Research Paper First Draft

Many people visualize forceful doctors, painful seizures, torture devices, and spiritless patients when they think of ECT. Accompanied by these images are the thoughts of controlling, abusive, and unnecessary shock treatments used to control confused patients. People often speak of their “knowledge” of the excruciating, scream-inducing convulsions that accompany shock treatments. Such people are usually surprised to discover that ECT is still in use, and is actually enthusiastically endorsed by professionals and patients alike. [cite to McMan’s] What people don’t seem aware of is that only part of what “shock therapy” has been portrayed as in the media was ever realistic, and nearly none of it exists today. In reality, electroconvulsive therapy is a safe and beneficial treatment for depression.

Before a patient receives ECT, they must be referred, and then informed consent must be given by the patient or the party legally responsible for the patient in the case where the patient is unable to consent. There are some pre-treatment assessments to weigh any possible risks, and if there are risks, the tests continue to see how they may be minimized. [Cite to Armenian Medical Network] A patient will usually receive treatments around six to twelve times over the course of two weeks, or in some cases, every other day. [Cite to answers.com] In preparation for the treatment, the patient receives medication to keep heart rhythms normal, an anesthetic, and blocking agents. The electrodes through which the electricity is sent are fastened to one or both sides of the patient’s scalp before the treatment is applied. [Cite to McMan’s] The jolt of electricity generally only lasts for 0.1-0.5 seconds. [cite to answers.com] The “convulsion” itself, which is really limited to twitching fingers, ends in about thirty seconds. In a few minutes, the patient will be awake, with little to no recollection of the treatment. [Cite to McMann’s]

There are only a few reasons that many people are against electroconvulsive therapy, and these reasons are founded mostly on confusion and misinformation. The first reason is that people are confused and believe they have been misinformed. This confusion turns people against ECT, but really has little to do with the therapy itself. The confusion stems from the information presented by ECT experts and which supposedly makes ECT look safer and more worthwhile than it really is. For example, there are claims that the American Psychiatric Association (APA) falsified reports and statistics regarding frequency and severity of certain side effects, mostly memory loss, of ECT. These claims consist largely of the accusations that the APA report fewer people have suffered memory loss than really have, and that more people have experienced severe or permanent memory loss than the APA reports. [cite to ect.org] However, this confusion should not reflect poorly on ECT directly, as it seems to have. If anything, it should reflect on the doctors and the APA, if they are really down-playing side effects or falsifying information. In their defense, one statistic that the APA is accused of falsifying, the APA claimed was an estimate. Estimating was probably the best they could do, because only four of the fifty United States “require reporting on ECT statistics.”

The misinformation misleads people into thinking ECT is more dangerous than it really is. These half-truths usually scare people into their biases. One variation of half-truth is that presented by the media, which has constantly made ECT appear as an abusive way to control patients rather than a way to help them. The movie “One Flew Over the Cuckoo’s Nest” seems to have lead the charge in this attack on ECT. [Cite to newspaper] However, it doesn’t stop there. Other movies include “The Snake Pit,” “Frances,” and “Shine.” Studies have repeatedly shown that after watching films that depict ECT as barbaric and ineffective, the majority of respondents, medical students included, “decreased their support” of the practice. The saddest part of this is that the portrayal of ECT in these movies was not accurate. [cite to psychiatrictimes] Another form of frightening half-truth is the overly simplified terms in which ECT is sometimes thought of. People tend to think of electroconvulsive therapy in such expressions as “electrocuting someone’s brain” or “giving someone a seizure,” which are not altogether accurate. Decades ago, these fears may have been somewhat justified, but ECT has made so many advances in recent years that these are far from the concerns that knowledgeable people have. It is not used for anything other than treating depression, bipolar disorder, and occasionally schizophrenia. [cite to familydoctor.org] ECT has also become much safer than before. In fact, “shock” therapy’s original stimulatations didn’t use electricity, and medication-induced “seizures” were actually much more dangerous than the electric ones, particularly compared to the ones today, where anesthesia, muscle relaxants, and well-controlled amounts of electricity are used. [answers.com]
Fifty years ago, patients might have been given over 100 treatments, with larger quantities of electricity and a different waveform. The treatments weren’t supervised well, and because muscle relaxants and anesthesia weren’t used, the treatments and convulsions were painful and could result in broken bones. Today, the convulsions have been lessened to the twitch of a finger or two with the muscle relaxants, and a patient might get up with a headache or sore limbs, never an injured bone. [Cite to Electroboy] These are all very important improvements to the safety of ECT, but there are also improvements to the therapy itself. One is the use of what is called unilateral ECT, where they place the electrode only on the right side of the scalp. This keeps the side of the brain where language and auditory memory is stored from being affected. The other significant improvement is the beginning of using [use of] brief-pulse stimulus instead of a steady stream of electricity. With a quick, short dosage of electricity, it lessens the chances of serious memory problems. [City to Electroboy] One more area in which ECT has made serious progress is figuring out what it does. When ECT was first practiced, they believed that epilepsy could not exist with seizures, so they induced seizures to patients, hoping to dispel the epilepsy. [Answers.com] It has since been observed that ECT does marvelous things, not for dispelling epilepsy, but for dispelling depression. However, we have only recently begun to figure out why. There are a few theories, but probably the most widely accepted explanation is the “Neuroendocrine theory,” which claims, simply put, that the electrical shock delivered in ECT causes many chemicals in the brain to be released. These chemicals help the brain cells and “chemical messengers” in the body work better together. [Cite familydoctor.org] A chemical that may be released is called neuropeptide, which also helps to regulate mood. [Cite to electroboy]

