SYSK Selects: 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 (00:00):
M Hey everyone, it's your old pal Josh. And for
this week's s Y s K Selects, I've chosen how
electro convulsive therapy works. Uh. This one was an eye
opening episode. It came out in May of two thousand thirteen,
and prior to this I always thought it was just
kind of a barbaric treatment that was used to keep
patients quiet, when actually, in reality, it's an effective therapy

(00:23):
that is still in use today. Like I said, I opening.
I hope you enjoy it. Welcome to Stuff you Should
Know from House Stuff Works dot com. Hey, welcome to

(00:43):
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 I take the rap for a bad pun,
but you in fact said that before we recorded. I
know I before we recorded. I have a public image.
I have to carefully got um Chuck. Yes, have you

(01:08):
ever seen or read or both One flu Over the
Cuckoo's Nest? Yes? Both? Oh? Yeah? Did you like the
book more than the movie or vice versa? Both? The
book was great. I've seen the movie a dozen times. Yeah.
One of my faiths it is a great movie. 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. It is. Um. What else did he write?

(01:30):
He did the Well, actually he didn't write. That was
Tom Wolfe that wrote the Electrical light Estra. But Kesi
was figured prominently obviously. Oh yeah, he was the main
KESI wrote the crap. I'll come back to it. Okay,
he wrote the what was it the book? Well, if
you haven't seen or read one flu Over the Cuckoo's Nest,

(01:53):
you totally should. It 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 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

(02:17):
basically keep the patients in check. Um. Just the very
threat of getting electro convulsive therapy shock treatment, a type
of shock treatment, we should say, is enough to just
keep everybody very docile and calm and settle down when
they started to get riled up. You can just ask
them do you want some shock treatment? They're like no, No,
everything's good, Everything's fine. And apparently because of that and

(02:42):
Keisi worked as an orderly in a mental institution in Oregon,
so he saw his firsthand 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 key easy um making this stuff up
like he said, he was a he was a disorderly,

(03:04):
like like the fat boys. Um. But there was also
a study in NY the National Institutes of Health that
found like that was pretty common practice among antal institutions
at the time because it was drug free. Yeah, it
was just using electrical shock and it wasn't a lobotomy,
right and um it was the effects were temporary and

(03:25):
apparently it worked to keep everybody in line. But that's
a gross abuse of this pretty effective 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,

(03:46):
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 du Caucus, former presidential nominee
until he wrote in a tank, uh, wrote a book
because she had it and it's called Shock, The Healing

(04:08):
Powers 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 right through depression. Apparently
also helped Dick cabin Oh yeah, yeah, it did not
help so much. Um, Sylvia Platha in a steeming Way right, Um,

(04:31):
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. Six under who who got
George the James cam Yeah yeah that's right. Yeah, yeah,
we've already spoiled that show, so we might we should
just like do dramatic readings from scripts. Uh yeah, Um,

(04:54):
so we we should also say before we go forward,
It's very easy to call it electro shock therapy. It'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 Hyppocrates, it was noticed that people who have mental

(05:16):
illnesses who experienced convulsions tended to feel a little better
after the after they experienced their seizures. Yeah, 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 cure, whether temporarily or permanently,

(05:40):
um 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, may feel like more

(06:01):
relaxed now, 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

(06:23):
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 into somebody,

(06:43):
puts him in a coma temporary coma um that 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 seizure or um. Yeah,
seizures and the curing of mental illness. He took it

(07:05):
one step too far and saying that schizophrenia and epilepsy
were counter productive maladies. So if you had one, you
couldn't have the other. Not true. He was wrong about that,
but he was right about seizures having a curative effect
on mental illness. Though interesting, but he was the one
who started championing and champion championing using insulin to produce seizures.

