David John Impastato (January 8, 1903 – February 28, 1986) was an American neuropsychiatrist who pioneered the use of electroconvulsive therapy (ECT) in the United States. A treatment for mental illness initially called "electroshock," ECT was developed in 1937 by Dr. Ugo Cerletti and Lucio Bini, working in Rome.A History, Shorter and Healy, op. cit., 34ff.American Psychiatric Association. Mankad, Mehul V. et alia. Clinical Manual of Electroconvulsive Therapy. Arlington, Va: American Psychiatric Publishing, 2010. Chapter 1, "History of Electroconvulsive Therapy" by John L. Beyer, MD. Print.Impastato, David J., MD. "The Story of the First Electroshock Treatment." The American Journal of Psychiatry vol. 16, June 1960: pp. 1113–1114. Print. Cf. Impastato-Cerletti correspondence, 1945–1963. Impastato has been credited with the earliest documented use of the revolutionary method in North America, administered in early 1940 to a schizophrenic female patient in New York City. Soon after, he and colleague Dr. Renato Almansi completed the first case study of ECT to appear in a U.S. publication. Impastato and Almansi, "Electrically Induced Convulsions in the Treatment of Mental Illness.," New York State Journal of Medicine vol.98, September 1940. Print. Impastato spent the next four decades refining the technique, gaining recognition as one of its most authoritative spokesmen. He taught, lectured widely and published over fifty articles on his work. He called on ECT practitioners to observe the strictest protocols of patient safety, countered resistance to ECT from both the medical and cultural establishments, and met later challenges to electroconvulsive therapy from developments in psychopharmacology.Payne, Nancy A. and Joan Prudic. "Electroconvulsive Therapy Part I: A Perspective on the Evolution and Current Practice of ECT." Journal of Psychiatric Practice 15(5), September 2009: 346–368.A History, Shorter and Healy, op. cit., p. 177, p. 216.Lebensohn, Zigmond M.. "Prejudice Against ECT." Convulsive Therapy 13(4), 1997, 266–267. Impastato would live to see ECT recommended by the American Psychiatric Association for a distinct core of intractable mental disorders.America Psychiatric Association. Clinical Manual. op. cit., Chapter 2, "Indications for Use" by John L. Beyer, MD.New York State Office of Mental Health. Electroconvulsive Therapy Review Guidelines. 2012. Retrieved November 2012 at http://www.omh.ny.gov/omhweb/ect/guidelines.htmNational Institute for Clinical Excellence (UK). Guidance on The Use of Electroconvulsive Therapy. London: April 2003. Section 2: "Clinical Need and Practice." The U.S. Food and Drug Administration took longer to respond to the treatment's potential. But in 2016 the FDA drafted guidelines for ECT similar to those of the APA, as well as proposing regulations for treatment with Class II and Class III devices. U.S. Food and Drug Administration. Electroconvulsive Therapy (ECT) Devices for Class II Intended Uses - Draft Guidelines for Industry, Clinicians and Food and Drug Administration Staff Though still not free of controversy, electroconvulsive therapy is the treatment of choice for an estimated 100,000 patients a year in the United States.Hermann R, Dorwart R, Hoover C, Brody J (1995). "Variation in ECT use in the United States." American Journal of Psychiatry 152 (6): pp. 869–75. .National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapiesSmith, Daniel. "Shock and Disbelief ." Atlantic Monthly, February 2001. pp79-90.Stone, Gene. "When Prosac Fails, Electroshock Works." New York Magazine. November 14, 1994.Goleman, Daniel. "The Quiet Comeback of Electroshock Therapy." The New York Times, August 2, 1990, B5.
Life and works Impastato was born in the Sicilian port town of Mazara del Vallo, the youngest in a family of ten children. In 1912, he emigrated to the United States at the age of nine, settling with his mother Rosaria and a number of his siblings in New York City's "Little Italy." His father Domenico, a schoolteacher, stayed behind in Mazara and died before he was able to join his wife and children in America. Early on it was decided that "Davide" would be the doctor in the family. His mother collected the paychecks of his older brothers and sisters, most of whom worked in New York's garment district, and redistributed the funds to family members according to need. A share of the money was set aside for young David's future education.Family information courtesy of Nancy Barr Impastato." Impastato Records, Documents and Oral Histories." November, 2013. (Ancestry.com) When the family moved to Brooklyn, he was enrolled at Clason Point Military Academy, run by the Lasallian Christian Brothers, to avoid the uncertainties of the local schools. He went on to receive his pre-medical degree from Columbia University in 1925, and three years later, his Doctor of Medicine from the George Washington University Medical School.Impastato, David J. "Bibliography," op. cit. See also "General Information, Education, Appointments, Awards, Societies." New York, NY: The Osar Diethel Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College.
