Medications & Psychiatry

 email page    print page

All Topic Reviews
Psychiatry Under the InfluenceAlternatives Beyond PsychiatryAmerican MadnessAmerican PsychosisAn Unquiet MindAntipsychiatryBad PharmaBefore ProzacBetter Than ProzacBiological PsychiatryBipolar, Not So MuchBlack Man in a White CoatBlaming the BrainBrain Science and Psychological DisordersBrainwashedClinical Psychopharmacology Made Ridiculously SimpleComfortably NumbCompassion and Healing in Medicine and SocietyComplete Mental HealthConcise Guide to PsychopharmacologyCrackedCritical PsychiatryCultural FormulationDeconstructing PsychosisDemystifying PsychiatryDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDiagnosis: SchizophreniaDiagnostic Issues in Depression and Generalized Anxiety DisorderDimensional Models of Personality DisordersDisordered Personalities and CrimeDoctoring the MindDoctors of DeceptionDrop the Disorder!DruggedDrugs for LifeEmpirical Ethics in PsychiatryEssential PsychopharmacologyEssential Psychopharmacology of Depression and Bipolar DisorderEssentials of Psychiatric DiagnosisEsssential Philosophy of PsychiatryEthics in PsychiatryEvidence-Based Treatment of Personality DysfunctionExercise-Based Interventions for Mental IllnessFinding the Right Psychiatrist:Forces of HabitHandbook of Clinical Psychopharmacology for TherapistsHappy Pills in AmericaHealing the Soul in the Age of the BrainHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHerbs for the MindHigh PriceHippocrates CriedHistory of Psychiatry and Medical PsychologyHookedHuman TrialsInfectious MadnessInspired SleepIntoxicating MindsIs It Me or My Meds?Let Them Eat ProzacLife-Threatening Effects of Antipsychotic DrugsLitLiving with Bipolar DisorderMad in AmericaMad ScienceMalignant SadnessMedicating ChildrenMedicating Modern AmericaMental Health in Asia and the PacificMind FixersMoments of EngagementMommy I'm Still in HereNatural Healing for DepressionNo One Cares About Crazy PeopleNot CrazyOrdinarily WellOur Daily MedsOverdosed AmericaPathologist of the MindPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPharmaceutical FreedomPharmacracyPharmageddonPharmageddonPhilosophical Issues in PharmaceuticsPoets on ProzacPower HerbsPowerful MedicinesPrescriptions for the MindProfits Before People?Prozac and the New AntidepressantsProzac As a Way of LifeProzac BacklashProzac DiaryProzac on the CouchPsychiatric DiagnosisPsychiatric HegemonyPsychiatrists and Traditional HealersPsychiatry and EmpirePsychiatry and the Business of MadnessPsychiatry as Cognitive NeurosciencePsychiatry at a GlancePsychiatry in PrisonsPsychiatry ReconsideredPsychopathyPsychopharmacology Problem SolvingPsychotropic Drug Prescriber's Survival GuidePsychotropic Drugs And Popular CulturePsychotropic Drugs: Fast FactsRaising Generation RxRe-Visioning PsychiatryRecovery from SchizophreniaReligious and Spiritual Issues in Psychiatric DiagnosisRitalin NationRunning on RitalinRutter's Child and Adolescent PsychiatrySaving NormalSchizophreniaShock TherapyShock TherapyShould I Medicate My Child?ShrinksSide EffectsSometimes Amazing Things HappenStraight Talk about Psychiatric Medications for KidsSuccessful PsychopharmacologySuffer the ChildrenTaking America Off DrugsTalking Back to ProzacTextbook of Cultural PsychiatryThe $800 Million PillThe Age of AnxietyThe Anti-Depressant Fact BookThe Antidepressant EraThe Antidepressant SolutionThe Antidepressant Survival ProgramThe Big FixThe Book of WoeThe Complete Guide to Herbal MedicinesThe Conceptual Evolution of DSM-5The CorrectionsThe Creation of PsychopharmacologyThe Cult of PharmacologyThe Dream DrugstoreThe Emperor's New DrugsThe Essential Guide to Prescription Drugs 2005The Essential Guide to Prescription Drugs 2006The Making of DSM-III®The Medical Model in Mental HealthThe Medicated ChildThe Medication QuestionThe Merck DruggernautThe Mind/Mood Pill BookThe Natural Pharmacist : Natural Health Bible from the Most Trusted Alternative Health Site in the World The Pill BookThe Pill Book Guide to Natural MedicinesThe PlaceboThe Rise and Fall of the Biopsychosocial ModelThe Sedated SocietyThe Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Truth About the Drug CompaniesThe Use and Misuse of Psychiatric DrugsThe World of CaffeineThomas S. SzaszToxic PsychiatryTrouble in MindTry to RememberTry to RememberTwilight of American SanityUnderstanding Physician-Pharmaceutical Industry InteractionsUnhingedVoluntary MadnessWarning: Psychiatry Can Be Hazardous to Your Mental HealthWhat Is Mental Illness?What Psychiatry Left Out of the DSM-5What Works for Whom?Will@epicqwest.comWomen, Madness and MedicineYour Drug May Be Your Problem

Related Topics
Shock TherapyReview - Shock Therapy
The History of Electroconvulsive Treatment in Mental Illness
by Edward Shorter and David Healy
Rutgers University Press, 2007
Review by Mark Welch, Ph.D.
Mar 23rd 2010 (Volume 14, Issue 12)

If there is one thing that the general public seems to know about psychiatry it is that shock therapy is a very bad thing. It is, if the popular conception is to be believed, nasty brutish and not always short. It is barbaric and unscientific. It is also very cinematic, a point that comes up frequently in an attempt to understand the public image.

