As a Clinical Social Work Intern at a major university-based psychiatric center in San Francisco back in 1973, I was required to observe a session of shock therapy. Standing in a small, windowless and poorly ventilated room along with five other trainees, we watched as an unconscious woman was wheeled in on a gurney. A doctor and a technician first injected her with a large syringe of anesthesia that was intended to keep her unconscious and discomfort-free during the procedure. They then lubricated and applied electrodes to either side of her forehead and turned the switch on.
The woman’s body tensed and she cried out. They stopped and injected her with more anesthesia. They explained, simply, “She needs more of this.” There were three more attempts made but, somehow, even with the strength of the electrical shock increased each time, the shocks did not produce the desired convulsion. The doctor’s face suggested that somehow it was the unconscious patient who had failed. I will never forget the look on his face that day. I was dizzy and sweating and thought I was about to pass out when she was wheeled out and we were invited to leave.
I felt that I had witnessed something clearly barbaric. The experience left me with a lot of discomfort with and curiosity about the procedure.
Electro-Convulsive (“Shock”) Therapy is still in use at many psychiatric hospitals. The procedure involves electronically inducing convulsions in a generally desperate last-resort attempt to help people with severe depression that has proven to be unresponsive to other interventions. Sometimes, it seems to relieve the intensity of an otherwise intractable chronic Major Depression. But, at what cost?
In most human acts and, most particularly, in ones taken in desperation, there is risk. There are both anticipated and unanticipated consequences in just about everything we do. The risk factor rises in direct proportion to the desperation driving the action.
When the football team in possession of the ball is down by five points and on their own fifteen yard line with seven seconds left to go in the game, desperation summons. A frequent desperation play, under these circumstances, is what we call the “Hail Mary” pass. The quarterback tosses a long lob into the end zone in the hopes that it will be caught by one of his own team. The risk is great at nearly 50/50 that it will be brought down by the other team. But there are only seconds left and more conservative plays do not present even a glimmer of home. They are desperate to win. It has become all or nothing.
Shock Therapy (ECT) is a similarly desperate intervention, generally used when all else has failed, which brings with it great risks. Some of these risks are known and some may turn out to be entirely idiosyncratic to the individual patient. The risks we know about are entirely sufficient to cause several levels of personal and professional thinking and re-thinking before it is used.
A Brief History of ECT
ECT was developed as a medical intervention for depression and other severe mental illnesses in 1938. At that time, the instruments used were primitive by modern standards. The specific force of the shock was difficult to regulate, comfort was not regarded as a high-priority issue and the anesthesia available for the patient were not reliably effective. Shock therapy seems to hold some promise but was displaced in the 1960’s as more effective medications were developed to treat these illnesses.
A moderate resurgence in the use of ECT began in the 1970’s with better equipment, anesthesia and more control over the target area of the brain and of the dose of electricity applied.
How does ECT “Work?”
While it is known that the introduction of this electrical energy can cause a convulsion and that, sometimes, a series of these induced convulsions can result in a partial or full amelioration of some serious mental disorders, particularly, chronic major depression, the scientific understanding of exactly how it works remains speculative. No one really knows. It just seems to work with some people some of the time. It remains, quite literally, a last-ditch shot in the dark. A Hail Mary with the human mind.
Much of the continuing use of and research into ECT has been focused on making it medically ‘safer’ for the patient. Better technology and chemistry have, indeed, reduced the chances that a person will break bones during the convulsion (as they sometimes did in the 1930’s and 1940’s.) The efficacy has been better documented. The procedure is more often performed with some carefully researched evidence assuring its safety.
When the procedure has the desired outcome, a part of the person’s brain has been somehow wiped clean. In this way ECT parallels the process of wiping a part of a computer’s hard drive. Where it differs, however, is significant. While a skilled computer user can control which elements and areas of a hard drive are to be erased or ‘scrubbed’, such precision is not possible when using shock therapy on a person.
The depression or other serious mental illness is the target but other things are quite apt to be erased as well. Therein is one of the primary risks of the ECT procedure.
Known Side Effects of ECT
The most common and well documented unintentional side-effects of shock therapy are in the area of memory loss. Oftentimes, in a series of shocks that seem to have reduced or eliminated the intense depression, chunks of memory are erased as well. These can be both short and long-term memories. The reported losses can be temporary or permanent.
In many patients studies and described both pre- and post-ECT, there seems to be a change in overall energy and an alteration of personality. Many patients regarded as having been ‘successfully’ treated with ECT are experience by those who know them best as being more withdrawn and quieter. Their loved ones often say that it as though their personality had been removed. The person is simply not the same after the ECT and it is not just the muting or elimination of the illness that has changed.
In nearly any major medical intervention, there are risks. Some are known and some are not. There are ALWAYS side-effects when using psychotropic medications. Surgeries are notorious for repairing one problem while, inadvertently, causing another. There is always risk to be evaluated when deciding whether or not to have a procedure done.
When it comes to Electro-Convulsive Therapy, a person would need to feel pretty desperate. An informed patient would understand that the procedure MAY alleviate their depression but may cause them to lose some random aspects of their memory along with it. To the person tormented by a chronic and disabling mental illness, the hope offered by ECT may be sufficient to cause them to go for this “Hail Mary” intervention. It might be absolutely worth it.
Careful consideration of the possible pros and cons is of the essence for anyone considering this procedure and for the loved ones.
There is no significant medical intervention that does not pose significant risks. The potential pros and cons of any procedure always need to be carefully understood and weighed in deciding what to allow done to ones self.