Biology 103
2000 Third Web Report
On Serendip

ECT was developed in Europe in the 1930s when doctors and psychiatrists observed that occasionally schizophrenic individuals who later developed epilepsy would become less schizophrenic as a result. From this evidence, doctors began to chemically induce epileptic seizures in schizophrenics with positive results. Then came the development of using electric currents to induce the seizures. Using electricity was less complicated and easier to administer. However, when more forms of psychotropic medication were developed, ECT moved to the sidelines, and drugs became the preferred method of treatment for mental illnesses. In the 1970s when doctors and psychiatrists began to have patients for whom the psychotropic drugs failed, ECT was brought back, and modified and modernized to be safer, including the administering of anesthesia for the procedure, which had not been previously done.(3).

The procedure of receiving ECT as a treatment goes as follows. The patient is hooked into equipment to monitor their vital signs and anesthesia followed by a muscle relaxant are given. Electrodes are placed either on both the left and right temple or on the right temple and the back of the head (Bilateral and Unilateral ECT respectively.) Then an electric stimulation of up to 450 volts is administered to the patient's brain and a seizure of 30-180 seconds in length follows. During the procedure the patient is breathing pure oxygen. The patient awakes within minutes and a half hour later is able to get up and walk around. Immediate side effects include headache, nausea, muscle aches, which are treated with medications.(2,3).

ECT is a form of treatment that is today recognized by the American Psychiatric Association (APA), the American Medical Association, the National Institute of Mental Health, as well as comparable medical and psychiatric institutions abroad. The APA website gives a description of ECT as though it were comparable to a minor out-patient procedure, (although it is indeed primarily an in-patient procedure.) ECT, however, is not tested or regulated by the Food and Drug Administration (FDA).(1,5).

Both the APA and Dr. Max Fink, a neuropsychiatrist with a mission to allay public fears of ECT, state on their respective websites that ECT is only used for severe cases of mental illnesses in which an individual's daily life is adversely effected. This includes, but is not limited to, individuals who suffer from bipolar disorder, depression, schizophrenia, and catatonia. ECT is also only recommended when more than one type of psychotropic drug has proven ineffective for a particular individual.(1,3).

>From the anti-ECT side, however, there comes a different tale of the uses and effects of ECT. One counter argument is that any modification in ECT procedure and equipment since the 1950s is "cosmetic". Anesthesia and muscle relaxants don't make the procedure any safer and may even increase risks because each type of drug carries its own set of side effects. These additions to the procedures were added simply to calm the fears of perspective patients of ECT, (i.e. make it look and seem safer because there would be no pain felt and the body would not thrash about during seizures.) The amount of electricity that modern ECT machines send into a human brain (up to 450 volts) is enough to kill the patient if it were applied to the chest. There is also evidence that doctors in Britain are now using ECT to treat less severe mental illnesses such as post-partum depression, and bereavement, which has activists in a rage.(5,2).

It is the widely accepted belief now that mental disorders and illnesses are a result of the chemical imbalances of the brain's neurotransmitters. The development and use of psychotropic drugs came about because they work to rebalance these brain chemicals. Dr. Fink argues, however, that ECT is more effective than the psychotropic drugs because it gives treatment to more than just the unbalanced neurotransmitter chemicals. It also treats endocrine glands in the brain that produce and regulate hormones. Hormones are also linked to mental disorders, such as post-partum depression, which is caused by the imbalance of sex hormones. ECT stimulates the endocrine glands in the brain and can rebalance hormones as well as neurotransmitter chemicals. Therefore ECT gives a more comprehensive treatment than the psychotropic drugs which only work on neurotransmitter chemicals.(3).

One anti-ECT group on the internet is Support Coalition International, which advocates for human rights within all of what they call the "mental health system." Support Coalition International also believes that no major changes have been made in the way ECT is administered, and "Fraud, coercion and even force are still used to give shock."(5). The Coalition has gathered a great deal of evidence that doctors in psychiatric hospitals are administering ECT by force to patients who in many cases have refused it as a method of treatment. On their website, they have news of a case that broke earlier this month involving a 25 year old male in a psychiatric institute in New York. A court had ruled in favor of forcefully administering ECT to this patient because doctors in the hospital had found that psychotropic drugs had failed and in fact proved harmful to the patient. The doctors though that ECT would be the best course of action in terms of this man's treatment, even though when they asked the patient and his family they said no.(5).

The Coalition has also gathered evidence that the effects of ECT on memory are not temporary, as doctors would have patients believe, but long lasting. Also, studies show that positive results from ECT last up to roughly 4 weeks and treatments result in cumulative brain damage.(5).

Aside from what expert doctors/neuropsychiatrists and militant activist have to say about the issue, the data from patients' personal experiences is also conflicting. The following are two personal accounts of ECT as a method of treatment.

"My medications weren't working...[then] I started to see a new doctor...[who] is trained to do ECT. ...I checked myself into the mental ward of a hospital. I told my doctor that I wanted to try ECT. ...It has been two weeks now. I feel better than I have in years. In fact, I think I feel better than I ever have. I can now get out of bed and lead a normal life. I have so much motivation. Mentally, I feel sharp and alert. My short-term memory was only temporarily affected. I am writing more, and excelling at everything I do. ...It is not nearly as scary as it is made out to be. The risks are very low, and it really works." (4).

"I am an individual who has undergone a series of the so-called "new and improved, more humane, and safe and effective" shock treatments.... These occurred when I was unable to say "NO" because they were done to me as I lay in a medically unconscious state. ...Not only did it not benefit me, I have suffered harm as a result of receiving those treatments. ...In my opinion, shock treatment is, always has been and will always be, a crime against humanity done to people under the guise of so-called medical treatment and thus shielded, protected and legitimized by the medical profession and certain governmental and non-governmental entities."(6).

Both of these patients have very strong feelings about their experiences with ECT as a form of treatment for their mental illnesses. It is difficult to tell which side of the argument has a stronger case. Both cases are strong and have valid evidence. However, it is clearly up to the individual seeking treatment to decide what is best for them. In the end it is clear to me that this is where the true problem lies: ECT - while it may or may not be an effective or safe course of treatment - should indeed be administered with the consent of the patient and not by force, fraud or coercion.

WWW Sources

2) Anti-ECT information page

3) Pro-ECT site by Max Fink, M.D.

4) A personal account of a positive ECT experience

5) Support Coalition International , anti-ECT grassroots advocacy group

6) A personal account of a negative ECT experience

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