****** - Verified Buyer
4.5
If you are considering the pros and cons of Electroconvulsive Therapy (ECT), this is the best book for a general audience that exists on the subject. It was published in 2007 but I found the information in the book to be still relevant. I did personal research into the pros and cons of ECT (perhaps the most controversial medical procedure that is still practiced today as the book states) in 2021. I read everything from Scientology anti-psychiatry propaganda to the zealous defenders of ECT amongst psychiatrists and psychologists. “Shock: The Healing Power of Electroconvulsive Therapy” by Kitty Dukakis and Larry Tye was the most balanced source I read. It is also written for a general audience and does not require detailed knowledge of psychiatry. It is ultimately pro-ECT but is not shy in describing the possible devasting side effects that can follow ECT. The book is split between the story of Kitty Dukakis’s (wife of Michael Dukakis) personal narrative about her lifelong struggle with addiction and her treatment resistant depression and how ECT eventually became her best treatment option. The other half is by Larry Tye (a medical journalist) who details ECT’s complicated history and what the medical community has to say about its efficacy and possible reasons for working. The balance between these two narratives help to humanize the experience of untreated depression and the choice to do ECT and living in the aftermath of the procedure while also detailing the history of ECT’s problematic history and the science behind ECT.The book begins by describing how ECT is making a comeback after being attacked and heavily regulated due to its dark history. Since the 1980s, ECT has been slowly regaining ground. This is primarily because not everyone can be treated with medication and/or therapy. This is known as “treatment resistance.” Thus, psychiatrists began to call for more ECT being done to help people who had no other alternative. Mr. Tye also describes how the procedure is generally done and this is useful information for those considering ECT and want to know what happens during the procedure. I will not summarize Mrs. Dukakis’s story in full here only to say that it is great at showing the human side of depression, the struggle when treatment does not work and the surrounding logic and emotion that comes with the choice to do ECT. Mr. Tye gives a detailed history of failed and often barbaric treatments that eventually led to the first use of ECT in 1936 by Ugo Cerletti. Once ECT was demonstrated to have some positive effect, it became a fad and was used either inappropriately (against those who it was not indicated for such as homosexuals or mentally handicapped) or excessively (in some cases as a form of punishment in psychiatric hospitals.) This dark history is no doubt why ECT is still so controversial (even though it is now only used strictly in cases of treatment resistance depression and sometimes in the cases of bipolar disorder and schizophrenia.) There are two main reasons why ECT began to decline in use around the 1950s and beyond. One reason was because of those who called attention to its excessive use in psych hospitals (which culminated in a civil rights movement in the 1960s that called for the end of permanent hospitalization of psych patients and the end of use of ECT and from negative portrayals of ECT in popular culture such as “One Flew Over the Cuckoo’s Nest.”) The other reason was the introduction of the first anti-psychotic Thorazine in the 1950’s, which sparked the pharmaceutical revolution in psychiatry. Doctors began to rely solely on medication and abandoned ECT. States also began to regulate the use of ECT and it became harder to do the procedure.The rest of the book deals with issues like controversies over the indications for who should do ECT (it is now overwhelmingly only recommended for treatment-resistance depression) and the science over why ECT works (they still do not have a definite explanation but believe it has something to do with the induced-seizure causing the brain to “reboot” like a computer.) When Mrs. Dukakis finally decides to do ECT, she describes it as helping her symptoms tremendously but that there were significant side effects. The most common reported side effect of ECT is memory loss. Mrs. Dukakis does not sugar coat the side effects of ECT and describes major memory loss such as forgetting phone numbers and where she lives when driving home. Still, she says ECT was worth it and is happy to do the procedure again in the future. Mr. Tye also discusses the possible side-effects of ECT as well. As I stated above, this book is extremely balanced and anyone considering ECT should read this book to help them make an informed decision. One draw back of the book is that since 2007, new treatments have been approved by the FDA and other new treatments are being researched and tested. The biggest development has been the FDA’s approval Transcranial Magnetic Stimulation (TMS) and the fact that it is being used more widely in clinics. TMS has fewer side effects than ECT and has an efficacy rate close to ECT. However, its current state of treatment takes a longer amount of time than ECT to administer and it is of course not guaranteed to work. There is also Vagus Nerve Stimulation, which I admit I don’t know much about. Ketamine has also been approved and exists as private pay at the moment. Lastly, psychedelics are currently being tested to treat depression and PTSD and more research is being done on other forms of electric stimulation (such as Transcranial Direct Current Stimulation and Deep Brain stimulation.) I mention this only to inform the reader that other options exist outside of ECT and that you might want to try TMS or ketamine first before considering ECT.
