October 5, 2010

Shockingly Unshocking: Observing Electroconvulsive Thearpy (ECT)

Last week I did something that I never thought I would do; I watched a doctor administer ECT to a patient suffering from Bipolar Affective Disorder. ECT is often administered to patients who are treatment-resistant to other, more traditional forms of treatment such as medication.

The patient receiving ECT was resistant to a variety of MAOI med cocktails and other anti-psychotic drugs. Because his delusions (increasingly present in his manic state) were becoming unmanageable, the medical team decided ECT would be the most effective therapy in controlling the patient's delusions. I was present for patient's 14th session.

Prior to observing ECT, I was extremely anxious about witnessing a violent seizure, largely because of preconceived notions I gained from watching this scene in One Flew Over the Cuckoo's Nest:

The reality of the procedure could not have been more different from this scene. The tongue plate inserted into the patient's mouth (to prevent the patient from clenching their teeth or severing their tongue) was the only similarity.

In the operating room, every detail is controlled, with the procedure lasting only five minutes. The patient is put under an anesthetic and remains unconscious for the duration of the procedure. Once unconscious, the patient is administered medication to enter a fully paralyzed state (with the exception of the feet), and then administered a seizure-inducing medication. Two electrodes are placed on the patient's temples, to which the doctor is able to administer the electroshock waves to the patient's brain.

Successful ECT elicits a 15-30 second grand mal seizure. Researchers are still unable to determine why ECT is effective at treating individuals with severe mental illness, but its benefits have been widely documented.

What was surprising about the ECT session, was how little the patient moved throughout the procedure. If it weren't for his toes wiggling back and forth, or the EEG spitting out a brainwave scan, I probably would not have noticed the patient received ECT at all. 

The reason I felt it was important to document this experience is twofold.  
  1. Misconceptions about ECT are rampant. So many of us cringe when we hear someone suggest ECT, often because we automatically think of the media's portrayal of what ECT used to be.  
  2. If administered correctly, ECT can be one of the most painless and effective intervention methods for patients suffering from extremely debilitating illnesses.
Many of us are are biased towards ECT because we too often associate the therapy with violent and negative outcomes. I hope this post elicits a more positive perception of an intervention that has been misconstrued for decades.


Keav said...

I'm glad you posted about your experience :) I would like to read more about everything else you do! :D

Cheryl said...

Just because the body isn't thrashing around doesn't mean the brain isn't being fried!

Anonymous said...

Thanks for posting this! It's so easy to come out against ECT, especially in light of Cuckoo's Nest, which is most people's reference point. It isn't perfect, and it has risks, much like medication. But for people with treatment resistant disorders, it can be very effective.

Anatolia said...

Thanks for sharing your experience. I definitely want to read more about ECT. I remember my psychology professor in college talking about efficacy of ECT (granted I don't remember exactly in what contexts) and being surprised to hear that. I've seen ECT as overwhelmingly negative in film and TV -- I'm thinking of Quantum Leap as another example.