Shock: The Healing Power of Electroconvulsive Therapy

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.

I had successful ECT in 2011. I don't talk about it, but when I do people share their successes, or their friends and relatives.Occasionally someone has had a bad experience. The activists who are anti-ECT make it sound like we all have bad experience, not so!This book is so well written that I've bought about 5 copies. When someone is considering ECT I am quick to lend out a copy. It is essential to be well informed.Larry Tye is such a talented write, it is a joy reading and he is very balanced. Individual stories are told, both good and bad.Kitty did something to set the standard for all mental health presenters. She made 100% of her medical records available to Larry Tye. He is an experienced medical writer, in the past for the Boston Globe, and now conducts an annual fellowship for medical journalist called the Health Coverage Fellowship. If there was anyone capable to look at Kitty's records and co-author her journey to ECT, it is Larry.I was fortunate to meet Michael and Kitty as a result of my story being on page 135. They are so busy, really amazing people. Both Michael and Kitty give various presentations. Kitty is a supporter of the US setting high standards for ECT facilities. I'm sure most already meet this criteria, but she wants to make sure each patient gets the best care available. She also advocates for patients being told in the beginning of their treatment about ECT as one of possible treatments along with medications, CBT, DBT, etc. She was not told about ECT until long after she had treatment resistant depression. Finally a doctor recommended she may want to try, she did, it worked and she is doing excellent with a schedule most of us could do without exhaustion.Michael does his political presentations but during the talks he mentions Kitty and mentions for those that choose ECT it could be lifesaving. They have plenty of examples of where it has worked, from Kitty and myself to others in her book. Then there are they many that tell them during their presentations. Michael is a remarkable supporter of treatment availability for the mentally ill. If I am at his presentation he let's the audience know there is an advocate in the room and acknowledges me.The take home message is please buy the book, have it handy in case someone you know, or yourself, is considering ECT. A tip: read it while well, as during depression some tasks like reading are difficult if even possible. There is nothing better than full disclosure and example of people using a modality, Kitty and Larry did such a good job with their book that here I am writing a such a long review I've got to stop before I write a book, about their book!

I totally recommend this book to anyone thinking of ECT treatments. I was scheduled for ECT because my depression was not responding to any anti-depression medicines Finally I found a psychiatrist who recommended considering ECT(Shock Treatment). I was desperate. My life was miserable. After talking to the ECT psychiatrist and agreeing to start treatment. I ask him if there was a book I could read to help me understand the treatment. .I was so scared. He mentioned this book by Kitty Dukakis. Reading it gave me information about ECT and the confidence I needed to start treatment. ECT seemed like a "miracle", after only a few treatments I could feel the difference !If I could rate this book any higher than 5 stars I would.

I read this when my adult daughter was considering ECT for bipolar disorder, and it was a big help in knowing what to ask the doctor and what to expect. I liked how the author went back and forth between the history of ECT and the personal experience of Kitty Dukakis. My daughter's first round of treatment is almost over and has been helpful, but we know that it doesn't help everyone, and the author was very fair in her discussion of why some people don't like ECT and even want to outlaw it. This was the best layman's resource for ECT that I could find. Thanks also to Kitty Dukakis for being willing to share her experience.

Read the notes. By the way I am not against ECT, but the experiments done in the beginning... I feel really bad for all the dogs, mice, monkeys, and children.

This book was recommended to me by a professional. I had requested information that not only gave me the facts about ECT but also the perspective of the person who was receiving the treatment. I found the book to meet and exceed my request. This book was enlightening and informative.