Electroconvulsive therapy, or ECT, is a behavioral health treatment that has a somewhat negative connotation in popular culture. Thanks in no small part to books and movies, such as One Flew Over the Cuckoo’s Nest, many people came to believe that ECT side effects were overwhelmingly harmful and that the therapy itself was prone to be abusive.

However, ECT remains a viable treatment option for some individuals, especially those with schizophrenia. Although ECT was once a very popular mental health treatment, it has since been usurped by medications and alternative therapies. Even so, sometimes ECT provides relief where other therapies fail.

Understanding the history of ECT helps to put its use into perspective.

How ECT Was Developed

ECT began to be explored as a treatment option for conditions like schizophrenia in the early 20th century after scientists made a few important independent discoveries.

First, Julius Wagner von Jauregg noted that the mental health of patients in asylums drastically improved after they survived fever-inducing diseases, such as typhoid fever or tuberculosis. This was the first clue that the brain might be capable of healing itself if presented with the right stimulus.

A few years later, a neurophysiologist named Manfred Sakel induced a coma in a young woman by “shocking” her system with insulin. Afterward, her mental health symptoms practically disappeared. Sakel continued to try this “insulin shock therapy” on patients with schizophrenia or psychosis and achieved a 70% success rate.

Meanwhile, a scientist named Ladislaus von Meduna noted a connection between improved mental health and the onset of epileptic seizures. He then began to test his hypothesis by inducing convulsions in patients. His efforts resulted in a 50% success rate, but the drug he used to induce the convulsions was too strong and caused a staggering number of spinal fractures.

Another scientist took the reins at this point: Ugo Cerletti. He recognized the usefulness of Meduna’s induced convulsions in treating schizophrenia, but wanted to find a safer way to provide the treatment. Cerletti’s background was in epilepsy research, and based on experiments he had already conducted with animals, he knew that one way to induce a convulsion was to send an electric shock from one side of the head to the other.

Electroshock therapy was developed as we know it by a colleague of Cerletti’s, L.B. Kalinowski. He campaigned around the world to promote it as a treatment for schizophrenia and other mental health concerns, citing in particular that ECT side effects were less intense than those of other shock-like therapies.

ECT Side Effects and a Decline in Popularity

ECT side effects are generally mild. Patients are sedated in order to keep the muscles relaxed and to keep the experience as pain-free as possible. However, some muscle soreness may linger after the treatment. Jaw pain, headache, nausea, confusion and memory loss are also possible ECT side effects.

ECT eventually declined in popularity not because of damaging and harmful side effects, but because it began to come to light that some mental institutions were using ECT in an abusive way. Patients would be administered ECT without sedation or anesthesia, making it an uncomfortable or painful experience. Patients who acted out might then be threatened with ECT even if it was not medically necessary. Reports indicated that ECT was sometimes given to patients multiple times per day.

Of course, not every facility misused ECT in this manner, but enough were found guilty of such abuse to spark public outrage. But that outrage was not the only reason why ECT declined in popularity. Other promising treatment options, most notably medications, were being developed and quickly replaced ECT.

Today, ECT remains a possible option for mental health treatment, and sometimes provides relief when other therapies don’t provide adequate relief from symptoms.

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