Electroconvulsive Therapy: Fake News?

In my Abnormal Psychology class, we had to write a paper relating three topics between a video and the material in the textbook/class. This assignment’s video was about the effectiveness of the controversial mental illness treatment: electroconvulsive therapy.  This is my take on it.

            Electroshock therapy, or electroconvulsive therapy (ECT), has been used as a treatment since the 1930s for psychological disorders such as severe depression and schizophrenia. While there has been widespread debate since the early 20th century about the use and value of ECT, there have also been many cases of ECT successfully improving patients’ mental health. A more modern example was presented in the TED Talk by Dr. Sherwin Nuland, from a first-person perspective. The topics discussed in this presentation included the way ECT was introduced to Dr. Nuland’s case not as a first choice by any means, other early mental health treatments, and of all things, the involvement of a certain famous figure in human history who may after all seem like the obvious individual to be involved.

            ECT has been a topic of controversy since about the 1960s. Indeed, it is generally used as a last resort for the hopelessly depressed, suicidal, or psychotic. This is demonstrated by Dr. Nuland’s personal experience with ECT and the process his doctors went through to administer this treatment in the 1970s. While at first they thought only a lobotomy would work to treat Dr. Nuland, who was going through an incredible depression, they conducted a series of ECT treatments just to humor Dr. Nuland’s highly-esteemed resident doctor who suggested it. Then to their surprise, Dr. Nuland’s psychological state improved—the ECT was a success, which happens with only 50% of patients who do not respond to psychotropic medication.

            Dr. Nuland relayed a brief history of mental illness and convulsions in medicine. In that brief history, he mentioned that psychiatrists in the 1930s noticed a correlation between their depressed, epileptic patients having epileptic fits and their depressions lifting afterwards. This became part of the tradition of using convulsions as a treatment, if not a cure, for mental illness. Similar correlations have been found in treating “mad” patients with malaria and with insulin. Syphilis patients would present with symptoms of psychosis, a condition termed general paresis, and before the discovery of penicillin, an effective treatment of the illness was infecting them with malaria. As a result, the high fever burned out the syphilis bacteria and many patients recovered from the syphilis and general paresis. Another treatment called insulin shock therapy became popular around the same time as ECT. High doses of insulin were found to cause convulsions and temporary comas, but afterwards, some patients’ mental health improved. Later, due to the high risk of coma and death associated with insulin shock therapy, ECT replaced it. ECT, the malaria treatment, and insulin shock therapy are all controversial for ethical reasons nowadays, but they were among the first treatments to make a connection between mental illness and physical conditions, and using a potentially harmful treatment like infections or convulsions.

            Dr. Nuland also spoke briefly of Benjamin Franklin’s famous discovery of electricity with his kite, nearly electrocuting himself in the process, and doctors after that were inspired to use electricity as a means of producing convulsions in their patients. However, what Dr. Nuland does not elaborate on, and what many people do not know, is that Franklin discovered not only how to harness electricity, but also experimented on electricity’s effects on the human body and brain as early as the 1750s. He determined that electric shocks produced bodily convulsions and memory loss but otherwise caused no harm. A doctor friend of his tried these electric shocks on himself and reportedly felt “strangely elated,” which led him to wonder whether electric shocks could be used to treat depression. In regard to the development of ECT, the rest is history.

            Because of the controversy surrounding it, and the decades-long debate about its usefulness, Dr. Nuland’s firsthand account of the effectiveness of ECT came as an interesting surprise. What was also surprising were the similarities of ECT to other early mental illness treatments, Benjamin Franklin’s contributions, and the frequency of cases in which the patient does not recover their mental health after ECT treatments. I did not expect the reaction Dr. Nuland, and so many others over the years, had after their treatments. It definitely opened my mind to new (or old, like ECT) possibilities considering mental healthcare, but also made me realize there is so much about the human body and mind we do not know and have never known in all the centuries of study, such as the reasons behind the success of electroconvulsive therapy.

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