The Showtime drama "Yellowjackets" has repeatedly received praise for its portrayal of trauma, but a recent episode in particular has people buzzing.
In it, we see that Simone Kessell's Lottie was so traumatized by her experience trying to survive winter in the forest that her parents forced her to get electroshock therapy. The series shows Lottie convulsing in her hospital bed as she receives treatment, and naturally, it's raised some questions about this type of treatment.
For the record, yes, electroshock therapy — known medically as electroconvulsive therapy (ECT) — is a real thing. But it's a little different from how it was portrayed on the show. Here's what you need to know about ECT, plus why and when it's still used today.
What Is ECT?
ECT is a medical treatment that's typically used in patients who have severe depression or bipolar disorder that haven't responded to other treatments, according to the American Psychiatric Association (APA).
The treatment involves a patient getting a short electrical stimulation of the brain while they're under anesthesia (meaning, they're not consciously aware that this is happening). It's usually administered by a team of trained medical professionals, including a psychiatrist, anesthesiologist, and nurse or physician assistant, the APA notes. People usually get ECT two to three times a week for a total of six to 12 treatments, depending on how severe their symptoms are and how well they respond to treatment, the APA says.
"This is a voluntary treatment," says Thea Gallagher, PsyD, a clinical assistant professor at NYU Langone Health and co-host of the Mind in View podcast. "Shows and movies often show someone being given ECT against their will, but people cannot get it unless they want it. It's not like we're taking people into asylums and forcing them to undergo electroconvulsive therapy." (The APA specifically notes that written consent must be granted before someone is given ECT.)
Is ECT Still Used?
Yes and, in fact, there are ECT programs at several major academic medical centres across the country. Nagy Youssef, MD, PhD, is director of the ECT program at The Ohio State University College of Medicine. "ECT started in 1938, though early forms of ECT bear little resemblance to modern ECT procedures and techniques," he says. "Advances in anesthesia and the ECT stimulus have made it safe with low risks."
But ECT isn't something your average person with depression or bipolar disorder undergoes. In fact, one research paper in the journal Psychiatric Services called the treatment "exceptionally uncommon."
Still, people can and do get ECT. "Unfortunately, the general public often believes ECT may be dangerous," says Hillary Ammon, PsyD, a clinical psychologist at the Centre for Anxiety & Women's Emotional Wellness. That, she says, is "partly due to the less humane conditions of this procedure years ago, including patients being awake for the procedure. Media has portrayed ECT as such, so many people may not know how the protocol for ECT has positively changed."
What Gallagher, Ammon, and Dr. Youssef all indirectly referenced is ECT's controversial history. While the therapy was always intended as a way to help patients, in the 1950s it was used as a threat psychiatric hospitals, a way to keep patients in control, writes Jonathan Sadowsky, author of "Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy", for Scientific American. It also carried more health risks than it does today, and was used in harmful ways — such as, to "treat" same-sex attraction, Sadowsky writes.
There's no denying, then, that people had good reason to fear ECT. But today, it does serve a tremendous purpose — although most people aren't aware of how the treatment has evolved, at least partially due to the way it's often portrayed in media.
What's ECT Used For?
There are a few different things ECT is used to treat, Youssef says. Those include:
- Severe or treatment-resistant depression or bipolar disorder.
- Depression that poses an imminent risk or is life-threatening.
- Severe manic episodes of bipolar disorder or schizoaffective disorder, especially if it's treatment-resistant or poses threat to the safety or health of the patient.
- Catatonia, a neurological psychiatric syndrome where someone has life-threatening extreme immobility or extreme motor excitement.
- Psychotic symptoms of schizophrenia or mood disorders.
In general, "ECT is typically used when typical treatments, such as medication and therapy, have not been successful," Ammon says.
Does ECT Work?
While ECT seems extreme, it's "generally very effective, even when medications and psychotherapy do not work, have a very low chance, or only lead to slight improvement," Youssef says. Some data even suggest that it can have an up to 90 percent success rate of improving symptoms in severely depressed patients.
"ECT is recognised as a valuable therapy of some psychiatric disorders by many organisations/institutions including the National Institute of Mental Health, the US Surgeon General, and the American Medical Association," Youssef says.
The APA also emphasises, however, that while ECT is considered a very effective treatment, it doesn't prevent someone from having symptoms again in the future. So, most people with ECT need to have some kind of maintenance treatment, like medication and/or psychotherapy, or even ongoing ECT treatments.
ECT comes with some risks too, including temporary memory loss and temporary difficulty learning. But most people's memory improves within a few months, the APA says. There are also risks of undergoing general anesthesia, like nausea, headache, fatigue, and slight memory loss—which are similar to the anesthesia risks for other procedures, the APA notes.
If you're interested in undergoing ECT, it's important to have a conversation with your psychiatrist. "They can discuss the risks and benefits of this procedure and potentially identify other interventions that have not yet been implemented," Ammon says. There are other forms of brain stimulation, including transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) that they may recommend first. If not, though, you will likely be referred to a major medical centre to discuss next steps.
If you or someone you know is struggling with depression, the National Alliance on Mental Illness has resources available including a helpline at 1-800-950-NAMI (6424). You can also dial 988, the nation's new mental health crisis hotline.