Running head: AN INSIGHT TO THE TWENTY-CENTURY ELECTROSHOCK THERAPY

An Insight To The Twenty-First Century Electroshock Therapy

Karla Moriel
The University of Texas at El Paso
RWS 1301
Professor Marco Rodriguez

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

Abstract

Mental disorders have a strong presence in our lives than most of us would consider of.
Since their first diagnostic extensive research has been made to suppress these types of illnesses
and provide some kind of relief to people suffering from them. On account of many available
treatments, one rises from the shadows and generates a significant controversy, the electroshock
therapy. Since its appearance in the twentieth century it has been heavily criticized and object of
a consistent negative image. For the most part this negative image is constant due to the poor
research that sustains its effectiveness, in addition to the severe side effects it causes on the
patients. It is the purpose of this report to provide with a detailed insight on the procedure by
which is administered and inform to the reader regarding the different theories that support this
type of treatment. It will present a variety of studies made on the potential side effects patients
may experience after the treatment has been performed and after the treatment has been finished.
Moreover, the expectation for this report is to generate and raise a level of conciseness towards
the argument of whether electroshock therapy should still be performed on the twenty-first
century, with the information provided is intended for the reader to build a critical and concise
opinion on the matter based on reliable information.

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

An Insight To The Twenty-First Century Electroshock Therapy

Throughout the history of medicine physicians have made extensive efforts in reaching a
well-founded and deep knowledge on the human body to ensure and promote the prosperity of
the human population. The understanding on the physiology and anatomy of humans grew
altogether with the techniques used by physicians to restore health in patients. Still, with the
extensive research that has been made, many questions are yet to be answered and diseases are
yet to be cured.
The brain is a particularly complex organ that until know still remains as an incognita and
the diseases targeting it lack thorough understanding. Mental disorders date back to the sixteenth
century and in attempts of refining a better understanding on the perplexity of these diseases
doctors developed several treatments to relieve people suffering from them, among these
treatments electroconvulsive therapy (ECT) was firstly conceived and performed.
Electroconvulsive therapy evolved with modern medicine that is still practiced in present times.
Nevertheless, there is a persistent negative image revolving around the aforementioned
treatment.
This report will provide an overview on the current knowledge as of what this treatment
consists of and the side effects that patients are likely to present. The report will focus into
discussing the level of effectiveness it exhibits and the scientific evidence that sustains its alleged
efficacy. It will conclude with providing a perspective on the line between the doctors job of
ensuring the welfare of the patient and the practice of what can be considered to be an inhumane
procedure. This report seeks to raise a social awareness regarding the controversy of this

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

particular procedure that eventually will lead to the formation of a critical and well-founded
understanding and opinion on the electroconvulsive therapy.
The development of the electroconvulsive therapy is a result of several events in the
history psychiatric diseases. It dates back to the sixteenth century when several cases of
convulsions were induced using camphor in oil. In 1934, Ladislaw Meduna investigated the
relationship between the lack of glial cells, a supportive cell in the nervous system different from
neurons, in individuals with schizophrenia and the overgrowth of these cells in people with
epilepsy. In attempts to cure schizophrenia he injected camphor in oil to a patients suffering from
schizophrenia to induce epilepsy; as a result he caused a sixty second seizure. The patient went
into a full recovery after a short series of this treatment and five more people were submitted to
it. (Payne, A.,N.; Prudic, J.; 2011).
Later on, camphor was replaced by metrazol, and the treatment spread throughout
Europe. Patients treated with metrazol constantly reported extremely unpleasant sensations after
being submitted to the treatment, and because of this scientists developed the concept of
applying an electric current to the heads of people suffering from mental disorders (Payne, A.,N.;
Prudic, J.; 2011).
The Italian scientists, Cerletti and Bini were successful in defining the parameters for
applying electricity directly into the human scalp and it was in 1938, that they treated a thirtynine year old man who was found in a train station and considered to be delusional. The patients
delusions decreased after several sessions of the treatment, and he recovered after being
submitted to eleven treatments without side effects (Payne, A.,N.; Prudic, J.; 2011).
Over the years, with the appearance of anesthesia and the availability of new technologies
the treatment refined the procedure to be less harsh on the patient and ultimately minimize the

