talks to Giovanni Cassano
Italian health ministry has decided to sanction the use of
electroconvulsive shock therapy, ECT, on mental patients in state
hospitals. That it has taken such a controversial step is largely
due to one man, Giovanni Battista Cassano, professor of
psychiatric medicine at the University of Pisa - better known as
private consultant to Italy's rich and famous.
involves sending an electric current through the brain and was
once commonly used on the mentally ill, some would argue, with
devastatingly harmful effects. Books like The Bell Jar, by the
poet Sylvia Plath, who subsequently committed suicide, gave the
practice a bad name and its use declined.
however, is at the forefront of a new wave of psychiatrists,
advocates of the use of drugs and physical treatments such as ECT
to tackle debilitating illnesses of the mind. For these
psychiatrists the more we learn about the chemical balance of the
brain, the more obvious such treatments appear. This is in stark
contrast to psychiatrists inspired by analysts such as Freud, who
suggest that mental illness can be traced back to childhood trauma
and cured by analysis.
soft-spoken man with an aversion to interviews, Cassano is
nevertheless prepared to oblige when it is a question of
persuading people as to the virtues of his psychiatry. Italian
departments of psychiatric medicine, Cassano complains, have a
history of stubborn indifference to scientific progress in
understanding the mind. No sooner had psychiatry come into
existence in Italy in the early 1960s, he recalls, than it was
crushed and held in check by the universities, which transformed
it into a mixture of sociology, psychology and politics.
result was the dangerous idea that mental illness does not really
exist at all, that it is simply the expression of contradictions
within a diseased society, and that by curing society the problem
will disappear. From this follows the argument that it is a
scandal that society wants to fill patients with drugs or lock
them up in psychiatric hospitals," he explains.
Italy, says Cassano, depressives are still told they are not
really ill after all - that they are simply in the wrong job, have
an unhappy marriage or some sort of mother complex, or suffered
violence as a child. "This has led to countless tragedies.
But what is even worse is that it has also produced an
impoverished form of psychiatry, one not based on the progress of
research. These other forms of psychiatry," he says,
"are built on explanatory models that do not search for
Cassano's latest proposal - for the use of ECT to be extended to
children and the elderly - has met with implacable opposition.
"Why is it that we commonly use an electric current in the
case of the heart but not the brain?" he counters. "If
we accept surgical laser treatment in cases of epilepsy, why not
for mental disorders? ECT consists of a small electrical discharge
lasting five or ten minutes. This inspires a convulsive crisis
together with all its accompanying therapeutic benefits and is
carried out under anaesthetic. There is no risk: 40 minutes later
the patient can go home. Possible after-effects - a slight
headache or a vague feeling of amnesia - soon pass."
finds widespread neglect of ECT alarming: "There are many
places in Europe where the very existence of ECT seems to have
been entirely forgotten. Where it is used, it tends to be
prescribed only for classic cases (of schizophrenia and
depression) - about 20 per cent, with the remaining 80 per cent
condemned to terrible suffering with the real risk of suicide.
Despite their ideological prejudices, Italy's commissions and
bioethics committees have always recognised the efficacy of ECT.
The problem is adverse popular reaction."
public has been misled too, according to Cassano, by journalists'
irresponsible criticisms of psychotropic drugs. He argues that
such drugs are as effective in treating mental disorders as
antibiotics are in treating infectious illnesses. Psychiatrists
now have distinctive drugs that will, for example, eliminate
compulsive nailbiting, he says.
In his bestselling book, And Deliver Us from this Dark Illness: Depression and How to Get Rid of it, stars like the film director Federico Fellini pay witness to Cassano's methods. Fellini tells of a friend who suffered terrible depression, turning in vain to psychoanalysis and acupuncture before enlisting with a psychiatrist who diagnosed a chemical imbalance in the brain and prescribed drugs. Six months later he was well and has remained so. "What really struck me was the sheer efficacy of the treatment and the speed with which it took effect where previously nothing else had succeeded. But in a way there is really nothing to be surprised about. Aren't we all in the end no more than chemistry?" says Fellini.
Cassano is slowly getting his message about the brain across to a sceptical public. His book is a bestseller. "I believe that the progress of the neurosciences will help us to understand this instrument which so characterises our humanity," he predicts. "We are moving towards a new, neuroscientific form of humanism."
Note: This interview first appeared in The Times Higher Education Supplement on September 25 1998.