Duhaime's Law Dictionary


Electroconvulsive Therapy Definition:

A psychiatric treatment of certain mental illnesses, the administration of electric current through the brain inducing seizures.

Also Electro-Convulsive Therapy, electro-shock therapy or ECT.

Bilateral or unilateral ECT may be administered. In a bilateral ECT, electrodes are placed on both sides of the head and the current is passed across the entire brain. In a unilateral ECT, the two electrodes are placed on the same side of the head and electrical current is passed across that side.

Both procedures produce a seizure. Bilateral ECT is more widely used because it works more quickly and effectively, but right-side unilateral ECT has fewer side effects and results in less memory loss. A typical course of ECT requires four to twenty treatments.1

According to the American Psychiatric Association:

''Electro-convulsive therapy (ECT) is a safe and effective treatment for certain psychiatric disorders. ECT is most commonly used to treat patients with severe depression. It is often the safest, fastest, and most effective treatment available for this illness. ECT is also sometimes used in the treatment of patients with manic illness and patients with schizophrenia.... During ECT, a small amount of electrical current is sent to the brain. This current induces a seizure that affects the entire brain, including the parts that control mood, appetite, and sleep. ECT is believed to correct biochemical abnormalities that underlie severe depressive illness. We know that ECT works: 80% to 90% of depressed people who receive it respond favorably, making it the most effective treatment for severe depression.

ECT Electroconvulsive therapy"ECT is given as a course of treatments. The number needed to successfully treat a severe depression ranges from 4 to 20."

In their 2007 article, authors Harold Sackheim2 and others wrote:

"Electroconvulsive therapy (ECT) is widely considered the most effective antidepressant treatment, with medication resistance its leading indication (American Psychiatric Association, 2001). However, critics contend that ECT invariably results in substantial and permanent memory loss (Breggin, 1986; Sterling, 2000), with some patients experiencing a dense retrograde amnesia extending back several years (Donahue, 2000; Sackeim, 2000). In contrast, some authorities have argued that, with the introduction of general anesthesia and more efficient electrical waveforms, ECT’s adverse cognitive effects are short-lived, with no persistent effects on memory."

A 2008 University of Louisville Law Review article by Stetson College of Law professor Helia Hull described an ECT on a fictitious person, "Mary":

"Two staff members reach underneath Mary and lift her onto a padded bed. A nurse places an oxygen mask over Mary's nose, and another staff member places straps around her wrists and ties them tight to the sides of the bed. A few moments later, a nurse injects atropine into Mary's vein to prevent Mary from suffocating from the physiological insult her body is about to experience. A moment later, the nurse returns and begins applying electroconductive jelly to the top of Mary's head to protect her scalp from electrical bums that could result from the massive jolt of electricity racing through her head. The nurse places one electrode on Mary's right temporal lobe and then another on the top of Mary's head. Mary starts to fall asleep as the nurse administers (intravenous anesthetics). Once unconscious, Mary is injected with succinylcholine to temporarily paralyze her muscles and reduce the risk of physical injury that could result from the convulsions she is about to experience. Virtually paralyzed, Mary is given oxygen from a mask. A flexible piece of rubber is inserted into her mouth to prevent tooth fracture or jaw injury when her jaw muscles contract from the shock. With the push of a button, a pulse of electricity races through Mary's brain and induces a seizure. Her body convulses, her muscles contract, and her jaw clamps down, but Mary feels no pain because she is unconscious. In less than a minute, it is over.....

"Because ECT is used in virtually every country of the world, it is estimated that between one and two million patients per year receive ECT....

"(T)he seizure causes massive physiological disturbances in the brain, some of which are permanent. Research has demonstrated that during an ECT-induced seizure, blood pressure increases to the point where the blood-brain barrier is compromised. These events may result in hemorrhage, edema, and possibly toxic effects to the brain from exposure to chemicals in the blood from which the brain is normally protected."

The American novelist Ernest Hemingway received an involuntary ECT at the Mayo Clinic in 1960 and 1961 and days after the last treatment, shot himself, and left behind these words about his ECT experience:

"Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient."

REFERENCES:

  • Hull, Heila Garrido, Electroconvulsive Therapy: Baby Boomers May Be in for the Shock of Their Lives, 47 U. Louisville L. Rev. 241 (2008-2009)
  • McNall v Summers, 30 Cal. Rptr. 2d 914 (Court of Appeals of California, 1994)
  • NOTE 2: "Dr. Sackheim is a Ph.D. in clinical psychology and experimental psychopathology, and a professor in the psychiatry and radiology departments at the Columbia Presbyterian Medical Center. He was chief of the Department of Biological Psychiatry at the New York State Psychiatric Institute, and was also an advisor to the American Psychiatric Association's Task Force on ECT, co-authoring its 1990 report." Shafran v St. Vincent's, op cit.
  • Powell v. Hawkins, 2007 Ohio 3557, (Court of Appeals of Ohio, 2007).
  • Sackeim, H. and others, The Cognitive Effects of Electroconvulsive Therapy in Community Settings, 32 Neuropsychopharmacology 244 (2007)
  • Shafran v. St. Vincent's Hospital & Medical Center, 694 N.Y.S. 2d 642, (Appellate Division of the Supreme Court of the State of New York, 1999).
  • Weiner, R. and others, The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging, A Task Force Report of the American Psychiatric Association {visited on July 9, 2012 at http://www.ect.org/resources/apatask.html] - NOTE 1.
  • Winger v. Franciscan Medical Center, 701 N.E. 2d 813, (Appellate Court of Illinois, 1998).

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