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

later appearance of side effects. The current mechanism of ECT involves applying a brief
electrical pulse to the scalp of the patient while being under anesthesia. The electrical pulse
excites the brain cells causing them to discharge altogether and result in a seizure (Payne, A.,N.;
Prudic, J.; 2011).
Electroconvulsive therapy is regularly administered three times in a week, and the
complete course of the procedure can range between six and twelve treatments. The number of
treatments performed is determined by degree of the symptoms and the response the patient
presents to the treatment. (Maixner, F.D.; 2015).
The procedure has two different methods of application; they involve different electrode
placements, stimulation on different brain areas, the timing of the patients response and the
potential side effects that may present. The right unilateral treatment induces a seizure by the
placement of one electrode on the crown of the head and the other on the right temple. Patients
submitted to this technique exhibit a slower response and the progress usually takes one or two
more additional treatments. The right unilateral treatment has been proven to provoke less
memory loss. It is when the patient does not respond to this approach, that the treatment must be
changed to the bilateral treatment. (Maixner, F.D.; 2015).
With the bilateral ECT treatment the electrodes are placed on both temples of the head.
This technique may lead to a more severe loss of memory than the previous treatment. Bilateral
ECT is prescribed for acute mental illnesses such as depression with psychotic or manic
episodes, bipolar disorder with manic episodes, schizophrenia with psychotic episodes and
catatonia (Maixner, F.D.; 2015).
One of the greatest risks present in patients under the ECT is memory loss; short-term or
long-term memory loss are common side effects. Short- term memory loss is probable of

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

occurring during the course of the ECT treatments. Some examples are forgetting what you had
for lunch or not remembering talking to someone before. The ability to retain new information
will generally return within few weeks or months after the treatment is finished (Maixner, F.;
2015).
When it affects the long-term memory recent past events, two to six weeks before the
treatment is initiated, are more susceptible to be lost. However, patients consistently report not
remembering events that happened more far back than six months before the beginning of the
treatment, and some even years, and this memory impairment is potentially permanent (Maixner,
F.; 2015).
The conflict and controversy between whether the procedure is effective or not lays on
the fact that there is not sufficient research on the topic and the studies that have been made can
be found to be inadequate, since they analyze very few people. It is important to restate that the
main reason for the practice of ECT having a negative image is the lack of evidence and
references available that can sustain or refute this alleged efficacy.
Until present day there is no definite theory that can provide with a compelling
explanation on the effectiveness of the procedure. One theory proposes that the alterations on the
neurotransmitters, chemical messengers in the brain, made by the seizures enhance the positive
results. Another theory suggests that ECT treatments regulate the stress hormone production in
the brain leading to a change in energy, sleep, appetite, and mood (Maixner, F.; 2015).
Other recent biological theories discuss the neurological and physiological alterations
produced by the ECT relate the progress exhibited by the patients to the anticonvulsant effects.

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

These theories suggest that the reduction of bioelectrical activity within the body and the limited
electricity applied are the main factors contributing to the positive results and progress of
patients under the treatment. However, these results are more commonly obtained in patients
suffering from severe epilepsy, not from the many other disorders in which ECT is recommended
(Payne, A.,N.; Prudic, J.; 2011).
Brain scans have revealed increases on blood flow in the brain and an increment in brain
activity leading to accelerate the brain metabolism during the ECT seizure. On the other hand,
the post- seizure brain images reveal a decrease in blood flow and in activity of the brain that
altogether result in a reduction in the brains metabolism. Furthermore, recordings on the scalp
activity suggest reduction in neural activity. (Payne, A.,N.; Prudic, J.; 2011). Not only theories
contribute to this alleged efficacy the psychiatric community maintains. The level of progress a
patient exhibits is one indicator that the procedure works and a green light for psychiatrist to
keep up the practice.
Researchers have conducted studies based on questionnaires answered by former and
current patients under the treatment, in order to have a recording of the patients perspectives.
Both levels of satisfaction and negative views on the treatment have been recorded through these
studies; but recent these studies are limited to low patient numbers. On top of that, most of the
studies have been conducted by clinicians, and it was found in 2003 by a study of Rose, Wykes,
Leese, Bindmas, and Fleishcman that patients were more likely to report that ECT improved
their condition when the study was conducted by clinicians than by patients. Due to the fact that
patients restrict themselves from reporting a negative perspective to the doctor who practiced the
procedure. (Rayner, L.; Kershaw, K.; Hanna, D.; Chaplin, R.; 2009).

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

According to a recent patient-designed, many positive comments were received on

account of ECT including its rapid effect. Three quarters of the surveyed patients commented the
treatment improved their condition, however the experienced progress was only temporal, many
patients retrieved back to their initial severe conditions. It was also found that studies in which
interviews were conducted briefly after the treatment had the highest positive reviews. (Rayner,
L.; Kershaw, K.; Hanna, D.; Chaplin, R.; 2009).
As stated in the section Should ECT be prohibited? Contained in the book: Controversial
Issues on Mental Health there is a 70 to 80 percent of improvement on people suffering from
severe depressions. It was shown that ECT is effective as or even superior to medications used to
treat this type of disorders, and since it acts on a more rapid rate it reduces suicide risk. (Kirk,
S.A.; Einbinder, D.S.; 1994).
The counter part to the argument of many of anti-ECT organizations and its
representatives argue the degree of damage that the ECT procedure has on the brain. Leonard
Roy Frank argues in the section Should ECT be prohibited? That if it is corroborated in several
studies and by a fair amount of psychiatrists that ECT does cause a brain damage, it is even
compared to having similar side effects of organic brain syndrome, how such treatment can be in
practice to this day if it is clear that an irreparable damage has been done. Moreover, Professor
John Reed, from the University of Liverpool, criticized the recent studies that promote the
effectiveness of the procedure. He claimed that the first fault with these studies is the few people
surveyed and more importantly that the clinicians in charge of the study have yet to determine
how this treatment improves the patients condition (University of Liverpool; 2013).
The key factor for a treatment to be considered effective and safe is promoting a welfare
state to its patients after they have been submitted to it. That on perspective, is the physician

