The Stigma of Electroconvulsive Therapy

Updated: May 19

“It was a queer, sultry summer, the summer they electrocuted the Rosenbergs, and I didn’t know what I was doing in New York.” This famous first line, penned by Sylvia Plath for The Bell Jar, is believed by many eminent scholars to foreshadow the electroconvulsive therapy later experienced by the protagonist as a treatment for her depression. She undergoes ECT twice, the first time with little warning and without any anesthesia. Disturbingly, the scene plays out like a horror movie—”I thought my bones would break and the sap fly out of me like a split plant”—and ends with a final heart-rending thought: “I wondered what terrible thing it was that I had done” (Plath).


For many of us, hearing the phrase “electroconvulsive therapy” elicits a mental image that resembles the above passage. My own initial impression of ECT was that it was some obsolete form of medicine, a vestige of an era before the establishment of research ethics boards. However, its use in healthcare persists, and to my surprise, the terrifying things that we imagine do not represent its modern reality. 


These days, ECT is recommended for patients with severe depression for whom medications are ineffective. The procedure begins with general anesthesia, after which a small current is passed between two metal electrodes on the surface of the scalp, inducing a seizure that lasts from 20 to 90 seconds (CAMH). Usually, an ECT session lasts less than an hour and is repeated once or twice a week for a total of six to twelve sessions (Hopkins Medicine). More importantly, however, ECT is reported to have an astounding remission rate of 70-90% in patients with depression (Tokutsu et al.) and is touted by numerous prestigious institutions as a valid and effective treatment for major medication-resistant depression. Of course, ECT has its flaws like everything else; memory loss, headaches, and delirium are among some of the known serious side effects of the treatment (Tokutsu et al.). Moreover, the actual mechanism of how ECT alleviates depression is unclear, although possible mechanisms have been proposed involving changes to neuroplasticity and immune function (Singh and Kar). 


Naturally, the stigma surrounding ECT is no small matter either. In fact, what I personally found engaging about researching the topic was that it was so different from what I had imagined it would be. As Dr. Goldbloom writes, “There is something terrifying about the idea of electrical current being passed through the brain”. Indeed, many elements of popular culture unwittingly perpetuate the stereotype that ECT is some sort of punitive torture tool, with the “electric chair” and horror movies (Dr. Goldbloom brings forth the 1931 film Frankenstein, in which a monster is “brought to life with electric current”) being our most readily available associations with ECT. But why is this a problem? Consider the patients suffering from major depression who have tried every other option or their caregivers who give unconditional support. Perhaps these seemingly trivial conceptions of ECT will cause harm in generating fear or perhaps social stigma will brand these patients as broken and needing to be repaired through punishment. These beliefs, based on some antiquated stereotype of what electroconvulsive therapy is and whom it is useful for, only add emotional burden and social isolation to an already difficult situation—an unnecessary amplification of their suffering.

At the end of The Bell Jar, the protagonist undergoes ECT again but with a doctor she trusts, with consent and anesthesia. This time, she wakes up feeling finally “open to the circulating air”, reaching a state of peace that her depression denied her for many years.

Citations:

Plath, Sylvia. The Bell Jar. Faber and Faber.

“Electroconvulsive Therapy ECT.” CAMH, https://www.camh.ca/en/health-info/mental-illness- and-addiction-index/electroconvulsive-therapy. Accessed 6 Mar. 2020.

Frequently Asked Questions about ECT at The Johns Hopkins Hospital in Baltimore, Maryland. https://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/ect/faq_ect.html. Accessed 6 Mar. 2020.

Tokutsu, Yuki, et al. “Follow-up Study on Electroconvulsive Therapy in Treatment-Resistant Depressed Patients after Remission: A Chart Review.” Clinical Psychopharmacology and Neuroscience, vol. 11, no. 1, Apr. 2013, pp. 34–38. PubMed Central, doi:10.9758/cpn.2013.11.1.34.

Singh, Amit, and Sujita Kumar Kar. “How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms.” Clinical Psychopharmacology and Neuroscience, vol. 15, no. 3, Aug. 2017, pp. 210–21. PubMed Central, doi:10.9758/cpn.2017.15.3.210.

Goldbloom, David. “The Past, Present and Future of Electroconvulsive Therapy (ECT).” CAMH, electroconvulsive-therapy. Accessed 15 Mar. 2020.

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