It is no secret, historical physicians have had some obscure theories and practices on how to treat patients. From the ancient Egyptian use of bloodletting[1] to the Victorian use of arsenic to treat anaemia; scientists and doctors have used all manner of methods to treat a physically or mentally ill person. However, there is one unusual treatment that still sparks controversy amongst psychiatrists and doctors to this day. This treatment is Electroconvulsive Therapy (ECT) and entails the use of electrically induced seizures to provide relief from mental disorders. ECT is still practiced today although under safer conditions.
In the early years of usage it was thought that ECT should be restricted to only treating depression, although many others utilised ECT to treat schizophrenia, epilepsy, neurosis and hysteria. In some institutions, some doctors were even using ECT as and a deterrent for bad behaviour[2].
The origins of Electroconvulsive Therapy can be traced back to the work of scientist Ladislaus von Meduna[3]. Meduna did not use electricity, instead opting for chemically induced seizures in animals, however it was his ideas that lead to the use of electricity as a possible alleviation for illness. In one instance, he used pentylenetetrazol to induce seizures for patients with catatonic schizophrenia. In 1935 he published the results of this type of therapy; of 110 patients treated, half recovered from catatonia. These results were rapidly reproduced in many places around Europe, throughout the remainder of the 30s, and in 1938 scientist Ugo Cerletti and his assistant, Lucio Bini successfully used electricity instead of pentylenetetrazol as a therapeutic treatment.
Lothar Kalinowsky, another assistant of Cerletti, bought ECT to the UK when he demonstrated Cerletti’s techniques at the Burden Neurological Institute (BNI)[4]. He stated that electrically induced seizures were cheaper and easier to administer than pentylenetetrazol seizures. Shortly after this Gerald Fleming, the medical superintendent of Barnwood House Hospital (Gloucester), Fredric Golla, a psychiatrist of the BNI, and William Grey Walter, a neurophysiologist at the BNI, wrote and published the first British paper on Electroconvulsive Therapy. They had tested five chronic schizophrenia patients with ECT. In the paper they discussed the method of ECT with electrical parameters, techniques used, seizures induced and electroencephalograms, but failed to discuss the therapeutic results of the test.
Later an article titled “More Shocks” was published and within it, stated that ECT “may well turn out to be a valuable step forward”[5] regarding treatments. Even though the article seemed to ostensibly support the use of Electroconvulsive Therapy, it also had a number of reservations. The article criticised Fleming’s claim that ECT did not require much training and conversely, that these techniques needed to be practiced precisely. It also queried Kalinowsky’s claims about the therapy not causing brain damage. In the 1950’s neurologist Max Fink applied rigorous scientific research methods to clear up concerns and give the treatment scientific legitimacy.
It has been documented since, that 70-90% of patients who have received ECT have had success where pharmaceuticals have been ineffective. ECT has also been proven to increase the resolution rate of psychiatric problems. Depression could be resolved in as little as one or two treatments, whereas medications might take weeks to even begin to have an effect. Improved ECT practice also means it can be safely used on pregnant women and people with heart problems if certain criteria is met..
Unfortunately, there are many negative aspects to Electroconvulsive Therapy. The common side effects of ECT include memory loss, confusion, paranoia, nausea, muscle aches and headaches[6]. Memory loss can either be long lasting, permanent or short term, none of the above being a welcome addition to a patient’s already troubled psyche. Likewise, there is also now no doubt that ECT causes damage to the brain, what remains to be known is the severity of the damage caused and how long the effects will last. One example of the negative effects of ECT is shown in Linda Andre’s book “Doctors of Deception: What they don’t want you to know about shock”. Linda Andre is a psychiatric survivor, activist and writer; she has spent the last 40 years recovering from the effects of ECT. After undergoing five years of ECT , she described the deletion of those years as “a terrible secret impossible to tell”. She now is the director of the ‘Committee for Truth in Psychiatry’, in which she encourages the US Food and Drug Administration to regulate ECT machines.
