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BOOK REVIEW

Two insightful views into shock therapy

The term "shock therapy," the transmission of electricity into a patient's brain, is laden with negative connotations. It evokes the film "One Flew Over the Cuckoo's Nest," in which Nurse Mildred Ratched employed the technique to maintain control over rebellious patient Randle Patrick McMurphy , played by Jack Nicholson. Larry Tye, a former Boston Globe reporter, explains just how shock therapy (now called electroconvulsive therapy, or ECT) came to be seen so negatively, and how ECT is making a major comeback, especially for the treatment of severe depression.

"Shock" is told in two alternating voices. One is that of Kitty Dukakis, who describes her long struggle with addiction and depression. Dukakis, like most other people treated for depression, was prescribed psychotropic drugs (such as Prozac) and talk therapy. This combination didn't work for her: "They worked for a while, then ran out of power."

As Tye, the book's other voice, tells us, such drugs simply aren't effective for about 20 percent of patients, and also have serious side effects such as loss of libido and weight gain. His chapters bolster Dukakis's personal experiences with stellar medical and historical research. Thus, while Dukakis write s of her anxieties about trying ECT for the first time, Tye objectively considers the historical foundations of the treatment, and how it came into public disrepute.

As he makes clear, ECT was seen as a miracle cure when it first gained popularity in the 1940s. Until about 1960, it "was the dominant technique in psychiatry and the preferred option for most psychiatrists." But ECT was applied indiscriminately, writes Tye, largely because nothing else worked.

In the 1960s, the tide began turning toward a series of new antidepressant drugs, such as lithium. These drugs, combined with mounting questions about ECT, notes Tye, effectively diminished its appeal. Pills reigned supreme. But the wheel turned again when the limits of these psychotropic drugs became apparent, as they did to Dukakis.

Tye brilliantly explores the reasons for the recent "startling comeback" of ECT. For depressed patients who have seen no improvement after a combination of drugs and talk therapy, ECT can be an effective treatment. It works faster than other treatments, , Tye points out, making it ideal for suicidal patients. In a 2005 study cited in the book, 67 percent of suicidally depressed patients treated with ECT stopped thinking about suicide. ECT has also proven effective in cases of mania and epilepsy.

Like most treatments, ECT has its troubling side effects, most notably memory loss. Thus, Dukakis writes of forgetting names, appointments, and details of a vacation in Paris with her husband, Michael. But for her, the benefits of ECT in ameliorating her depression outweigh its costs. As Tye makes clear, others may make a different calculation. Another patient whom he describes, Vermont legislator Anne Donahue , takes the middle ground, praising ECT's benefits in treating her depression while simultaneously criticizing it for diminishing her memory.

Tye points out that the indiscriminate use of ECT in the past, combined with a history of being employed without the patient's consent (the Nurse Ratched model), should offer lessons going forward. Today, the use of ECT continues to grow as a treatment of last resort for many patients. Still, explains Tye, many important issues related to ECT require further research. He concludes this well-researched and thorough examination of the rise, fall, and revival of ECT by terming it "an imperfect remedy. But it is not the crude and sometimes brutal procedure it once was." "Shock" is essential reading for anyone considering psychiatric treatment options.

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