Electroconvulsive therapy

A patient lays on a table, surrounded by people in starched white uniforms. They open their mouth and something is put in their mouth. Electrodes are applied and they begin
to convulse, violently, their face a map of agony.

Repeated in countless films over the years,
it's a popular image for mental illness.

It's Electroconvulsive Therapy.




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ECT was introduced to the therapeutic world in 1938
by Italian neuropsychiatrists Lucio Bini and Ugo Cerletti.
Dr. Cerletti became interested in the electrical shocks applied to the temples of pigs being prepared for slaughter. The electricity left the pigs unconscious, but not dead.


At the time, it was that believed that epilepsy and schizophrenia never appeared in the same person
at the same time. Since epilepsy caused seizures,
it was thought that by artificially inducing seizures,
one might cure schizophrenia.

It was not the only shock therapy on offer. People were being overdosed on insulin to induce convulsions or perhaps a brief coma. Shock and convulsion experiments were being done with strychnine, metrazol and other substances, as well as inducing high fevers via malaria.
I'm not making this up.


When Dr. Cerletti tried it on his patients, he found
the shocks rendered obsessive and difficult mental
patients meek and manageable. ECT caught on,
and became a common form of treatment in the
1940s and 1950s in Europe and North America.












100 to 150 volts of electricity was applied to the brain,
via an alternating current. This is fired through the brain
for anywhere from a tenth of a second to about 1 second, inducing a seizure.

The current travels from temple to temple (bilateral)
or from the front of one side to the back of it (unilateral), depending on where the electrodes are applied.














It was later found that epilepsy and schizophrenia can appear in the same person, but ECT remained in use as it clearly was having an effect on patients.

It is especially recommended for patients who do not respond to drug therapy or whose depression has led them to seriously consider suicide.



























It has long been a controversial therapy. Some swear by it, including Carrie Fisher who has regular ECT sessions.Others see it as a form of torture and note it was often
used to subdue troublesome patients, by giving
them several shocks a day.

Public figures who experienced ECT include Paul Robeson, Lou Reed, Peter Green, Yves Saint Laurent, Gene Tierney, Roky Erickson, Vladimir Horowitz, Judy Garland,
Cole Porter, Oscar Levant, Dick Cavet, Ernest Hemingway, Sylvia Plath and Frances Farmer.









 

As always, there are studies- studies that point to it's good effect and studies that show it as high voltage snake oil.
What is known is that ECT on its own does not usually
have a sustained benefit. Half those who remit then
relapse within six months.

And also as always, when it comes to mental health treatments, there are side effects. The most common side effect of electroconvulsive therapy is memory loss. 

It's implicated in the suicide of Ernest Hemingway.
He became extremely depressed, was medicated and ultimately given ECT; but he became even more depressed and complained about the effects of the electroshock -

   "Well, what is the sense of ruining my head
     and erasing my memory, which is my capital,
     and putting me out of business?
     It was a brilliant cure
     but we lost the patient...."

In 1961, after a second series of ECT, Hemingway
used his shotgun to commit suicide.












Two years later, Sylvia Plath would publish The Bell Jar, based on her descent into mental illness and treatment including ECT and insulin shock treatments. Her ex-husband Ted Hughes has suggested The Bell Jar may have been
a response to years of electroshock treatment
and the scars it left.

Soon after it was published, she committed suicide.




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To this day no one is really certain quite
why ECT works for some patients.





Neuroscientist Christian Schwarzbauer at the University of Aberdeen suggests that depression may be caused by an overactive brain, where there is so much internal communication that the brain becomes preoccupied
with itself and less able to process information coming
in from the outside world.

There is a growing interest in repeated transcranial magnetic stimulation (rTMS), where a magnetic field
is passed over the scalp above the brain. It may offer
many of the benefits associated with ECT with less
risk of cognitive dysfunction like memory loss.

The development of more effective drugs for the
treatment of depression and other mental health
issues has been key to the decline in the use of ECT,
but it is still in use today around the world.

The process has evolved to minimize the negative
effects and ensure to some degree that patients
are undergoing the procedure of their own free will.

The closest most people will ever get
to Electroconvulsive therapy aka electroshock
aka ECT is the scene in the movie
One Flew Over the Cuckoo's Nest....

Based on the novel of the same name, the film
was informed by Ken Kesey's experience as an
orderly working graveyard shifts at a mental
health facility in California.



     "The Shock Shop, Mr. McMurphy, might be said
       to do the work of the sleeping pill, the electric chair
       and the torture rack. It's a clever little procedure,
       simple, quick, nearly painless it happens so fast,
       but no one ever wants another one. Ever."

                                       from One Flew Over the Cuckoo's Nest

Here is a look at the history and current procedures
for administering ECT.

The Wikipedia entry on ECT.

Did you know that the Frank Zappa song Camarillo Brillo refers to a hairstyle resembling that of a mental patient who has recently received ECT?
In Canada, ECT is used more than 15,000 times
across the country every year.

There is a lot of news and background information
about the use of electroshock at Mindfreedom.


There's a fascinating summary of the treatment
and a nice list of links for further reading here.


If you'd like to purchase a unit yourself,
Welcome to Somatics, the World's Leader in ECT Innovation and Sales




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