Electroshock Therapy Making a Comeback
When American writer Ann Bauer penned a Salon article in May about the downward spiral of her autistic teenaged son and his seemingly impossible recovery, she told her readers everything. The frightening behaviour, the excrement-smeared sheets, even the time "he turned to look at me - his eyes empty and cold - then beat me until the neighbours heard me screaming and called 911." Everything, that is, but the therapy that gave Bauer back her "sweet and articulate" boy: electroconvulsive therapy (ECT), more commonly known as shock treatment. "Frankly," she later wrote, "I didn't feel like going through a hailstorm of reader outrage and Frankenstein jokes."
It's hard to blame Bauer, since she surely read right the prevailing public reaction to sending blasts of electricity through a human body. One present-day review of The Snake Pit, an earnest 1948 Hollywood drama that decried standard treatments for the mentally ill, mentions in passing that ECT is a "dated' technique, "today regarded as barbaric." In fact, it's the review that's dated. ECT is back, in a big way, in medicine (even if most people still think of it as a relic of an unenlightened past). And about time too, argue historian Edward Shorter and psychiatrist David Healy in Shock Therapy (UTP), their polemical but convincing account of the rise, fall and rise again of "the penicillin of psychiatry."
Less than a century ago, psychiatrists had nothing to offer for the major crippling disorders of depression or bipolar illness. Some frustrated practitioners began work with drugs, the first stirrings of the pharmacological revolution to come; others with physical remedies - therapies designed to act on the diseased brain, not on the mind. Many sought to "shock" the brain into readjusting itself - the concept of shock treatment predates the idea of using electricity to deliver it. Insulin, in fact, was the first means of inducing convulsions that proved effective. (Just how they worked to bring people out of catatonia or depression and banish suicidal compulsions remains a mystery. The current best guess is that ECT somehow reboots the brain, perhaps by repairing neurotransmitter receptors that bind to serotonin and dopamine, the two major "happiness" transmitters.)
But injections of insulin and later replacement drugs affected patients' health in other ways, and when Italian psychiatrist Ugo Cerletti pioneered the use of electricity as a delivery vehicle in 1938, mental health practitioners quickly embraced ECT. "It was a godsend," one reported at the time, "because, compared to nothing, it was an enormous relief. We used to see severe depressions and a suicide rate that was very, very high."
So what happened to give ECT its brain-frying reputation? It did have its problems: it didn't work on everyone; before psychiatrists administered muscle relaxants, the convulsions sometimes broke bones; there was frequent loss of memory, almost always restored within weeks, but real enough in the immediate aftermath; it just plain looked scary, with its gurneys and weird electrical machines, like - as Ann Bauer suggested - Victor Frankenstein's lab. Most importantly, ECT had natural enemies: psychoanalysts.
The entire biological logic of shock therapy was an affront to the psychological basis of analysis. As one Freudian asked in 1951, how could anything like this help someone whose real problem "is that his mother never loved him"? A 40-year clash between medical paradigms, according to Shock Therapy, won over the chattering classes to the analysts' side, that ECT was a sadistic assault on wretched people who really needed to talk. ECT's public image was fixed by movies like The Snake Pit and One Flew Over the Cukoo's Nest (1975), in which Jack Nicholson's character emerged an apparent vegetable from a conflated lobotomy-ECT treatment. Temporary memory loss was inflated in public opinion into permanent memory obliteration. Drugs were accepted as the humane way forward.
But as drug-resistant depression became increasingly recognized, convulsion therapy began its comeback. By 2004, the World Psychiatric Association had endorsed it as a first-line treatment - the best available - for severe depression. So it was, at the Mayo Clinic, that doctors were ready to use ECT on Ann Bauer's son. Eighteen hours after his first session, he was up and about, greeting his parents and playing cards. He would relapse and need further sessions, as well as drug therapy, but he had come "back to life," in Bauer's words. She decided to heed an appeal from the doctor who had referred her to the Mayo: "If you wish to help other parents of such adolescents, you should disclose the fact that, despite its stigma, electroshock is one of the most effective treatments in medicine." "Everything he wrote," Bauer declared, "is true."
See also MENTAL HEALTH.
Maclean's October 15, 2007