Shock Therapy by Edward Shorter and David Healy

Thursday, July 18, 2013

Shock Therapy

by Edward Shorter and David Healy
Rutgers University Press

Somewhere deep in the dark bowels of a psychiatric hospital, a patient lies helplessly strapped to a gurney. A single light bulb dangles overhead, illuminating the patient and a maniacal-looking doctor clearly bent on using the patient as a human lab rat. Wires dangle from electrodes placed on the patient’s head, and with the flip of a switch the doctor sends the patient into wild convulsions. The patient writhes and screams under the electric current, while the doctor stands back, expressionless.

This is the image of electroconvulsive therapy, or “shock therapy” as it is more commonly known, that authors Edward Shorter and David Healy don’t want readers to think of as they traverse the nearly eighty-year history of electroconvulsive therapy throughout the globe. Shorter, the Jason A. Hannah Professor of the History in Medicine at the University of Toronto, and Healy, a professor of psychiatry in the Department of Psychological Medicine at Cardiff University, seek to dispel the perception of ECT as inhumane and dangerous. They anticipate distaste from their readers, which they try to defuse with light humor in passages like the following: “So deeply has [ECT] been stigmatized that some readers will peruse these pages with astonishment. Shock therapy! We thought that barbarous treatment long out of style! It is as though we had considered a rehabilitation of the ducking stool in the treatment of hyperactivity.”

Though the book is neutrally subtitled A history of Electroconvulsive Therapy in Mental Illness, it is important to keep in mind while reading that Shorter and Healy do have an agenda—namely, to inspire mental health professionals to reconsider ECT as a potential treatment option for some clients. They write not just to provide the reader with a glimpse of the evolution of the practice of ECT but also to highlight the benefits of the treatment for some patients. They maintain, “The basic reality to grasp here . . . is that ECT really does work in illnesses where drugs fail. A treatment of last resort may again be a therapy of first choice, particularly for the nonresponder group of psychiatric patients.”

The authors spend a great deal of time delving into the first uses of shock therapy, the derivation of the term, the fact that it is a misnomer, and the first cases where ECT proved to be effective when medication was not. Shorter and Healy choose not to engage with critics of ECT, past or present, and instead offer an overwhelmingly positive assessment that at times seems to ignore efficacy issues that surround this type of therapy. Surely there have been times when ECT was abused by medical professionals or other caregivers, or has had long-term negative impacts, none of which are mentioned in the text. They acknowledge their lack of information when it comes to long-term impacts of the treatment, but they don’t think such research is necessary for them to make their argument effectively. They write: “This is a history, not a chapter in a task force report, and hence it is not our goal to establish whether ECT causes memory problems beyond the relatively short-term difficulties that everyone agrees can arise for some people immediately after treatment.” Shorter and Healy do not give much time or attention to evidence of both long- and short-term memory loss that can accompany the use of ECT, or the possibility of sustained cognitive impairment that can accompany ECT.

The authors seek to portray the procedure realistically, not as “a series of Hollywood horror images.” They reference media portrayals of mental illness and ECT and dismiss them as incorrect. However, the basis for horrific scenes of the treatment of mental illness in media, and how those ideas developed over time, is never explored. Addressing the widespread fear of ECT, and how justified that fear is both culturally and medically, would have added a valuable nuance to their argument, and it would have helped to prove their argument that ECT is a valuable and positive way of treating mental illness.

Despite their bias, Shorter and Healy have compiled an intensively researched and highly readable book on a subject that may seem daunting, uncomfortable, or just plain unpalatable. While the authors do make some assumptions about the reader’s bank of knowledge, particularly when it comes to multisyllabic medical terms, the book is appropriate for the average reader. Most likely thanks to Shorter’s training as a historical writer, the book offers a personal, insider journey into the world of mental illness, a topic that isn’t often openly discussed. One method used to achieve this intimacy is the incorporation of case studies and interviews to support the book’s argument about ECT and the overall nature of mental illness, which helps them avoid making unfounded generalizations. Still, the case studies and interviews used seem to have been very carefully picked, as they highlight only positive outcomes from the use of ECT.

There is a feeling of hope that comes from reading this book. Despite the challenging technical terms and images, it seems clear that Shorter and Healy want to help people overcome the debilitating effects of mental illness by reconsidering a therapy that has been particularly demonized by modern media and the medical community itself. Their book, then, offers not only a history of the successes of ECT but also a beacon of hope for anyone suffering from mental illness that is not responsive to talk or pharmaceutical therapies.