Return of the electrical monster

Nutrition Health Review, 01-01-1992, pp 22.

In many horror science fiction movies it served as a tool of terror. Audiences were panic-stricken when the mad scientist pushed a button that sent electrical shock waves through the victim's skull. It was also a time when legitimate physicians were engaged in dealing with the agonies of depression by the use of electroshock therapy.

Fortunately, pharmaceutical manufacturers discovered drugs that could allay and ameliorate mental disturbances. Electro-convulsive therapy (ECT) was abandoned by many psychiatrists. Less intrusive and less dangerous drugs succeeded in lifting the curtain of mental darkness. Lobotomy, the surgical science of operating on the brain, also encountered the profession's lack of enthusiasm.

Despite its poor image among both doctors and patients, ECT is enjoying a quiet revival. It is emerging as a treatment of choice in dealing with patients who, some doctors say, are not responding to drugs.

Its popularity among practitioners can be measured by the large number of people who have submitted to the treatment; more than 97,000 patients were treated in 1989, according to Medicare statistics of reimbursement. The American Psychiatric Association is endorsing the procedure, so are many recently published medical textbooks dealing with the subject. The press is heralding the revival of electroshock therapy to be "miraculous," and critics of the procedure complain that not enough patients are being warned of ECT's serious aftereffects.

The procedure consists of administering a muscle relaxant and a general anesthetic before an electric current is charged through the brain. The current induces a convulsion, a short seizure. For reasons that are unknown, the seizure seems to relieve the symptoms of depression temporarily. It is hoped that after three sessions a week, consisting of six to ten electroshock incidents, the patient will find long-term relief.

These are the joyful results about which most patients hear. They are not warned that ECT destroys parts of the memory complex and often inflicts spasms that result in broken bones.

The psychiatric profession still harbors practitioners who do not understand the limitations of ECT and employs ECT upon individuals suffering from probable genetic disorders such as Tourette Syndrome, Obsessive-Compulsive Disorder and Panic Disorder who will not respond to shock treatment. Fortunately, these conditions are now known to be aided by particular medications and behavior therapy.

Enough critics have voiced their concerns about insurance companies that are implicated (they press for patients to be discharged from hospitals sooner -- ECT often shows quick but temporary results). Richard S. Abrams, a psychiatrist at Northwestern University, recently made that observation.

There is no rule or regulation that can dampen the ardor that many psychiatrists have developed for ECT. With such passions raging, many patients will be urged to enter treatment that may leave them mentally confused, permanently disabled, or organically mangled.

If ECT has some success with hopelessly complicated cases, then with complete disclosure to the patient there may be an excuse for venturing into this forbidding area.

However, the psychiatric profession itself should establish such guidelines and warn its irrepressible colleagues that the brain is too delicate a blessing with which to tamper.