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Fry Your BrainWho came up with the idea of electroshock therapy?

By Christopher BeamPosted Wednesday, July 15, 2009, at 7:10 PM ET

The Chinese government has banned electroshock therapy as a treatment for Internet addiction after one psychiatrist administered electric currents to nearly 3,000 teenagers. When did we realize that you could shock someone to make them less crazy?

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In the 1930s. The idea originated with the theory that an inverse relationship existed between schizophrenia and epilepsy, since schizophrenics rarely had epilepsy and epileptics were rarely schizophrenic. This observation led a Hungarian neurologist named Ladislas Meduna to experiment with chemically induced seizure as a treatment for psychotic patients. (Doctors had been using convulsive therapy to cure madness as early as the 16^th century, when Swiss physician Paracelsus gave a patient camphor to induce seizures. But Meduna was unaware of the precedent.) The approach was effective, but the drugs took a while to kick in and were considered dangerous. A few years later, a psychiatrist named Ugo Cerletti managed to achieve the same effects using only an electric current. He first tested electroshock therapy on a human in 1938 on a vagrant he found in a Rome train station. Before treatment, the patient spoke only gibberish. After a series of high-voltage bursts, according to Cerletti, he began talking.

Electroconvulsive therapy, or ECT, quickly became a popular treatment for psychosis and depression. By the early 1940s, nearly half of American mental hospitals were using it. During World War II, depressed soldiers were given ECT. The practice declined in the 1960s and '70s, due in part to the rise of psychopharmacology. Drugs like tranquilizers, antispychotics, antidepressants, and lithium salts were less frightening to patients than getting hooked up to a machine. There was also a strong movement against hospitals and institutionalization, which viewed the treatment as inhumane. At the same time, negative depictions of ECT were common in popular culture, most famously in One Flew Over the Cuckoo's Nest. Shock therapy saw a revival in the 1980s and is now used on an estimated 100,000 patients every year.

So does it work? Yes, in the short run. Someone diagnosed with depression will usually take medication and undergo psychotherapy before resorting to ECT, but a mental health report by the surgeon general in 1999 said that "[n]o controlled study has shown any other treatment to have superior efficacy to ECT in the treatment of depression." Plus, whereas drugs take time to kick in, the results of electroshock treatment are immediate. That said, ECT is not a good way to treat addiction, anxiety, or personality disorders. Nor is it always a permanent fix.

ECT remains controversial because of the risk of side effects, particularly short-term confusion and memory loss. Studies have found that between 29 percent and 55 percent of ECT patients report experiencing some memory loss. But impairment varies depending on the type of treatment, as well as the person. A study published in 2006 found that the elderly, people with lower IQs, and women were at greater risk of memory loss after ECT.

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Explainer thanks Jonathan Sadowsky of Case Western Reserve University and Edward Shorter of the University of Toronto.

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Christopher Beam is a Slate political reporter. Follow him on Twitter.

Illustration by Robert Neubecker.

COMMENTS

There are lots of treatments which we know work, but we don't know how. If we have large scale studies, which provide compelling evidence of safety and effectiveness, what's the problem? One Flew Over the Cuckoo's Nest probably contributed to more depressed people being denied ECT and then killing themselves that just about anything else.

Raise whatever objections you like - ECT works, and is generally very safe.

-- NickBanglo
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Maybe the problem isn't so much the treatment itself, but who it's applied to. My grandmother, who in her 70s and 80s suffered from severe and unspecified dementia, intense headaches and memory loss, was given shock treatment. It was probably the worst thing that could have been done to her. Her memory worsened, she began to have vision problems which led to several falls (which she'd never suffered from before, and one of which probably damaged her left eye permanently), and she also began hallucinating. This all happened in a very short space of time after the shock treatment. It was probably one of the most painful and awful things I have ever witnessed. In fact, my grandmother's whole experience made me doubt the whole psychiatric profession - all they seemed to want to do is pump her full of drugs or shock her. I think she would have been much the same or better if everyone had just left her alone.

-- Tinyredcar
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To quote Robert Heinlein, another crazy guy, "A thing can look great on paper and be absolutely crumby in the field." So it goes with mental health treatment, at least in the bulk of my experience in the US. The cure is often at least as bad as the disease.

I have no issue with medications or drugs, if prescribed by a skilled psychiatrist who knows what he/she is doing, who listens to the patient, who has no agenda other than helping the patient generally get himself together. God knows the right ones certainly saved my ass. But psychiatrists like that are as rare as hen's teeth...I make the observation that a lot of people go into the "helping" professions not to help people be whatever the most is they can be or want to be--not to help people "be all they can be" to coin a phrase--but to have untrammeled power over people who have no voice and cannot fight back. Just a thought.

-- elbertthemindreader
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Slate's previous coverage of topic is pretty good, too. The archives are rich and include coverage of deep brain stimulation, a related topic...

-- Radiotone
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