PSYCHOTHERAPY: THEORY, RESEARCH AND PRACTICE
VOLUME 8, #1, SPRING, 1971
FROM THE SLAUGHTERHOUSE TO THE MADHOUSE
THOMAS S. SZASZ
State University of New York
Syracuse, N. Y.
I the psychiatric "therapeutics" of "mental ill-
Like all widely-shared beliefs with impor-
tant social consequences, the belief in "mental
illness" as a medical disorder is embedded in
our language, supported and reflected by it.
Thus, we call problems in living "mental ill-
nesses"; individuals who consult psychiatrists
or are compelled to submit to them by force or
fraud are "mental patients," their complaints
or the complaints of others about them are
"mental symptoms," and the conditions im-
puted to them that allegedly "cause" and "ex-
plain" their conduct are "mental diseases"
( among these, "schizophrenia" occupies an es-
pecially important position); we call psychiat-
ric inquiries, whether invited by consenting
clients or imposed on them against their will,
"diagnoses," and psychiatric interventions
"treatments"; finally, we call the setting in
which psychiatric encounters take place "med-
ical offices," "clinics," and "hospitals." And
since we even have a National Institute of
Mental Health it is easy to see why the right-
thinking person considers it unthinkable that
there might be no such thing as mental health
or mental illness. If that were so, we would be
the victims of our own folly, (Szasz, 1961).
No! It is better that we maintain, and if nee-
essary, fortify our fictions.
Many illustrious physicians have labored,
and continue to labor, on strengthening the
medical fiction of mental illness: the result is
the very real fortress that is Institutional Psy-
chiatry, (Szasz, 1970). As I showed in The
Manufacture of Madness, (Szasz, 1963), the
most highly esteemed psychiatrists are those
who have forged the best weapons for defend-
ing and broadening the justifications for the
medical claims and pretensions of their profes-
sion. Their "discoveries"-from unchaining
t b e m~~11;anht~ shockin~, lobohtomhi~ing, and
tranqm 11zmg 1m-const1tute t e 1story of
64
ness."
This brief note is intended to review the or-
igin of one such discovery-that of electric
shock treatment; and to suggest that this pro-
cedure is paradigmatic of the interventions of
Institutional Psychiatry: based on force and
fraud,. and justified by "medical necessity,"
the prime purpose of psychiatric treatments-
whether utilizing drugs, electricity, surgery, or
confinement, especially if imposed on uncon-
senting clients-is to authenticate the subject
as a "patient," the psychiatrist as a "doctor "
and the intervention as a form of "treatment'."
The cost of this fictionalization runs high: it
requires the sacrifice of the patient as a per-
son; of the psychiatrist as a critical thinker
and moral agent; and of the legal system as a
protector of the citizen from the abuse of state
power, (Szasz, 1963).
II
The Italian psychiatrist Ugo Cerletti is
credited with the introduction of electroshock
therapy into psychiatry. In an essay on the
discovery of this treatment, he described the
work that led to its development as follows:
"Vanni informed me that at the slaughterhouse in
Rome hogs were killed by electric current. Such infor-
mation seemed to confirm my doubts regarding the
danger of electric applications to man. I went to the
slaughterhouse to observe this so-called electric
slaughtering, and I saw that the hogs were clamped at
the temples with big metallic tongs which were
hooked up to an electric current (125 volts). As soon
as the hogs were clamped by the tongs, they fell un-
conscious, stiffened, then after a few seconds they
were shaken by convulsions in the same way as our
experimental dogs. During this period of unconscious~
ness ( epileptic coma), the butcher stabbed and bled
the animals without difficulty. Therefore, it was not
true that the animals were killed by the electric cur-
rent: the latter was used, at the suggestion of the So-
ciety for the Prevention of Cruelty to Animals, so
that the hogs might be killed painlessly.
 FROM THE SLAUGHTERHOUSE
It occurred to me that the hogs of the slaughter-
house could furnish the most valuable material for
my experiments. And I conceived, moreover, the idea
of reversing the former experimental procedure : while
on dogs my aim had been the use of minimal quantity
of current capable of inducing a seizure without harm
to the animal, I now decided to establish the time
duration, voltage, and the method of application that
would be necessary to produce the death of the ani-
mal. Electric current would therefore be applied
through the skull, in different directions, and through
the trunk for several minutes. My first observation
was that the animals rarely died, and then only when
the duration of electric current flowed through the
body and not through the head. The animals that re-
ceived the severest treatment remained rigid during
the flow of the electric current, then after a violent
convulsive seizure they would lie on their sides for a
while, sometimes for several minutes, and finally they
would attempt to rise. After many attempts of in-
creasing efficiency, they would succeed in standing up
and making a few hesitant steps until they were able
to run away. These observations gave me convincing
evidence of the harmlessness of a few tenths of a sec-
ond of application through the head of a 125-volt
electric current, which was more than sufficient to in-
sure a complete convulsive seizure.
