The Scientific American website has published (27 November 2017) an article about electroconvulsive therapy (ECT), “Neuroscience: Beyond the Cuckoo’s Nest: The Quest for Why Shock Therapy Can Work”, by R. Douglas Fields. The subtitle says: “Nearly 90 years old, electroconvulsive therapy can rescue some people, but not others, from depression, bipolar and other mental disorders.”
Can anyone at Scientific American do some simple arithmetic? If, as the article (correctly) says, electroconvulsive therapy was first used in April 1938 then it is nearly 80 years old, not 90.
The article that follows brings out all the tropes that characterize articles about ECT in the popular scientific press: One flew over the cuckoo’s nest, pigs and slaughterhouse, kinder and gentler, over 100,000 a year in the US…
Is ECT really used on over 100,000 people a year in the US? The article helpfully gives us a link to support their claim and the link takes us to an article published in the American Journal of Psychiatry in 1994. The title of the article is: “Use of ECT in the United States in 1975, 1980 and 1986.” The abstract to the article says that an estimated 37,000 people were given ECT in 1986 compared to 59,000 people in 1975. I don’t know how the author of the Scientific American article used those figures from thirty to forty years ago to arrive at an estimate of over 100,000 people currently being given ECT every year in the US.
There is mention of a recently published article from the Journal of ECT on state regulation of ECT: “Six states have no regulation at all on ECT, limiting who can administer or receive the treatment, who can provide consent, how it is practiced or administrative requirements on reporting.” Surely it is the other way round, with those states that have regulations putting limits on the practice, while in states without regulation it is a free-for-all.
Most articles of this type would talk about “small currents” but this author has tried something different, describing the electric shock as “pulses of high-voltage electricity”. The wave-form used in American ECT machines is brief-pulse, but coming at a rate of, typically, 70 a second you are not going to feel pulses but a continuous electric shock, just as with sine-wave current you don’t feel waves of electricity. What about high-voltage? ECT machines nowadays in the United States are “constant current”, leaving the voltage to vary automatically according to impedance. Specific voltages are not therefore included in electrical parameters, but the Thymatron machine for example has a maximum voltage of 450. There is, meanwhile, no generally accepted definition for “high-voltage”: Collins Dictionary says anything over 1,000 volts, while Oxford Dictionaries simply says “An electrical potential large enough to cause injury or damage”. So ECT would not qualify as high-voltage using one definition but possibly would using another.
The article focuses on Wendy Ingram, PhD, Psychiatric Epidemiology Postdoctoral Fellow at Johns Hopkins Bloomberg School of Public Health in the Mental Health Department, who, together with Sharon Larson, Stanley Poler and Fatin Nahi, is looking at the effect of using different anaesthetic agents on the outcome of ECT. Dr Ingram is understandably disappointed that the patient records (from Geisinger Health Center) are so poor that it is impossible to draw any useful conclusions from them. She describes how a cousin killed herself following ECT, but this doesn’t seem to have influenced her views of the treatment and its “tremendous therapeutic effects”.
The article predictably finishes with a call for less stigma, less regulation of ECT, the need to acknowledge mental illness as a biological disease, and more funding for research.