he STAT headline blares “Psychiatric shock treatment, long controversial, may face fresh restrictions.” But there isn’t a hint of controversy inside the electroconvulsive therapy (ECT) service where we work. The schedule is already overbooked and new appointments are made every day. Our grateful patients bring gifts of chocolate and wine for the nurses and doctors and send holiday greeting cards. ECT isn’t fringe science — it helps hundreds of thousands of people overcome severe depression every year and saves many from suicide.
Contrary to its presentation in the media, ECT isn’t medically or clinically controversial. Experts recognize its importance as a life-saving measure for individuals with severe psychiatric illnesses such as depression, bipolar disorder, schizophrenia, and catatonia. Thousands of studies conducted over the past 50 years have demonstrated ECT’s safety and effectiveness.
So where does the “controversy” come from? Mainly from a combination of outdated information and popular culture.
Years ago, ECT was done with no anesthesia, which gave rise to its depiction in movies like “One Flew Over the Cuckoo’s Nest.” Even though ECT has changed radically since then, it is still rarely depicted accurately today.
Modern ECT is performed under full general anesthesia and muscle relaxation. The patient sleeps right through it. At our ECT service, patients can let their friends and family watch the treatment. Observers are typically surprised by how benign the procedure is. “That’s all it is?” they ask, when we tell them the patient will be awake again in just a few minutes.
Inaccurate portrayals of ECT aren’t a thing of the past. In the upcoming DC Comics movie “Suicide Squad,” for example, a character is shown using an ECT device to torture a woman into insanity.
Although journalists usually present this therapy in a more factual light than Hollywood does, they aren’t immune from the temptation to sensationalize. One way they do this is by using the outmoded, melodramatic term “shock therapy.” Another way is by misconstruing scientific research. A recent news article from STAT about ECT, for example, cited a Scottish study as evidence of ECT’s potential for harm. According to the article, the study showed that ECT may “interfere with the connections that underlie the brain’s complex circuitry.” The study itself, however, said nothing about harm. It did demonstrate, though, that ECT affects brain connectivity and this may be beneficial, rather than harmful.
All too often, journalists uncritically present two opposing sides of an issue to give the illusion of balance. ECT is seldom reported on without the story including claims of extreme memory loss or brain damage. Severe memory loss is a rare side effect, while claims of brain damage are unfounded.
ECT seems to get this treatment more often than other therapies do. Coronary artery stents are widely used to treat heart disease, even though they also increase the risk of blood clots and stroke. But reporters don’t give equal weight to arguments that stents are too dangerous to use and should be banned because a small percentage of patients have bad outcomes, including death.
Not all inaccurate portrayals of ECT are the result of simple factual ignorance. The Church of Scientology and its Citizens Commission on Human Rights have spent decades waging a deliberate smear campaign against ECT, and against psychiatry as a whole. The Citizens Commission website denounces “shock therapy” as torture and provides links to sites that promote “alternative therapies” instead, such as treating psychosis with vitamin supplements. It may seem easy to mock an organization that runs the colorfully named “Psychiatry: An Industry of Death” museum in California, but the group has deep pockets and a wide reach.
We need to stop sensationalizing ECT. By continuing to do so and fueling the “controversy,” we’re risking people’s mental health, and even their lives.
ECT isn’t perfect. Like any medical procedure, it carries risks and potential side effects that should be discussed honestly and openly. Its benefits should also be discussed that way.
Finally, please don’t call ECT “shock therapy.” It may be a catchy term, but it perpetuates people’s false impressions. Treat ECT like you would any other medical procedure and call it by its proper name.
Kate G. Farber is a volunteer in the Department of Psychiatry and Charles H. Kellner, MD, is professor of psychiatry and director of the ECT service at the Icahn School of Medicine at Mount Sinai.