Italian psychiatrist Ugo Cerletti was the first to try electricity to induce grand mal seizures after seeing how slaughterhouses stunned pigs into unconsciousness before turning them into pork.

In 1938 he tried it on a clearly psychotic man who talked only in gibberish.

"The third time was the charm,'' said Timothy Kneeland, a history professor at Greenville College in Greenville, Ill., who has just completed a book on the history of ECT. "He snapped out of it and asked where he was. But the cure was short-term.'' It caught on very fast, Kneeland said, quickly replacing chemically induced shock treatments in England and the United States. It became popular in part because there were no other treatments. But it was also appealing, Kneeland said, because it was fast and simple.

Doctors - general practitioners and psychiatrists alike - even made house calls with their electroshock machines.

But the treatment, a terrifying and painful procedure at the time, was overused and misused. Powerful voltages coursed through the body, sometimes breaking bones or causing burns or even death. As "One Flew Over the Cuckoo's Nest'' pointed out so graphically, it was sometimes used to punish and control inmates in mental institutions.

Making it milder, easier

With the advent of antipsychotic drugs, such as thorazine, in the 1960s and the closing of state mental hospitals in the following decades, use of ECT began to wane. And because of its past, use on patients in public institutions required court supervision.

Those legal restrictions remain to this day, said Dr. Alan Radke, medical director at the Minnesota Department of Human Services. The department only can administer ECT on a patient who is competent, or it must obtain two physician opinions and a court order, he said. As a result, ``we do not give ECT in an emergency.''

ECT was revived in the early 1980s, primarily because of the support of the American Psychiatric Assocation. Its use has climbed steadily, but it's no clearer now than it was in Cerletti's day why it works. Theories abound: Electricity may flood the brain with its chemical messengers, called neurotransmitters, which may alleviate depression; electricity has some affect on the glands, such as the hypothalamus, which control hormones that affect mood, or the brain' s effort to resist seizures dampens abnormally active brain activity, stabilizing mood.

Despite the still-unsolved mystery, Kneeland said that he, like thousands of others, would choose ECT for himself or a family member over depression or suicide. ``If history is any predictor,'' he suggested, "ECT is here to stay.'' But his endorsement is lukewarm. He worries that blanket acceptance of ECT simply legitimizes ``push-button psychiatry,'' which is also the name of his book.

We live in a time of rising mental illnesses, he said. Suicide rates for teenagers and young adults are increasing. Depression among the elderly is at epidemic proportions.

It is popular to assume that all emotional and mental problems can be reduced to their molecular level, he said, and be treated in a physical way. But that may be oversimplified. ``We are avoiding some interesting questions. If it's just biological, why has [mental illness] risen so dramatically in our culture? Can our thoughts, or life itself, be the cause of our mental illness? Can our behavior be the cause of mental illness? And if your behavior and thoughts make you ill, can't they also make you well?'' In other words, perhaps medicine has given short shrift to talk therapy and to other efforts that help people change their lives, and experts may find it easier instead to give them treatment at the push of a button.

The mystery of ECT

Although electroconvulsive therapy (ECT) has been used since 1938, no one knows why it alleviates depression and other mental illnesses. The treatment consists of running a small amount of electrical current through a patient's brain, initiating a grand mal seizure, similar to that in epilepsy.

The procedure

- Treatments usually consist of six to 12 sessions over several weeks.

- The patient receives general anesthesia and muscle relaxants, making the procedure painless.

- After the patient is unconscious, two electrodes are placed on the patient's head. A series of approximately 90-volt electric impulses - the amount needed to run a 40 watt bulb - run through the brain for about 50 seconds, causing the seizure.

- The patients' vital signs - heart rate, breathing rate and blood pressure - are monitored throughout. An oxygen mask ensures the brain is not deprived of oxygen.

- The patient awakens an hour or so later, confused and often with a headache and short-term memory loss about events around the time of the treatment.