Knocked Out, Paralyzed, and Shocked

Electroconvulsive Therapy (ECT), or shock therapy, is a controversial psychiatric “treatment” in which seizures are deliberately induced in the patient with an electrical current to the brain. There are roughly 100,000 ECT sessions given per year in the U.S.

The unproven theory is that somehow a seizure is beneficial; in actual fact, seizures are considered a serious health issue by real medical doctors.

There are several different words used to describe the seizures. “Tonic-Clonic,” or “Convulsion,” or “Grand Mal” seizure, are some of these terms. Tonic means stiffening, and Clonic means rhythmical jerking. Grand Mal is generally associated with epilepsy, so its use is discouraged for ECT seizures.

In the 1500’s seizures were induced by chemical means to treat various mental conditions. At some point it was observed that some agitated people appeared to improve during spontaneous epileptic seizures — at least, they got quieter. In 1939 Cerletti in Italy substituted electricity for chemicals to induce seizures. (See here for more information.)

The severe muscle contractions attendant with seizures was causing bone fractures and dislocations, resulting in the use of neuromuscular-blocking drugs (NMBD) to paralyze the muscles, along with anesthetics to block the pain. In 1951, the introduction of the synthesized NMBD suxamethonium as an alternative to curare led to the more widespread use of ECT since that regimen was less likely to result in broken bones and presumably had less side effects than curare. Suxamethonium has been described as a “perfect poison” for murder, and has been used by criminals in murders.

The ECT seizure lasts about a minute, and is administered two or three times a week, or until the patient’s cognitive side effects become too severe. A seizure lasting more than 5 minutes would be a medical emergency. There is a delicate balancing act to the administration of anesthetic, NMBD, and electricity, since the side effects of improper dosage and current can be a restriction of blood flow to the heart, or heart attack, or hemorrhage of blood vessels in the brain, or loss of vision.

Total paralysis with suxamethonium or another NMBD is not desired, since the attending psychiatrist needs to observe some muscle twitching in order to judge if a seizure is occurring. Total paralysis would also interfere with normal breathing, although intubation would normally be used during ECT.

The appropriate dosage of suxamethonium is difficult to determine; it would likely be adjusted in subsequent sessions based on the parameters of the individual’s response. Suxamethonium has a long list of possible side effects such as: high blood potassium leading to cardiac arrest; prolonged paralysis; slow heart rate; low blood pressue; neuroleptic malignant syndrome, a fast rise in body temperature with severe muscle contractions; skin rashes.

There are other NMBDs which can be used if suxamethonium is contraindicated, although these have their own peculiarities. [Reference: “Neuromuscular blocking agents for electroconvulsive therapy: a systematic review”, Acta Anaesthesiol Scand 2012; 56: 3-16]

All told, it is a complicated procedure, and not one to be suffered lightly. Full informed consent is a must. If you know someone who was abused by electroshock therapy, or who has witnessed such abuse, have them submit an abuse report here.

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