How Electroconvulsive Therapy Works

With the exception of lobotomies, no other psychological treatment has a worse reputation. But thanks to some thoughtful tweaks, ECT has lately emerged from the dark ages and toward the respectable forefront of treatment for major depression.

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Episode Transcript

Speaker 1 (00:01):
Welcome to Stuff you Should Know from House Stuff Works
dot com. Hey, and welcome to the podcast. I'm Josh
Clark and there's Charles W. Chuck Bryant, which means it's
time for Stuff you should Know. Indeed shocking edition. See

(00:22):
I take the rap for a bad pun, but you
in fact, I said that before we recorded. I know
I before we recorded. I have a public image. I
have to care. Got um Chuck. Yes, have you ever
seen or read or both? One flu Over the Cookies Nest?
Yes both? Oh? Yeah? Did you like the book more

(00:43):
than the movie or vice versa? Both? The book was great.
I've seen a movie a dozen times. Yeah, one of
my favs. It is a great movie. Yeah. I haven't
read the book. Although I was a KINKSI fan. I
thought he was a cool dude. Yeah, I've read a
few us. Um, what else did he write? He did
the Well, Actually he didn't write. That was Tom Wolf
that wrote the electrically, that was figured prominently obviously. Oh yeah,

(01:06):
he was the main KESI wrote the crap. I'll come
back to it. He wrote the what was it the Well?
If you haven't seen or read One Flew Over the
Cuckoo's nest you totally should is, like Chuck was saying,
one of the best movies of all time. It is
a great book apparently, and Um. One of the things

(01:27):
that factors into it setting in insane asylum in the
fifties I would say maybe sixties. UM. And one of
the I guess almost a character in this UM movie
or book is electro convulsive therapy, which the staff uses
to basically keep the patients in check. UM. Just the

(01:49):
very threat of getting electroc convulsive therapy shock treatment, a
type of shock treatment, we should say, is enough to
just keep everybody very docile and calm and settled down.
And they started to get riled up, you can just
ask him, do you want some shock treatment? They're like no, No,
everything's good, Everything's fine. And apparently because of that and

(02:09):
KESI worked as an orderly in a mental institution in Oregon,
so he saw his first hand when he wrote it. Um,
because of that, E. C. T. Got a pretty bad
rap over the course of a couple of decades, the
point where it's basically forced almost out of existence. And
it wasn't just keezy Um making this stuff up like
he said he was. He was a disorderly like like

(02:32):
the fat Boys. Um. But there was also a study
in n by the National Institutes of Health that found
like that was pretty common practice among antal institutions at
the time because it was drug free. It was just
using electrical shock and it wasn't a lobotomy, right, and
um it was the effects were temporary and apparently it

(02:53):
worked to keep everybody in line. But that's a gross
abuse of this pretty effect of therapy for mental illness, yeah,
for severe depression. And these days it is approved by
the National Institute of Mental Health, the a p A,
the a m A, and the U. S. Surgeon General

(03:14):
and they all say that if used properly e c
T these days and you know, tweaked diversion of what
they did back then, is can be very beneficial. And
Kitty Dukakus, wife of Michael Ducacus, former presidential nominee until
he wrote in a tank, uh, wrote a book because
she had it and it's called Shock, The Healing Powers

(03:36):
of electro Convulsive Therapy, and um it helped her out.
And I've read excerpts and reviews and stuff, and she
doesn't like champion it for everyone or anything, but gives
a lot of great history and then says how it
has helped her in her journey through depression. Apparently also
helped Dick cab It. Oh yeah, yeah, it did not
help so much, Um, Sylvia platha in a standing way, right, Um,

(03:59):
But yeah, it's been it's been used on a decent
amount of people. Apparently about a hundred thousand Americans a
year undergo electro convulsive therapy. Who who got George? Yeah,
yeah that's right. Yeah, yeah, we've already spoiled that show.
So we should just like do dramatic readings from scripts. Uh. Um,

(04:21):
So we we should also say before we go forward,
it's very easy to call it electro shock therapy. That's
kind of right. Electro Convulsive therapy is a type of
shock therapy and shock therapies. The aim is to shock
your system into having a convulsion because as far back
as Hippocrates, it was noticed that people who have mental

(04:44):
illnesses who experienced convulsions tended to feel a little better
after the after they experienced their seizures. So what you're
trying to do with any kind of shock treatment is
induced a seizure and a convulsion. Because no one knows
why still to this day, but it does something to
your brain and can hear whether temporarily or permanently, UM,

