Electroconvulsive therapy (ECT) was not always a treatment; it was at one point weaponized against individuals deemed deviant by authorities. This episode delves into the dark history of ECT, revealing its descent from a promising medical tool into a means of systematic oppression, used to reshape minds and enforce compliance on marginalized and dissenting populations.

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The Origins of ECT

At the dawn of the 20th century, as mental hospitals became overcrowded and struggled under inhumane conditions, the urgent need for radical solutions emerged. Existing treatments offered only limited relief: insulin therapy, inducing deep comas, or chemical shocks that produced powerful tremors. However, none consistently achieved the desired therapeutic outcomes.

In 1938, in Italy, neurologist Ugo Cerletti and psychiatrist Lucio Bini conceived a novel idea. Inspired by the use of electric shocks to stun animals in a slaughterhouse, they questioned whether electricity could do more than simply numb the mind; could it potentially heal it? The prevailing belief at the time held that epilepsy and psychosis were mutually exclusive. Cerletti and Bini hypothesized that inducing artificial seizures might unlock the enigma of schizophrenia. Before the advent of psychotropic medications, ECT became a last resort, a faint glimmer of hope in the treatment of severe schizophrenia and intractable depression. However, this last resort was primitive and often resulted in fractures and injuries. From its inception, ECT sparked a debate that continues to this day: is it a life-saving treatment or a thinly veiled instrument of torture?

Expansion and Misuse

While ECT gained traction as a treatment for severe depression, its applications soon expanded to encompass a wide range of conditions, often unrelated to depression. In the 1950s, ECT was introduced as a treatment for schizophrenia, despite limited scientific evidence supporting its efficacy. Studies reported highly variable improvement rates, ranging from 20% to 50%, suggesting inconsistent effectiveness. Nevertheless, some physicians used it to treat “anxiety neurosis,” as described by the Journal of the American Medical Association in 1950, further broadening its application.

Most disturbingly, ECT was used as a “cure” for homosexuality, particularly in the 1960s and 1970s. Based on the erroneous assumption that homosexuality was a mental disorder, LGBTQ+ individuals were subjected to painful and degrading experiments. Even personality disorders, such as borderline personality disorder, were targeted with ECT, despite the lack of compelling evidence of its effectiveness for these conditions.

By 1976, the calls for restricting ECT had grown from faint whispers to resounding cries, exposing the dark and terrifying aspects of this treatment. This was not merely misuse, but a deliberate and horrific exploitation.

ECT as a Tool of Oppression

In the 1950s and 1960s, ECT became a brutal tool of oppression, particularly against marginalized groups. Homosexuals, for example, were forcibly subjected to attempts to “cure” their sexual orientation, which was considered a shameful deviation. Even Time magazine, in 1967, contributed to the normalization of this disgraceful practice by promoting ECT as an effective treatment for homosexuality, further exacerbating the problem. The atrocities extended beyond this. In South Africa under apartheid, physicians widely used ECT against Black political activists, often without their knowledge or consent, in a blatant violation of human rights. In the Soviet Union, ECT was transformed into a political weapon, used to punish dissidents falsely diagnosed with “sluggish schizophrenia” in an attempt to silence their dissenting voices. Even children were not spared; in 1952, Dr. Walter Freeman, the infamous pioneer of the lobotomy, conducted horrific and inhumane experiments on children and adolescents he deemed “abnormal.”

During that dark era, an estimated one hundred thousand to two hundred thousand individuals underwent this harsh procedure each year in the United States alone. These numbers conceal painful and chilling personal stories of memory loss, a double-edged sword associated with ECT. While it may erase pain, it also erases cherished memories, moments of joy, and even the ability to learn, leaving a void that cannot be filled. In 1975, a patient named Ann broke the silence, describing ECT in Asylum magazine as horrific torture, a devastating experience for both the self and the body. Her words encapsulated years of suffering and nightmares.

A 2003 study in the journal Neuropsychology revealed a concerning finding: a significant decrease in gray matter volume in the brains of patients who underwent ECT, particularly in areas crucial for memory and learning. Is this the exorbitant price we must pay for this so-called treatment? In 2018, a group of ECT survivors filed a class-action lawsuit against a manufacturer of ECT devices, accusing the company of gross negligence and failure to warn of the potential and devastating risks of the treatment. This represents a desperate plea for justice and a sincere desire to prevent others from experiencing the same trauma.

Evolution and Modern Practices

From the heart of this controversy, we return to the origins of ECT. In 1938, in Rome, Italy, Ugo Cerletti and Lucio Bini administered the first ECT to a patient suffering from schizophrenia. The initial procedure was primitive, involving the direct application of unmodified alternating current to the brain. This resulted in violent convulsions and broken bones. However, science is dynamic. In the 1950s, the introduction of curare, a muscle relaxant, reduced the severity of convulsions and the risk of fractures and physical injuries. In the same decade, the advent of general anesthesia made the procedure less painful and more tolerable. Was this the beginning of the end of suffering? The evolution continued. Unilateral ECT, which focuses the current on one side of the brain, emerged as an attempt to mitigate cognitive side effects, such as memory loss. Sham ECT (S-ECT), in which the patient is anesthetized but no current is applied, became a crucial tool in studies designed to assess the true effectiveness of the treatment.

Today, modern ECT devices monitor brain activity via electroencephalography (EEG) during the procedure, aiming to optimize the dosage and better target seizures. However, are these advancements sufficient to redeem a dark history? Can technology atone for the mistakes of the past?

The Fight for Ethical Treatment

Alongside technological improvements, the voices of patients yearning for justice and dignity grew louder. In 1975, The Lancet issued a strong critique of the use of ECT without informed consent. This criticism sparked a widespread debate, heralding a new era of ethical awareness and hope. In California, in 1976, the Committee for Informed Consent in Psychiatry was founded, one of the first organizations to advocate for the rights of patients undergoing psychiatric treatment. This movement extended beyond ECT, focusing on the inherent dignity of human beings and their right to self-determination.

In 1979, this struggle was embodied by Ken Kesey, author of One Flew Over the Cuckoo’s Nest, who filed a lawsuit against Oregon State Hospital for using ECT on patients without consent. Kesey represented a symbol of rebellion against tyrannical authority and systematic oppression, a voice for the voiceless. In 1982, the New Jersey Supreme Court issued a landmark ruling granting psychiatric patients the right to refuse ECT, even if they were deemed incompetent to make their own decisions. This victory for human rights resonated throughout the legal system. In 2001, the United Nations condemned the use of ECT without informed consent, considering it a violation of human rights.

ECT Today

Today, ECT persists, albeit in a modified form. It is no longer considered a panacea but a last resort, as described by the American Psychiatric Association, reserved for cases of severe depression, acute mania, and intractable psychosis, specifically when all other treatments have failed. In the United States alone, nearly one hundred thousand individuals undergo ECT annually. However, the debate surrounding its use continues. While the Royal College of Psychiatrists in the United Kingdom emphasizes its effectiveness in certain cases, it also calls for careful monitoring and transparency. Anesthesia and muscle relaxants have significantly reduced physical complications, but the risk of memory loss remains a concern. A study published in PLOS One revealed divergent patient opinions, with some viewing ECT as a lifeline and others expressing regret. Informed consent has become a legal requirement in many countries, prohibiting forced treatment except by court order in cases where the patient lacks decision-making capacity. While not a complete victory, this represents a significant step forward.

The journey of ECT, from its brutal beginnings to its modern practices, serves as a cautionary tale. The California Supreme Court’s decision in Rogers v. Okin served as a warning against coercive