T

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 Mainly from a combination of outdated information and popular culture.

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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.

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  • EST is NOT a “medical” procedure. It is a bogus assault on vulnerable people by individuals who are “doctors” practicing “pseudo-science”.
    I am asking AGAIN, where is Dr. Kellner’s response to the comments made by Deirdre Oliver? The silence is deafening. No argument? Nothing to say in light of the truths Deirdre presented?

    The FDA needed to ban shock in 2011 when testimony from hundreds and hundreds of people showed the damage it caused. Now it is 2016 and the FDA has 2,575 stories and signatures stating the same thing- ECT is a brutal assault that decimates, disables, and kills. Shock docs need to give up the money they make brain damaging people and stop lying about ECT.
    Still waiting for Dr. Kellner’s enlightening reply.

    • Christopher Dubey the link you shared brought tears to my eyes. Just like that person I had started ECT treatments at 17 for depression. I didn’t know other people had the same struggle as I did/do after ECT.

  • I am asking to remain anonymous because I am a current ECT patient who is also an elementary teacher. I would NOT be alive today without ECT. It has given me my life back and continues to do so when I have a small set back. Please hear me…. I would be DEAD without this procedure. I have experienced mild side effects that improve within a couple of weeks. These side effects are no where near as problematic as the 35 pounds I gained on Abilify.

    • I heard you. Your personal story doesn’t change my mind about ECT at all, and for people like me, I doubt it will change any of their minds. Lots of people have said, ECT saved my life! It’s nothing new to hear. To me, it sounds like an alcoholic saying, Alcohol gets me through the day, or like a smoker saying, A pack of cigs gets me through the day, therefore it’s good for me. And not too long ago in history, doctors helped cigarette companies market their cigarettes with claims of it being smoking being good for their health, helping to calm their nerves, protecting their throats from infections…
      Another point: Your personal experience does not represent the experiences of all people who’ve had ECT. It certainly doesn’t represent mine. I know many people who’ve become debilitated from ECT, even some who initially liked it, but later changed their minds as the side effects manifested.

    • Really? Well, I am a teacher who lost her 31 year teaching career because of the ECT produced brain damage, cognitive dysfunction, and memory loss I experienced. I would have preferred Abilify and a 35 pound weight gain. That can be reversed.
      Again, all brain injury /ECT is not the same. Why do you not say ” I had 4 or 5 low dose (1 not 8 on energy control- maybe 12.5 joules versus 160) ultra brief pulse right unilateral ECT spaced out at one a week that “seemed” to help.
      I “had ECT” says nothing, because many victims are given bilaterals 3 times a week for 4 weeks and their brains never recover.
      If ECT were regulated so that no more than 6 “treatments” were allowed and bilaterals were banned, there would certainly be a reduction in the amount of brain damage and destruction being visited on poor vulnerable people.

      But even ONE unilateral can be destructive.No one needs multiple anesthetics and a brain boiling procedure that is like a taser to the head, causing petechial hemorrhages, breaching the blood brain barrier and creating massive grand mal seizures. It is absolute stupidity. A quack procedure practised by indifferent, uneducated, blind “doctors” who have no clue about “healing” anyone. Simple- they make money on this bogus treatment. For every 1 person given a mild regimen that survived, there are 6 or 7 suffering the permanent brain injury that repetitive closed head injury concussion causes.
      Please re-read Deirdre Oliver’s comments below. Where is Dr. Kellner’s rebuttal?? Notice he has absolutely NOTHING to say in regards to her statements. What does that tell you?

  • I have personal experience with someone who has received this numerous times and it has obviously caused brain damage and memory loss. I could not disagree with this articlee more.

  • Not to long ago the pharmaceutical companies and the. FDA reduced. Acetamenaphen from most prescribed RX by doctors. to 325/500. But all over the department and drug stores most OVTC have Tylenol/acetamenaphen in many cold remedies like Tylenol, Alieve, Excederan and many pain remedies. If a lawyer is willing to take a case against the pharmaceutical companies, I have a case that happened to me due to OD on acetamenaphen. Call Teres at. 562-321-4182…Case: 10/11/2015
    Thank you

  • No Dr Kellner, I won’t call it `therapy’ at all.

