David J. Impastato

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.

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.

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.

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.

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."

During his Bellevue tenure he was also appointed visiting neuropsychiatrist at Columbus Hospital.

A treatment for mental illness initially called "Electroshock," ECT was developed in 1937 by Dr. Ugo Cerletti and Lucio Bini, working in Rome.

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 had seen the promise of Cerletti's revolutionary technique from the outset.

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 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.

Impastato would live to see ECT recommended by the American Psychiatric Association for a distinct core of intractable mental disorders.

The U.S. Food and Drug Administration took longer to respond to the treatment's potential.

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.

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.

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.

Impastato was born in the Sicilian port town of Mazara del Vallo, the youngest in a family of ten children.