What’s electroshock therapy?

In this brief guide we are going to answer the question ‘’what’s electroshock therapy?’’ we will explain what it consists of, how it emerged as a psychiatric alternative and its use today.

What’s electroshock therapy?

Electroshock therapy, now known as electroconvulsive therapy, consists of provoking a medically controlled seizure, through which neurotransmitters such as serotonin, dopamine and acetylcholine are massively and immediately released, which is not the case with antidepressant drugs.

On April 18, 1938, an engineer who the police had found wandering around a railway station in Rome with schizophrenic syndrome underwent a therapy that would forever change the history of psychiatry.

A team of researchers led by Dr. Ugo Cerletti (1877-1963) placed electrodes on his head and, using an alternating current device, administered a 70-volt shock in just a fraction of a second. To the surprise of all present, after the muscle spasm, the patient began to sing.

But what Cerletti was hoping for was to induce a seizure and loss of consciousness. He asked for another attempt with higher voltage, to which the engineer refused: “Non una seconda! Mortifera!”, he exclaimed, agitated. The second shock was 110 volts and 0.5 seconds and caused an epileptic seizure. After a dozen sessions over two months, the symptoms of schizophrenic disorder disappeared completely.

Electroshock, or electroshock – also called electroconvulsive therapy (ECT) – is used for therapeutic purposes in humans who have just been born.

And, despite its bad press – remember Jack Nicholson writhing in pain every time the psychiatric ward nurse tortures him with electric shocks in Someone Flew Over the Cuckoo’s Nest (Milos Forman, 1975) – it is a very effective treatment in cases of severe depression, acute mania and some types of schizophrenia.

Electroshock therapy: seizures

The first decades of the 20th century witnessed a major revolution in the understanding and treatment of mental illness. Until then, there were hardly any curative options for people with psychosis, many of whom ended up locked up in insane asylums.

The turnaround came about thanks to the contributions of Sigmund Freud, the father of psychoanalysis, a theory according to which mental pathologies – especially neuroses – are due to personality deviations caused by external factors, such as childhood problems. Psychoanalysis proposes a therapeutic method based on techniques of free association or dream interpretation.

At the same time, a trend appeared suggesting that, rather than personality deviations, mental illnesses are caused by chemical alterations of the brain.

The treatment, in this case, would consist of provoking a physiological shock in the individual, which, before the invention of the electroshock apparatus, was induced, with greater or lesser success, with drugs.

The Austrian physician Julius Wagner-Jauregg (1857-1940) played a prominent role. He had observed that many of his psychotic patients improved after suffering episodes of fever due to infectious diseases such as tuberculosis or erysipelas.

Impressed by this coincidence, he began to provoke high fevers in the patients artificially, using different bacteria and even tuberculin.

That same year, a young Polish psychiatrist named Manfred Sakel (1900-57) accidentally stumbled upon an important finding: a high dose of insulin could provoke convulsions which, in the case of schizophrenic patients, restored their mental faculties.

Insulin, discovered only a few years earlier, is a hormone produced by the pancreas to maintain the balance of glucose in the blood. Diabetes is caused by an abnormal increase in the amount of glucose (hyperglycemia), while if there is a deficit (hypoglycemia), symptoms such as headache, dizziness and tremors appear.

When Sakel announced the results of his studies at the Viennese Medical Society in 1933, László Meduna was trying to induce convulsions in animals with chemicals such as strychnine, thebaine or caffeine. Shortly thereafter, the Hungarian psychiatrist began treating his first patients with camphor oil, which was gradually replaced by metrazol.

Both substances were effective in the treatment of schizophrenia, but had unpleasant side effects: from anxiety to spinal fractures due to the shocks.

Inspiration in the slaughterhouse

The scientific community was divided between those who advocated insulin shock therapy and those who preferred metrazol-induced seizures when Cerletti broke through with the innovative method of electroconvulsive therapy.

The Italian psychiatrist, director of the Department of Mental Diseases and Neurology at the University of Rome, had specialized in the study of epileptic seizures, and had induced seizures in dogs using electric shocks.

The idea of testing the technique on humans came to him while visiting a slaughterhouse, when he saw how butchers paralyzed pigs with tongs connected to the current before slaughtering them, as a form of anesthesia.

He was joined in the adventure by his colleague Lucio Bini (1908-1964), who in 1938 manufactured the first electroshock device. His machine had a potentiometer, which measured the electrical potential between 50 and 150 volts, and two circuits, one to regulate the time and the other the resistance.

After applying ECT to hundreds of animals, the next step was to test it on humans. The specialists obtained spectacular results in patients with severe depression, schizophrenia, and affective disorders…, with a success rate of up to 90% in only 10-20 sessions on alternate days.

The great advantage over insulin or metrazol was that the treatment could be repeated if it had not been satisfactory, and also that the patients suffered slight amnesia that made them forget the events immediately prior to the shock, making the experience less traumatic. Let us not forget that, until the appearance of synthetic muscle relaxants in the early 1950s, electroshocks were applied without sedating the patient.

ECT, what is it?

Electroconvulsive therapy (ECT) is a psychiatric treatment that acts on the central nervous system. It consists of provoking a seizure in the patient by means of a small dose of electricity in the brain.

A specific device and electrodes placed on the cranial skin surface are used for this purpose. The discharges stimulate the activity of neurotransmitters, which allow the transmission of information between neurons. The aim is to “reset” the brain.

Since its introduction almost eighty years ago, the technique has evolved considerably. Currently, the sessions, which lasted barely ten minutes, are carried out with computerized equipment, and the patient is anesthetized, assisted with artificial ventilation and monitored at all times.

Significant changes are not usually seen until the third session, and the treatment has to be repeated six to ten times. Side effects are minimal, generally, small amnesia that disappears after a few days.

Conclusion: From Abuse to Abandonment

ECT became popular in record time. So much so that many psychiatric hospitals began to apply electroshocks indiscriminately, not so much to cure as to keep patients under control, who would receive several shocks a day even though the technique was not indicated in their case.

It is not surprising that an anti-psychiatric movement advocating the use of therapies based on humane treatment emerged, mainly in Europe and the United States. Electroshock, therefore, lost popularity during the 1960s and 1970s, only to make a strong comeback in the 1980s, when more and more studies demonstrated its effectiveness.

Today, ECT continues to be a current treatment in psychiatry, specially indicated for severe depressive disorders, schizophrenia, some cases of acute mania and even Parkinson’s disease, with a response rate of between 70% and 90%, according to the American Psychiatric Association.

In the specific case of depression, it has one of the highest remission rates of all antidepressant treatments.

When a specialist prescribes electroconvulsive therapy it is because the patient has not responded to the pharmacological route, there is a high risk of suicide or refuses to eat, or the patient is a pregnant woman or elderly person to whom the medication may cause harm.

The main reason, they argue, is a false perception among both the public and medical professionals, who perhaps still imagine Jack Nicholson in the psychiatric ward every time they hear the word “electroshock”.

If you have any questions or comments please let us know!

References

Cerletti, U. (1954). Electroshock therapy. Journal of Clinical & Experimental Psychopathology.

Madow, L. (1956). Brain changes in electroshock therapy. American Journal of Psychiatry, 113(4), 337-347.

What was missing from this post which could have made it better?