Carrie Fisher’s ashes are in an urn designed to look like a Prozac pill. It’s fitting that in death she continues to be both brash and wryly funny about a treatment for depression.The public grief over Fisher’s death was not only for an actress who played one of the most iconic roles in film history. It was also for one who spoke with wit and courage about her struggle with mental illness. In a way, the fearless General Leia Organa on screen was not much of an act.
Fisher’s bravery, though, was not just in fighting the stigma of her illness, but also in declaring in her memoir Shockaholic her voluntary use of a stigmatised treatment: electroconvulsive therapy (ECT), often known as shock treatment.
Many critics have portrayed ECT as a form of medical abuse, and depictions in film and television are usually scary. Yet many psychiatrists, and more importantly, patients, consider it to be a safe and effective treatment for severe depression and bipolar disorder. Few medical treatments have such disparate images.
I am a historian of psychiatry, and I have published a book on the history of ECT. I had, like many people, been exposed only to the frightening images of ECT, and I grew interested in the history of the treatment after learning how many clinicians and patients consider it a valuable treatment. My book asks the question: Why has this treatment been so controversial?
ECT’s origins in the 1930s
ECT works by using electricity to induce seizures. This is certainly a counter-intuitive way of treating illness. But many medical treatments, such as chemotherapy for cancer, require us to undergo terrible physical experiences for therapeutic purposes. The conflicts over ECT have other sources.
ECT was invented in Italy in the late 1930s. Psychiatrists had already discovered that inducing seizures could relieve symptoms of mental illness. Before ECT, this was done with the use of chemicals, usually one called Metrazol. By many reports, patients experienced a feeling of terror after taking Metrazol, just before the seizure started. A Cleveland psychiatrist who was active then once told me that the doctors and nurses used to chase the patients around the room to get them to take Metrazol.
Ironically, given that ECT would become iconic as a frightening treatment, the Italian researchers who proposed using electricity instead were searching for a safer, more humane and less fearsome method of inducing the seizures. Their colleagues, internationally, believed they had succeeded. Within only a few years of its invention, ECT was widely used in mental hospitals all over the world.
ECT used as a threat in hospitals in 1950s
Many depictions of ECT in film and television have portrayed the therapy as an abusive form of control. Most famous is the film One Flew Over the Cuckoo’s Nest, in which an unruly patient is subjected to the procedure as a punishment. There is probably no fictional story that so haunts our consciousness of a medical treatment.
Cuckoo’s Nest, and many other depictions, are sensational, but we cannot grasp the historical background to the stigma around ECT if we do not acknowledge that Cuckoo’s Nest, while released as a movie in 1975, was not completely unrealistic for the era it depicts, the 1950s.
There is no question that ECT was benefiting patients then, but there is also a lot of evidence from that period showing that ECT, and the threat of it, were used in mental hospitals to control difficult patients and to maintain order on wards. ECT was also physically dangerous when first developed. Now there are ways to mitigate those dangers. Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anesthesia to avoid pain from the electricity.