(07:27):
So he led the way, followed by Italian scientists in
the nineteen thirties who finally 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

(07:48):
he was testing something called metrozol, which is the respiratory stimulant.
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. They're like of patients
who had um shock therapy using metros all stuff suffered

(08:11):
spinal fractures from because the convulsions were so hardcore. Yeah,
like the Exorcist. Yeah, and then some now we're electricity Yeah,

(08:43):
they discovered electricity. No, eight, that's not true. That was close.
I think it was like, um, these Italians, they were scientists,
and they said, we can 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

(09:06):
the nineties it was being used as a regular treatment
in the US for schizophrenia, depression, bipolarism. Um, but it's
not like it is today. No, 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,

(09:28):
so you're wide awake and conscious when they applied an
electro shock, yet your brain like in cuckoo's nests. Yeah,
violent physical reactions with the body that don't happen these
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 foot, eighth

(09:52):
single foot. Well, when it has a blood pressure cuffin,
I'm sure it is the big foot. But yeah, they
introduced it intravenously and then they put a blood press
your 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,

(10:13):
so someone's actually a doctor looking just at your foot supposedly.
I haven't seen that anywhere else. I saw, Yeah, I
saw that. Um like they even with the muscle relax
and 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

(10:34):
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
seen it on TV, even when they portray modern like
on six ft Under, they show people are always rendered
this like zombies, like lobotomized essentially, and that's that's not

(10:55):
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,
there was then, there still is now. So I think
that it's almost like that's what that's what some artists
rendering or some directors rendering of what somebody with memory

(11:17):
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,
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

(11:39):
with the cuckoo's nest. He's causing problems, so let's just
drag him in there, strap him down and shock him.
These days are gonna five disorderly to hold them exactly. Uh,
you're gonna go through a battery of pre treatments um
like blood test, electrocardiograms, 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

(12:00):
this kind of treatment. It's you know, it's not as
I don't know if it was willing only 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 I believe device, just the strictest and classification. And
so it was up for reclassification for a little while,

(12:22):
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
have changed by then. 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

(12:44):
not like the same thing as going for like laser
hair removal, like you can also get e c T
in the same office. 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
pulse your brain. You know, you've got these little things
about the side of a quarter, these pads on the
side of your head, either on both sides or one side,

(13:06):
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
for more humane purposes or works better? Yeah, I think
they're finding that it works at least as well. But

(13:27):
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, these days, you're gonna get
it two to three times a week for three to
four weeks, is a typical treatment. Yeah, that's of course,

(13:47):
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 but that's a period of your
life that you have a lot of trouble remembering much of.
I don't think it's a picnic still, no, because you're

(14:09):
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
e c. T in the fifties than they did because
they were anestecized. Yeah they weren't. No, Yeah, that's what
I mean that today. That's funny. I didn't think about

(14:29):
it like that. UM I found one staff. 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 six in the time. Yeah, and that's
what pretty much what they're using it for is just
like major depression is pretty much the thing that they found, like, Okay,

(14:54):
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.

(15:14):
UM 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 e c T
in England dropped by half, and that was because there
was a rise of anidepressants. 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

(15:34):
then as people were as physicians, I guess we're finding
that there were plenty 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 act because the results are so much faster.

(15:58):
Huh that 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 antidepressants can extend the good, uh,
the good effects of the e c T longer, which

(16:19):
was interesting because like I guess they can work in
concert 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 improved functioning going. And we should say, like,
all this is theory. We don't no one knows specifically

(16:39):
what e c T does to the brain. We just
know 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

(17:01):
blood flows or how cells metabolize things, and UM that
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.

(17:22):
I think they likened it in here to turning the
stereo down, like there's just so much noise and this
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

(17:44):
and emotion, um, we're less active. And so they said
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 question well, and they tested with
Placebo's two and I think like anytime you test with

(18:05):
the placebo, you're gonna find that some there's gonna be
a little bit of it that works. But yeah, you know,
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,

(18:26):
but there were some that received the fake treatment that
did recover as well. So they think that might have
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

(18:48):
C t UM. One is you have trouble making memories
around the appointment, UM, which is to be expected. That
usually fades. UM. Then there's larger member reloss that of
past events long before your ect therapy. UM. But that
also fades not in old people though, So there is

(19:09):
like memory laws associated with it. With zapping the 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 how
many one in ten thousand, So every year ten people
die from from in America. But they say that that's

(19:31):
typically a reaction to or a result of anesthesia, like
just going on right, 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. Yeah,
and you will still find people that poop po would
of course, but this article points out a lot of

(19:52):
those people are the same people that are pretty anti
psychiatry in general and stuff like this. 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, have you got anything else?

