ECT Is Not Torture: 70% Get Relief, 60% Recover
ECT brings relief to roughly 70% of patients and clears symptoms in about 60%. It is not the electrical punishment of One Flew Over the Cuckoo's Nest, but the oldest somatic therapy still standing — one that came out of a slaughterhouse and survived the anti-psychiatry movement.
The video won't play here. Listen to the audio instead:
The argument · tap a timestamp to hear it
The worst side effect is not memory loss, it is stigma
The episode opens with a nurse named Elan telling her own story: depressed since childhood, she chose ECT after medication did nothing for her. After three treatments, she says, the colors around her looked as if someone had turned up the saturation, and the world became approachable again. The side effects were real: for a few days after treatment she could not retrieve nouns, she got lost in neighborhoods she knew well, she lost words in the middle of a conversation. Her distant memories from before the treatment are still there, but it is as if the room holding them had been rearranged. The heaviest side effect, she says plainly, is the stigma around ECT — she worries that sharing her experience will change how people see her, and she believes that stigma is exactly why her doctors did not recommend ECT sooner.
— ElanFear of ECT is not innate; the screen taught it
A global survey of film and television published in 2016 found that 81% of films and 72% of TV shows portrayed ECT inaccurately and negatively. The most famous case is One Flew Over the Cuckoo's Nest, in which Jack Nicholson is strapped down and shocked while fully conscious, filmed to look close to torture. A few positive depictions exist — Homeland, Call the Midwife — but they are rare. The hosts' judgment: public fear of ECT did not appear out of nowhere, it is a media stigma reinforced over decades of film and television, and it leaves people unwilling even to consider ECT.
ECT is the most effective psychiatric intervention we have
ECT treats severe psychiatric illness, including treatment-resistant depression, by passing a current through the brain to induce a seizure. Today it must be done under anesthesia and muscle relaxation, with strict informed consent. Two numbers usually get left out: roughly 70% of people see their symptoms ease and roughly 60% reach clinical recovery, which makes it one of the most effective psychiatric interventions available. Set against the patient feedback the show heard in its earlier episode on SSRIs, it works especially well in treatment-resistant cases where antidepressants alone fail.
Electricity is only the tool; the target was always the seizure
The shock therapies that emerged in the 1920s had nothing to do with electricity at first: insulin coma therapy drove patients into hypoglycemic coma and convulsions, and Metrosol chemical shock therapy used a drug to induce seizures. Doctors stayed on this path because of what they observed at the time — epilepsy and schizophrenia seemed rarely to coexist, and some catatonic patients improved after a spontaneous seizure — so they treated the seizure itself as the active ingredient of the treatment. Cerletti turned to electricity only later, when he went looking for a safer and more tolerable way to induce one. Electricity is just the tool; the target is the seizure.
ECT's technique began with pigs in a slaughterhouse
Cerletti's starting point was the slaughterhouse: workers shocked pigs to stun them, and some of the pigs seized afterward. In April 1938, a man found speaking incoherently on the streets of Rome and brought to the hospital by police became the first human subject. There was no anesthesia and no muscle relaxant, and the first two currents failed to induce a seizure. On the third, at a higher dose, he had a grand mal seizure; his breathing stopped and he turned cyanotic, and only after forty-five seconds did he draw a long breath and return to normal. Cerletti later reported 36 cases: 11 full remissions, 20 improved, 5 unchanged.
It spread this fast because informed consent did not yet exist
By 1941, only three years after the first human trial, 42% of psychiatric hospitals across the United States had an ECT machine. Several things drove the speed: it was seen as an improvement on shock therapies that already existed, so the barrier to adoption was low; doctors had run out of options for chronic, severely ill patients; ECT was not the only treatment on offer but was usually 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 such as an extended trial period. That last point is precisely what planted the root of the general distrust of psychiatry that followed.
Using ECT as punishment was not invented by the movies
The negative history is not a film fabrication: some institutions used ECT to treat homosexuality or hysteria, and records from the 1940s admit that the amnesia and disorientation the shock produced kept patients quiet and stopped them from disrupting the ward. Abuses like these happened mostly at institutions with fewer resources that took in more marginalized people — not the practice of every hospital, but once exposed they caused enormous public outrage. The anti-psychiatry movement then went on to cast mental illness itself as social control. The hosts do not excuse any of this; they only point out that effective drugs did not exist, wards were severely overcrowded, and doctors and families alike were trapped in desperation.
The anti-psychiatry movement forced ECT to produce its evidence
The anti-psychiatry movement drove ECT use down sharply through the sixties and seventies, but it also forced ECT to submit to tighter scrutiny and randomized controlled trials. The result is that it is the one major somatic therapy that held up under testing and survived from before psychopharmacology. After the 1980s, the public accounts of Dick Cavett, Carrie Fisher and the psychologist Norman Endler brought a positive narrative back. Memory loss remains a genuine dispute: research says long-term effects are rare, but some patients believe their own experience is not adequately captured by the measurement tools. The experience cannot be reduced to one star or five stars — it should be neither sanctified 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 film and TV portrayals of ECT that were inaccurate and negative, 2016 survey | 81% of films, 72% of TV shows | 7:53 |
| ECT symptom relief and clinical recovery rates | roughly 70% see relief, roughly 60% see symptoms disappear | 13:07 |
| Cerletti's first reported ECT case series | 36 cases: 11 full remissions, 20 improved, 5 unchanged | 24:17 |
| Share of U.S. psychiatric hospitals equipped with an ECT machine in 1941 | 42% | 31:26 |
| Patient population at one Georgia psychiatric hospital | 600-1000 people | 28:22 |
Glossary
- electroconvulsive therapy (ECT)
- Passing a current through the head of an anesthetized patient to induce a seizure, used for severe psychiatric illness such as treatment-resistant depression.
- somatic therapy
- Changing a mental state by acting on the body, 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
- Chemical shock therapy using the drug Metrosol to induce seizures; the experience was unpleasant and recovery slow, and ECT later replaced it.
- anti-psychiatry movement
- A current of social thought that rose in the 1960s and 1970s, holding that mental illness is not real and that psychiatry is a form of social control.
How to listen
Psychiatrists, families of patients with treatment-resistant depression, and editors working on medical content — and especially anyone who has only ever seen ECT in the movies and now faces a decision about it.
The cocktail chatter at the top, roughly 4:38-6:50, is skippable; the substance starts at about 6:50.