Meduna, Ladislas J.

Ladislas J. Meduna

Hungarian neurologist Ladislas J. Meduna (1896-1964) was a pioneer in the treatment of schizophrenia and other psychosis-type disorders with what is known as convulsive therapy. Meduna used drugs to induce convulsions in his first trials in the 1930s, but the practice was soon replaced by a more reliable way to induce seizures via the application of electric current to the patient, which became known as electroshock therapy. Meduna later emigrated to the United States and taught at Loyola University in Chicago, Illinois.

Meduna was born in Budapest, Hungary, on March 27, 1896, to Francis and Gisela (Eissler) Meduna, and grew up in relative middle-class comfort during the waning years of the Austro-Hungarian Empire. In 1914 he began studies at the Royal University of Science in Budapest, but left a year later to serve in the army of the Austro-Hungarian Empire as World War I erupted in Europe. He served on the Italian front, and resumed his studies at the war's end in 1918. Three years later he earned his medical degree, and began specialty training in neurology. In 1924 he accepted a teaching position at the Budapest Interacademic Institute for Brain Research.

Became Intrigued by Mental Disorders

Meduna's initial research investigated disorders of the pineal gland, the endocrine gland that plays a role in human sexual development at puberty and later produces melatonin, a chemical that regulates sleep patterns. But in 1927 he began a new position as associate professor at the University of Budapest's Clinic for Mental and Nervous Diseases, and became intrigued by the emerging field of clinical psychology and its ties to neurological disorders. He began sitting in on autopsies conducted on recently deceased clinic patients. There was talk at the time that the mentally ill had marked differences in their brain structures, though there were few diagnostic tools available to prove this theory.

Schizophrenia was a disorder that mental health professionals believed to be incurable. It was characterized by delusions, hallucinations, disordered speech patterns, and distorted perceptions of reality, and patients often sank into a catatonic state. Among medical professionals, rumors arose in the late 1920s that some schizophrenics who suffered epileptic seizures—an entirely separate and unrelated neurological disorder—seemed to have been cured of their mental disorder by the violent convulsions. Meduna began to research the matter further, and discovered that there were very few patients with epilepsy who also exhibited signs of psychosis. He also tracked 6,000 known schizophrenics, and found that just 20 of them also had epilepsy. Postmortem investigations seemed to show that those who suffered from epilepsy had more neuroglia—the network of supporting tissue and fibers found in the brain and spinal cord—than the average person. In autopsies on schizophrenics, by contrast, Meduna believed he saw far fewer neuroglia cells. He theorized that convulsive seizures caused formation of the neuroglia, and that inducing the production of more of these cells might prove to be the cure for schizophrenia.

A Remarkable Outcome

Meduna conducted his first experiments in inducing seizures on animals using camphor dissolved in oil. He injected it in his first human patient on January 23, 1934, at the Budapest State Hospital. The 33-year-old male patient, named L.Z., had been at the institution since 1930 after he began to hear voices that he claimed came from his ears as well as his stomach; the man also believed that when he was out in public people were waving at him. He spent all of 1933 in his bed under the covers, the hallmark of a genuinely catatonic patient. Meduna injected him with camphor six times over the next 18 days, and L.Z.'s symptoms began to abate. “On the morning of February 10, the patient spontaneously arises from bed, is lively, speaks, and asks for something to eat,” Meduna's notes reported, according to Edward Shorter's book A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. “He is interested in everything going on about him, asks about his illness and realizes that he has been sick. He asks how long he has been in the hospital, and as we tell him that he has already been there four years he cannot believe it.”

