Shock: An investigation into the startling comeback of electroconvulsive therapy
By Jennifer Wells and Diana Zlomislic
Few medical treatments are as fraught with fear, misunderstanding and controversy as electroshock, or electroconvulsive therapy. Most of us consider it a treatment of the 1950s and 60s, an option medicine and society have left behind. Yet ECT is experiencing a startling resurgence and is seen as especially efficacious among older Canadians.
Has its execution grown more sophisticated? What is its success rate? Are there still side effects?
Toronto Star journalists Jennifer Wells and Diana Zlomislic set out to answer these questions, delving deep into the science and ethics of ECT. Compelling and timely, Shock is essential reading.
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By Jennifer Wells and Diana Zlomislic
Few medical treatments are as fraught with fear, misunderstanding and controversy as electroshock, or electroconvulsive therapy. Most of us consider it a treatment of the 1950s and 60s, an option medicine and society have left behind. Yet ECT is experiencing a startling resurgence and is seen as especially efficacious among older Canadians.
Has its execution grown more sophisticated? What is its success rate? Are there still side effects?
Toronto Star journalists Jennifer Wells and Diana Zlomislic set out to answer these questions, delving deep into the science and ethics of ECT. Compelling and timely, Shock is essential reading.
When you subscribe to Star Dispatches, you'll receive new eRead titles, for only $1/week. That's only $1 per week, with a minimum subscription period of 1 month, to explore news and features from a new and unique perspective. Single copies of Star Dispatches eReads can be purchased for $2.99 at starstore.ca or itunes.ca/stardispatches
Excerpt:
Shock: An investigation into the startling comeback of electroconvulsive therapy
Based on a survey of the 175 Canadian centres that identify ECT as part of their practice, researchers estimate that 75,000 ECT treatments are delivered in Canada annually.
In Ontario, data released by the Ministry of Health show an acute rise in electroconvulsive therapy. In the fiscal year 2010-2011, the most recent year for which statistics are available, a total of 16,259 ECT treatments were delivered, an in patient outpatient tally. That’s more than a 350-per-cent increase in seven years. A breakdown by age and gender reveals startling subsets, especially a 1,300-per-cent treatment increase for patients in the 55-59 age cohort. Treatments for women versus men run two to one, a pattern that has been historically true and one that has been conventionally attributed to a higher rate of depression among women.
The numbers seem almost incomprehensibly high, even given the championing of ECT by members of the psychiatric community who cite the vast numbers of patients who remain pharmaceutically unreachable with antidepressants. The health ministry can offer no insights into what might account for the data explosion. What is known is that almost three decades after a provincial inquiry into the practice of ECT in Ontario, there are no training standards, no agreed-upon protocols, no consistent measurements of care, no auditing mechanisms to monitor outcomes. Thirty years after the government was goaded into examining what was then and is still the most controversial treatment in the history of psychiatry, the province has no clinical practice guidelines.
To the general public, ECT is a historic artifact, a throwback to the postwar era, or possibly the Seventies, but back there somewhere. Truth is, it never went away and is today experiencing something of a cultural renaissance. There’s a recent New Yorker schoolroom cartoon (“We’ve found by applying just the tiniest bit of an electric shock, test scores have soared,” says the teacher to a set of button-eyed parents). There’s the threat of ECT leveled against sadly orphaned and besotted Sam Shakusky in Wes Anderson’s Moonrise Kingdom (Sam having failed to comply with the behavioural expectations of Ms. Social Services). And perhaps most notably there’s the gripping, season-ending moment of the ingenious television series Homeland, in which CIA operative Carrie Mathison (Claire Danes) checks herself in for electroshock in the hopes of leashing the hounds of the bipolar disorder that has left her wild-eyed and unhinged (and stratospherically creative). “It’s not Cuckoo’s Nest,” Carrie admonishes her horrified mentor and ex-boss, Saul, before she’s fixed with a set of electrodes and a rubber bite block. Homeland aficionados were left on the edge of their seats: would Carrie — anesthetized, legs twitching — emerge from her electricity-induced seizure with the ability to remember a crucial, plot-twisting piece of evidence?
As a narrative device, ECT is inarguably riveting. Perhaps, then, it should not come as a surprise to learn that the vast majority of the general public draws its knowledge and opinions of shock therapy from movies and TV. It may come as a surprise to learn that the same goes for medical students. This is not an incidental consideration. ECT proponents have been fighting the public imagination for decades, ever since Hollywood exquisitely captured that seminal scene in One Flew Over the Cuckoo’s Nest in which an electrode-sporting Jack Nicholson as the single-minded, anti-establishment Randle McMurphy clamps down on a piece of rubber hose as he’s fried, awake, like a strip of bacon on a hot griddle.
In Ontario, data released by the Ministry of Health show an acute rise in electroconvulsive therapy. In the fiscal year 2010-2011, the most recent year for which statistics are available, a total of 16,259 ECT treatments were delivered, an in patient outpatient tally. That’s more than a 350-per-cent increase in seven years. A breakdown by age and gender reveals startling subsets, especially a 1,300-per-cent treatment increase for patients in the 55-59 age cohort. Treatments for women versus men run two to one, a pattern that has been historically true and one that has been conventionally attributed to a higher rate of depression among women.
The numbers seem almost incomprehensibly high, even given the championing of ECT by members of the psychiatric community who cite the vast numbers of patients who remain pharmaceutically unreachable with antidepressants. The health ministry can offer no insights into what might account for the data explosion. What is known is that almost three decades after a provincial inquiry into the practice of ECT in Ontario, there are no training standards, no agreed-upon protocols, no consistent measurements of care, no auditing mechanisms to monitor outcomes. Thirty years after the government was goaded into examining what was then and is still the most controversial treatment in the history of psychiatry, the province has no clinical practice guidelines.
To the general public, ECT is a historic artifact, a throwback to the postwar era, or possibly the Seventies, but back there somewhere. Truth is, it never went away and is today experiencing something of a cultural renaissance. There’s a recent New Yorker schoolroom cartoon (“We’ve found by applying just the tiniest bit of an electric shock, test scores have soared,” says the teacher to a set of button-eyed parents). There’s the threat of ECT leveled against sadly orphaned and besotted Sam Shakusky in Wes Anderson’s Moonrise Kingdom (Sam having failed to comply with the behavioural expectations of Ms. Social Services). And perhaps most notably there’s the gripping, season-ending moment of the ingenious television series Homeland, in which CIA operative Carrie Mathison (Claire Danes) checks herself in for electroshock in the hopes of leashing the hounds of the bipolar disorder that has left her wild-eyed and unhinged (and stratospherically creative). “It’s not Cuckoo’s Nest,” Carrie admonishes her horrified mentor and ex-boss, Saul, before she’s fixed with a set of electrodes and a rubber bite block. Homeland aficionados were left on the edge of their seats: would Carrie — anesthetized, legs twitching — emerge from her electricity-induced seizure with the ability to remember a crucial, plot-twisting piece of evidence?
As a narrative device, ECT is inarguably riveting. Perhaps, then, it should not come as a surprise to learn that the vast majority of the general public draws its knowledge and opinions of shock therapy from movies and TV. It may come as a surprise to learn that the same goes for medical students. This is not an incidental consideration. ECT proponents have been fighting the public imagination for decades, ever since Hollywood exquisitely captured that seminal scene in One Flew Over the Cuckoo’s Nest in which an electrode-sporting Jack Nicholson as the single-minded, anti-establishment Randle McMurphy clamps down on a piece of rubber hose as he’s fried, awake, like a strip of bacon on a hot griddle.
