Cure or Curse? A look at today’s Electroconvulsive Therapy

For Americans suffering from severe depression, successful treatment options are still limited. Some psychiatrists say one effective weapon in the arsenal is under-utilized – because of a bad image stemming from long ago…

For Americans suffering from severe depression, successful treatment options are still limited. Some psychiatrists say one effective weapon in the arsenal is under-utilized – because of a bad image stemming from long ago…
(Photo: Evaluating the patient’s brain’s response to the brief electro shock.) [audio:101019msect.mp3]

The scene from “One Flew Over the Cuckoo’s Nest” seems to be etched into America’s cultural memory.

Jack Nicholson as Randle Patrick McMurphy, strapped helplessly onto a gurney. Detached psychiatrists administering electro shocks, as his body twitches in agony.

Carol Kivler says that’s the first image of “shock therapy” that came to mind when doctors suggested she try what is today called “electroconvulsive therapy” or ECT. She reacted accordingly:

Kivler: NO WAY!!! I will never be able to go to work again, what will my neighbors think? What will my colleagues think? No way, there is no way I am having shock therapy.

Kivler was in her forties then, and had been hospitalized for several weeks with a severe depression. She wasn’t responding to medications or therapy. She thought about suicide all the time:

Kivler: Can I take that picture and break it and slash my wrists. Or can I get the liner of the garbage pail and smother myself. 24-7, nothing but suicidal ideation.

In her desperate state, she agreed to try ECT. During a brief anesthesia, doctors stimulated her skull with a quick electric current. When her husband came to see her afterwards, he started to cry:

Kivler: I said – what are you crying about? He said – you actually have some life in your face for the first time, you are smiling, your eyes look clearer, your face looks brighter. You look different.

Psychiatrist Dr. John O’Reardon at the University of Pennsylvania says ECT stimulates the production of neurons, which send and receive signals from the brain and nervous system

O’Reardon: Depression, on a persistent basis, causes neurons to die in the brain, so depression if you will can be toxic to the brain. And ECT, instead of what we fear it to be, can restore normal health and function to that circuit including that extraordinary process of generating new neurons

Carol Kivler has used the treatment ever since. She’s written a book about her experience, titled, “Will I Ever Be the Same Again?” She speaks out about her positive experience with ECT because she believes too many people shun it due to its terrible reputation.

That reputation is earned, insists Susan Rogers of the Mental Health Association of Southeastern Pennsylvania.

Rogers: It is a hugely controversial treatment, because there are people who claim it has saved their lives, and other people who say it has damaged their lives, blighted their lives, ruined their lives.

Rogers says many patients who try the procedure lose their memory, and their brains are permanently damaged:

Rogers: I have a letter from somebody who received ECT in the 80s. Her name is Barbara, and she said: “There is no amount of money on the face of this earth that could pay or reimburse me for what they took from me through their slipshod, careless, negligent medical techniques. I want them to know that they took Barbara, lost her somewhere in the electrical currents. If they know where she is, tell me and I will get her now.”

On a recent Wednesday morning, Dr. O’Reardon is administering ECT to patients at Pennsylvania Hospital.

They have about ten minutes of full anesthesia, and the stimulation of the brain lasts only seconds…

Robert Cronin has been coming in from the suburbs for over a year – and says ECT has only had positive effects on his life, especially his brain function:

Cronin: I feel much more positive, I have much more energy, I am focused, I can concentrate. One of the things I love to do is read, and I couldn’t read in my depression, now I am reading again, and it is wonderful

O’Reardon says that today’s ECT is effective and says the chances of memory loss are slim.

O’Reardon: we have figured out how to avoid it completely for most patients, that that no longer has to be a burdensome side effect.
But mental health advocate Susan Rogers says patients also need to hear about the patients WHO SUFFER LONG-TERM DAMAGE FROM ECT.

Rogers: I’d let them know that they are taking a huge risk here, and that it may work out really well, or it may not and there’s no way to know it IN advance

She urges people to fill out a psychiatric advance directive when they are doing well. That’s a document that specifies which treatments they are willing to accept.

Yet acceptance is exactly what Carol Kivler hopes to promote, when it comes to ECT.

Kivler: I often say if we could just change the image of ECT to a defibrillator of the brain – when we have a heart attack, they shock us with electricity. Well, when you have a depression your neurons need to be shocked, yet people don’t look at it that way. It’s no different!