(05:08):
mental illness. Yeah, I wonder how this I never I
didn't think about until just now. I wonder how it
ties in with like a temper tantrum, like a kid
feeling better afterward or more settled afterward, or an adult
that just loses it, you know, and then you know,
I think everyone's truly lost it before in some emotional way,
and then afterwards you're like, boy, I feel like more

(05:29):
relaxed now a right, like resetting after like a catharsis. Yeah,
I bet you. It's sort of similar pathways in the brain, right,
except this is with electricity exactly. So, UM, let's talk
about the history of shock therapies and electro convulsive therapy
or e c T. That's easier to say. So. One
thing that they did in the twentieth century, Um, they
started to experiment with insulin shock, where they would just

(05:51):
dose the crud out of somebody with insulin and basically
like bring them into a coma and in the comma
they would have convulsions. Is that right? Yeah? Right, that
was the point. Like they figured out this guy named
Ladislaus von Maduna, who was a Hungarian physician. Yeah, he
figured out that if you take insulin and injected in
somebody puts him in a coma temporary coma, UM, that

(06:13):
you can bring him out of with glucose, and then
while they're in the coma, they have seizures. And he
was one of the ones were probably the first modern
physician to suggest that there was a link between seizures
or um. Yeah, seizures and the curing of mental illness.
He took it one step too far and saying that

(06:34):
schizophrenia and epilepsy were counter productive maladies, so if you
had one, you couldn't have the other. He was wrong
about that, but he was right about seizures having a
curative effect on mental illness though. But he was the
one who started championing and champion championing using insulin to
produce seizures, so he led the way, followed by Italian

(06:57):
scientists the nineteen thirties who only brought electricity into it. Well,
hold on, there was another guy too before. Yeah, like
right around the same time they are all these competing
shock therapies, UM, and there was the insulin guy, and
then there was another dude UM named Manfred's sakel And
he was testing something called metrozol, which is the respiratory stimulant.

(07:20):
And when you give somebody this stuff, they have seizures.
And it's very reliable and it's very powerful, more powerful
than insulin, and it requires less recuperation time in hospitalization time.
The problem is it's so powerful. The like of patients
who had shock therapy using metrosol suffered spinal fractures from

(07:41):
because the convulsions were so hardcore, like the Exorcist. Yeah,
and then some now we're electricity. Yeah they discovered electricity.
No way, that's not true. I think it was like, um,
these Italians, they were scientists, and they said, we can

(08:01):
use this to jolt this guy like with these delusions.
He's he's clearly suffering, like shock him with electricity, and
the delusions receded after like several treatments, and then just
a few years later, in the nineteen forties, it was
being used as a regular treatment in the US for schizophrenia, depression, bipolarism. Um,

(08:24):
but it's not like it is today. You said they've
tweaked it. They've definitely improved it. They figured it out,
Like we were a little barbaric before no anesthesia back then. Yeah,
so you were wide awake and conscious when they applied
in electro shock in your brain like in Cuckoo's Nest.
Violent physical reactions with the body that don't happen these

(08:48):
days were very powerful. Yeah, because a there's anesthesia. And
they also these days put um muscle relaxers and stuff
everywhere except the big the big Foot, the big foot
eight single foot, well when it has a blood pressure cuff,
and I'm sure it is the big Foot, but yeah,
they they introduced it intravenously and then they put a

(09:08):
blood pressure cuff on your around your ankle, so your
body isn't like convulsing anymore, but dick and tell it's
going on by e G s and stuff. And then
the foot single foots movement, Yeah, because you're keeping the
muscle relaxer and I guess the anesthesia out of the foot. Yeah,
so someone's actually a doctor looking just at your foot supposedly.
I haven't seen that anywhere else. I saw that. Yeah,
I saw that. Um like they even with the muscle relaxant,

(09:32):
your fists are going to clench it on clanch in.
Your chest might heave and they'll still put a tongue
thing in your mouth to keep you from buying your
tongue off, right, But the the cumulative effect of it
is not going to be felt at all by you
because you're out under general anesthesia and you're probably feeling
pretty good anyway. That's true thanks to Mr Muscle Relaxer.
And then the you know what, the way you've always

