ECT damage is easy to find if you look for it

Nature
Jan 20, 2000

Sir The reviewer of Max Fink's Electroshock: Restoring the Mind claims that electroconvulsive therapy (ECT) "has proved to be one of the safest procedures in medicine" and that there is a "myth, largely promoted by anti-psychiatrists, that ECT damages ... brain functioning".

One can be sympathetic to psychiatry (as I am) and still imagine that passing 150 V between the temples to evoke a grand mal seizure might cause brain damage, especially when you realize that this 'cure' for depression requires this procedure to be repeated 1020 times over a week or so. And when you talk to a friend who has been so treated and discover that a year later she is still experiencing huge gaps in recall of major life events, you begin to worry. Finally you discover that ECT's benefit is only temporary, so that many psychiatrists administer it chronically. Hmm.

Turn to the design of ECT protocols and you discover that many practitioners now administer ECT only unilaterally to the 'non-dominant' - non-verbal - hemisphere. Why? To avoid damaging the verbal hemisphere. In short, although ECT is completely safe, it is even safer when applied to the non-verbal hemisphere. Of course, equal damage is done to the non-verbal hemisphere, but it tells no tales.

ECT is used as an experimental tool by neuroscientists, as it releases massive quantities of glutamate, whose release following stroke causes significant neuronal death. Indeed, observers describe people who have had many ECT treatments as "punch drunk" - resembling boxers who have sustained chronic brain damage.

One reason psychiatrists are unaware that ECT is causing memory loss is that they do not test for it. Memory loss could be monitored by questioning patients before ECT about early events in their lives and then re-questioning them following each series of ECT. When this was done 50 years ago, memory losses were marked and prolonged. However, no effort has been made since to routinely perform this simple test.

It is a good bet that history will view ECT as one of what neuroscientist and author Elliot S. Valenstein calls the "great and desperate cures" - and its promoters as kin to the promotors of lobotomy.

Peter Sterling
Department of Neuroscience, University of Pennsylvania, Philadelphia, Pensylvania