ECT isn’t inhumane, and it is certainly making leaps and bounds where progress is concerned – but does it actually serve a purpose? It most certainly does. Electroconvulsive therapy is the quickest form of therapy available for treating depression. Patients usually undergo treatment for about two weeks before they are done, as opposed to multiple weeks or months that may be required for medication or talk therapy to take effect. [cite to WebMD] Some people might wonder why this is relevant, and these people are probably forgetting one very important thing about depression, which is how it sometimes ends – death. More specifically, it may end in suicide. Approximately 15% of all people with depression will end up committing suicide. [Cite to newspaper] ECT is a very valuable option in the case of depression when there is a risk of suicide or homicide. In these cases, counseling, and medication may not take effect fast enough to deter these attempts. Because ECT works almost immediately, with nearly immediately results [redundant], it is the best solution for these situations. However, ECT, like any kind of therapy, is not permanent. [cite to WebMD] Unless the use of ECT is continuous, or the patient is merely experiencing a depressive episode, then it can’t prevent suicide; it can only postpone it.. [Cite to ect.org]] This is because depression, for the most part, isn’t curable [Statistic?]. Any time that depression is overcome by any means, it is possible for it to return, so even if ECT is used right away to alleviate the immediate risk of suicide, further treatment is always recommended and is usually necessary. [cite to WebMD]

ECT is not only the fastest form of therapy for depression; it is also the most effectual form of therapy offered. [site to McMann] Some patients that are treated for depression may not respond significantly, or even at all, to medication or counseling. Other patients may not be able to take the medications they need due to other health restrictions. In such cases, it is likely that ECT will help. In fact, ECT has an 80-85% “response rate” for acute depression. [cite to answers.com] Compare this to an average of 51% success rate for the 12 most common antidepressants and do the math. [cite to findcounseling.com] There are cases when medication or counseling will be able to build on what ECT has initiated in a patient, but in more difficult cases, they may use continuous treatment. This hasn’t been very common in the past, due to uncertainty of the effects of long-term exposure to ECT, but has experienced a rise in the medical community. [cite to Armenia thing] One aspect that must be handled with special care in the use of continuous ECT is the diagnosis of the person receiving it. They should be properly diagnosed with depression, and it should be made certain that they don’t have bipolar disorder that has been misdiagnosed. There is a risk that, while ECT may help improve bipolar disorder to some extent, excessive use of electroconvulsive therapy may increase the frequency of episodes. [cite to Armenia thing) For this reason, before receiving continuous ECT for any reason, it is important to be absolutely sure about the diagnosis. ECT is a valuable alternative, and a truly remarkable treatment in many aspects. However, as with any kind of therapy or medicine, it can do damage if used for the wrong purposes.