(09:54):
seen it on TV, even when they portray modern like
on six ft Under, they show people are always render
this like zombies, like lobotomized essentially, and that's that's not
what's going on these days. No, well, even back then,
it was kind of a caricature of what a person
looked like coming out of it because there is memory
loss associated with it, yeah, and there still is. Yeah,

(10:17):
there was then, there still is now. So I think
that's almost like that's what that's what some artists rendering
or some directors rendering of what somebody with memory loss
looks like. And so that's what just kind of got
picked up in the popular culture following e. C. T.
As you're just like catatonic, lobotomized zombie like, But really
it's that's shorthand for it. There's weird memory loss. Yeah,

(10:40):
and these days are going to check you out a
lot more beforehand, I think, especially in the media portrayed
as you know, some like a McMurtry and one flew
over the cuckoo's nest. He's causing problems. Still just drag
him in there, strap him down and shock him. Uh.
These days you're gonna five disorder least to hold them exactly. Uh,
You're gonna go through a battery of pre treatments, um

(11:00):
like blood test, electro cardiograms. They're gonna give you a physical,
they're gonna give you a mental, and they're gonna make
sure you're a good fit all the way around for
this kind of treatment. It's you know, it's not as
I don't know if it was willing naily back then,
but that's how it appeared to be at least, and
there was there's actually a decision by the f d A.
It's an electro convulsive therapy machine is a Class three

(11:23):
I believe device, just the strictest and classification. And so
it was up for reclassification for a little while, and
um they said, you know what, We're gonna stick with
this classification because it's used for electro shocks, and a
lot of people said, whoa old stuff. Yeah, you guys,
this is this is you're still looking at it under
this the medieval use from the forties and fifties. Things

(11:46):
have changed by that. But I have to say, I
mean it's I kind of am comforted by the fact
that you still have to go to a doctor. It's
not like the same thing as going for like laser
hair removal, like you can also get E C T
in the same fits. Like it's very much medicalized, and
I think it should be because we still don't understand
what the mechanisms are. Yeah, that's true. Um, they will

(12:08):
pulse your brain. You know, you've got these little things
about size of a quarter, these pads on the side
of your head, either on both sides or one side,
and they pulse you with for one millisecond, even though
I think recently even shorter like millisecond point to five
to point three seven milliseconds. Yeah, that's what they're starting
to use. And I guess that that's like is it

(12:30):
for more humane purposes or yeah. I think they're finding
that it works at least as well. But there's also
fewer side effects, like apparently a one millisecond pulse of
electricity is enough to like really interrupt memory, right, consolidation,
I guess, whereas like a quarter of a millisecond, it's
not so bad, all right, And these days you're gonna

(12:51):
get it. Two to three times a week for three
to four weeks is a typical treatment. Yeah, that's of course,
five or ten minutes at a time. Yeah, from the
time that they inject you with the the anesthesia till
the time you start to wake up is about ten minutes,
which I mean, like that doesn't sound like much. But
if you're doing that two to three times a week
for several weeks, all that that's a period of your

(13:13):
life that you have a lot of trouble remembering much of.
I don't think it's a picnic still, because you're you
are still coming out of it. You're still groggy coming
out of anesthesia. You can still be confused. What's ironic
is now that they use anesthesia, you probably look more
like the portrayal of people coming out out of ect
in the fifties than they did because they were anesthecized.

(13:35):
Yeah they weren't. No, Yeah, that's what I mean. Today,
that's funny. I didn't think about it like that. UM.
I found one step funny, I found one stat that
said it is effective in of people these days with
severe depression, whereas any depressants are only UM effective about
sixty at the time. Yeah, and that's what's pretty much

(13:57):
what they're using it for. Is just like major depression
is pretty much the thing that they found, like, Okay,
it's really effective for this, Like when drugs don't work, well,
that's usually when they're turning to it. UM is after
an adepressant, after antidepressant hasn't worked. But this is like
a pretty significant rebound, a hundred thousand people a year
getting this and coming under wide medical and public acceptance UM.

