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Calef, V. (1950). British Journal of Medical Psychology. XX, 1944: Theory of the Rationale of Convulsion Therapy. W. Abse. Pp. 33–50.. Psychoanal Q., 19:137-138.
Psychoanalytic Electronic Publishing: British Journal of Medical Psychology. XX, 1944: Theory of the Rationale of Convulsion Therapy. W. Abse. Pp. 33–50.

(1950). Psychoanalytic Quarterly, 19:137-138

British Journal of Medical Psychology. XX, 1944: Theory of the Rationale of Convulsion Therapy. W. Abse. Pp. 33–50.

Victor Calef

This paper elaborates on the view previously stated by Abse that the 'efficacy of convulsion therapy in mental disorder is dependent upon the fact that it exposes the patient to repeated traumatic situations' which has psychological consequences. The traumatic effect results from the excessive stimulation at the instinctual level while there is progressive disorganization of the higher centers. The induced state is labeled a 'regression' and the whole process including the 'restitution' from the convulsion is likened to an experience of rebirth. The physiological changes which are seen are compared to those of birth and its attendant 'anxiety'. These changes are reversible but the pattern leaves a lasting impression in the psyche which may be a forceful affective symbol. This 'primal anxiety' is said to be followed by an attempt at defense consisting primarily of repression and accompanied by an alteration in the distribution of the libido. A case history is given of a man admitted to a hospital in a catatonic state. Postconvulsive behavior of homosexual, anal and oral types is described. Also the fears expressed by the patient verbally and by action are stated. Despite resistance, condemnation and attempts at flight on the part of the patient after the second treatment the injections were continued.

Abse believes that the transference situation is important and that it should

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be used but warns against bringing id-impulses into consciousness in the psychotic patient who is undergoing convulsion therapy. Convulsion therapy is 'a reversal of psychoanalytic technique'. Psychotherapy in convulsion therapy should be re-educative (to encourage the process of repression).

Von Meduna's hypothesis of the antithetical relationship between epilepsy and schizophrenia seems to be borne out by psychological observation. The convulsion of the epileptic seems to serve as a discharge phenomenon having a meaning. It is an attempt at stabilization in a patient who is making a withdrawal from object relationships. The patients 'endogenously generate a traumatic situation as a consequence of their defective libidinal and ego organization'. The convulsion permits a redistribution of libidinal cathexis. These themes are elaborated by means of case histories and analogies made between epileptic attacks and the induced convulsion in the treatment of schizophrenia.

The observation that little success attends convulsion therapy when there are either fixed delusions or pronounced apathy is confirmed and theoretical considerations (consistent with the above formulations) are given to explain these observations.

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Article Citation

Calef, V. (1950). British Journal of Medical Psychology. XX, 1944. Psychoanal. Q., 19:137-138

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