Some Reflections on Electroconvulsive Therapy, Past and Present
The online magazine Psychiatric Times features an exchange between two respected psychiatrists on the history and status of electroconvulsive therapy (ECT). In a piece entitled “Electroconvulsive Rx: A Memoir and Essay (Part 1),” Dr. Alan Stone (Touroff-Glueck Professor of Law and Psychiatry in the Faculty of Law and the Faculty of Medicine at Harvard University) discusses his experience after reporting for military service at Fitzsimmons Army Hospital outside Denver, Colorado in 1959:
The Colonel in charge of the psychiatric unit prescribed a course of 20 to 25 unmodified ECT’s for virtually every soldier requiring admission to the inpatient unit. When I questioned this rigid regimen and expressed my unwillingness to participate, the Colonel informed me that I was not being asked I was being ordered and would either take my turn administering the full course of unmodified ECT or be court martialed. As I look back on my military service, I have always regretted that I did not risk being court martialed. In any event, under the Colonel’s threat, I learned what a course of 20 -25 unmodified bilateral ECT could do to a sample of approximately 100 young physically healthy men of various diagnoses.
Stone goes on to reflect on what he considers to be the unethical and careless manner in which ECT was employed at the time.
In his response, “ECT Today: The Good It Can Do,” Dr. Charles Kellner (Professor of Psychiatry and Chief of the Division of Geriatric Psychiatry at the Mount Sinai School of Medicine in New York City) insists that any abuses of ECT committed some fifty years ago should not be taken to impugn ECT today, which, in his view, is “practiced to high standards of medical care and with fully informed consent.” Kellner sums up the benefits of ECT this way:
ECT is the only “somatic” treatment from the early 20th century that has survived. It has done so because of its unparalleled efficacy and safety. ECT is the most effective antidepressant treatment we have; response rates are typically in the 60% to 90% range. Because ECT is rarely given as a first line treatment, most ECT patients have already proven refractory to multiple trials of antidepressant and other psychotropic medications. Severely suicidal or catatonic patients often improve dramatically within 1 to 3 weeks of starting an ECT course. Interestingly, the most severely ill patients respond best to ECT; high severity of depressive symptoms, presence of melancholic and catatonic features, and psychosis all predict better outcomes with ECT. Where else in medicine is severity of illness a predictor of good outcome?
You can follow this exchange and all subsequent reader comments at Psychiatric Times. Keep in mind, you must register in order to read articles at the site, but registration is free.