(14:23):
Because just as as recently in the eighties, there's a
stat in this article that says between eighty five and
two thousand two, the use of ECT in England dropped
by half, and that was because there was a rose vanidepressants.
It's like, you can take these pills, or we can
put electrodes on your brain and zap you. What do
you want to do? But then as people were as physicians,

(14:45):
I guess we're finding that there were plenty of people
out there who don't respond well to UM antidepressants. Shock
therapy is a great alternative. And if you're if you
suffer from major depression and you are suicidal or at
risk for suicide, they may hop right to e c
T because the results are so much faster. Huh that

(15:09):
makes sense, I know. Well. One of the interesting things
they pointed out too, was that, um, once you've had
e c T, if drugs were not previously effective on you,
then the anti depressants can extend the good, uh, the
good effects of the e c T longer, which was
interesting because like, I guess they can work in concert

(15:31):
if you go e c T first, which makes it
sound like like the e c T goes in there
and like shake things loose, and then the drugs come
in and like keep their functioning going, keep the new
and improve functioning going. And we should say, like, all
this is theory. We don't no one knows specifically what
e c T does to the brain. We just know

(15:51):
it works. Then we should also say, no one's exactly
certain how anidipressants work, right or what effects they have
on the brain. But there's a couple of theories, um
that are kind of brain based. One is that Um.
The the idea is that the electricity UM changes how
blood flows or how cells metabolize things, and UM that

(16:15):
leads to some sort of improved function. Yeah. The other
one is they think it might release certain chemicals that
can help out UM, and everything I've read sort of
likens it to a like a control all delete, reset,
or like some sort of reset function on your brain.
I think they're likened it in here to turning the
stereo down, like there's just so much noise and this

(16:36):
just sort of resets a troubled brain, right. Yeah. There
was a study in from Scotland in two thousand twelve
where they did brain scans of people with major depression
before ect and after a round of E C T
and UM, they found that these regions associated with mood
and emotion, um, we're less active. And so they said

(16:57):
that they basically altered the functional connectivity of these regions
between the regions so that the person could think more clearly,
was less distracted, and they think that that had an
effect on reducing their depression. Well, and they tested with
placebo's too, and I think like anytime you test with
the placebo you're gonna find that some there's gonna be
a little bit of it that works, but yeah, you know,

(17:19):
but not always. And that's what they found here is
that some of the people that were told that they
received e c T put under. Didn't you think this
is kind of mean? Yeah, they would put them under
and say they did it and not do it. Um.
That the people with e c T did recover UM faster,
but there were some that received the fake treatment that
did recover as well. So they think that might have

(17:41):
just been because they received that extra TLC from a
proper clinician and the free drugs. That's true. So UM,
we should say there are risks to it, Like there's
at least two types of memory laws associated with e
c T. UM. One is you have trouble making memories

(18:01):
around the appointment, UM, which is to be expected that
it usually fades. UM. Then there's larger memory loss that
of past events long before your ect therapy. UM. But
that also fades not in all people though, So there
is like memory laws associated with it. With zapping the

(18:21):
brain with electricity, who who would have thought? Um? And
then uh, you can also die um. One in ten
thousand patients undergoing it dies. But they they say that
that's one in ten thousand. So every year ten people
die from city in America. But they say that that's
typically a reaction to or a result of anesthesia, Like

(18:44):
just going on, Yeah, it's dangerous in and of itself.
You're gonna get headaches obviously, in some muscle pain. But um,
I don't. I don't think it's anything quite like the
old days as far as muscle pain and stuff like that.
And you will still find people that poop who would
have worse. But this article points out a lot of
those people are the same people that are pretty anti

(19:05):
psychiatry in general and stuff like this. So that seems
like a bit of a leap to me. What from
the author to say that, Yeah, at least she wasn't
just like scientologists hate it. Um, you got anything else,
I got nothing else. Le've got to try this out.

(19:28):
I would certainly try it out if I needed it. Okay, Yeah,
we too. You know, there's something appealing to me about
using electricity over drugs. Yeah, you drugs are some great
thing to pump your body for love. Yeah, it's just
I don't know, I wonder if it's going to become
more and more widespread, you know, Yeah, and if it
comes back Gangbusters. Man, that's really going to be impressive

(19:52):
because it was almost gone. Yeah. You know, imagine if
the Little Botomy came back. Yea, I know it's still around,
but it's not back. But you know ect is back, baby,
maybe a little blood letting the leaching right. If you
want to learn more about electro convulsive therapy, type that
word in the search bar how stuff works dot com

(20:13):
and see if you can do it on the first try.
And since I said search bar, um, I guess it's
time for message breake mm hmm. And now listen to mail. Yes,
and I'm gonna call this misheard song lyrics. Um oh yeah,