At this point I felt we could venture to experiment
on man, and I instructed my assistants to be on the
alert for the selection of a suitable subject.
On April 15, 1938, the Police Commissioner of
Rome sent a man to our Institute with the following
note: 'S.E., 39 years old, engineer, resident of Milan,
was arrested at the railroad station while wandering
about without a ticket on trains ready for departure.
He does not appear to be in full possession of his
mental faculties, and I am sending him to your hospi-
tal to be kept there under observation .... ' The con-
dition of the patient on April 18 was as follows: lu-
cid, well-oriented. He describes with neologisms deliri-
ant ideas of being telepathically influenced with re-
lated sensorial disturbances; his mimicry is correlated
to the meaning of his words; mood indifferent to en-
vironment, low affective reserves; physical and neuro-
logic examination negative; presents conspicuous hy-
pacusic and cataract in L.E. A diagnosis of schizo-
phrenic syndrome was made based on his passive be-
havior, incoherence, low affective reserves, hallucina-
tions, deliriant ideas of being influenced, neologisms.
This subject was chosen for the first experiment of
induced electric convulsions in man. Two large elec-
trodes were applied to the frontoparietal regions, and
I decided to start cautiously with a low-intensity cur-
rent of 80 volts for 0.2 seconds. As soon as the cur-
rent was introduced, the patient reacted with a jolt
and his body muscles stiffened; then he fell back on
the bed without loss of consciousness. He started to
sing abruptly at the top of his voice, then he quieted
down.
Naturally, we, who were conducting the experiment
were under great emotional strain and felt that we
had already taken quite a risk. Nevertheless, it was
quite evident to all of us that we have been using a
TO THE MADHOUSE 65
too low voltage. It was proposed that we should al-
low the patient to have some rest and repeat the ex-
periment the next day. All at once, the patient, who
evidently had been following our conversation, said
clearly and solemnly, without his usual gibberish:
'Not another one! It's deadly!'
I confess that such explicit admonition under such
circumstances, and so emphatic and commanding,
coming from a person whose enigmatic jargon had
until then been very difficult to understand, shook my
determination to carry on with the experiment. But it
was just this fear of yielding to a superstitious notion
that caused me to make up my mind. The electrodes
were applied again, and a 110-volt discharge was ap-
plied for 0.2 seconds'' (Cerletti, 1956).
III
Like all honest self-disclosures, Cerletti's
account of his discovery of electric shock
treatment is perhaps more revealing than he
realized or would have wished. I shall list cer-
tain facts mentioned by Cerletti, and some in-
ferences based on them, which seem to me
particularly significant.
1. Electroshocking of hogs was an empiri-
cally discovered method for tranquilizing and
subduing the animals, so that they could be
butchered without the excitement and squeal-
ing which they normally exhibit.
2. The first human being on whom elec-
troshock was tried was a man, identified only
by his initials, "S.E.," by his occupation, "en-
gineer," by the city of his residence, "Milan,"
and, significantly, by the psychiatric diagnosis
attached to him, "schizophrenia."
3. S.E. was a complete stranger to Cerletti,
whose help he did not seek (and whose inter-
vention he later rejected). In actuality, S.E.
was a prisoner: he had been "arrested" by the
police for "wandering about," and instead of
being tried for his offense, he was sent to Cer-
letti.
4. Although sent to the hospital expressly
"for observation," Cerletti flagrantly dis-
obeyed the instructions of the Police Commis-
sioner of Rome: instead of observing S.E., he
used him as an experimental subject for elec-
troshock.
5. Cerletti does not mention having ob-
tained permission for his experiment from
anyone. It would appear that having received
the prisoner from the police, Cerletti immedi-
ately regarded him as his "patient" and him-
self as the sole judge of the sort of "treat-
66 THOMAS
ment" his "patient" should have. Thus Cer-
letti writes that "we, who were conducting the
experiment, were under great emotional strain
and felt that we had already taken quite a
risk"; but he says nothing about the risk to
which S.E. had been subjected without his
consent.
6. Throughout the experiment, S.E. was
treated as a thing or an animal. He had no
control whatever over his fate. When, after
the first shock, he announced "clearly and sol-
emnly: 'Not another one! It's deadly!'" his
seemingly entirely rational communication
had no effect on those who were experimenting
on him.
7. In short, the .first person on whom elec-
troshock therapy was tried was neither a hu-
man volunteer; nor a regular (voluntary or
committed) mental patient, with whose his-
tory, personality, and family the psychiatrists
were familiar; nor a prisoner convicted of
crime subsequently declared mentally ill and
under the jurisdication of a court. These facts
are important because, as a professor of psy-
chiatry at the University of Rome, Cerletti
must have had access to many "schizophrenic"
patients who might have been potential candi-
dates for his experimental treatment.
