Max Fink, a psychiatrist and neurologist who advanced the acceptance of electroconvulsive therapy as an option for treating severely depressed patients who do not respond to drugs or psychotherapy, died on June 15 in Westfield, Mass. He was 102.
His death, at a senior living community, was confirmed by his son, Jonathan Fink.
Dr. Fink believed that electroconvulsive therapy was a potent treatment — and shouldn’t be considered a last resort — for patients who are suicidal or suffering from delusions.
“Many severely depressed patients are maintained for weeks, for months and even years on antidepressant drugs,” he told a conference on depression in Philadelphia in 1988. “Are we not unfair when we do this to our patients when ECT remains an active and excellent treatment?”
He first witnessed the use of ECT in 1952, on his first day as a neurology and psychiatry resident at Hillside Hospital (now Zucker Hillside Hospital, a part of Northwell), in Queens. One by one, he watched as five patients — under restraints, with rubber bite-blocks in their mouths and electrodes applied to their temples — received enough electrical current to induce a grand mal seizure.
“Observing a full grand mal seizure in each patient jarred me,” he wrote in 2017 in an unpublished memoir for Stony Brook University in New York, where he worked for many years. But over the next few months, he continued, “I had learned that ECT effectively reduced suicide thoughts, relieved negativism, aggression, depressed and manic moods. Of the hospital populations, the patients treated with electroshock improved the most.”
Although Dr. Fink was convinced of ECT’s positive effects, others in the psychiatric profession weren’t.
“Max was trained in an era when the main theme of psychiatry was orthodox Freudian psychoanalysis,” said Dr. Charles Nemeroff, chair of the department of psychiatry and behavioral sciences at Dell Medical School at the University of Texas at Austin, who collaborated with Dr. Fink on a paper about ECT. “But he was part of a small group of academic psychiatrists who recognized that severe depression and schizophrenia were brain diseases.”
Dr. Fink, the author of many scientific articles about ECT and the founding editor of the quarterly Convulsive Therapy (now The Journal of ECT), faced opposition from other doctors, Scientologists and protesters at conferences.
“We had a problem getting this accepted by the public, and I was protested at meetings across the United States and Europe,” he said in 2019, when he received an award for lifetime achievement from the Institute of Living, a psychiatric center in Hartford, Conn.
Some opponents of ECT said it was ineffective or left people with memory loss and trauma. Others described it as a brutal practice, an enduring view reinforced by the 1975 film “One Flew Over the Cuckoo’s Nest,” in which a patient at a psychiatric hospital, played by Jack Nicholson, undergoes ECT without anesthesia as a punishment for his rebelliousness.
In his book “Electroshock: Healing Mental Illness” (1999), Dr. Fink wrote that “the picture of a pleading patient being dragged to a treatment room, where he is forcibly administered electric currents, as his jaw clenches, his back arches, his body shakes, all the while he is held down by burly attendants, may be dramatic but it is wholly false. Patients aren’t coerced into treatment.”
Critics of Dr. Fink’s passionate support of ECT said he downplayed the risks, including memory loss and cognitive impairment.
“One of Fink’s books describes going to get ECT as no more significant than going to the dentist, which I thought was pretty glib,” said Jonathan Sadowsky, the author of “Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy” (2017). “And there are a lot of scientific studies about memory loss from ECT.”
Dr. Fink insisted that antidepressants and antipsychotics could cause more damage, including memory loss, than ECT did.
Dr. Nemeroff — who described Dr. Fink as “an irascible, dominant figure” as well as “the world’s leader in electroconvulsive therapy” — said Dr. Fink’s focus was firmly on the effectiveness of the treatment.
“He was a zealot, no question about it,” Dr. Nemeroff said. “He thought ECT was a panacea.”
ECT’s effectiveness in treating serious mental illness has been recognized by, among others, the American Psychiatric Association, the American Medical Association and the National Institute of Mental Health.
But while it is useful for treating serious mental illness, it does not prevent recurrence. Consequently, most people treated with ECT need to continue the procedure or use another type of maintenance treatment.
Maximilian Fink was born on Jan. 16, 1923, in Vienna. His father, Julius, was a doctor in general practice who was trained in radiology. His mother, Bronislava (Lowenthal) Fink, known as Bronia, left medical school at the University of Vienna after three years; later, in the mid-1950s, she became a social worker. Max and his mother immigrated to the United States in 1924, joining his father there. (His brother, Sidney, who was born in 1927, also became a doctor, specializing in gastroenterology.)
As a boy, Max developed X-ray film in his father’s office. He started college at 16, at New York University’s University Heights campus in the Bronx, and graduated in three years, with a bachelor’s degree in biology, in 1942. After earning his medical degree at the N.Y.U. College of Medicine (now the Grossman School of Medicine) three years later and interning at Morrisania Hospital in the Bronx, he served in the Army from 1946 to 1947, attending the School of Military Neuropsychiatry.
After his discharge from the Army, he worked as a surgeon on three passenger ships. From 1948 to 1953, Dr. Fink served as a resident at Montefiore, Bellevue, Hillside and Mount Sinai Hospitals. From 1954 to 1962, he ran the division of experimental psychiatry at Hillside. He later served as director of the Missouri Institute of Psychiatry and as a professor of psychiatry at New York Medical College. From 1972 to 1997, he was a professor of psychiatry and neurology at Stony Brook University (where he later became a professor emeritus).
Dr. Fink’s research had unusual breadth. He showed early in his research career that penicillin, still an experimental drug, was better than sulfa for patients with pleural cavity infections. He studied the pharmacology of LSD, marijuana and opioids; used electroencephalograms, or EEG tests, to measure the changes caused by electroshock, insulin coma and psychoactive drugs; and wrote about the effects of changing the placements of electrodes in ECT.
He was also among the scholars who successfully argued for the recognition of catatonia — a syndrome characterized by irregular movements and immobility — by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., as separate from schizophrenia.
Dr. Fink’s other books include “Convulsive Therapy: Theory and Practice” (1979); “Electroshock: Restoring the Mind” (1999); “Ethics in Electroconvulsive Therapy” (2004, with Jan-Otto Ottosson); and “The Madness of Fear: A History of Catatonia” (2018, with Edward Shorter). He wrote or collaborated on some 800 scientific papers, including one on catatonia that was accepted for publication by Journal of the Academy of Consultation-Liaison Psychiatry shortly before his death.
In addition to his son, Dr. Fink is survived by two daughters, Rachel Fink and Linda Fink, and four grandchildren. His wife, Martha (Gross) Fink, died in 2016.
In a 2018 interview for Stony Brook, Dr. Fink reflected on his career and its influence.
“I think I was very lucky,” he said. “However I worked it out, I was always able to find projects and kept busy.”
“We’ve saved lives knowingly,” he later added. “It’s been a very interesting life.”
Richard Sandomir, an obituaries reporter, has been writing for The Times for more than three decades.
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