During his general internship at Metropolitan Hospital Center in New York, Impastato was drawn to neurology. In 1929, he began a year of residency at New York's Central Neurological Hospital, followed by two years as clinical attending neurologist at Postgraduate Hospital (later NYU Hospital Center). His presentation of spongioblastoma multiforme of the brain, published in 1932, reflects his neurological foundation.Impastato, David J. "A Case of Spongioblastoma Multiforme." Medical Clinics of North America. vol. 15, 1932: pp. 1247–48. Print. That year he began a residency in Bellevue Hospital's Psychiatric Department, foreshadowing his lifelong interest in the biomedical aspects of human behavior. After his residency, he remained at Bellevue as an assistant psychiatrist, gaining the experience of the city hospital's diverse patient population of "the great, the poor, the wealthy and the unfortunate."Cutolo, Salvator R., MD. Bellevue Is My Home. New York: Doubleday, 1956. p. 93, quoting New York City Mayor Vincent Impellitteri's description of Bellevue Hospital at a dedication. During his Bellevue tenure he was also appointed visiting neuropsychiatrist at Columbus Hospital.
In 1937, certified as a Diplomate of the American Board of Psychiatry and Neurology, Impastato established his private practice in Manhattan. The same year, Drs. Ugo Cerletti and Lucio Bini, after experimentation with dogs, administered the first ECT to a catatonic patient in Rome. Though convulsive treatments for mental illness had been conducted earlier with the use of metrazol, this was the first therapeutic seizure in medical history induced by electric current. Impastato was later to describe the event in The American Journal of Psychiatry.
In September 1939, Dr. Renato Almansi, an Italian neuropsychiatrist and future colleague of Impastato's, emigrated to the United States to escape the rising anti-Semitism in Europe. He brought with him a version of the ECT machine that Cerletti and Bini developed for their work in Rome. Soon after arriving in New York, Almansi introduced the Cerletti-Bini device to Impastato, whose growing reputation in America had caught the attention of Dr. E. Secondari, one of Almansi's former psychiatry professors.Impastato, David J. History of the Use of EST in the United States. 1969. New York, NY: The Osar Diethel Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College.Impastato, David J. Letter to Mary Anthony, February 13, 1980. American Psychiatric Association Library and Archives, Arlington, VA. Impastato had seen the promise of Cerletti's revolutionary technique from the outset. After conducting his own experiments with the device over the next few months, he administered his first electroconvulsive treatment on January 7, 1940, in his West 55th Street office (see "First ECT in America" below).
Almansi had been unable to persuade hospitals in Philadelphia, New York and Boston to sponsor a clinical trial of ECT. Impastato appealed to Columbus Hospital, where he had served in the Department of Neuro-Psychiatry for the prior half-dozen years. Founded by Mother (now Saint) Frances Xavier Cabrini and run by the Missionary Sisters of the Sacred Heart of Jesus, Columbus Hospital might have seemed an unlikely venue for the controversial treatment. But the medical establishment's aversion to controversy weighed less with a small private hospital, and the sisters had long admired Impastato's work with mental sufferers. Rev. Mother Enrica, Mother Superior of the hospital, gave Impastato the go-ahead. He and Almansi began a clinical trial there on February 6, 1940, the earliest ECT treatments reported by any hospital in the United States.
The five-month trial was conducted with male and female patients under the age of fifty. A total of 100 ECT treatments were completed "without a single complication." In September of that year, Impastato and Almansi released the account of their work in the New York State Journal of Medicine, the first case study of the treatment to appear in an American publication. Almansi commented later on the changed environment. "As word spread that the treatment was being administered," he recounted, "others felt encouraged and reassured."Almansi on the eventual spread of ECT in the US quoted in Endler, Norman, Electroconvulsive Therapy: The Myths and The Realities. Toronto: Hans Huber, 1988. p22. Early U.S. practitioners such as Victor Gonda, Douglas Goldman and Lothar Kalinowsky followed the landmark Impastato and Almansi article with their own published studies of ECT. During the war years in the 1940s, electroconvulsive therapy would become a fixture in psychiatric centers in the U.S. and abroad.
Impastato served the war effort as a psychiatric examiner, even as his practice during that period expanded rapidly into large offices on Manhattan's Fifth Avenue and a private out-patient clinic. His clientele ranged from the immigrant population to the city's elite, mirroring his Bellevue experience. He described his therapeutic approach as "eclectic," offering biomedical care as well as psychotherapy and family counselling.APA Biographical Directory, op cit. "I am not for any one type of treatment," he explained, "I am only for the patient."Impastato, David J. "Indications and Complications of EST and Pharmacotherapy." From "A Symposium on the Importance of Shock Therapy in the Treatment of Depressive States (Montreal)." Diseases of the Nervous System, 23:11, November 1962: p. 5. Print. Emphasizing the humanity of the doctor-patient encounter, he pointed out the "psychic component in any treatment situation, even if the therapy seems to be essentially somatic."Impastato, David J. "Physiologic Therapy in Psychiatry." Journal of the Medical Society of New Jersey. vol. 52. October 1955: p. 528.
His work with ECT would continue to evolve. He authored more than fifty articles covering a range of subjects from his clinical findings, to historical notes, to his innovations in ECT technology. Impastato supplemented his published work with numerous lectures in the U.S., Europe and Asia, as well as with presentations on radio and television, becoming one of ECT's most respected voices in the international psychiatric community.