AN INSIGHT TO THE TWENTY-FIRST CENTURY ELECTROSHOCK THERAPY

crossing the line between ensuring the welfare of the patient and the practice of what can be
considered to be an inhumane procedure? Defining a pro or con opinion on the argument it goes
beyond finding the matter interesting. ECT has few evidence that back up its effectiveness, not
diminishing the potential it possess as a treatment for mental disorders, but for such an invasive
treatment the complete knowledge on how it promotes the well-being of its patients its
imperative. Building a critical understanding on the matter will bring from the shadows this
heavily criticized procedure; the level of indifference the country sheds upon on the subject
contributes to criticism without foundation or direction. It promotes the highly negative
perspective on the procedure without fully comprehending its composition.
The controversy about ECT is held by unsupported evidence, driven by anti-psychiatric
organizations in general are full of inaccuracies; the procedure only seeks to provide relief to
people who suffer from severe depression, so why such hostility towards it? (Kellner, H.C.;
2011). In a recent review on the ECT procedure Professor John Read, from the University of
Liverpool, stated that without a clear spectrum on how the procedure even works, there is no
method of testing the alleged efficacy the several pro-ECT, such as the Aberdeen research team.
He does mention of the collaboration with Professor Richard Bentall and they failed in
determining any benefit after the treatment ended (University of Liverpool; 2013).
With the data and facts presented above, both from the favor and against positions it is
intended for the reader to generate a knowledgeable opinion on whether ECT should be
prohibited or not.
The idea of passing an electric current through the most complex organ of the body to
treat mental disorders has been heavily criticized since its appearance in the twentieth century.
Many studies being conducted, still little information on why it is found to be effective is at its

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minimum. It is not clear why triggering seizures provide relief for depression, but the psychiatry
community finds it effective. Nevertheless, passing an electric current through the brain is not
without risk and the side effects can be so serious that it can certainly outweigh any possible
benefits. Similarly with any other treatment, every patient exhibits a different reaction and
progress, but ultimately the best spokespeople of ECT are the very patients that have lived firsthand the procedure and provide with an insight of their experience.

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References

BBC News (2013, July 24). Why are we still using electroconvulsive therapy [video file].
Retrieved from
https://www.youtube.com/watch?v=1Zip88ArtwQ&spfreload=1
Kellner, H.C. (2011, February 08). Electroconvulsive therapy: the second most controversial
medical procedure. Retrieved from
http://www.psychiatrictimes.com/major-depressive-disorder/electroconvulsive-therapysecond-most-controversial-medical-procedure
Kirk, S.A.; Einbinder, D.S.; (1994). Controversial issues in mental health. Retrieved from
http://www.breggin.com/ECT/CntrvslIssMntlHlthShldECTbePrh.pdf#page=1&zoom=auto,266,792
Maixner, F.D. (2015), Electroconvulsive therapy program. Retrieved from
http://www.psych.med.umich.edu/ect/how-does-ect-work.asp
Payne, A.,N.; Prudic, J. (2011). Electroconvulsive Therapy Part I: A Perspective On The
Evolution And Current Practice Of ECT. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042260/
Perrin, S.J.;Merz, S.;Bennett, M.D.;Currie, J.;Steele, J.D.;Reid, C.I.;Schwarzbauer, C. (2012).
Electroconvulsive Therapy Reduces Frontal Cortical Connectivity In Severe Depression
Disorder. Retrieved from
http://www.pnas.org/content/109/14/5464.full
Rayner, L.; Kershaw, K.; Hanna, D.; Chaplin, R. (2009, October 01). The Patient Perspective Of
The Consent Process and Side Effects Of Electroconvulsive Therapy. Retrieved from
http://0-web.a.ebscohost.com.lib.utep.edu/ehost/pdfviewer/pdfviewer?sid=3def2cfa46bc-4b80-a395-943db425f5f8%40sessionmgr4001&vid=9&hid=4104
University of Liverpool (2013, July 25). Viewpoint: new study on electroconvulsive therapy.
Retrieved from
http://news.liv.ac.uk/2013/07/25/viewpoint-new-study-on-electroconvulsive-therapy-ect/

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