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NAMI Book Shelf: Shock

September 2006

Shock: The Healing Power of Electroconvulsive Therapy is a book that needs to be read by practitioners, consumers, family members, and even policymakers. You may be surprised, rather than shocked.

“There is no treatment in psychiatry more frightening than electroconvulsive therapy” (ECT), sometimes also known as electroshock therapy, the book begins. “There also is no treatment in psychiatry more effective than ECT.”

The authors are Kitty Dukakis, the wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis, and in her own right, a social worker and advocate for homeless persons and refugees, and Larry Tye, former Boston Globe medical and health reporter, who NAMI honored with an Outstanding Media Award in 2001.

Shock is two books in one, built in alternating chapters. The first is Dukakis’ personal narrative about her long struggle with the drug addiction and alcoholism that masked an underlying bipolar disorder -- which she in recent years has overcome through ECT.  The other is Tye’s journalistic examination of ECT as a therapy, and the controversies that surround it.

Having fallen into disfavor in the 1960s and 70s, ECT is experiencing a revival since. More than 100,000 Americans receive it each year, making it twice as common as knee replacement surgery.

But the treatment still is highly stigmatized, due in part to past abuses, old technology, and movie images. Some critics consider it “an absolute evil” that hurts people, calling for it to be completely banned.

Shock “separates scare from promise, real complications from lurid headlines” as an “exercise is demystification.’ The book is a brief in favor of ECT, but acknowledges its shortcomings and negative effects head-on, and in some cases, meets critics half-way.

It notes that NAMI does not endorse any specific medications or treatments, but because ECT does work, opposes any measures to ban it or unreasonably limit it as a consumer option. Among its candid personal stories of people who have experienced ECT are some from NAMI members, pro and con.

“ECT presents a better prospect for relieving severe depression than even the best antidepressants or the sagest psychotherapist,” Shock proclaims. “It goes to work faster, which is essential for patients determined to kill themselves. It also is accessible to the elderly, pregnant women, the physically ill, and those who cannot tolerate psychotropic drugs.”

“Like chemotherapy, ECT is a toxic treatment for a crippling disease. Like any surgery requiring anesthesia, it carries risks. And like the electric paddles that cardiologists use to shock a fibrillating heart back into rhythm, ECT is not a cure, but can offer relief and even remission.”

No one knows exactly why it works. There are theories, but little consensus. It could be the seizure that is produced. It could be the electricity. It could be biochemical reactions like those produced by antidepressant medications. Some compare ECT to “somehow resetting the brain when it gets out of balance, the same way rebooting a balky computer sometimes fixes it”

Memory loss is a major concern -- which critics attribute to “brain damage.” Shock, recognizes memory loss as a central concern, but calls the brain damage label “a red herring.” Neither proponents nor critics can know for sure what process is involved, for good or bad.

“We do know that alcohol, sedatives, antibiotics, and other commonly used drugs can cause amnesia without necessarily causing immediate and extensive damage to the brain.” At the same time, there is hard evidence that “ECT does sometimes result in serious and permanent cognitive deficits, whatever the cause.”

Sometimes, but not always.   

Arguments over brain damage therefore are “a distraction to most patients,” Shock argues. They already know their brains are “malfunctioning,” to a degree that is often life-threatening. That’s why they are considering ECT in the first place. What consumers need to know is whether the risk of memory loss outweighs the benefits of overcoming depression, and how risks can be minimized.

There are several ways to reduce the risk. But huge gaps exist between knowledge and practice -- as well as access.  Psychiatrists aren’t being educated about modern ETC. Most people who receive it are white, with higher incomes, and private health insurance coverage.

“I don’t know how ECT works,” Dukakis writes. “I don’t really care…All I know is that it breaks me out of depressive cycle.”

“I don’t feel like my brain is damaged…It makes me better.” Dukakis’ affirmation occurs despite the fact the she has absolutely no memory of a “magnificently romantic” trip to Paris taken for her 38th wedding anniversary, one week before her first ECT session. She forgets people’s names and how to get places; forgets conversations and commitments.

“It was a price I was told I might have to pay. I did it willingly.”

She also is 69 years old, and notes that her husband, her sister, and many friends exhibit some of the same forgetfulness.

Bottom line: “Would I rather be depressed or forgetful?”

Shock is an engaging, easy to read study. It provides an important framework for discussion and dialogue about ECT.

It also provides a practical guide for those who may be considering ECT as an option. The epilogue addresses questions such as:

  • Can ECT help me?
  • At what stage in my illness should I explore ECT?
  • How often will I need treatment?
  • How do I find the right doctor?
  • What will ECT cost?
  • What about consent?
  • What plans should I make before getting ECT?
  • Is there anything I can do to minimize memory loss?
  • Is there anything I can do to plan for memory?

Read an excerpt from the book

Transcript of Kitty Dukakis' Interview on ABC-TVs Good Morning America

Purchase a copy of the book from Amazon.com and NAMI will receive a percentage of the sale, at no extra cost to you.

 

 

 

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