episode 34. Electroconvulsive Therapy: The Shocking Truth

Tying tubes, nonconsensual hysterectomies, withholding medical care without contraception use…these are just a few ways that forced sterilization has occurred in the United States. The history of forced sterilization is sewn into the fabric of US history, and has played an insidious role in this country. This episode, we learn about the eugenics movement, its impact on communities of color and how these issues continue to manifest today. Then join us in our Feminist Corner as we discuss forced sterilization in the context of abortion bans and how healthcare providers play a key role in protecting patients from experiencing this blatant violation of human and reproductive rights.

Feminist Corner:

If the “expert” specialties, which one would you most like to do?

How would you reckon with going into a specialty within internal medicine that doesn’t have many women knowing that you going into it could help change the culture of that specialty?

Listen to the episode, discuss these questions with friends and family, let us know what you think!

Show Notes:

What is ECT? 

  • ECT is a medical treatment most commonly used in patients with severe depression and bipolar disorder that is treatment refractory, meaning that it doesn’t respond to treatment. 

History of ECT:

  • The therapeutic use of electricity dates back to Ancient Egypt, Rome and Greece, where they used currents produced by electric eels to treat headaches, arthritis and even to assist in obstetrical procedures. 
  • It was in the 1700s that “medical electricity” became this popular option to treat different diseases, particularly “nerve disorders.” and it was actually a German professor named Georg Bose that made using electricity fashionable as just like, an attraction and a spectacle for people. But this was electrotherapy, used to treat physical ailments. 
  • In the 1930s, there were multiple treatments of schizophrenia that came about: insulin shock therapy, psychosurgery, and convulsive therapy. 
  • It makes sugar enter body cells. But you need a certain amount of sugar just in your blood so when you have too much insulin you can get low blood sugar or hypoglycemia, and that’s what they were trying to do to patients in order to induce a convulsion. 
  • A Hungarian man in 1934 named Ladislas von Meduna was the first to induce convulsions using pharmacologic therapy. He believed that schizophrenia and epilepsy were antagonists so chemically inducing convulsions could help the psychotic features of schizophrenia like hallucinations and delusions.
  • In 1938, two psychiatrists in Italy did the first electr0-shock therapy using an instrument that could produce an electrical current. This was the first official ECT! It spread in popularity and by the 1950s it had become a standard treatment for hospital depression. 
  • But in the 1940s and 50s were finally when medications to anesthetize the patients started to be used in ECT patients and this decreased a LOT of the risks associated with ECT like bones breaking, muscle issues, etc. 
  • But from 1960 to ~1980, ECT kind of disappeared from practice. Any thoughts on why Char?
  • It was a combination of the 1960s counterculture vibe against ECT because of the novel and eventual movie called One Flew Over the Cuckoo’s Nest which painted ECT and Lobotomy together as really gruesome forms of punishment for deviant behavior.
  • But by the 1990s, it kind of became this treatment for pharmacologically resistant depression that we still use today! 

ECT and women:

  • Women are up to 40% more likely than men to develop mental health conditions and 75% more likely than men to have suffered from depression. This has been posited that it’s because women are more likely to suffer from “internal” problems because they tend to take out problems on themselves while men tend to externalize their problems. This lends to why men have higher rates of substance use disorders. 
  • And so it makes sense to me that women receive ECT 2-3 times more often than men. In a 1974 study, 69% of patients that received ECT were women. But back before anesthesia was used and convulsions could break bones. But it all kind of ties back to…why are rates of ECT higher in women and what leads women to have higher rates of depression?

Sources:

Burstow, B. (2006). Electroshock as a Form of Violence Against Women. Violence Against Women, 12(4), 372–392. https://doi.org/10.1177/1077801206286404

Davis, N. (2018, February 14). Electroconvulsive therapy mostly used on women and older people, says study. The Guardian. https://www.theguardian.com/society/2017/oct/20/electroconvulsive-therapy-ect-mostly-used-women-older-people-nhs

Electroconvulsive Therapy: What Is It, Risks, Benefits. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/9302-electroconvulsive-therapy#:%7E:text=Procedure%20Details&text=Before%20ECT%20treatment%2C%20a%20patient,brief%20seizure%20in%20the%20brain.

Lebensohn, Z. M. (1999). The history of electroconvulsive therapy in the United States and its place in American psychiatry: A personal memoir. Comprehensive Psychiatry, 40(3), 173–181. https://doi.org/10.1016/s0010-440x(99)90000-7

Shorter, E., PhD. (2020, November 16). The History of ECT: Unsolved Mysteries. Psychiatric Times. https://www.psychiatrictimes.com/view/history-ect-unsolved-mysteries

Suleman, R. (2020). A Brief History of Electroconvulsive Therapy. American Journal of Psychiatry Residents’ Journal, 16(1), 6. https://doi.org/10.1176/appi.ajp-rj.2020.160103

Wright, M.D., Bruce A. (1990) “An Historical Review of Electroconvulsive Therapy,” Jefferson Journal of Psychiatry: Vol. 8 : Iss. 2 , Article 10. DOI: https://doi.org/10.29046/JJP.008.2.007 Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol8/iss2/10

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