Although tamed down from its days in the 1940s, the practice of using electricity to treat psychological disorders still has its critics.

Minneapolis Star Tribune
Josephine Marcotty
Staff Writer 11-17-1999

Sherrie always wears screaming-yellow Tweety Bird socks when she comes to Abbott Northwestern Hospital for electroconvulsive therapy (ECT). After dozens of sessions during the last year, she knows that she'll be fast asleep when her doctors run a current of electricity through her brain to initiate a grand mal seizure, and she won't feel or remember a thing about it.

But still, as she lays on the gurney and a doctor starts an intravenous line for the anesthesia and muscle relaxants, Sherrie, who asked that her full name not be used, admits that she gets nervous, and her lucky socks bring her comfort.

ECT is a far cry from the violent and punishing images of what used to be called electroshock therapy that have been imprinted on the public's mind - for example, by the film "One Flew Over the Cuckoo' s Nest'' or by its subliminal parallels to Frankenstein's monster and the electric chair.

Despite its negative image, ECT is a common treatment for mental illnesses, primarily severe depression. Use of anesthetics and muscle relaxants makes it far more humane today than it was at its sometimes bone-breaking inception in the 1940s.

Next month, the U.S. Surgeon General's Office is expected to approve ECT as a safe and effective treatment when it issues the Surgeon's General's Annual Report, which this year focuses on mental illness.

ECT long has been accepted by the medical establishment as a treatment that works when all else fails. But its dark history, public image and the fact that to this day no one knows why it works make ECT a natural focus not only for misunderstanding and fear, but for conflict and controversy as well.

Advance notice of the preliminary report's endorsement of ECT already has set off a flurry of sparks. Some groups say that the report does not adequately reflect the risks associated with ECT, primarily memory loss.

Memory troubles

Objections to the Surgeon General's Report were voiced by the National Mental Health Consumers' Self-Help Clearinghouse, based in Philadelphia. The four-paragraph section of the report describing ECT was given to the group for advance review.

The clearinghouse and others who question the procedure said that the preliminary version of the section downplayed the degree and frequency of memory loss. ``I had five years of memory loss, and to this day, I can't tell you what happened,'' said Linda Andre, director of the New York group Committee for Truth in Psychiatry, which claims 500 members nationally. Andre, now 39, had shock treatment when she was 25, she said.

The report said that permanent memory loss remains a legitimate topic for careful, long-term study. Yet psychiatrists and their patients have said that memory loss is by far a better choice than the agony of severe depression and the risk of suicide.

Sherrie, who is 37, is a classic example. She started her slide into depression somewhere in her 30s. She has lost her job as a nurse, lost her house and lives with her parents. She has struggled against suicide and has tried many antidepressants, none of which have been effective. Her psychiatrist, Dr. Doug Nemecek, gives her a series of ECT sessions once every two weeks.

Each session lasts only a few minutes. The anesthetic puts her to sleep in seconds, and machines monitor her heart rate and breathing. An oxygen mask is used to make sure that her brain is not deprived during the seizure. Nemecek places a rubber strap across her head, with electrodes at her temples, and puts a bite guard between her teeth. The ECT machine at his side delivers a burst of electricity that's less than what it would take to light a 40-watt bulb for one second. Sherrie grimaces, and it's over. She's wheeled to the recovery room, where an hour later she wakes confused and with a headache.

"It's been effective enough to keep her from being suicidal, '' Nemecek said. ``But not effective enough to get her back to work."

Sherrie falls into the surprisingly large group of people for whom antidepressants don't work, or at least not for long.

Anywhere from six to 10 percent of the population will suffer from severe depression at some point in their lives, said Dr. Teri Rummans, a psychiatrist at the Mayo Clinic in Rochester, Minn. Of those, 50 to 70 percent respond to medications. Those who don't are candidates for ECT, and it works on about 80 percent of them, she said. But it's not a one-shot deal, so to speak. Many patients need to repeat ECT periodically as well as combine it with medication, psychiatrists said.

Long, disturbing past

Electricity in one form or another has been used to treat mental and physical illnesses for centuries, starting with the Romans, who placed electric torpedo fish on the head as a cure for headaches. In the 1800s, when it became technically feasible to store static electricity, elaborate machines were devised to run electricity through patients to treat paralysis, "nervous disorders" and other ailments.

The first recorded therapeutic seizures were actually induced by chemicals - with drugs such as insulin - inspired by the incorrect belief at the time that people who suffered from epilepsy did not suffer from schizophrenia. So, physicians deduced, perhaps inducing a seizure would cure mental illness.