ECT, or electroconvulsive therapy, has been used to treat mental illness since the 1930s but remains controversial. While proponents view it as a safe and effective treatment for severe mental disorders like depression, opponents argue it is an abusive procedure that risks damaging the brain. The debate around ECT touches on whether mental illness should be viewed as a medical condition, the historical misuse of psychiatric treatments, and the power dynamic between patients and doctors. Both the risks and benefits of ECT must be considered, as well as alternative treatment options.

1. Should ECT be used to treat
mental illness?
Lecture 1
Dr. Christopher Wilson

2. Lecture Aims
• Describe the procedure and origins of ECT
• Discuss changes in perception over time and discuss
contributing factors
• Describe how the debate incorporates various
controversial aspects of psychology
• Outline key terms and theoretical perspectives
• Define the scope of the debate
2

3. A COMPLEX HISTORY
3

4. “a barbaric and destructive process which delayed our
opportunity to deal with the real issues of our distress”
4

5. “among the safest treatments given under general anesthesia”
(RCS, 2005)

6. The history of ECT has become a metaphor for both advocates
and opponents to explain their vision of psychiatric power and
its promise for or threat to society (Hirshbein & Sarvananda, 2008).
6

7. The ECT debate incorporates many
controversial aspects.
• What is mental illness?
• What lengths should we go to to treat somebody
with a mental illness?
• The power dynamic between health professionals
and mentally ill patients.
• Various vested interests in the medical profession
7

8. WHAT IS ECT?
8

9. Origins of ECT
• Convulsive therapies
• Disrupted problems in
the patient’s thinking
and restored some
semblance of
normality.
• Patients became
calmer

10. Origins of ECT
• Looking for new ways
to cause convulsions
(e.g. Insulin Coma)
• Cerletti and Bini (1938)
– electricity
• ECT was easier to
administer and better
tolerated than metrazol

11. The procedure
• Muscle relaxants &
anesthetic
• Electrical current is
passed through brain
• Epileptic seizure
• 4-12 individual shocks-
a few days apart

12. How common is its use?
• 9,200 people a year (UK) - Decline over
20yrs
• Mainly hospitalised patients
• Used similarly in USA, Scandinavia, Ireland,
Australia and New Zealand
• Low, research-based usage in Canada,
Germany, Japan, Italy and Netherlands.

13. Modern research into the technique
• Voltage / Current*
(0.8-0.9 A)
• Vary: pulse width,
frequency and the
duration
• Unilateral / Bilateral

14. What does it treat?

15. What has it been used for?
alcoholism, anorexia, anxiety disorder, catatonia,
drug withdrawal syndrome, homosexuality and
hysteria, narcotic addiction, neurosis, obsessive-
compulsive disorder, personality disorder,
postpartum depression, postpartum psychosis,
pseudodementia, psychosis, Alzheimer’s disease,
backache, chronic pain, delirium tremens,
dementia, epilepsy, neuroleptic malignant
syndrome, Parkinson’s disease, and psoriasis.
(Frank, 2006)

16. HOW DOES IT WORK?

17. Two current theories
• ECT Produces a seizure which affects the
entire brain.
• ECT changes the way brain cells respond to
their chemical messengers.
• EEG measured during treatment – low
interseizure EEG indicates effective
treatment
(Fink, 1999)

18. A technical description?
“ECT has been compared to kicking a
machine to start it up.”
(Harvard Mental Health, 2007).

19. CHANGING VIEWS OVER TIME
19

20. A marvel of modern medicine - 1940’s
• “restore to sanity the ‘living dead’ affected by
the dementia praecox form of mental illness.”
• In this context, the subsequent risk for
vertebral fractures caused by “violent
convulsive shocks” appeared entirely
reasonable
20

21. A marvel of modern medicine – 1950’s
• In 1952, physicians first used electricity on a
patient in order to induce cardiac
defibrillation.
• Articles in both Time and Newsweek explained
that a cardiologist had developed a machine
for shocking the heart, based on the principles
of shocking patients developed in ECT.
21

22. Not everyone was convinced – 1950’s
• “Some psychiatrists—particularly
neuropsychiatrists—think people become
severely troubled because something is
chemically or glandularly wrong with them”.
• “They search for a chemical compound, a
form of brain surgery, or a physical process to
solve the mystery of emotional illness”
22

23. An abuse of power? – 1970’s
• “Accounts of ECT became more concerned
with the power transaction that occurred with
the treatment.”
• “Commentators increasingly raised questions
about psychiatrists’ right to wield this kind of
power.”
23

