When I tell people that I am currently undergoing electroconvulsive therapy, the modern equivalent of “shock therapy”, I am most often met with semi-horrified surprise or confusion. Many think that the treatment is no longer used due to its harsh side effects and potential for abuse. This belief makes sense, given the way that this treatment has been portrayed in the media, but is far from the reality of those currently going through ECT. In these conversations, I am tasked with giving the person I am talking to a more accurate perspective of ECT, but it can be hard to develop a good explanation. If ECT is not the torture that it has been portrayed as, what is it?
Electroconvulsive therapy, or ECT, is a treatment that uses electricity to induce brief seizures. Though little is known about how/why ECT works, it is often described as a “reset” of the brain. This “reset” can help treat a variety of mental health problems, including treatment resistant depression, catatonia, bipolar disorder, and schizophrenia. While it is not always a last-resort treatment, it is usually reserved for patients who have seen little progress with other therapies or have more severe symptoms. Today, ECT is held in high regard by the psychiatric community and is considered to be a generally safe procedure. When it was first invented in the 1930s, however, ECT was very different. Anesthesia wasn’t given, more electricity was applied, the seizures were not controlled, and patients didn’t always consent to the procedure. These issues, combined with media representations like “One Flew Over the Cuckoo’s Nest”, gave ECT a reputation for being dangerous that persists today.
My electroconvulsive therapy journey began my junior year of high school, when my doctors recommended that I start the treatment. My depression had been worsening for some time, and I had exhausted most other treatment options, so ECT was a logical next step. At the time, however, I was very focused on school and the college admissions process, and I worried what effect ECT might have on my future. Negative portrayals of ECT made me scared that it would take away my memory and make going to college impossible. At the same time, my doctors said that ECT was incredibly effective and that its side effects would be minor. In the end, debate over side effects didn’t really matter: if my depression didn’t get better, I didn’t know if I would make it to college anyway. I decided to start.
I stayed in the hospital for four weeks after beginning ECT, getting treatments three times a week. Memory loss makes it hard to remember most of my stay, but I do know that my mood started to improve. After a few treatments, my family and the hospital staff began telling me how different I seemed; after a few more, I realized that I was not only no longer suicidal, but actually happy for the first time in years. I felt almost “cured” and had yet to notice major side effects, making ECT seem pretty magical.
Post-discharge, however, my return to normal life was complicated. On my first day back at school, I realized that I couldn’t remember where any of my classes were. I ended up stumbling through the halls until I found a teacher that pointed me in the right direction. Things did not improve once I got to class, either, as I couldn’t remember where I was supposed to sit. I had dropped several classes in anticipation of potential side effects (so long, AP Calc), but not being able to navigate my own school made me extremely worried for the rest of my classes. Soon, more side effects piled on: it was hard to concentrate and keep track of what I was learning. I started to notice a general mental fog. This made daily functioning very difficult, but having been told that the side effects of ECT were unimportant, I felt like I was overreacting. As the side effects continued, I realized that I wasn’t overreacting, and that I didn’t want to continue ECT. I ended up stopping treatment early, hoping that the positive effects I had seen would continue, just without the negatives.
While ECT has a higher success rate than most medications used for depression, patients often relapse after they end treatment (because of this, maintenance ECT is often given after an initial course). After a few months, my depression got worse again, to the point that I no longer felt safe at home. I decided that the potential for relief was worth the side effects, so I restarted ECT. Right now, I get ECT once every two weeks, and my experience is still mixed: my side effects are manageable, but I haven’t seen as much improvement as I would like.
At this point, I’ve done a lot of ECT, so I’ve had the “I do ECT” talk many times and answered a wide variety of questions. Most people respond with a fair amount of concern, asking “does it hurt?” or “was it your decision?”. Some people that know more about the procedure want to know how much progress I’ve seen, or if I still feel depressed. Almost everyone asks me something along the lines of, “does it work?” or “what do you think?”, but I always struggle to find a good answer.
I usually feel pressured to respond with some kind of reassurance, because I don’t want to worsen ECT’s reputation or increase its stigma. When I was first researching ECT, I came across a number of stories that portrayed the procedure in a negative light. Reading them made me more worried about what ECT would be like for me, and often made me feel like a “crazy” person for even having it as an option. It can be tempting to only focus on the good parts of my experience to prevent anyone else from feeling the same way. Sometimes I end up discussing the facts about ECT (it’s lessened my depression) without mentioning the varied emotions it’s created (losing memory is painful).
These days, however, I’m trying to incorporate both the facts and the emotions, because I know that focusing only on one aspect does ECT patients a disservice. I am not the only person to try and make ECT look “shiny”: while doing my pre-ECT research, I also found articles that proclaimed ECT to be the best cure for severe mental illness and only discussed the positives of the treatment. The articles and the doctors who shared similar outlooks made me feel worse when my experience turned out to be less than perfect. If we switch to pretending that ECT is a “miracle cure” and ignore its side effects, ECT’s reputation might improve, but patients with complicated relationships with the procedure will only feel more isolated. I want people to know that ECT isn’t as scary as they might think, but I also don’t want to hide the fact that ECT is scary for me, personally. I hope that by being open, I can help ECT patients know that it’s okay if they’re scared, too.
Many medical treatments involve a variety of complicated facts and emotions, but we keep these semi-distant in order to ensure that people access the medical care that they need. For example, I’m scared to get my wisdom teeth out, but getting them out will still be helpful. For many patients, ECT can also be scary and helpful at the same time. We shouldn’t take ECT’s helpfulness as a reason that patients shouldn’t be scared, nor its scariness as a reason that ECT should not be used—both can, and should, coexist.
In order to tear down ECT’s bad reputation, we don’t have to ignore the negative effects of ECT, we just have to remember that there are significant positive effects as well, and that the balance between positive and negative effects is different for everyone.
To anyone currently doing ECT, considering starting, or who has done ECT in the past, I wish you the best of luck. Whether your experience has been mostly good, mostly bad, or somewhere in between, I know that having to deal with stigma while also getting your brain shocked can be difficult. Know that other peoples’ opinions of you or your treatment are far less important than you, your health, and your happiness, and that you are not responsible for anyone else’s opinions about ECT: you’re a patient, not a spokesperson. Feel free to contact me with questions about my experience.
PS: The best thing about doing ECT is all the electricity puns you get to make. Shocking, right?
