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Traumatic shock and electroshock: the difficult relationship between anatomic pathology and psychiatry in the early 20th century

机译：创伤性休克和电击：20世纪初期解剖病理学与精神病学之间的困难关系

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In the conviction that a look at the past can contribute to a better understanding of the present in the field of science too, we discuss here two aspects of the relationship between early 20th century anatomic pathology and psychiatry that have received very little attention, in Italy at least. There was much debate between these two disciplines throughout the 19th century, which began to lose momentum in the early years of the 20th, with the arrival on the scene of schizophrenia (a disease histologically sine materia) in all its epidemiological relevance. The First World War also contributed to the separation between psychiatry and pathology, which unfolded in the fruitless attempts to identify a histopathological justification for the psychological trauma known as shell shock. This condition was defined at the time as a “strange disorder” with very spectacular symptoms (memory loss, trembling, hallucinations, blindness with no apparent organic cause, dysesthesias, myoclonus, bizarre postures, hemiplegia, and more), that may have found neuropathological grounds only some hundred years later. Among the doctors with a passed involvement in the conflict, Ugo Cerletti, the inventor of electroshock treatment, focused on the problem of schizophrenia without abandoning his efforts to identify its organic factors: if inducing a controlled electric shock, just like an experimentallyinduced epileptic seizure, seems to allay the psychotic symptoms and heal the patient, then what happens inside the brain? In seeking histological proof of the clinical effects of electroconvulsive therapy (“the destruction of the pathological synapses”), and attempting to isolate molecules (that he called acroagonins) he believed to be synthesized by neurons exposed to strong electric stimulation, Cerletti extended a hand towards anatomic pathology, and took the first steps towards a neurochemical perspective.
机译：相信回顾过去也有助于更好地理解科学领域的现状，因此我们在这里讨论了20世纪初期解剖病理学与精神病学之间关系的两个方面，在意大利，这些方面很少受到关注至少。在整个19世纪，这两个学科之间存在许多争论，而在20世纪初，它就失去了发展势头，因为精神分裂症（一种组织学上为正弦的疾病）在所有流行病学方面都引起了人们的关注。第一次世界大战也加剧了精神病学和病理学之间的分离，这种现象在为心理学创伤（被称为“壳牌休克”）的组织病理学辩护中徒劳无功。当时将这种情况定义为一种“奇怪的疾病”，具有非常明显的症状（记忆力丧失，发抖，幻觉，没有明显器质性原因的失明，感觉异常，肌阵挛，奇异的姿势，偏瘫等），并且可能已经发现了神经病理学仅在几百年后才提出理由。在经历过冲突的医生中，电击疗法的发明者乌戈·塞莱蒂（Ugo Cerletti）专注于精神分裂症的问题，但没有放弃他的努力来确定其有机因素：如果像在实验中诱发的癫痫发作一样诱发受控的电击，似乎可以缓解精神病症状并治愈患者，那么大脑内部会发生什么？为了寻找电痉挛疗法的临床效果的组织学证据（“病理突触的破坏”），并试图分离他认为是由强电刺激的神经元合成的分子（他称其为丙烯醛），Cerletti伸出了一只手。走向解剖病理学，并朝着神经化学的观点迈出了第一步。

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