24. CONTROVERSIAL ASPECTS: THE
MEDICAL MODEL
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25. The medical model of mental illness
• Terminology such as
"mental illness,“
"mental disorder," and
"biologically based
brain disease"
• Describe both the
putative cause and the
nature of disturbing
human behavior.
25

26. Criticism of the medical model
• Mental disorders are
accorded disease status
without meeting the
classic Virchowian
criteria for disease
• In contrast to well-
validated medical
diagnoses such as
cancer and
hypertension
26

27. CONTROVERSIAL ASPECTS: THE
DARK HISTORY
27

28. Opponents of ECT link it to older
techniques.
• ECT was in the tradition
of “beating up those
labeled insane with
methods ranging from
torture to lobotomy to
psychosurgery”.
28

29. Proponents describe ECT as an
advance
• ECT to illustrates the
upward progress of
modern science.
• The use of a treatment
for mental illness directed
toward the brain
represented a major step
forward.
29

30. CONTROVERSIAL ASPECTS: THE
POWER DYNAMIC
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31. An abuse of trust?
• ECT was often done without regard to patient
consent in its early years
• Patients trust doctors to decide the best
treatment
• In no other psychiatric treatment is a patient as
passive—or as unaware of the treatment itself
while it is occurring.
31

32. Trust the experts
• Some ECT patients have gone public and
insisted that they chose ECT with open minds
in order to help treat their severe illnesses.
• “Like chemotherapy, ECT is a toxic treatment
for a crippling disease.”
• “high tech anti-depression therapy”
32

33. THE SCOPE OF THE DEBATE
33

34. What are the important features of
any treatment?
• How it works
• Efficacy
• Safety
• Comparative utility
• Comparative cost
Which are the most important?
34

35. Further Reading
Breggin, P. (2007). ECT damages the brain: Disturbing news for patients and shock
doctors alike. Ethical Human Psychology and Psychiatry: An International Journal of
Critical Inquiry, 9(2), 83-86.
Carney, S., Cowen, P., Geddes, J., Goodwin, G., Rogers, R., Dearness, K., et al. (2003).
Efficacy and safety of electroconvulsive therapy in depressive disorders: A
systematic review and meta-analysis. The Lancet, 361(9360), 799-808.
Esmaili, T., Malek, A. (2007). Electroconvulsive therapy (ECT) in a six-year-old girl
suffering from major depressive disorder with catatonic features. European Child
Adolescent Psychiatry, 16(1), 58-60.
Fink, M. (1982). ECT in anxiety: An appraisal. American Journal of Psychotherapy,
36(3), 371-378. Retrieved from PsycINFO database.
Frank, L. (2006). The Electroshock Quotationary. Ethical Human Psychology and
Psychiatry: An International Journal of Critical Inquiry, 8(2), 157-177.
doi:10.1891/ehpp.8.2.157.

36. Hirshbein, L., Sarvananda, S. (2008). History, power, and electricity: American popular magazine
accounts of electroconvulsive therapy, 1940-2005. Journal of the History of the Behavioral
Sciences, 44(1), 1-18. doi:10.1002/jhbs.20283.
Johnstone, L. (1999). Adverse psychological effects of ECT. Journal of Mental Health, 8(1), 69-85.
doi:10.1080/09638239917652.
Johnstone, L., Frith, H. (2005). Discourse analysis and the experience of ECT. Psychology and
Psychotherapy: Theory, Research and Practice, 78(2), 189-203.
doi:10.1348/147608305X26657.
Keltner, N., Boschini, D. (2009). Electroconvulsive therapy. Perspectives in Psychiatric Care, 45(1),
66-70.
doi:10.1111/j.1744-6163.2009.00203.x.
Maybaum, L., Crockford, D. (1999). Electroconvulsive therapy, personality structure, and suicide.
The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 44(9), 922-923.
Retrieved from PsycINFO database.

37. Morgan, J., Kellett, J. (1997). Consumer satisfaction and outpatient ECT.
International Journal of Geriatric Psychiatry, 12(4), 495-496.
Philpot, M., Collins, C., Trivedi, P., Treloar, A., Gallacher, S., Rose, D.
(2004). Eliciting users’ views of ECT in two mental health trusts with
a user-designed questionnaire. Journal of Mental Health, 13(4),
403-413.
Ross, C. (2006). The sham ECT literature: Implications for consent to
ECT. Ethical Human Psychology and Psychiatry: An International
Journal of Critical Inquiry, 8(1), 17-28.
Wilkinson, D., Daoud, J. (1998). The stigma and the enigma of ECT.
International Journal of Geriatric Psychiatry, 13(12), 833-835.