For decades, personal essays on electroconvulsive therapy have highlighted pain and discomfort, a dismaying loss of memory, and an indifference of practitioners who forced the treatment on unwilling patients. It took much persuasion to assure patient cooperation. In the 1960s, the raucous testimony of ECT "survivors" focused the debate on the horrors of the treatment and away from the illness and benefits. Sadly, legislators and psychiatric leaders hearkened to the ranting, and laws were passed restricting the use of ECT. Despite the limitations, increasing numbers of patients who developed "therapy-resistant depressions" from the inherent limitations of medicines encouraged another look at ECT.
Personal essays about ECT have changed their tone. Professionals who believed that they would never be subject to this outmoded and primitive treatment have experienced it and then testified publicly to their experience, changing the public rhetoric.
Norman Endler, a Canadian professor of psychology, described a severe episode of depression that failed to respond to medications and that also induced severe side effects (Endler, 1982). Electroconvulsive therapy was recommended. Chagrined that a clinical psychologist should need a somatic psychiatric treatment, he sought help in another city. He described his experience:
A needle was injected into my arm and I was told to count back from 100. I got about as far as 91. The next thing I knew I was in the recovery room. ... I was slightly groggy and tired but not confused. My memory was not impaired. I certainly knew where I was. ...
After about the third or fourth treatment, I began to feel somewhat better. ...
My last ECT session was the next morning [September 16th, treatment 6], and that evening my wife and I went to a symphony concert. ... On the next Wednesday, September 21, I taught my first class; I also played my first game of tennis in more than three months and won. That night my sex drive returned--my holiday of darkness was over. ...
In a postscript, Endler wrote:
Negative attitudes about ECT die hard. A few months later ... I phoned another friend who is a professor of psychology and a clinician. ... When we met I told him about my depression and about ECT. His response was 'Oh, my gosh! How could you let them do this to you, Norm?'
The disbelief that a rational, educated scholar would allow himself to be subjected to this primitive treatment is repeated by Martha Manning, an American psychologist and psychotherapist (Manning, 1994). She became depressed, failed to respond to insight therapy, eventually realized that she fulfilled the criteria of major depression and reluctantly concluded that the depression was not psychologically determined, but had a biological--probably hereditary--origin. Antidepressant and sedative drugs gave troublesome side effects and only temporary relief. Thoughts of death and suicide became more and more intrusive. She was hospitalized and recovered with a course of ECT. Her colleagues and friends were prejudiced against her decision for medication and ECT, and in reminiscence, she wonders why the attitude is so dissimilar to another electric treatment, that of electroconversion of a cardiac arrest, which is also life-saving. She wrote:
Anonymous (1984), How I owe my life to ECT--By a practicing psychiatrist. Am J Soc Psychiatry 4:16-17.
A practicing psychiatrist (1965), The experience of electro-convulsive therapy. Br J Psychiatry 111:365-367.
Endler NS (1982), Holiday of Darkness: A Psychologist's Personal Journey Out of Depression. New York: John Wiley & Sons.
Fink M (1997), Prejudice against ECT: competition with psychological philosophies as a contribution to its stigma. Convulsive Ther 13(4):253-265; discussion 266-268.
Manning M (1994), Undercurrents: A Therapist's Reckoning with Her Own Depression. San Francisco: HarperCollins.
Miller J (1991), Madness [PBS/BBC Documentary].
Nuland SB (2003), Lost in America: A Journey with My Father. New York: Alfred A. Knopf.
Plath S (1996), The Bell Jar. San Francisco: HarperCollins.
Rosenberg LE (2002) Brainsick: a physician's journey to the brink. Cerebrum 4(4):2-10.
Rouech‚ B (1974), As Empty as Eve. The New Yorker. Sept. 9:84-100.
Smith S (2003), Shock therapy aiding Kitty Dukakis. Boston Globe. July 24:B1.
Wasserman D, Kesey K (1970), One Flew Over the Cuckoo's Nest: A Play in Two Acts. New York: Samuel French.