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

[1][2][3] 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.

[17] 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.

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.

[3] 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.

[21] 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.

"[4] 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.

"[23] 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.

[5] 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.

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.

[18] Impastato was married to the former Jane Doris Justin, RN, whom he met at Bellevue and who served as his office manager and medical assistant in the first years of practice.

[17] The first to administer an electroconvulsive treatment for mental illness in North America, Impastato was in the vanguard of pioneering neuroscientists who challenged the medical establishment's resistance to ECT.

[6][7][29][30] He also contended with negative representations of the treatment in popular culture such as those in the novel and film One Flew Over the Cuckoo's Nest, which portrayed ECT as a punishment for unruly asylum inmates.

In bracing articles published in Diseases of the Nervous System, he documented the complications that can result from ECT, including fatality, when treatment protocols are compromised.

Early on he experimented with sodium amytal, a barbiturate derivative that managed patients' anxiety when preparing for ECT and helped to reduce the treatment's musculoskeletal complications.

"[37] Impastato would live to see the American Psychiatric Association move beyond lingering controversy and adopt this pragmatic approach, recommending ECT in otherwise "untreatable" cases where drugs or psychotherapy remain ineffective.

[8] For the APA these include depression with psychotic features, manic delirium, and catatonia when low food or fluid intake threatens the patient's life.

But in 2016 the agency acknowledged that the benefits of electroconvulsive therapy outweighed the risks, especially to memory which in clinical trials referenced by its Draft Guidelines was shown to "return to baseline" within three moneths after treatment.

Impastato uses the older designation "EST," since at the time the terms "electroshock" and "electrofit" were not yet superseded by the "ECT" acronym for electroconvulsive therapy: Then in Jan 1940 I was revisited by the father of a schizophrenic patient who, seeing that his [29-year-old] daughter was becoming progressively worse, asked me if there was anything new, any new discovery that might arrest the course of her illness.

[39]Zigmond Lebensohn, MD, provides specifics in his account of the event in Comprehensive Psychiatry:[40] "Dr Impastato's records reveal the following handwritten entry for January 7, 1940: 'Volts 70, T-.1 sec MA 400.

[36] Almansi later felt that the human urgency of the circumstances played a large part in the "precipitous" nature of the episode, among the more dramatic in the treatment's history.

By contrast, she cites the "compelling" case made by Impastato's chart for his first ECT patient, dated January 7, 1940, which is on file with his papers in the Library and Archives of the American Psychiatric Association in Arlington, Virginia.

She concludes: "In the absence of primary-source evidence to the contrary, or a differing interpolation of Impastato's file, this document would appear to identify the first ECT treatment given to a human subject in the U.S."