    “Contrary to its presentation in the media, ECT isn’t medically or clinically controversial. “
    Perhaps there is no controversy where you work, Dr Kellner, but SHOCK has always divided medical opinion. Today over 70% of psychiatrists world wide NEVER prescribe it, Sicily, Slovenia, Luxembourg, parts of Switzerland and Italy have banned it entirely, and there are bans on its use in children, the very elderly, and pregnant women in many places including parts of the USA. The United Nations states it should be banned for minors and never used without fully informed consent. In recent times psychiatry students have sent petitions to educators at universities by asking for conscientious objections to performing SHOCK to be honoured. In fact, in most countries, its use is controlled by Acts of parliament because of its controversial nature.
    “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.”

    Can we please have a list of these 1000s of studies, Dr Kellner, because though you might know of these, no one else does. Read & Bentall’s 2011 mega review only found 10 usable placebo studies and even 2 of these were invalid; the National Coordinating Centre for Health Technology Assessment (NCCHTA) on behalf of the National Institute for Clinical Excellence (NICE) in the UK could only find (from over 400), “two good quality systematic reviews of randomised evidence of the efficacy and safety of ECT (SHOCK) in people with depression, schizophrenia, catatonia and mania. We also identified 4 systematic reviews on non randomised evidence, though only one of these could be described as good quality. There was no randomised evidence of the effectiveness of ECT (SHOCK) in specific subgroups.”
    The last attempt at a placebo trial that I could find was in Denmark in 2013 for schizophrenia. It found no superiority of placebo over real SHOCK, and no significant beneficial effects for either.

    “ECT isn’t fringe science — it helps hundreds of thousands of people overcome severe depression every year and saves many from suicide.”
    I’m not sure that one can state that something is science simply because it helps people – religion, astronomy and clairvoyance help millions of people but no one can claim they’re science. In fact the SHOCK `science’ I’ve seen rather closely resembles astronomy. Both begin their discussions with a stated core belief; astronomy, that it knows that the conformation of stars at the time of birth has a significant impact on personality formation, then presents a lot of jargon filled assertions that `prove this’; SHOCK “science”, that it knows that SHOCK is “safe and effective” and presents a lot of jargon filled assertions that “prove” this. “Fringe science”, indeed.
    Pseudoscience Law…“Core principles untested or unproven” and “ Has the trappings of science, but lacks the true methods of science”.
    About suicide. Perhaps you haven’t heard where you work, Dr Kellner, that where actual figures have been produced as by Munk-Olsen in 2007, (who found that people getting SHOCK were 5 times MORE likely to commit suicide that equally depressed people who DIDN’T get SHOCK), the findings have been that, “treatment was not shown to affect the suicide rate” – Avery & Wintour 1976, Milstein,1986; Black & Wintour 1989; Sharma 1999 (also found it increased); Prudic, Sackheim 1999; Bradvik, Bergland 2000; Breeding 2000; UK ECT Review Group 2003; NZ Ministry of Health Report 2004.
    Perhaps it’s the `feelings of fear, shame and humiliation, worthlessness and helplessness, and a sense of having been abused and assaulted…that had reinforced existing problems and led to distrust of psychiatric staff’, as identified by Dr Lucy Johnstone in 1999, that were intolerable; or of the disconnect between staff and patient experience where the staff didn’t appear to know about or perhaps believe the patient’s issues, which included `loss of a life once known’ of cherished memories of children growing up, educational history, friends, conversations, inability to hold meaningful jobs and a sense of diminishment” documented by Dr Cheryl van Daarlen-Smith in 2011. Or was it that 40% of any benefit was gone after 10 days (Prudic). so that after all that, the depression was back?

    Maybe feelings of suicidal despair occur especially when people are told that, a) SHOCK was the best treatment in existence for depression and b) that it was all that was left for them.