Electroconvulsive therapy has many advantages over other forms of therapy, and it can produce miraculous results, but in the end, it isn’t a miracle. Electroconvulsive therapy is just what it is – it is therapy. Like any kind of therapy, there are downfalls, and these are the downfalls that anti-ECT enthusiasts will emphasize when they try to tear it down. In reality, though, ECT at its worst is no worse than another form of medication or therapy. ECT, like any other type of treatment, can be damaging if it’s misused. A patient can become sick or their condition may actually worsen if they are given the wrong medicine. ECT may hurt the person or make their condition worse if it was the wrong treatment – that’s why it’s so important, as mentioned before, that a patient is properly diagnosed. In addition, there can be too much of a good thing. A patient may overdose, intentionally or unintentionally, by their fault or a doctor’s mistake prescription. This is definitely harmful, but one would not blame the medication, because that was not the medicine’s intended use. Similarly, if a person receives too much ECT, there will almost definitely be increasingly adverse effects. Any blame for too much electricity being applied or having too many treatment sessions would probably be placed on the doctor in charge – regardless, it isn’t the fault of ECT itself, because ECT is not intended to be given at certain amounts. However, if any of these errors happened with a medication, or another form of more widely-accepted therapy, people would probably not try to deprive other patients of whatever treatment was involved. Similarly, there are no good reasons to try to deprive future potential patients of ECT. If a form of treatment has been misused, the answer should not be to get rid of the treatment – it should be to take better precautions to prevent the misuse.
Also like any kind of therapy or medication, ECT has side effects, the only difficult one being memory loss. Any medication, including over-the-counter drugs, can have side effects. Some anti-depressants’ side effects include the risk of increased suicidal thoughts. Hypnotic drugs, which are most commonly used for treating insomnia or other sleep conditions, have such side effects as weakness, chest pains, a wide variation of stomach and intestinal problems, and even insomnia – which is what the medicine is supposed to be fixing. [Cite to rxlist] Some even claim that there is somewhat of a side effect even to therapy – a stigma that will always follow a person and affect their life. [Cite to antipsychiatry] If a person accepts this negative stigma about themselves, it is even possible that they will develop a dependence on talk therapy through a self-fulfilling prophecy, in which they subconsciously act in conjunction with their thought, thus making this thought a reality. [cite to psychologysuite101.come] If the thought was, “Only crazy people need therapy,” and that thought turned into a self-fulfilling prophecy, then the person would start to subconsciously act more “crazy,” which might actually result in the need of more therapy. Everything in the medical world has some kind of side effect. ECT is no different, and its side effects are relatively few in comparison to some more widely-accepted medications. Despite this, every time someone’s are unpredictably worse than expected, they seem to call forth a lawsuit or a horror story.

There are horror stories galore regarding the effects of memory loss due to ECT. Among these are the cases of Peggy S. Salters, who lost 30 years of her memory, including that of her marriage to her deceased husband; Ernest Hemingway, who killed himself because he claimed he could not write without his memory; and Melissa Holliday, who claimed that ECT was worse than rape. [Cite to answers.com] These stories would seem enough to scare away any potential patient, but considering how many patients undergo ECT, which is an estimated 100,000 in the United States each year [cite to History and Use], these incidents are few and far between. Success stories, while much less splashy, far out-number the accounts of failure. Some patients would talk about their treatment like it was a nightmare, and then clarify that, compared to how they felt before, the memory loss and temporary soreness was nothing. It makes one wonder how much they were suffering before the treatment. The patients can tell us. One patient describes their prior depression as “hellish.” Another described their depression as a disease that “stole his self,” “executed” him, and “forced him to stand and look down at his own corpse.” [Cite to answers.com] To go from that kind of misery to memory loss, headaches, and soreness of limbs must be some relief. Relatives of those who have undergone ECT say that their loved ones are like “being brought back from the dead.” [Cite to Armenian thingy bob] Nobody likes losing memories, but with the advances they are making in discovering exactly how ECT works, the closer they are to being able to prevent and treat the memory problems. Until then, as with any kind of treatment, it is a balance of pros and cons. Ms. Kitty Dukakis, who has undergone ECT and is glad for it, has a counselor who puts the question rather simply: “Would you rather be depressed or be forgetful?” [cite to answers.com] When depression reaches the point that your thoughts continuously focus on death, you can’t sleep, but you can’t get out of bed, and there’s nothing, including medication and therapy, that seems capable of making you feel better, then the answer is probably just as simple.

When it is put that way, it certainly does look simple. Then why is it so hard for outsiders to reach such a seemingly straightforward answer? When people hear about a failed heart being revived by electric pulses, they are relieved – but once the same principle is applied to the brain, it is often considered barbaric, inhumane, and horrific. Hopefully, this kind of thinking can be put to an end by people being properly informed about ECT’s use, procedure, and overall benefits. It is important for people to support ECT for two main reasons. One reason is that, with support, more research can be done, which can lead to being able to better prevent or treat the side effects of ECT. With the impressive progress that ECT has made in the last 40 to 50 years, it can certainly continue to make progress. Another reason is to raise awareness of its availability. Many people who might benefit from ECT don’t realize it is an option. A person may undergo ECT after suffering from depression for four years, only to wonder why they hadn’t done it three years earlier. [Cite – Newspaper?] That doesn’t mean that ECT is for everyone, because it isn’t. No doctor or expert would ever claim that it is, but it is hardly reasonable to argue that ECT is right for no one. Electroconvulsive therapy has repeatedly and undeniably saved and changed lives for the better, and it would be a drastic mistake to deny future depression victims the chance to have their lives turned around by the opportunities that ECT can offer.