Why Is Electroconvulsive Therapy Still Controversial?

Andrew Scull says electroconvulsive therapy is still controversial because it only eases severe depression for a time, can damage memory, and draws legal limits and organized opposition even where some trials look favorable.

Muscle relaxers changed the old seizure procedure. Curare, then newer drugs, paralyzed the muscles and eliminated the fractures, but they also paralyzed the breathing muscles, so an anesthesiologist and breathing support became necessary. The practice stayed widely disdained once psychiatric drugs were available. The drugs proved only partly effective, and often weak in suicidal cases and extreme melancholia. Sessions very often have to be repeated. It is maintenance therapy: it has not cured the illness, symptoms can lift for a fairly long stretch, and they very often return. Memory problems can be quite severe, and worry about brain damage calls for caution. Treatment-resistant depression means the patients who do not respond to drugs. They may not have a different disease. Few psychiatrists are willing to give the treatment. Many states surround it with legal restrictions. In California it almost cannot be given to involuntarily confined patients, because the person has to volunteer. Most medical procedures are not fenced in that way. A powerful group, some of them psychiatrists, many of them former patients, and others suspicious of modern medicine, opposes it. Trials now seem to give decent evidence that it works for some patients who were deeply distressed beforehand, and the treatment remains controversial.