Books like Andre’s are not the only way ECT has been portrayed negatively in the media. The most famous use of ECT in a film is in “One Flew Over the Cuckoo’s Nest”. This movie led to bad press against the use of Electroconvulsive Therapy, as people did not want to turn out like Jack Nicholson’s character; a near comatose wreck. Following the release of the movie, articles were written about modern day use of ECT, however they failed to refer to contemporary use and instead used images referencing the treatment styles of the 1930/40’s, just as in the movie.
Another negative depiction of ECT comes from the Oscar nominated movie “The Changeling”. This movie portrays ECT as a violent, brutal way to sedate a patient. This movie caused bad press because it claimed to be based on a true story and insinuated that ECT was violent rather than therapeutic. However, the time in which the film was set was 10 years before ECT had even been invented, so the historical accuracy of the film is questionable.
A more recent depiction of Electroconvulsive Therapy can be seen in the second series of Ryan Murphy’s “American Horror Story: Asylum”. The use of ECT in this series, was used to illustrate it as a means of subduing and punishing patients, whilst disguising it as treatment. The series shows the effect of the treatment on the characters and depicts them as almost zombie-like, with all emotion erased from their face and minds.
In all three of these examples, the media portrays ECT negatively and each with life changing side effects for the worse. This could be a reason why the use of ECT has decreased since the 80’s. In the present day, Electroconvulsive Therapy is used as a last resort and is administered safely under strict conditions, yet despite this, the use of this therapy is still decreasing. Other than the negative media portrayal, another factor in this decrease is the cost of ECT. The average cost of 6 successive ECT sessions is “…£2475. This does not include inpatient costs, estimated as £171 per day”[7]. This is just too much money to use on treatment that could cause more damage than it can resolve.
Electroconvulsive Therapy still sparks controversy today for many reasons, the most pertinent being:
- The side effects can be so severe there is a threat to life.
- ECT is considered politically incorrect, expensive, and old fashioned in comparison with the varied pharmaceutical range of chemical treatments.
In some cases, it has been claimed to have been forced on patients, thus colouring the public opinion of the treatment even further.
Based on what you’ve read, do you believe ECT should still be administered today or even if it should have ever been administered at all? Was the work of Cerletti, Bini and Kalinowsky beneficial or did it bring damage to the world as it does the brain?
[1] Page(s) 12-14 – Premise. Gerry Greenstone and Page(s) 12-14 – Premise. Gerry Greenstone, ‘The History Of Bloodletting | British Columbia Medical Journal’ (Bcmj.org, 2020) <https://www.bcmj.org/premise/history-bloodletting> accessed 2 July 2020.
[2] L Mosher and D Cohe, ‘The Ethics Of Electroconvulsive Therapy’ (AMA Journal of Ethics, 2003) <https://journalofethics.ama-assn.org/article/ethics-electroconvulsive-therapy/2003-10> accessed 2 July 2020.
[3] ‘Meduna And The Origins Of Convulsive Therapy | American Journal Of Psychiatry’ (Ajp.psychiatryonline.org, 2006) <https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.141.9.1034?journalCode=ajp> accessed 2 July 2020.
[4] Colin Jones and Steven Jones, ‘Electro Convulsive Therapy: Milestones In Its History’ (2018) 38 Mental Health Nursing.
[5] ‘MORE SHOCKS’ (1939) 234 The Lancet.
[6] ‘Electroconvulsive Therapy (ECT) – Mayo Clinic’ (Mayoclinic.org) <https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894> accessed 2 July 2020.
[7] ‘Final Appraisal Determination Electroconvulsive Therapy’ (Nice.org.uk, 2002) <https://www.nice.org.uk/guidance/ta59/documents/final-appraisal-determination-electroconvulsive-therapy2> accessed 2 July 2020.
Written by Alfie Jacobs