    “Modern ECT is performed under full general anesthesia and muscle relaxation. The patient sleeps right through it.”
    Let’s look at “Modern ECT”, today’s SHOCK treatment. Cosmetically it is vastly improved. An uninformed observer could well say, “Is that all?” But this person cannot see the EEG record a massive convulsion followed by a `flat-line’ coma, because the body is artificially paralysed. But no matter how many cosmetics you use, ugly, is still ugly underneath.
    Today, the electrical power must be greater to overcome the anticonvulsant effect of the anaesthesia and muscle-paralyzing agents, and patients frequently receive other medications, such as sedatives and minor tranquillizers, which further raise the seizure threshold. Plus patients too often receive neuroleptics, antidepressants, and especially lithium, all of which can worsen the impact of SHOCK.
    Recent studies into the effects of anaesthesia indicate serious long term outcomes from that source alone, particularly for the elderly and for children. As we know SHOCK for the elderly is a special interest of yours, Dr Kellner, and more SHOCK for children is a current initiative by the APA.
    In fact the only changes in shock application since 1970 have been a massive increase in the the power and duration of the electrical force. Today’s SHOCK is 4-5 times greater than in the `bad old days’ and is applied for up to 10 times as long. That’s 225-450 volts today vs 80-100 volts, for 8 seconds instead of 0.2-1 second.
    The claim that “Modified ECT (SHOCK) was introduced in the 1950s to prevent fractures reduces brain damage is a very recent public relations twist and has no validity whatsoever.” (Dr Bob Johnson UK). At that time brain damage was the required result.
    The square wave pulse machines currently touted as `new’ were invented in the 1940s, failed, and were re-developed in the 1960s when they failed again. The moving around of the electrodes also began in the 1940s. These modifications were attempts to reduce the brain damage, all failed as they do today.
    “Severe memory loss is a rare side effect, while claims of brain damage are unfounded.”
    First, Dr Kellner appears to have forgotten his January 2015 statement in the Psychiatric Times, “The amazing structural detail that can now be seen with high magnet-strength MRI has resulted in a re-thinking of the old dictum that ECT (SHOCK) does not cause structural brain changes.” There are at least 9 studies since 2012 that ALL document brain damage.
    Second, there is ample evidence that memory damage can be severe and permanent. The UK ECT Review Group, 2003, acknowledged that “both anterograde and retrograde memory impairment are common,” In the 1940s it was accepted that ECT (SHOCK) worked precisely because it does cause brain damage and memory deficits. In 1941, Walter Freeman, who exported ECT (SHOCK) from Europe to the U.S., wrote: “The greater the damage, the more likely the remission of psychotic symptoms.” Myerson (1942) explained: “I think the disturbance in memory is probably an integral part of the recovery process”.
    Nothing has changed. 
    “The most common cognitive impairment among severely head-injured patients is memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones.” (NINDS)
    There is also the loss of the ability to solve problems and to plan and initiate actions, trouble with concentration, attention, and thinking. The person may become inappropriately elated (euphoric). This latter is usually referred to as “success”.
    “Our grateful patients bring gifts of chocolate and wine for the nurses and doctors and send holiday greeting cards.”

    I hope you all enjoy the flowers, wine and chocolate, but what do the ungrateful patients give you? The 55-80% who DON’T get any benefit, like Joan Prudic’s subjects in 2004, or those whose benefits only last until their brain partially recovers from the 10-12 (or 15 or 20 over 4+ weeks), 450 volts for 8 seconds assaults, and whose symptoms return full force within a month pr two? Do they just disappear into some kind of limbo? Or do they get more of the same until they are so damaged they no longer complain?

    Many information brochures about shock explain that it `rewires” the brain. Does yours say this? Do you tell your patients about the after effects of SHOCK, listed above, do you tell them that a human whose brain has “rewired” around millions of broken wires emerges from that rewiring as a different person, that as a survivor of SHOCK they will not be the same person they were? Do you tell them that they really don’t really have memory loss that includes their education, their work skills, and their family memories? Or that the fact that they can’t seem to be able to retain new knowledge, or access their creativity, or feel anything at all, is all in their minds, and since they are mentally ill they wouldn’t really know how they feel and it’s the depression that does that anyway?
    Except it isn’t that depression that does it, is it, Dr Kellner? And we know that because everyone regardless of their diagnosis, who has SHOCK has the same problems. Or don’t you treat schizophrenia, mania, catatonia, OCD, and PTSD with SHOCK where you work?

