One morning in early October, on her final day as the chair of the psychiatry and behavioral-sciences department at the Duke University School of Medicine, Sarah Hollingsworth Lisanby ushered me over to a display case in one of the department’s conference rooms. There, behind glass, sits the world’s only museum, such as it is, of electroconvulsive therapy (ECT), or what most people still call “shock therapy.” The oldest artifacts on display, some of which are made of polished wood and brass, date to the late 19th century, when electrical stimulation was promoted as a cure for a host of ailments. A mid-20th-century relic labeled electro shock therapy equipment features a red button in the center helpfully marked start shock.
In the popular imagination, ECT—the application to the scalp of an electrical current strong enough to induce a brief seizure—is an archaic practice that might as well be relegated to a museum collection. But according to Lisanby and other leading researchers, the modern version of ECT, far from outmoded, is the most effective therapy available for severe, treatment-resistant depression and bipolar disorder (and even sometimes, when deployed early enough, schizophrenia). No one knows exactly why ECT works—there are many theories—but numerous studies have established that it does work: The vast majority of severely depressed, even suicidal, patients feel much better after a course of treatment. Many experience a total remission. Refinements over the past few decades, moreover, have dramatically reduced the temporary memory loss once associated with ECT. And yet, due largely to the stigma surrounding the treatment, only a tiny fraction of the millions of Americans with depression unresponsive to psychotherapy or medication ever receive it.