This site contains a brief, non-partisan introduction to some of the hotly debated issues surrounding electro-convulsive therapy (electro-shock therapy) and provides links to more detailed scientific papers on the topic.
Electro-convulsive therapy has been a controversial procedure, ever since its introduction in 1938 by Cerletti. It involves applying an electric shock to the brain to instigate convulsive seizures, in an attempt to treat various mental disorders. ECT became a widespread treatment in the 1940's-50's, during which time extensive research lead to refinements in the procedure. Its popularity as a clinical tool decreased with the introduction of pharmacological treatments in the 1960's.
Despite having a very negative media image, it was re-introduced to treat certain types of mental illness in the 1970's. While it is generally regarded as a valuable treatment within the medical community, it has never really shed its barbaric public image and there remains a large number of pressure groups opposed to its use.
Nowadays psychiatrists are very selective in their application of ECT. In the U.S. 33,000 - 50,000 people receive ECT each year (this represents 0.02% of the estimated 15 million Americans receiving psychiatric treatment), compared to about 20,000 patients per year in the U.K.
ECT is mainly used to treat 4 categories of illness:
ECT is not considered an effective treatment for other types of mental illness like neuroses & character disorders.
The basic procedure for ECT is:
One of the main criticisms levelled at ECT is that there is no convincing scientific explanation of how it works, only a number of unsubstantiated theories.
In a review of the clinical literature Fink (1997) concludes that ECT is a very effective treatment for specific disorders, at least in the short term, with success rates of 60 - 80%.
However ECT only seems to be effective for certain categories of schizophrenia and the course of treatment needed to produce noticeable improvements is longer than for other disorders, typically 20-30 shocks.
The main advantages of ECT are that it:
It should be noted that there is considerable ambiguity in deciding what constitutes an effective treatment. Also while initial response is good there is a 50% relapse rate within six months unless anti-depressants or further ECTs are given as follow up treatment.
The major side effects can be identified as
By far the most serious of these are the memory deficits experienced by patients and the claim that ECT produces long term brain damage.
Breggin, P.R. (1979): Electroshock: Its brain disabling effects. New York: Springer.
Goldman, D. (1949): Brief-Stimulus electric shock therapy. J.Nerv.Ment.Dis. 110: pp36-45.
Lambourn, J. and Gill, D. (1979): Indications for electric convulsive therapy and it's use by senior psychiatrists. Brit Med. J. 1: pp1169-1171.
West, E.O. (1981): Electric Convulsive Therapy in Depression: A double-Blind Controlled Trial. Brit. Med. J. 282: pp355-357.
National Institute of Health statement on ECT.
Latest U.K. report on use of ECT.
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Citizens Commission on Human Rights
A Crime Against Humanity
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Webpage produced by Sean St.John on 13/02/99