(20:36):
I can't remember which one we asked, canal okay, um,
everyone has misheard sound lyrics. Excuse me while I kissed
this guy, Jimi Hendrix wrapped up like a douche Hanford, man,
that's not what he's saying. No, it wrapped up like
a deuce, like he's talking about craps. Is he cracks

(20:57):
or some other sort of gambling. I don't think so.
Because Springsteen wrote the song and it was cut loose
like a deuce, and he's song about a car engine.
I've heard gambling the Springsteen wrote it and then man
for man changed it. And it's funny Springsteen has come
out and said, you know, that song didn't become popular toil.
It became about feminine hygiene and then it was like

(21:18):
a big deal. Or there's a bathroom on the right
CCR instead was a bad moon. Right, I hadn't heard
that one. There's a bathroom No, No, I know the song,
but I mean, like, I've never heard anybody thinking he's
saying as a bathroom on their right. It's fairly common,
all right, So we got one from Cheryl. Hey, guys,

(21:38):
First of all, I want to say you're still keeping
me company on days when I get time to work
on my art projects. You're still as great as ever.
I was just listening to Panama Canal and I thought
i'd popp you a quick note to give you a grin.
Misinterpreted lyrics where my specialty as a kid far and
away in My most famous moment was when I was
five or six listening to Madonna with my Auntie and

(22:00):
I would sing Papa dom Bridge, I'm in trouble deep.
She said, thing is this really made sense to me?
And logically, logically if the bridge is made out of
papa doms, which or do you know what those are?
It's sort of like a like a flat bread, like
a crispy tortilla, sort of, it's like a crispy flatbread.

(22:22):
Uh So, if a bridge was made out of papa doms,
it would be bound to be weak, and if someone
were to walk over it, they would it would break
and they fall in the river below, and hence to
be in trouble deep And my dad still teases me
about that to this day. Does make sensense soon. So yeah, Cheryl,
Papa don bridge, well done? That's fine. You mean's mom?

(22:43):
She's Fromoking now and she called Madonna Papa don't preach?
How calls her that? It's her name? She's like, are
you listening to Papa don't preach? Again? My friend Fox
had the best misheard song lyric ever and I was
racking my brain earlier trying to remember it and I cannot.
So there's some good every one's out there. I'll try
and I'll try and remember and posted or something. I'll

(23:03):
get in touch with Fox. It was a funny one.
Nice you got any good ones. I'm like racking my
brain right now, and I know I've got one and
I can't remember. It looks like she does. Jerry just said,
if you did not hear instead of voices, scary by
until Tuesday men, horses scare me. Keep it down. Horses

(23:27):
scare me. Don't attract any horses because they scare me.
Do you know that? Technically? Uh? Until Tuesday was the
first band I ever saw alive. Oh really at my
first concert, Hall of Notes at the University of Toledo Coliseum,
they opened up on Yeah Until Tuesday opened up nice. Well.
I never really thought about that because I always say, oh,

(23:48):
my first concert was Cheap Trick. Yeah, I don't say
it was John Waite who opened up for Cheap Track?
Was it really John White? Yeah? Man, I would have
loved to seen that one. And those those are real concerts,
like I went to Kenny Rodgers and stuff when I
was a kid, and people like Couldey Rogers is real? Yeah?
It is about to say the same thing. I meant
concerts that my family didn't drag me too. Got that
I paid my own one for where I smelled marijuana

(24:10):
for the first time, like a real concert. I didn't
smell any marijuana at the hall and notates concert. Why
did a cheap drag? I was like, what is that?
I'm sure I've never smelled that before in my life.
Cheap trick. And everyone around me said, that is the
devil smell. Stay away. Yeah, and you did good going, Chuckers.

(24:30):
Uh is that it? That is it? Thanks to Cheryl
for um kicking off a pretty great little chap. You
should gets mom to call her Papa down Bridge now. Yeah,
see if you can get that done. Hey, listening to
Papa don Bridge. Yeah, say that's the Papa don preach,
that's Papa doan Bridge. Uh, what what do you want? Oh?
If you have any great marriage stories, we want to
hear them. We haven't asked for that ever. Family. Yeah,

(24:53):
and I don't mean wedding day fun. I mean marriage.
I would take wedding day fun. Those are two different things,
all right. Well, whatever you want to send related to marriage, um,
you can tweet to us at s Y s K podcast.
You can join us on Facebook dot com slash stuff
you Should Know. Uh, you can send us an email
to stuff Podcast at Discovery dot com and it's always good.

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