    “ECT seems to get this treatment more often than other therapies do…arterial stents.”
    Shame on you Dr Kellner, a comparison between SHOCK and stents is totally disingenuous and beneath you. It’s as silly as comparing an amoeba with a chimpanzee. However, to get a stent approved for use, it must pass a series of safety and efficacy tests. SHOCK machines have never been subjected to such tests. Why? Why is psychiatry afraid of performing such tests? How have they avoided it? (Another day, Dr Kellner.)

    Psuedoscience law: Invokes conspiracy arguments to explain lack of mainstream acceptance.
    Come now, let’s not blame the media and the scientologists. Let’s consider the other people who object to SHOCK: Professors from highly prestigious universities in many countries, the Critical Psychiatry Movement (your peers); The Council for Evidence based Medicine (more peers); The Cochrane Collaboration; neurologists; and most of all, those who have suffered SHOCK and survived, and their families, including those whose family members died as a result of SHOCK.
    There is no survivor group calling for a ban on cardiac stents, surgery, obstetrics, neurology, endocrinology, cardiology, ontology but there are thousands of people looking/demanding help for the ruination of their lives from SHOCK, and who are banding together to prevent this kind of destruction for others.

    We also must remember, too, SHOCK is very lucrative. NIMH and other grants flow into universities as long as they continue “research”, your group, CORE, does very well here, doesn’t it, Dr Kellner? Many hospitals’ profits rely on SHOCK. SHOCK doctors get hundreds of thousands of dollars more than those who don’t do it. It is a $5 billion a year industry that unfortunately costs the tax payer millions as they pay out welfare for brain damaged people unable to work after receiving SHOCK.

    Once again Dr Kellner attempts to blame everything and everyone for the bad image SHOCK has, except SHOCK. The stigma exists because it is well-known that it causes serious damage and little benefit. Indeed, it is impossible that any reasonable person would NOT view the application of hundreds of volts of electricity through the brain’s millivolt system as highly problematic.
    The public are not stupid. If something looks dodgy, feels dodgy, smells dodgy, it probably is dodgy.
    No I won’t call it SHOCK therapy, because, as a psychiatric professional who has seen it in action, AND a brain injured SHOCK survivor, it cannot be deemed THERAPY at ALL.

    FIRST, DO NO HARM, DR KELLNER.

    • Thank-you for telling the real truth about this barbaric, brain damaging “procedure”. So, Dr. Kellner, where is your response to Ms. Oliver’s challenges and her references? It is stupidity to call this lunatic assault anything but “shock”. How stupid is it to think it “looks” so benign when the equivalent of a nuclear bomb blast is going off in a delicate brain that works on millivolts. People who run an ECT “service” should be in jail with others who assault people, causing permanent injuries that decimate their lives.

  • I understand the writer’s view that the terminology can affect conceptions about ECT. Personally, I don’t think about it that much since I know first-hand how well ECT works, despite what other commenters have said. I suffered from major depressive disorder in 1999 and had a full course of ECT, which saved my life. It was as if my brain had been rebooted. I felt more connected to the world and was able to return home. Contrary to the article, there are almost NO side effects to ECT but occasional memory loss during treatment. And there is no contraindication for its use other than a heart condition, if I remember correctly. I understand that people see this treatment as barbaric, but I many more are living proof that it is not. It is a blessing to have this treatment when drugs don’t work. I believe it needs to be as valid an option as any antidepressant.

    • I’m glad you found something that helped you, but there are many people I know who have had side effects such as permanent memory loss, cognitive impairment, chronic ringing in their ears or migraines, emotional trauma. People who experience adverse effects may not report them publicly and doctors don’t always record them–I have heard these from people in my support groups. I also know of two cases of people going into cardiac arrest during ECT, and some cases of death, such as Elsie Tindle, who’se autopsy showed brain damage this year.

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