In an autobiographical piece that was not published until the 1980s in the journal Convulsive Therapy, Meduna provided an interesting sidenote to L.Z.'s seemingly miraculous recovery. Following the treatment with camphor, the man actually escaped from the Budapest State Hospital and returned home to find “that the cousin living with his wife was not a relation at all but his wife's lover. He beat up the cousin and kicked him out of the house; proceeded to beat up his wife and told her that he … preferred to live in the state mental hospital where there is peace and honesty,” according to Shorter's book. To Meduna and other professionals, however, the exit from a catatonic state was indeed nothing short of remarkable, and had only occurred through two other forms of treatment for schizophrenia: one was insulin coma therapy, in which schizophrenics were given high doses of insulin, which produced convulsions then coma. This was pioneered in Vienna, Austria, by Dr. Manfred Sakel (1900-1957) just a few years before Meduna's camphor trials. Insulin coma therapy replaced sleep therapy, which had come into use in the first years of the twentieth century. In this treatment, patients were given heavy doses of barbiturates for up to nine days, but there was a risk of death from circulatory collapse.

Treatment Had Serious Drawbacks

Meduna continued his Budapest trials with 26 more patients, and reported signs of remission in half of them. He submitted his first published report on the trials in January of 1935, but soon switched to using another convulsioninducing chemical compound known by its trademarked name, Metrazol, and sold under the brand name Cardiazol in Europe at the time as a circulatory and respiratory stimulant. It had some benefits over camphor, whose intramuscular injections were painful. Vomiting also sometimes accompanied the usual state of great anxiety that camphor induced in patients before the seizures began, which could take up to 45 minutes. Metrazol had similar disadvantages, because it, too, caused extreme distress for patients before they lost consciousness, and the treatments were described as stressful for even the medical professionals involved; aversion to second dosages was so strong that patients had to be restrained by force. Another drawback to Metrazol was that the convulsions could not be halted once they were underway—unlike insulin coma therapy, where a saline solution could be given that began to reverse the shock almost immediately—and spinal fractures occurred in some patients.

Meduna treated 110 patients with Metrazol, and presented his study results in 1937 at a meeting of psychiatry professionals in Münsingen, Switzerland. Within a year, however, a team of researchers led by Dr. Ugo Cerletti (1877-1963), chief of the University of Rome's Clinic for Nervous and Mental Diseases, had devised a new method of inducing convulsions that was much less barbaric. It was called electroconvulsive therapy, and became the standard treatment for schizophrenia and other psychosis-type disorders for the next several decades. It fell out of favor in the 1970s, but is still sometimes used to treat depression.

Settled in the Chicago Area

Meduna fled the encroaching threat of Nazi Germany in the late 1930s, emigrating to the United States and becoming associate professor of psychiatry and neurology at Loyola University in Chicago in 1939. Four years later he joined the faculty at the University of Illinois's Neuropsychiatric Institute in Chicago as an associate professor of psychiatry, and remained there until his death in 1964. Later in his career he devised carbon dioxide therapy as a course of therapy for schizophrenics. His formula of 30 percent carbon dioxide and 70 percent oxygen was known as the “Meduna mix,” and caused unconsciousness and in some cases near-death experiences reported later by patients, who reported feeling a sensation of moving through a tunnel toward a light source while under the influence.

Even Metrazol was banned by the U.S. Food and Drug Administration in 1982 because of the danger of convulsions, but a quarter-century later there were new theories that it could reverse the effect of mental retardation for those afflicted with Down syndrome. Meduna's ideas about neuroglia were later proven to have been in error, though scientists were still unsure about the root causes of schizophrenia. He was a respected colleague in his day, however, serving as editor-in-chief of the Journal of Neuropsychiatry and as president of both the American Society of Medical Psychiatry and the Society of Biological Psychiatry. The latter group was founded after World War II, partly in response to the then-fashionable theories of Austrian psychoanalysis pioneer Sigmund Freud (1856-1939), which focussed on the unconscious mind and its fixation on inanimate objects that Freud argued were representative of repressed sexual desires. When the Society was founded, Meduna said, according to a New York Times Magazine article by Mike Gorman, “Our flag is a flag of revolution upon which I should like to write the rebellious, the defiant motto: ‘A telegraph pole is a telegraph pole.’ ”

Books

Science and Its Times, edited by Neil Schlager and Josh Lauer, Volume 6: 1900 to 1949, Thomson Gale, 2000.

Shorter, Edward, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, John Wiley & Sons, 1997.

Periodicals

American Journal of Psychiatry, November 1999.

New York Times Magazine, January 13, 1957.