This controversial therapy is more widely used than ever, but its troubling consequences remain
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. It is unlikely that it will make a comeback.
Intended for severe, treatment-resistant depressions, severe mania and catatonia as well as dementia-associated agitation, aggression and aggression. ECT is usually performed up to 3 times per week, lasting between three and four weeks. It’s a treatment, not a “cure.”
” Most people who have been treated with ECT should continue receiving some form of maintenance therapy,” stated the American Psychiatric Association.
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. It’s still very popular, and is even undergoing a facelift. 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.
*) Patients are usually “asleep,” or asleep, during anesthesia. This means that they don’t feel any 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 claim that while the procedure is less dangerous than it actually is, they still cause bodily harm. 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. There are risks of teeth fracture, displacement or biting [of] the tongue and cheeks. They can lead to mouth bleeding and pulmonary aspiration. This can be mitigated by placing a mouth protector before the electrical stimulation .
Tooth fracture isn’t the only ECT risk listed in the Somatics’ Thymatron instruction manual.
There are many possible side effects of ECT, just like drug commercials on television.
“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 warns staff that they must avoid contact with the patient or touch any conductive surface, except when wearing electrically insulated gloves .”
” When holding the patient’s jaw, or touching their head with the electric stimulus, use electrically insulating gloves.” it states.
Does Money Drive the Continued Use of ECT?
Many critics of mainstream medicine claim that the reimbursement potential influences the nature of treatment. Hospitals and clinicians base their care on what the insurance company will cover.
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 believe ECT can be very lucrative. However, the problem is that it becomes more so as you increase your volume. It costs money to hire nurses, anesthesiologists, and any other expenses that are related to the equipment, space, or staff. If you only treat a few patients per day, it will be very expensive. It’s feasible to see 3-5 patients an hour if you have competent staff, efficient patients, and a single treatment room. You could run more rooms if you are able to get the things moving and you have enough staff. However, that would make it very busy and potentially unsafe .”
In 2018, research cited in MedPage Today also showed that finances factor into the use of ECT.
Specifically, the study found that ECT can be more cost-effective if it is given to patients suffering from treatment-resistant depressive disorder sooner than seven unsuccessful treatments. However, ECT should only be administered after two failed antidepressants have been tried.
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? We lost the patient .”
. It was an amazing cure.
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.
But not every ECT story recounted publicly is bad. Referring to the memory loss that occurs with ECT, late Star Wars actress Carrie Fisher said: “Some of my memories will never return. These memories are gone, along with the hopelessness and crippling sense of defeat. .”
is not a high price.
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 like the idea of ECT making 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 may cause artificial euphoria, which ECT doctors incorrectly label an improvement. The person with severe trauma becomes more apathetic and indifferent after several routine ECTs. They are unable or unwilling to experience genuine emotions. The confusion and memory loss worsen. The helpless person becomes incapable of expressing distress or complaining and is able to become docile, manageable and sociable. This is what ECT doctors incorrectly label an improvement, but it means that there has been severe brain injury .”
Breggin stated that ECT usage is increasing, and that it is also increasing the severity of shocks delivered by new machines in a telephone interview.
What Patients Say
While some people embrace ECT, others, like Dukakis or the late Fisher had heartbreaking stories. Fred, 58, said ECT was suggested for his 82-year-old depressed mother, who was no longer making her own health care decisions. A sibling approved the procedure before Fred could explore the options.
” At first she looked like her mom, happy and full of energy,” he stated in an interview. After a while, her positive feelings began to fade and she developed severe dementia in the second year. After a few months, she was no longer the same person and passed away from severe dementia .”
A woman referred to as Jill, was admitted for treatment-resistant depression. She said that her memory was so bad from her ECT treatment she couldn’t remember who prescribed it. She said that she was “in a complete fog” following the treatment. Five years later, her memories are no longer valid.
While suicide is a result of depression, siblings from another family spoke out about their loved ones who took their lives after they were “talked into taking ECT.”
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.”
However, the medical literature shows that neurogenesis can develop following brain injury — which is exactly what 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 suggests that after TBI (traumatic brain injury ].”
), neurogenesis might be inducible in the human brain.
ECT might look cleaner and more modern than half a century back, there are still questions about its safety as well as increasing usage.