Using electroconvulsive therapy (ECT) on the big screen of cinema to add to the audience’s horror or entertainment experience began with the 1948 Academy-award-winning The Snake Pit. With the element of trumpets signifying the treatment beginning, a cacophony effect was added to establish chaos. The reality of ECT being medically and carefully administered was not part of the narrative.
The Snake Pit did do a relatively good job in establishing that ECT was effective, as evidenced by the main character’s ability to recover enough to begin cognitive therapy.
Fast forward 25 years to One Flew Over the Cuckoo’s Nest and audiences were spellbound by the antisocial personality disorder experienced by Jack Nicholson’s Randle McMurphy character and theories defining sanity.
After all, the brain and its inner workings have long fascinated humans’ curiosity because, until relatively recently, it was hard to explore to even gain a semblance of understanding.
Always looking for new areas to explore is part of our DNA, going back to creating fire, sailing the high seas on some unseaworthy vessels, and shooting rockets into the atmosphere to see what exactly the moon looked like underfoot, rather than through a telescope.
But messing with a brain through volts of electric shocks? Now that’s downright unsettling to most. We know enough about the brain to know that it affects our cognitive functioning and central nervous system (CNS). One wrong whack can send someone to seeing stars or to an unconscious state. Surely a brain should be left well enough alone? It would take something really important to change this—pardon the pun—mindset.
History Behind Procedures To Cure Mental Illness
What if by introducing a different illness, a person could cure a person of a more extreme condition? That was the approach of Hungarian psychiatrist and neuropathologist Ladislas J. Meduna. He theorized in 1934, by comparing brain sections of patients with epilepsy to those of schizophrenics and noting similar concentrations of microglia, that he could induce seizures through an injection to cure some mental conditions.
Meduna did just that with a catatonic patient who, after five treatments, improved and was able to speak, talk, and feed himself. According to a 2017 article in Scientific American, “by the fifth seizure he induced on February 10, 1934, the man awoke, dressed himself, requested breakfast and greeted Meduna cheerfully by name. ‘I hear them talking that you were going to make some crazy experiment? Did you do it?’ he asked.”
Microglia maintain neural networks and regulate brain development and injury repair. Essentially, they “clean up” protein build-up, synapse duplications, and remove microbes and dead cells that affect CNS functioning. In essence, Meduna recognized early on that targeting microglia within the brain for therapeutic intervention produced positive results.
In his wake, as ECT increased in study, injections were replaced with measured electrical stimuli applied through electrodes strategically placed on the head’s exterior.
There have been many myths told and believed, both how and why ECT is used.
Myth #1: ECT Is Barbaric and Cruel
Movies Often Deal With Fiction, Not Facts
For example, ECT portrayals grew increasingly negative with depictions such as in One Flew Over the Cuckoo’s Nest, showing it as a form of punishment, and negative again with 1963’s Shock Corridor with a barbaric scene.
These movies have been shown to medical students as well, coinciding with accurate information about ECT procedures, to continue to overthrow myths that have been passed along with the moviegoing public.
Anti-Psychiatry Groups Oppose Medication
Neuroscientist Irving M. Reti, M.B.B.S., is the director of ECT Service at The Johns Hopkins Hospital and quite outspoken in his assessment of anti-psychiatry groups as behind most of the inaccurate portrayals of ECT therapy. Reti said the groups are opposed to treating depression with medication.
Reti points to proven lack of pain during therapy due to the unconscious state and reinforces that medication may prove effective in managing symptoms following therapy.
People are often under the impression of ECT as depicted through visions of someone writhing and screaming in a straightjacket, as seen in movies. Though inaccurate, it doesn’t help but offer some excitement for the popcorn-munching audience sitting transfixed and unable to look away.
The reality is not as exciting. Patients discuss all the benefits and side effects of the possible treatment, as with any medical procedure. They are made comfortable with muscle relaxants and anesthesia and undergo impulse treatment that is regulated and takes 5 to 10 minutes.
They wake up in a recovery room, and as in many outpatient procedures, can return home the same day with someone else driving. Some patients undergo the therapy while seeking inpatient care, and return to their rooms on-site.
Myth #2: ECT Is Only For The Most Severe Cases
With no visual proof of a physical problem, many people find it hard to wrap their brains around the idea of mental illness as real and therefore treatable. An obvious dangling broken arm is proof of a problem. The solution is also relatively simple involving splinting with a cast until the bone is healed properly.
Mental illness has long been subject to whispers and stigma. Sometimes the words “breakdown,” “nervous,” “weak,” or “crazy” have been tossed around carelessly, to mask the discomfort of others when dealing with a topic for which they are not educated. In absence of understanding a root cause and treatment, it is part of the survival instinct to cast off those deemed “damaged,” as they aren’t considered strong or whole.
Extreme depression affects an individual’s quality of life, social connections, and the ability to work. Extended periods of isolation and sleep, along with hopelessness and despair of feeling any better are real. In fact, according to results from the National Survey for Drug Use and Health, 17.3 million American adults, or 7.2% of the population, have experienced severe depression lasting longer than two weeks.
The typical treatment protocol is cognitive behavioral therapy and holistic therapy, along with medications. When depression proves resistant to medicine, the idea of ECT can be discussed.
Myth #3: ECT Wipes Away Memory
Loss of memories before or after treatment are common patient concerns and valid to discuss with a doctor. In fact, improvements in increased memory and learning have been reported by many patients. While there may be temporary loss of events shortly before the therapy, they are often regained within a few weeks. Similarly, it may take a few weeks to begin to develop new memories following the therapy. Severe, long-term memory loss is uncommon.
Myths Debunked With Closer Look at ECT
When it comes to real use in the medical world, ECT loses its depiction as a ghastly cruel form of torture in favor of the truth: ECT is a safe, comfortable, proven medical procedure to help a patient when a medicine is not effective, their quality of life is in jeopardy, and is fully completed with their consent. In the United States, ECT is chosen by 100,000 patients and worldwide by 1 million.
ECT Therapy: Who Should Receive It and Why?
Often, when a patient is experiencing mental health conditions, therapy, and/or medication are the first course of treatment. If there are not the expected improvements to the patient’s disorder from these measures, ECT is a safe, effective option for a doctor to discuss with their patient.
ECT is considered for patients experiencing
- Medication-resistant depression
- Multiple hospital visits for the same mental disorder
- Multiple suicide attempts
Relatively quickly, a patient will usually see an improved quality of life. Work, school, and family responsibilities can be managed during continuing therapy sessions along with medications and possible follow-up ECT treatments.
SUN Behavioral Houston continues to lead the way to solve unmet needs for its patients. Our core values of safety, teamwork, integrity, and compassion are considered throughout our patients’ treatments. If you or a loved one would like to learn more about ECT, please call us at 713-796-2273.