ECT Is Not Torture: 70% Respond, 60% Remit
ECT brings about response in roughly 70% of patients and wipes out symptoms in 60%; it is not the electrocution of One Flew Over the Cuckoo's Nest but the oldest somatic treatment to survive the slaughterhouse, the asylum, and the anti-psychiatry movement.
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The heaviest side effect is not memory loss, it is stigma
The episode opens with the nurse Elan telling her own story: depressed since childhood, she chose ECT after medication failed. After three treatments, she says, color looked like its saturation had been turned up, and the world was lovable again. The side effects are real: for days after treatment she could not summon nouns, got lost in familiar neighborhoods, lost words mid-conversation; remote memories from before treatment were still there, but felt like a room that had been rearranged. She says plainly that the heaviest side effect is the stigma around ECT — she worried that sharing her experience would change how people saw her, and she believes that stigma is exactly why doctors did not recommend ECT to her sooner.
— ElanFear of ECT is not innate, it was taught by film and television
A global survey of film and TV released in 2016 found that 81% of movies and 72% of television shows portrayed ECT inaccurately and negatively. In the most famous example, One Flew Over the Cuckoo's Nest, Jack Nicholson is strapped down and shocked while fully conscious, in a scene that is close to torture. A few positive depictions exist, such as Homeland and Call the Midwife, but they are rare. The hosts' judgment: mass fear of ECT did not come from nowhere — it was media stigma reinforced over decades, and it makes people unwilling even to consider ECT.
ECT is the most effective intervention psychiatry has
ECT treats severe mental illness such as treatment-resistant depression by passing electric current through the brain to induce a seizure; today it must be given under anesthesia and muscle relaxation, with strict informed consent. Two figures are routinely overlooked: about 70% of people respond and about 60% reach clinical remission, making it one of the most effective interventions in psychiatry. Set against the patient feedback the show encountered when it covered SSRIs, it is especially effective in treatment-resistant cases where antidepressants alone have failed.
Electricity was only the tool; the target was always the seizure
The shock therapies that appeared in the 1920s had nothing to do with electricity at first: insulin coma therapy put patients into hypoglycemic coma and convulsions, and Metrosol chemical shock therapy used a drug to induce seizures. Doctors stayed on this path because of an observation at the time that epilepsy and schizophrenia seemed rarely to coexist, and because some catatonic patients improved after a spontaneous seizure — so the seizure itself came to be seen as the key therapeutic ingredient. Cerletti later wanted a safer, more tolerable way to induce one, which is what turned him toward electricity. Electricity was only the tool; the target was the seizure.
ECT's technical starting point was a pig in a slaughterhouse
Cerletti's starting point was the slaughterhouse: workers would shock pigs to stun them, and some pigs seized after the shock. In April 1938, a man on a Rome street who spoke incoherently and had been brought to the hospital by police became the first human subject. There was no anesthesia and no muscle relaxant, and the first two shocks failed to induce a seizure. After the third, at a higher dose, a grand mal seizure appeared; the patient briefly stopped breathing and turned cyanotic, and only after forty-five seconds drew a long breath and returned to normal. Cerletti later reported 36 cases: 11 complete remissions, 20 improvements, 5 unchanged.
It spread so fast because there was no informed consent
By 1941, only three years after the first human trial, 42% of psychiatric hospitals in the United States had an ECT machine. Several things explain the speed: it was seen as an improved version of existing shock therapies and had a low barrier to entry; doctors had run out of options for chronic, severely ill patients; ECT was not the only therapy but often part of a recovery path alongside psychotherapy; early patient reports were broadly positive; and at the time there was no informed consent and no patient protections requiring a longer trial period. That last point is precisely what planted the seeds of the general distrust of psychiatry that followed.
Using ECT as punishment was not a movie invention
The negative history is not a movie invention: some institutions used ECT to treat homosexuality or hysteria; a 1940s account admits that the amnesia and disorientation caused by shock could quiet patients and keep them from disrupting the ward. This kind of abuse tended to happen in institutions with fewer resources and more marginalized patients — it was not what every hospital did, but when it was exposed it caused enormous public outrage. The anti-psychiatry movement then went on to describe mental illness itself as social control. The hosts do not excuse these acts; they only note that at the time there were no effective drugs, wards were severely overcrowded, and doctors and families alike were mired in desperation.
The anti-psychiatry movement is what forced ECT to produce evidence
The anti-psychiatry movement drove ECT use down sharply in the 1960s and 70s, but it also forced the treatment to submit to stricter scrutiny and randomized controlled trials. The result is that it is the only major somatic treatment to survive from before psychopharmacology and still stand up to testing. After the 1980s, public accounts by Dick Cavett, Carrie Fisher and the psychologist Norman Endler brought the positive narrative back. Memory loss remains a genuine controversy: studies say long-term effects are rare, but some patients believe the measurement tools do not capture their experience adequately. The experience cannot be reduced to one star or five stars — it should be neither mythologized 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
| Share of inaccurate, negative ECT portrayals in film and TV, 2016 | 81% of movies, 72% of television shows | 7:53 |
| ECT response and clinical remission rates | about 70% respond, about 60% see symptoms disappear | 13:07 |
| Cerletti's first ECT case report | 36 cases: 11 complete remissions, 20 improvements, 5 unchanged | 24:17 |
| Share of US psychiatric hospitals equipped with an ECT machine, 1941 | 42% | 31:26 |
| Patient population at a psychiatric hospital in Georgia | 600-1000 people | 28:22 |
Glossary
- electroconvulsive therapy (ECT)
- Passing electric current through the head of an anesthetized patient to induce a seizure, used for severe mental illness such as treatment-resistant depression.
- somatic therapy
- Treatment that acts on the body to change mental state, as distinct from psychotherapy; ECT belongs to 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, slow to recover from, and later replaced by ECT.
- anti-psychiatry movement
- A social current that emerged in the 1960s and 70s, arguing that mental illness is not real and that psychiatry is a form of social control.
How to listen
Psychiatrists, family members of patients with treatment-resistant depression, and medical content editors — especially anyone who has only ever seen ECT in a movie and is weighing a decision.
The cocktail-chat opening, roughly 4:38-6:50, can be skipped; the substantive content starts around 6:50.