poor therapeutic risks. The outcome you describe with convulsive therapy is rate, since patients who have her background are infrequently treated with this therapy. One of the limitations in getting therapists to have adequate experience with convulsive therapy is the prevailing social attitude that the therapy has less success than the psychotherapies, that it is less elegant, and that it repre— sents (in some minds) a failure of a 'better' therapy. Indeed, one would guess that the consulting psychiatrist was reluctant to recommend Regr tfully, had he chosen a form of this candidate for this therapy.convulsign there " in which the appli— the therapy called "unilateral cation of the electrodes is not to both temple, but to the scalp overlying the non—dominant cerebral hemisphere, the complaints would surely have been less, for this therapy yields allmet equivalent therapeutic change with decreased effects on memory and recall. There are also many errors of fact. The historical origins of convulsive therapy are not usually related to the experiences of Reil, but rather to the interest aroused in the biological causes of insanity by the successful treatment of general paresis by fever therapy by Wagner von Jsuregg. This observation was universally hailed as a step forward in the treatment of the insane (yon Jsuregg receiyed the Nobel Prize for medicine for this obserVatioh) and led many scientists in Europe to-seek other biological rays to relieve the symptOms of the mentally ill.- Convulsive therapy is usually described as originating in the lehdrstories of the Hungarian, Ladislas von Meduna, who Observed that schizophrenia was rare among epileptics and that ;-epilepsy was rune among those with schizophrenia. Seeking_a way to 'rnlieve the plight of severe psynhotics, he tried to simulate epilepsy hy'intrayenous administrations tirst of camphor, then of pentelenetetrasol "(Metrszole). The first-patients improved markedly and it was following his early reports that the Italians, Cerletti and Bini, tried electrical itinductions of seizures. »1 , ; , Electro—eonvulsive therapy has gone through many'modifications ‘hin the past 38 years. The techniques of administration have improved (succinylcholine is the latest of the muscle relaxants; the use of a gfl-sedstive, usually Brevital, is not to improve breathing, but to pro- vide relaxation for the patient before treatment and to-reduce the excitement which occasionally is seen after a seizure, unilateral seisures and flurothyl seizures are used in selected cases, etc.). ‘iOur understanding has gone from ideas that the treatment is a punish— nent for sins, or to frighten the patient to health, through the stage where the therapy was related to amnesia, to present views uhich ascribe “K\\\ \ �Berton Roueche September 2“. l97h Page 3 to the biochemical hhenges which result from the seizures. Indeed, the therapy is seen to produce long—lasting biochemical changes in the central nervous system which are remedial to depressive mood and psychotic idention, in appropriately selected patients. improvement carp about a few specific errors. Insulin come therapy is not in widespread use. For example, there is no insulin coma therapy unit in a community hospital in New York. It is far from the inspiretionsl prototype of electroconvulsive therapy since Sahel clearly separ~' sted insulin come from the convulsive therapies, as did many of his followers. To ECT cemphor were used I first was not the earlier. convulsive therapy - metrezole and surprised by the quotations from Noyes end Kalb, Hope and Adams, and Aubrey Lewis for none of these authors have written on the subject within the past two decades. The quotations from Squires end Ottosson are appropriate. Ottosson is one of the most experienced observers of convulsive therapy and it may have served him better to quote from his more recent studies, and those of his co—VDrkers, Lsurell and d'Elis, then to use an older study. Squires is a young am who hes done only one experiment. The gho— "New Home from Medical Encyclopedia" is probably accurate.’ the tstion but one would wonder why you have selected this lsy volume as an experimental psychologist authority to quote in the New Yorker. In sun, I em disappointed that the New Yorker, known and read for its accuracy and fine reporting, sew fit to publish a single case report, with many errors of feet in discussion therebydoing e dis~ service to the many patients uho‘will undoubtedly read or be given this article, Ind who will be scored out of their wits if a physician recommends this therapy. The harm that has been done will never be known by you, but the many therapists who will find it more difficult to use this therapy when it is useful will have reason to remember you, as will the families that will have lost a member by suicide.. — A Should you wish to reach other scientists who may find your report a disservice, I suggest you call Dr. martin Kata, head or the Clinical Research Branch of the National Institute of Nentel Health, or such concultants to the NIMH as Dr. Seymour Katy, Harvard Medical School, Dr. Lather Knlinovsky of the New York Medical College, or Dr. Charles Shegsss, of Temple University (also this year' s President of the Society of Biological Psychiatry and the American Psychopatho- logicsl Association). ‘ �Berton Roueche Page h You may Septuflber 2h, 197h also vish to read some of the more recent volumes to assist you, I am appending citationa that are on the subject. and well known. Lastly. I would suggest that you spend a week studying a ward of chronic mentally 111 (in any State mental hospital) and a week visiting laboratorics renoarching the nawnr tharnpiea of tho_mantally ill. Perhaps than you may be able to write a more balancoaroaponse to your~ self. ‘ Sincercly yours, Fink, M. D. Professor of Psychiatry Max Mrzed cc: Peter F. Fleischmann, President The New Yorker Magazine, Inc. Kalinowsky, L. and Hippius, H. Pharmacological, Cbnvulsive and ether Sbmatia freatmunts in Phyahiatry, N. Y., Grune and Stratten, ' 1969. Fink, M., Katy, 8., EcGaugh, Cbnvulaivc Therapy, Fink. M. J. and Williams T., Pbyahobiology qf Whahington; V. H. Winston and Son, 19TH. Convulsive Therapy, Saminara in Phyahiatry, 1g; 1972. / � 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 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 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 Correspondence to: Serban, George Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-05-00-027-7-522 Date A point or period of time associated with an event in the lifecycle of the resource 1974 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 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 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 Correspondence