About this series

Shock therapy is making a dramatic comeback, primarily as a treatment for severely depressed elderly patients. After a four-month investigation, USA TODAY reported Wednesday that patients are not adequately informed of shock's risks, including the chance of death:

Studies show the death rate for elderly patients is as high as 1 in 200, not 1 in 10,000, as the American Psychiatric Association states.

Shock machine manufacturers greatly influence what patients are told about shock.

Shock therapy is the most lucrative practice in psychiatry, and economics influence when shock is given and who gets it. In Texas, the only state that keeps track, 65-year-olds get 360% more shock therapy than 64-year-olds. The difference: Medicare pays.

Psychiatrist Richard Abrams, an influential shock researcher and author of the only medical school textbook on shock therapy, also owns shock machine manufacturer Somatics Inc.

Questions to ask if a family member is considering shock therapy:

Ask your doctor for a detailed explanation of potential risks and benefits.

Visit a medical library to read studies on shock therapy.

For information supportive of shock therapy, contact the American Psychiatric Association: 202-682-6000.

For information skeptical of shock therapy, contact the National Empowerment Center: 800-769-3728.

ECT: History of shock

The modern use of electroshock began in 1938 in Rome, when psychiatry professor Ugo Cerletti shocked a homeless man speaking gibberish.

The first jolt was too low to cause a full brain seizure, but it did cause a brief spasm. What happened next was described by psychiatrist David Impastato in 1960: "After the electric spasm . . . the patient burst into song. The professor suggested that another treatment with a higher voltage be given. . . . The patient suddenly sat up and pontifically proclaimed no longer in jargon, but in clear Italian, 'Not again! It will kill me!' This made the professor think and swallow, but his courage was not lost. . . . and the first electroconvulsion in man ensued."

'Cuckoo's Nest'

Ken Kesey's novel One Flew Over the Cuckoo's Nest (1962) and the movie (1975) were influential in bringing about a decline in shock therapy's use.

In Cuckoo's Nest, McMurphy (Jack Nicholson's character) is shocked to punish his behavior.

Unlike the movie, shock patients are now put under general anesthesia and given muscle relaxants. But Cuckoo's Nest remains the image of shock therapy for many.

"The movie permeates our culture. It comes up every time I talk to patients," says Dallas psychiatrist Michael Lambert, who does shock therapy.

An excerpt from Cuckoo's Nest, the book: "The Shock Shop, Mr. McMurphy ... might be said to do the work of the sleeping pill, the electric chair and the torture rack. It's a clever little procedure, simple, quick, nearly painless it happens so fast, but no one ever wants another one. Ever."

By USA Today

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