ECT Is Not Torture: 70% Improve, 60% Recover
ECT can bring about remission in about 70% of patients and symptom resolution in 60%; it is not the electric torture of One Flew Over the Cuckoo's Nest, but the oldest somatic therapy to survive from the slaughterhouse through the anti-psychiatry movement.
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The heaviest side effect is not memory loss but stigma
The episode opens with nurse Elan's firsthand account: she had been depressed since childhood, and after medications failed, she chose ECT. She says that after three treatments, colors seemed more saturated and the world became approachable again. Side effects are real: for days after treatment she couldn't name nouns, got lost in familiar neighborhoods, and lost words mid-conversation; long-term memories from before treatment remain, but it feels like the room has been rearranged. She states clearly that the heaviest side effect is the stigma surrounding ECT—she worries that sharing her experience will change how others see her, and she believes that stigma is exactly why her doctors did not recommend ECT earlier.
— ElanFear of ECT is not innate; it is taught by film and TV
A 2016 global survey of film and television found that 81% of movies and 72% of TV shows portray ECT inaccurately and negatively. In the most famous example, One Flew Over the Cuckoo's Nest, Jack Nicholson is strapped down and conscious during the shock, a scene close to torture. A few positive portrayals exist, such as in Homeland and Call the Midwife, but they are rare. The hosts' judgment: public fear of ECT is not凭空产生 but a media stigma reinforced by decades of film and TV; it makes people unwilling even to consider ECT.
ECT is the most effective psychiatric intervention available
ECT works by passing an electrical current through the brain to induce a seizure, treating severe mental illness such as treatment-resistant depression; today it is done under anesthesia and muscle relaxation, with strict informed consent. Two figures are often overlooked: about 70% of people experience symptom relief and about 60% achieve clinical remission, making it one of the most effective psychiatric interventions available. Compared with patient responses to SSRIs discussed in earlier episodes, it is especially effective for treatment-resistant cases that do not respond to antidepressants alone.
Electricity is just a tool; the target has always been seizure
Shock therapies that emerged in the 1920s were not originally electrical: insulin coma therapy put patients into hypoglycemic coma and convulsions, and Metrosol chemical shock therapy used drugs to induce seizures. Doctors persisted on this path because they observed that epilepsy and schizophrenia seemed rarely to coexist, and some catatonic patients improved after spontaneous seizures, so they treated the seizure itself as the key therapeutic ingredient. Cerletti later turned to electricity to find a safer, more tolerable way to induce seizures. Electricity is just a tool; the target is seizure.
ECT's technical origin is pigs in a slaughterhouse
Cerletti's starting point was the slaughterhouse: workers would stun pigs with electric shocks, and some pigs had seizures after the shock. In April 1938, a man in Rome with incoherent speech, brought in by police, became the first human subject. Without anesthesia or muscle relaxants, the first two shocks did not induce a seizure. On the third, at a higher dose, a grand mal seizure occurred; the patient briefly stopped breathing and turned cyanotic, then after forty-five seconds took a deep breath and recovered. Cerletti later reported 36 cases: 11 complete remissions, 20 improvements, and 5 no change.
It spread so fast because there was no informed consent then
By 1941, just three years after the first human trial, 42% of psychiatric hospitals in the US had ECT machines. The rapid spread had several reasons: it was seen as an improved version of existing shock therapies with a low barrier to entry; doctors were desperate for chronic, severely ill patients; ECT was not the only treatment but often part of a recovery path alongside psychotherapy; early patient reports were generally positive; and there was no informed consent or extended trial period to protect patients. That last point planted the seeds for widespread distrust of psychiatry later.
Using ECT as punishment is not a movie invention
The negative history is not fictional: some institutions used ECT to treat homosexuality or hysteria; 1940s records admit that shock-induced amnesia and disorientation could quiet patients and keep them from disrupting ward order. Such abuses occurred mostly in institutions with fewer resources and more marginalized patients—not in all hospitals—but when exposed, they sparked public outrage. The anti-psychiatry movement then framed mental illness itself as social control. The hosts do not excuse these actions; they only remind us that at the time, with few effective drugs and severely overcrowded wards, both doctors and families were trapped in desperation.
The anti-psychiatry movement forced ECT to prove itself
The anti-psychiatry movement caused ECT use to drop sharply in the 1960s and 1970s, but it also forced ECT to undergo stricter scrutiny and randomized controlled trials. The result is that ECT is the only major somatic therapy from before the era of psychopharmacology that has survived scrutiny. After the 1980s, public accounts by Dick Cavett, Carrie Fisher, and psychologist Norman Endler brought positive narratives back. Memory loss remains a real controversy: research says long-term effects are rare, but some patients feel their experiences are not fully captured by measurement tools. The experience cannot be reduced to one star or five stars; it should be neither deified nor stigmatized.
In their own words · checked verbatim
Colors appeared more vivid, literally as if someone had turned up the saturation. Everything seemed beautiful. I could actually feel love for the world and enjoy living in it.
Elan1:03
The worst side effect is the stigma around ECT. This is the most important change in my life, and I worry sharing it with anyone risks how they see me or my career.
Elan2:06
the vast majority eighty one percent of movies and seventy two percent of TV shows portrayed it inaccurately and in a negative light
today ect is carried out under anesthesia and with muscle relaxance, and there is a rigorous procedure of informed consent, and it has a pretty high response rate, like seventy percent of people will experience relief from symptoms and sixty percent of people will experience remission, which makes it one of the most effective psychiatric interventions that we have
some psychiatrists believed that there was a direct link between schizophrenia and epilepsy. They were kind of opposite each just on the spectrum of a disease.
careful, the first was pestiferous, the second will be more tiferous.
patient22:14
I can presume that electric current can induce seizures in a man without risks
Ugo Cerletti23:15
the amnesia and disorientation produced in these patients by the shock treatment keeps them quiet and prevents their disturbing or hurting the other patients and upsetting the ward routine
Figures
| Percentage of films and TV shows portraying ECT inaccurately and negatively (2016 survey) | 81% of films, 72% of TV shows | 7:53 |
| ECT symptom relief and clinical remission rates | About 70% relief, about 60% symptom resolution | 13:07 |
| Cerletti's first ECT case series | 36 cases: 11 complete remission, 20 improved, 5 no change | 24:17 |
| Percentage of US psychiatric hospitals with ECT machines by 1941 | 42% | 31:26 |
| Patient population at a Georgia psychiatric hospital | 600–1000 people | 28:22 |
Glossary
- electroconvulsive therapy (ECT)
- A treatment that passes an electrical current through the brain of an anesthetized patient to induce a seizure, used for severe mental illness such as treatment-resistant depression.
- somatic therapy
- A treatment that acts on the body to change mental state, as opposed to psychotherapy; ECT falls into this category.
- insulin coma therapy
- An early shock therapy that gave patients large doses of insulin to induce hypoglycemic coma and convulsions; dangerous and potentially fatal.
- Metrosol shock therapy
- A chemical shock therapy that used the drug Metrosol to induce seizures; unpleasant and slow to recover from, later replaced by ECT.
- anti-psychiatry movement
- A social movement of the 1960s–70s that argued mental illness is not real and psychiatry is a form of social control.
How to listen
Psychiatrists, families of patients with treatment-resistant depression, and medical content editors—especially those who have only seen ECT in movies and need to decide before listening.
The cocktail chat at the start, roughly 4:38–6:50, can be skipped; substantive content begins around 6:50.