Why shock therapy deserves its mini-revival.

Health and medicine explained.
Jan. 3 2008 7:38 AM

The Body Electric's New Look

Why shock therapy deserves its mini-revival.

 Edward Shorter and David Healy's Shock Therapy

The history of electric shock therapy would seem to lend itself to a rather straightforward tale of last-ditch, gruesome treatment of mental illness. After all, we've all seen One Flew Over the Cuckoo's Nest.

But in their new book Shock Therapy, Edward Shorter and David Healy say this version is almost entirely inaccurate. Shorter is a historian who has written extensively on psychiatry, and Healy is a psychiatrist who has been highly critical of the marketing of psychopharmacological drugs. They believe that electroconvulsive therapy is incredibly effective. And yet for decades, a severely depressed patient—even one on the brink of suicide—might not have been offered the therapy, or if her doctors had proposed it, she or her family might well have declined it. In explaining why, the authors demonstrate that though we may assume medical treatments get adopted or rejected based on objective statistics, in fact data are often misinterpreted and manipulated by outside influences that end up overpowering them.

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The history of ECT began in 1938, when Italian psychiatrist Ugo Cerletti connected a pair of electrodes to the head of a schizophrenic mechanic and shocked him until he seized. Cerletti was building on earlier work showing that seizures caused by injecting insulin seemed to help certain mentally ill patients. After several ECT treatments, Cerletti reported, the man's confusion and mutterings had resolved. Doctors did not know how ECT worked, although it was assumed that the seizure relieved symptoms by somehow "resetting" the nerve cells in the brain. But they were quite sure that it did work, not only for certain forms of schizophrenia but also for severe depression, a discovery made when Cerletti and others tried the technique on a broad range of patients. As one psychiatrist wrote about treating depressed patients with ECT: "It was like a miracle. I always related it to Lazarus risen from the grave." This was the professional response, moreover, even though early ECT was primitive, causing uncontrolled seizures and fractured bones even as it treated disease.

By the 1940s, Shorter and Healy write, ECT "had become part of the therapeutic apparatus of nearly every mental hospital" across the globe. In 1959, Group Health Insurance, a company that insured New York City employees, proudly announced that it would cover "ten electroshock treatments, in or out of the hospital," for all of its subscribers.

But within a decade, ECT would become stigmatized as dangerous and even sadistic, "a fearsome last-ditch remedy to be used only under extraordinary conditions and under the most elaborate legal safeguards," as the authors put it. This is the best-known part of the story. ECT fell out of favor for several reasons. When phenothiazines, the first pills that could treat schizophrenia, became available in the early 1950s, pharmaceutical companies marketed them as better and safer than shock therapy even though they did not always work and often caused jerking movements and other side effects. This marketing dovetailed with the social upheaval of the 1960s, which led to the formation of the so-called anti-psychiatry movement, a loosely based coalition of activists, disenchanted mental health professionals, and patients. They charged that psychiatric hospitals, through procedures such as ECT and lobotomy, were punitive as opposed to therapeutic—a la the 1962 novel One Flew Over the Cuckoo's Nest, which was made into a film in 1975. When the hero, Randle P. McMurphy, receives damaging ECT and a lobotomy, it is essentially to prevent him from saving the other patients. And this link between shock therapy and the second, much more dubious procedure made it seem all the more frightening.

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