IV
Although the circumstances surrounding the
discovery of electroshock therapy are reveal-
ing, they may be placed in fuller perspective
by noting a few facts about the discoverer,
Ugo Cerletti.
Cerletti was born in Cornigliano, Italy, on
September 26, 1877, and died in Rome, on
July 25, 1963. He studied medicine in Turin
and Rome, and received his medical degree in
Rome in 1901. First, he did special work in
histopathology and neuropathology. Then, he
studied clinical psychiatry under Kraepelin
and was captivated by him. In 1933, he be-
came interested in Meduna's work on schizo-
phrenia, and became an enthusiastic advocate
of the hypothesis of the incompatibility of
schizophrenia and epilepsy. In 1935, following
his appointment as Professor of Psychiatry at
the University of Rome, Cerletti began his ex-
periments on induced convulsions. In collabo-
ration with Professor Bini, he devised the first
electroshock apparatus, and, in April 1938,
s. SZASZ
they administered the first electric convulsion
to man, described above.
In Cerletti's obituary, Ferrucio di Cori
( 1963) appraised the significance of electro-
shock treatment as follows: "[Cerletti's] new
method was widely investigated and univer-
sally accepted throughout the world....
Countless lives, suffering, and tragedies had
been spared."
Cerletti continued to work on electroshock
until he died. "He formulated a theory that
the humoral and hormonal changes provoked
in the brain by the epileptic attack lead to the
formation of substances which he called
'acroagonines'-substances of extreme de-
fense. These substances, when injected into
the patient, would have therapeutic effects
similar to those resulting from electroshock"
( di Cori, 1963) .
Ayd ( 1963) has recorded another interest-
ing aspect of history's first electroshock treat-
ment. Cerletti was apparently in the habit of
recalling that memorable experience. "As he
described what transpired," writes Ayd, "he
remarked, 'When I saw the patient's reaction,
I thought to myself: This ought to be abol-
ished! Ever since I have looked forward to the
time when another treatment would replace
electroshock.' " But if Cerletti had thought
this, why did he say it only to himself? Nei-
ther Cerletti, nor other advocates of electro-
shock, ever spoke or wrote publicly about abol-
ishing this "treatment."
V
As the history of Anna 0. and Breuer,
(Szasz, 1963) is paradigmatic of a truly per-
sonal encounter between patient and doctor,
so the history of S.E. and Cerletti is paradig-
matic of a truly impersonal contact between
dehumanized subject and medical experi-
menter. As the former exemplifies the volun-
tary relationship between "neurotic" and
"psychotherapist," so the latter exemplifies
the involuntary relationship between "psy-
chotic" and "institutional psychiatrist." It is a
measure of the moral decline of the psychiat-
ric profession that these fundamental distinc-
tions-between person and object, physician
and alienist, voluntary and involuntary psy-
chiatric interventions---,were better appreci-
ated, in practice if not in theory, during the
 FROM THE SLAUGHTERHOUSE
early decades of this century than they are at
present, (Szasz, 1970).
The invention of electroshock is modern
therapeutic totalitarianism in statu nascendi:
the mental patient, a non-person, is handed
over to psychiatrists by the police, and is
"treated" by them without his consent. The
social circumstances in which electroshock
treatment was developed are consistent with
its "therapeutic" action. If a man wishes to
punish and subdue another, he does not ask
his permission. Nor can the public, in a soci-
ety that permits and even encourages this
type of human relationship because it is "ther-
apeutic," expect the law to protect the victim.
REFERENCES
Avo, F. T. JR., Guest editorial: Ugo Cerletti, M.D.
TO THE MADHOUSE 67
1877-1963, Psychosomatics, 4, A-6-A-7, Nov.-
Dec., 1963.
CERLETTI, U. "Electroshock Therapy," in, A. M. Sack-
ler, M. D. Sackler, R. R. Sackler, and Marti-Iba-
nez F. (Editors) : The Great Physiodynamic Thera-
pies in Psychiatry: An Historical Reappraisal, Chap-
ter 4, pp. 91-120, New York, Hoeber-Harper, 1956,
pp. 92-94.
DI CORI,FERRUCIO, In Memoriam (Cerletti), Journal
of Neuropsychiatry, 5, 1-2, Sept.-Oct., 1963.
SzAsz, T. S. The Myth of Mental Illness, New York:
Hoeber-Harper, 1961.
SzAsz,T. S. Law, Liberty, and Psychiatry, New York:
Macmillan, 1963.
SZAsz, T. S. The concept of transference, lnternat.
J. Psycho-Anal., 44, 432-443, 1963.
SzAsz,T. S. The Manufacture of Madness, New York:
Harper & Row, 1970, p. xvii.
SzAsz, T. S. Law, Liberty, and Psychiatry,· Psychiat-
ric Justice, New York: Macmillan, 1965; and
Ideology and Insanity, Garden City, N.Y.: Double-
day Anchor, 1970.