The use of Electroconvulsive Therapy (ECT) for the treatment of mental illnesses such as severe depression, schizophrenia, and bipolar disorder spans the course of more than seven decades. For sufferers of schizophrenia, ECT represented the long awaited miracle cure for a disease once “seen as a death sentence” by patients and physicians alike.[1] In 1938, Italian neurologist Ugo Cerletti revolutionized the technique of ECT by introducing the use of electric current to conduct shock therapy. However, as the years progressed ECT faced antagonistic treatment from the field of psychiatry. In concert with the air of social change illustrated by the many reform movements of the 1960s, ECT underwent extensive scrutiny by human rights activists, members of the antipsychiatry movement and patients alike. By the 1970s the environment surrounding ECT had been completely transformed into a regulated and restrictive atmosphere. This transformation coincided with the new era of bioethics beginning to take shape and one of its historic events: Henry Beecher’s 1966 New England Journal of Medicine whistle-blowing article. From that point forward “the genie of informed consent could not be contained within the bottle of research” and just as quickly as the article surfaced did authorities such as the FDA and NIH set fourth requirements for the implementation of a new concept called informed consent.[2] Fred Frankel, a member of Beecher’s ethics committee from Massachusetts General Hospital, helped to introduce informed consent to the field of psychiatry in the state of Massachusetts through a series of questionnaires and a subsequent establishment of a “committee to analyze the data and help him address the issues.”[3] Growing concerns over the ethical issues in the use and administration of ECT ultimately led to restrictive federal regulations prominently in Massachusetts and California with other states following suit. This eventually led to outright ECT prohibition in San Francisco, California, by 1976. Over the next two decades ECT would undergo a resurrection through a combination of targeting the severe legislation established against the use of ECT and perhaps more importantly through the work of scientists Max Fink and Richard Abrams. They sought to prove the safety and efficacy of ECT with hard data “based on the new science of the brain and biological psychiatry.”[4] These groundbreaking efforts on the part of Fink, Abrams and many others reverberated internationally and, by the dawn of the 21st century, ECT’s global stigma had dramatically diminished. With the new century has also come advances in science and explorations into new methods of therapy such as the increasingly popular magnetic seizure therapy (MST) and transcranial magnetic stimulation (TMS). These novel techniques are gradually being introduced to patients and represent a focuses of extensive research for efficacy, safety and the possible replacement of ECT. While the social climate of ECT has certainly returned to one that is more receptive and less restraining, concerns still loom over associated brain damage, memory loss, general safety and ethical issues.[5] The associated ethical issues are primarily dual in nature. If ECT is considered safe and effective it is “unethical to withhold the treatment from patients who would be expected to benefit [from it].” However, it is equally unethical to suggest it to patients if it is an “ineffective treatment that damages the brain and leaves patients with serious cognitive deficits”[6] Where do you stand on the issue? source
