Contrasting responses to electric shock therapy in clinically similar catatonics

Summary

The responses of three catatonic patients to electric shock therapy have been described. Each patient may serve as an example of certain types of catatonic patients who are frequently treated by means if shock therapy.

The material revealed by the patients illustrates the diverse nature of the clinical entity of catatonia. An attempt has been made to explain contrasting responses to electric shock therapy in clinically similar catatonics on the basis of dissimilar underlying psychopathological mechanisms. The variety of hysterical features, schizophrenic autism and negativism, and primitive, chaotic thinking in catatonia has been pointed out. In this connection an attempt was made to show the necessity for individual consideration in each case with regard to therapy and prognosis.

It is felt that the repression of painful and disturbing material in certain catatonic patients may be a protection against relapses. For this reason, it is suggested that an attempt should be made to prevent the patient from gaining too much insight into problems which cannot be worked out successfully. A specific approach by the therapist is therefore desirable considering that the prognosis, even with a physical agent, seems to depend upon the basic, dynamic structure of each individual case.