There are few psychiatric therapies that are as controversial as electroconvulsive therapy (ECT) which sends
pulses of electric currents through the brain to intentionally cause a seizure. Few people would expect it to make a comeback.
Intended to treat severe and treatment-resistant depression, severe mania, catatonia, and dementia-associated agitation and aggression, ECT is usually
conducted two to three times per week for three to four weeks. It’s a treatment, not a “
cure.”
“Most people treated with ECT need to continue with some type of maintenance treatment,” the American Psychiatric Association stated.
Kitty Dukakis, wife of the Democratic presidential candidate Michael Dukakis,
told media outlets in 2016 that she receives maintenance treatment every seven or eight weeks. At least 100,000
Americans receive ECT every year,
according to Mental Health America.
It isn’t
known why ECT affects mental conditions, although the supposition of early developers—that the seizures of epilepsy somehow obviated
schizophrenia—was subsequently debunked, according to “Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness” by Andrew Scull, a distinguished professor emeritus of sociology at the University of California–San Diego. In the 1930s, doctors tried to induce seizures with drugs until Italian psychiatrist Ugo Cerletti saw the fits of electrically stunned pigs at a Rome
slaughterhouse and thought the same could be done with humans.
Many believe that electroconvulsive therapy, historically linked to patient
punishment or efforts to produce patient
compliance in mental health settings, has vanished. But it’s still popular and even experiencing an image makeover. According to Scull, in the days of Cerletti, the “sheer
violence” of the induced seizures often produced “fractures of the long bones or of hips sockets” and
dislocated jaws. Many medical
attendants were necessary to hold patients down during the procedures.
Today, patients are typically “asleep” under anesthesia during the procedure, so they feel no pain. Muscle
relaxants are given so that fractures don’t occur during the seizures. Major or minor
memory loss still continues to be an existential risk with ECT.
Some critics say that the procedures only “look” less violent and still take a bodily toll. According to Somatics, the company that makes the top-selling ECT machine
Thymatron: “During the ECT stimulus and seizure the jaw muscles commonly clench tightly. This poses risks of tooth fracture or displacement and biting of [the] tongue and cheeks. These can cause mouth bleeding with pulmonary aspiration of blood. These risks are mitigated by inserting a mouth protector prior to the electrical stimulus.”
Tooth fracture isn’t the only ECT risk listed in the Somatics’
Thymatron instruction manual. As with drug ads on TV, an entire list of possible adverse effects from ECT includes:
“adverse reaction to anesthetic agents/neuromuscular blocking agents; adverse skin reactions (e.g., skin burns); cardiac complications, including arrhythmia, ischemia/infarction (i.e., heart attack), acute hypertension, hypotension, and stroke; cognition and memory impairment; brain injury; dental/oral trauma; general motor dysfunction; physical trauma (i.e., if inadequate supportive drug treatment is provided to mitigate unconscious violent movements during convulsions) including fractures, contusions, injury from falls, dental or oral injury; hypomanic or manic symptoms (e.g., treatment- emergent mania, postictal delirium or excitement); neurological symptoms (e.g., paresthesia, dyskinesias); tardive seizures; prolonged seizures; non-convulsive status epilepticus; pulmonary complications (e.g., aspiration/inhalation of foreign material, pneumonia, hypoxia, respiratory obstruction such as laryngospasm, pulmonary embolism, prolonged apnea); visual disturbance; auditory complications; onset/exacerbation of psychiatric symptoms; partial relief of depression enabling completed suicide; homicidality; substance abuse; coma; falls; and device malfunction (creating potential risks such as excessive dose administration), and death.”
The Thymatron instruction manual also cautions staff to avoid the risk of “accidental shock” by not contacting “the patient, or any conductive surface touching the patient, unless wearing electrically insulated gloves.”
“If holding the patient’s jaw or touching the patient’s head during the electrical stimulus, make sure to use electrically insulating gloves,” it reads.
Does Money Drive the Continued Use of ECT?
Many critics of the mainstream medical system say that reimbursement potential shapes the character of treatment—that clinicians and hospitals base care on a “wallet biopsy” of how much the patient’s insurance will pay.According to Kenneth
Castleman, a biomedical engineer who has been on the faculty of the California Institute of Technology and the University of Texas, ECT costs little to administer and “
brings in about two billion dollars per year in the USA alone.”
On a
forum of the nonprofit Student Doctor Network website in 2019, one poster detailed ECT’s financial appeal:
“I think ECT has the potential to be extremely lucrative, but the challenge is that it only becomes so with volume. Paying nursing staff, an anesthesiologist, whatever it costs to have the space, the device itself, etc. is going to be expensive and completely [nonviable] if you’re treating only a handful of patients each day. If you have staff that know what they’re doing, you’re efficient, patients show up on time, and you’re only running one treatment room, I think it’s possible to treat anywhere from 3–5 patients per hour. If you really get things running and can run two rooms at once ... you could double that, but that would be an extremely busy day and arguably unsafe.”
In 2018, research cited in
MedPage Today also showed that finances factor into the use of ECT.
