"Shock" Therapy

It's Not a Thing of the Past!

By David Boy

THE STIGMA AND CONTROVERSY OF "ELECTROSHOCK" THERAPY

Although electroshock is now commonly accepted and sanctioned by most medical associations and physicians, it is still the “most controversial treatment in psychiatry.”¹ Much of the stigma associated with electroshock, or electroconvulsive therapy (ECT), comes from its portrayal in films such as One Flew Over the Cuckoo’s Nest or The Snake Pit where the treatment is given to mental patients against their will. With the introduction of anesthesia, controlled oxygenation, and muscle relaxation, contemporary ECT has done away with the writhing convulsions depicted by Jack Nicholson’s character in One Flew Over the Cuckoo’s Nest.² These and other films have also caused confusion by failing to differentiate between ECT and abandoned treatments such as frontal lobe lobotomy.

Even though ECT is not completely risk free, it is far different from the past methods that gave it a bad reputation. Its use began in the early 1930s, when researchers injected chemicals to induce seizures in people with mental illnesses. The chemicals were soon replaced by electrical currents. It then came into widespread and sometimes indiscriminate use over the next few decades, before the advent in the 1950s of medications to treat depression.³

In the early days of ECT, before anesthesia and muscle relaxants, the electrical current was also much higher than what is used today. Patients would undergo violent seizures that had the potential to break bones. The images of doctors and nurses holding people down as they went through these seizures were recorded in movies and books that left quite an impression on their audience.

Although anesthesia now helps make ECT a safe procedure, there is still a significant stigma attached to the treatment. Claims of misuse, the idea that ECT is used as restraint, and confusion about its side effects, all contribute to widespread uneasiness about ECT use.⁴ These false beliefs may lead to unfounded fears which could discourage potential patient from seeking this oftentimes effective treatment. Therefore, it is important that potential recipients of ECT educate themselves and their loved ones about the potential positive and negative effects of the treatment.

The controversy surrounding ECT, says physician and ECT practitioner Max Fink, “is not about its efficacy and safety, which have been proved, but about the idea that the treatment actually alters the brain, changing the person=s personality and character.”⁵ Fink goes on to assert that this is a mistaken idea promulgated through the popular false perceptions of ECT. However, this topic is open to much debate, as evidenced by some research which demonstrates that ECT frequently results in memory loss and temporary personality change.⁶

WHAT IS ELECTROSHOCK THERAPY?

ECT is a method of treating mental disorders in which electric current is passed through the brain causing a storm of electrical activity in the brain. Although little is known about how ECT actually works, a seizure induced by the electric current creates substantial improvement in the conditions of many who undergo the therapy. ECT is most commonly used with “severely depressed patients when other forms of therapy are not effective, cannot be tolerated or will not help the patient quickly enough.”⁷ Schizophrenia and other mental and neurological disorders can also be treated by ECT.

For severe depression, ECT has a higher success rate than any other form of treatment.⁸ ECT often proves useful in individuals who do not respond, or cannot receive, other treatments. Thus, “It is particularly useful for people who suffer from psychotic depressions or intractable mania, people who cannot take antidepressants due to problems of health or lack of response and pregnant women who suffer from depression or mania.”⁹ Also, unlike antidepressant medication which may require three weeks to take effect, ECT usually yields results much earlier.

WHAT DOES THE TREATMENT LOOK LIKE?

The American Psychiatric Association describes the ECT treatment process as follows:

A course of treatment with ECT usually consists of six to twelve treatments. Treatments are usually given three times a week for a month or less. The patient is given general anesthesia and a muscle relaxant. When these have taken full effect, the patient's brain is stimulated, using electrodes placed at precise locations on the patient's head, with a brief controlled series of electrical pulses. This stimulus causes a seizure within the brain, which lasts for approximately a minute. Because of the muscle relaxants and anesthesia, the patient's body does not convulse and the patient feels no pain. The patient awakens after five to ten minutes, much as he or she would from minor surgery.¹⁰

Because of a higher relapse rate after the use of ECT than with pharmacological intervention, there is sometimes a need for “maintenance” or “continuation” treatment after the initial course of ECT. Maintenance treatments are often needed because patients who receive ECT have usually demonstrated that they receive little help from psychotherapeutic medications.¹¹ Although it is difficult to predict how many treatments of ECT will eventually be needed, it has been suggested that the number of maintenance treatments is rarely fewer than six.¹²

ARE THERE ANY SIDE EFFECTS?

Immediately following the treatment, some recipients report headaches, nausea, or confusion...all of which can be seen as side effects in any anaesthetized procedure.¹³ In addition patients sometimes report difficulty remembering new information learned during the course of the ECT, or certain events that occurred in the time leading up to the treatment. Usually the memories return when the course of ECT is completed. In fact, many patients report improved memory function, because the problems with concentration and memory caused by depression have been relieved.

It is also important to remember that there is a small amount of risk associated with ECT, just as with any other medical procedure. However, this risk is similar to that of most other procedures in which anesthesia is used.

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¹ Fink, Max. Electroshock: Restoring the Mind. New York:Oxford University Press, 1999. Preface.

² Ibid

³ Electroconvulsive therapy: Dramatic relief of severe mental illness." Taken from www.mayoclinic.com Viewed on 7/1/05.  

⁴ Ottoson, Jan Otto and Fink, Max. Ethics in Electroconvulsive Therapy. New York: brunner-Routledge, 2004. Pgs 3-19.

⁵ Electroshock: Restoring the Mind. Preface.  

⁶ Carlson, Neil R. Psychology: The Science of Behavior. 3rd Ed. Boston: Allyn and Bacon, 1990. Pg.625.  

⁷  Fact Sheet on Electoconvulsive Therapy (ECT). Washington, DC Amercian Psychiatric Publishing Group, 1977.

⁸ Paplos, Dimitri. "Overcoming Depression." Viewed on 7/18/05 from www.medhelp.org/lib/ect.htm  

 ⁹ Ibid

¹⁰ "Electroconvulsive Therapy (ECT)". Taken from the website for the American Psychiatric Association.  

¹¹ Electroshock: Restoring the Mind. Pg. 14.  

¹² Ibid.

¹³ "Electroconvulsive Therapy (ECT)". Taken from the website for the American Psychiatric Association.