However, in Shorter and Healy's estimation, it is much misunderstood, much maligned and very much underestimated. This book, chronicling what the authors call the not-so-civil war of shock therapy, is a reconsideration of the evidence and a defense of ECT and its practice, and in that the two well-credentialed authors look to counter the case against ECT and also provide evidence for its use.

Shorter (well known for his historical work) and Healy (respected for his clinical research) take aim not only at the public constructions of ECT (and who among us cannot but think of One Flew Over the Cuckoo's Nest?), but also what they see as the irrational aspects of the debate (they note somewhat wryly in the final sentence that medicine is not vacuum sealed against irrationality). They are clearly aware that the book will be controversial; they deliberately chose a title that would instantly bring strong feelings to the fore and might even be seen to be deliberately provocative. And yet, their argument suggests that the evidence for the efficacy and safety of ECT is so strong that there should be little controversy over its use.

Although, as they correctly assert, ECT can be said to have begun in 1938 with the work of Ugo Cerletti, it is important to note that the ideas of using electricity in the treatment of mental illness, or using shocks, or inducing seizures did not materialize out of thin air. There was a clear line of therapeutic hypothesizing, and this worked in concepts of neurological function as well as psychological processing. It would have been interesting to explore the historical roots of the shock in shock therapy a little more. We have, after all, seen patients placed in ice baths, douched with cold showers, put under a barrel of water emptied from a great height, spun round and round so fast as to disorientate, and so on, almost endlessly. There is, almost in common parlance, a feeling that people can be shocked to their senses. In a similar vein, electricity has been seen as a miracle cure in numerous disorders, even the very stuff of life itself, and so it seems that the historical context of the meaning as well as practice of ECT is highly significant.

However, even when seemingly positive results came through, no-one was ever quite sure how it worked. Did it some way, reset the brain's wiring -- a bit like thumping the television when the picture isn't quite clear? Did it effect a psychological punishment, thereby expiating a patient's guilt and allowing a recovery to happen? Persuasive theories came and went, but none really answered the central question. This, alongside the debate concerning memory loss often seems to be at the crux of the matter.

The position of Healy and Shorter is that evidence is now convincing enough to put an end to the debate, and that the opposition to ECT, while having some foundation in the past in procedures and practice such as unmodified seizures and no anaesthesia, has somehow shifted into entrenched positions that encompass ethical issues as well.

ECT has also become a touchstone in the psychiatric survivors' movement -- and again it is instructive to consider the language. It only takes a moment to search for related web-sites and to see how accusations of bias are flung back and forth by proponents and opponents of ECT. Evidence of whatever character is debunked, challenged, accused of bias and it is perhaps that each interest group spends its energy primarily preaching to the choir. Each group accuses the other of being in the thrall, and sometimes the pay, of enigmatic and nefarious pressure groups or conspiracies. It all becomes very tangled, and the real question can be forgotten.

But it is also interesting to note how ECT has begun to be considered by mental health legislation around the world. It is not seen as a standard treatment; there is something different about it. It often requires extra consultations and informed consent. And whether this is due to the very nature of the treatment or a result of its public construction is still not really clear.

So, if a book such as this cannot expect to change entrenched positions, what can it do? It may be noted that Shorter and Healy call the book 'a' history, and not 'the' history; there is an acknowledged authorial bias. It is also reasonable to assume that the two authors are not shy of any debate. However, a naїve reader may find this aspect difficult to extract, and may not be able to make unbiased sense of the material and the way it is presented. It comes across as self-confident, and perhaps even dismissive of other opinions.

There is a little doubt that the book is thoroughly referenced, but it may be that the methodological biases show through. Questions of patient testimony or patient choice could well be developed further. There may be those who suggest that just because something is rational, does not mean that everyone will agree that it is the right thing to do; it is possible that our actions are determined by irrationalism and image rather than the cold, hard facts. Furthermore, there is the question of "just because we can, does that mean we should?"; ECT may well be effective, it may well bring about a more rapid recovery from depression and save people from suicide, but is that all we need to know or consider. A reader would suspect that Shorter and Healy would say that if it works it is unethical not to use it while opponents may be saying that this is not always the case.

The strengths of the book are in the wealth of detail that it marshals, although as has been indicated there are certain areas and perspectives that could be developed more. It does include a final chapter on new initiatives such as magnetic seizure therapy and transcranial stimulation, and of course it may be that as neuroimaging becomes ever more sophisticated some of the mechanisms will become clear. However that is in the future. The weak points of the present text may be that it can be interpreted as overly dogmatic, and perhaps too aggressive in its argument for a history.

Nevertheless, it is an intriguing read. It may not be entirely satisfactory for those who do not have some prior sense of the debates and controversies, but for those who want to inquire into the subject in more detail, it is well worth the time. No one should be afraid of the debate, and no one should be unable to defend a particular stance unchallenged. Separating facts (if there are unbiased facts) and opinions (if there are informed opinions) in this issue may not always be really possible at this stage. The process of the debate may be the key, and in that this book, whether you agree with its premise or not, certainly makes a contribution.


© 2010 Mark Welch


Mark Welch, Ph.D., British Columbia


Welcome to Metapsychology.

Note that Metapsychology will be moving to a new server in January 2020. We will not put up new reviews during the transition. We thank you for your support and look forward to coming back with a revised format.

We feature over 8300 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our Google Group!

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716