Specifically, it was found that when health care providers start patients with treatment-resistant depression on ECT earlier rather than later, it’s more “cost-effective.” ECT is usually only given after a patient has tried seven antidepressants unsuccessfully, according to the article, but giving a patient ECT treatment after only two unsuccessful antidepressants, “maximizes ECT’s health-economic value.”
Writers and Public Figures Touched by ECT
References to ECT aren’t just found in movies such as the 1975 film “One Flew Over the Cuckoo’s Nest,” in which ECT was cruelly administered to Randle McMurphy, the
character played by Jack Nicholson.
In 1972, the Democratic nominee for vice president, Thomas
Eagleton, a senator from Missouri, was dropped when his prior shock treatment for depression was revealed. Famous writer Ernest Hemingway had shock therapy at the Mayo Clinic shortly before killing himself in 1961.
Hemingway
reportedly said of the experience: “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.'’
The poet Sylvia Plath referred to ECT in her autobiographical novel, “The Bell Jar,”
writing, “I wondered what terrible thing it was that I had done'' to deserve the punishment of ECT.
Yet not all ECT recounted by public figures is cast in a bad light. Referring to the memory loss that occurs with ECT, late Star Wars actress Carrie Fisher
said: “Some of my memories will never return. They are lost—along with the crippling feeling of defeat and hopelessness. Not a tremendous price to pay.”
Kitty Dukakis told The
New York Times that despite lost memories, “the treatment had banished her demons.” Both
women were
troubled with mental health conditions and substance abuse.
Is ECT Making a Comeback?
Google “electroconvulsive therapy” today, and you'll be assured the treatments are safe and effective and that
outdated myths need to be put to rest, such as that it produces brain
damage. In 2018, a
60 Minutes segment, “Is Shock Therapy Making A Comeback?” anchored by Anderson Cooper told viewers that “ECT is now considered one of the most effective treatments for people who haven’t been helped by antidepressant medication.”
During the segment, Dr.
Sarah Lisanby, of the National Institute of Mental Health, told Cooper: “It’s not something that you have to be afraid of, and so many of my patients, after they’ve had ECT, say to me, ‘Why did I wait so long to do this?’” Dukakis makes an appearance in the segment and viewers are told that she “has undergone ECT more than 100 times.”
Many don’t welcome such a comeback. Dr. Peter R. Breggin, who has been
called “the conscience of psychiatry,” has criticized ECT as early as 1979 in his medical book, “
Electroshock: Its Brain Disabling Effects.”
“ECT works by damaging the brain,” he
wrote in an ECT synopsis. “The initial trauma can cause an artificial euphoria which ECT doctors mistakenly call an improvement. After several routine ECTs, the damaged person becomes increasingly apathetic, indifferent, unable to feel genuine emotions, and even robotic. Memory loss and confusion worsen. This helpless individual becomes unable to voice distress or complaints, and becomes docile and manageable. ECT doctors mistakenly call this an improvement but it indicates severe and disabling brain injury.”
In a phone interview, Breggin told The Epoch Times that ECT isn’t just growing in use, but that the intensity of the shocks that new machines are delivering is also increasing.
What Patients Say
While some patients embrace ECT, as we saw with Dukakis and the late Fisher, those touched by ECT whom The Epoch Times interviewed had sad and upsetting stories. Fred, 58, said ECT was suggested for his 82-year-old depressed mother, who was no longer making her own health care decisions. Before he could investigate the treatments, a sibling authorized the procedures.“At first, she was like our old mom—happy and energetic,” he said in an interview. “But after a few months, the positive effects wore off, and in two years, she had serious dementia, which she had not had before. She was never the same and died with the severe dementia.”
One woman using the pseudonym Jill was hospitalized with treatment-resistant depression and said the memory loss from her ECT treatment was so severe that she “did not remember having it or consenting to it until I opened the file with the paperwork from the hospital.” Jill couldn’t even remember the name of the doctor who recommended it. “I was in a total fog” after the treatment, she said. After five years, memories of much of her life are gone and unretrievable.
While suicide certainly occurs from depression, we also spoke to siblings of another family whose loved one took her own life soon after being “talked into taking ECT.” They blame the treatments.
A Final Note
ECT promoters often cite
neurogenesis—the growth of new brain cells—which is often seen on brain scans after ECT, as physical evidence that ETC works and how it works. For example, research published in the
Journal of Psychopharmacology in 2020 opines that “neurogenesis might contribute to the efficacy of ECT.” Research published in
Psychiatry Research in 2015 suggests that “ECT could possibly bring the long-term beneficial cognitive effect by regulating neurogenesis.”
Yet the medical literature also shows that neurogenesis tends to develop after brain injury—the very side effect of ECT that Breggin cited.
Research published in 2013 in the
Journal of Neurotrauma states: “Many studies demonstrate that various brain injuries induce neurogenesis in a number of neurological disorders in humans, including Huntington’s disease, ischemic stroke, Alzheimer’s disease, epilepsy, and aneurysmal subarachnoid hemorrhage.
“Our data suggest that neurogenesis may be induced in [the] human brain after TBI [traumatic brain injury].”
ECT may look better and cleaner today than it did half a century ago, but questions remain about its safety and increasing usage.