(20:15):
I got nothing else. Let's go try this out. I
would certainly try it out if I needed it. Okay, yeah,
would too, you know, because there's something appealing to me
about using electricity over drugs. Yeah, drugs are some great
thing to pump your body full of 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

(20:38):
it comes back Gangbusters, man, that's really going to be
impressive because it was almost gone. Yeah. You know, imagine
if the little botomy came back. Yeah. I know it's
still around, but it's not back. But you know, ect
is back, baby, maybe a little blood letting lit leaching. Right.

(20:59):
If you want to learn more about electro convulsive therapy,
type that word in the search bar how stuff works
dot com. Let's see if you can do it on
the first try. And since I said search bar, um,
I guess it's time for message break mm hmm, and

(21:33):
now listener mail yes, and I'm gonna call this misheard
song lyrics. Um, oh yeah, I can't remember which one.
We asked hand Canal was yeah, 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

(21:56):
not what he's saying. No, it wrapped up like a deuce,
like a is talking about craps. Is he craps 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 tung about a car engine. I've
heard gambling. Springsteen wrote it and then man for man
changed it. And it's funny. Springsteen has come out and said,

(22:19):
you know, that song didn't become popular to what it
became about feminine hygiene, and then it was like a
big deal. Or there's a bathroom on the right CCR
instead of 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 same
as a bathroom on their right. It's fairly common. Okay,

(22:41):
all right, so we got one from Cheryl. Hey, guys,
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 populo a quick note to give you a grin
misinterpreted lyrics where my specialty as a kid far and away,
and my most famous moment was when I was five

(23:01):
or six listening to Madonna with my Auntie and I
would sing Papa Dom bridge, I'm in trouble deep. She said.
Thing is this really made sense to me and logical logically,
if a bridge is made out of Papa doms, which
or do you know what those are, sort of like
a like a flat bread, like a crispy tortilla, sort of,

(23:25):
it's like a crispy flatbread. 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 be in trouble deep. And my
dad still teases me about that to this day. Does
make sense and certain So yeah, Cheryl, Papa don Bridge,

(23:46):
well done, that's funny. UM's mom. She's from Oking. Now
she calls 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 Misshard
song lyric ever and I was racking my brain earlier
trying to remember it and I cannot. Yeah, there's some
good ones out there. I'll try and I'll try and

(24:07):
remember and posted or something. I'll get in touch with Fox.
It was a funny one nice. Do 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.
Do you have one? Jerry? Terry looks like she does
what Jerry just said. If you did not hear instead
of voices, carry by until Tuesday. Horses scare me, keep

(24:32):
it down, horses 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 at
my first concert, Hall of Notes at the University of
Toledo Colosseum. They opened up on Yeah, Until Tuesday opened
up nice. Well. I never really thought about that because

(24:52):
I always say, oh, 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've to love to see that one. And those those
are real concerts, like I went to Kenny Rodgers and
stuff when I was a kid, and people like Cooney
Rodgers 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 money for it.

(25:13):
And where I smelled marijuana for the first time, like
a real concert. I didn't smell any marijuana at the
Hall of Notes concert. Oh, I 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's smell. Stay away. Yeah,
and you did good going, Chuckers. Uh Is that it?

(25:38):
That is it? Thanks to Cheryl for um kicking off
a pretty great little chap. You should get youmy's mom
to call her Papa down Bridge now. Yeah, see you
can't get that done. Hey listening to Papa don Bridge. Yeah, say,
that's the papa don preachess Papa doan bridge? Uh what
what do you want? Oh? If you have any great
marriage stories, we want to hear him. We haven't asked
for that ever. We Yeah. And I don't mean wedding

(26:00):
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, you can tweet to
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you Should Know dot com. For more on this and

(26:26):
thousands of other topics, visit how stuff Works dot com