Medical Examiner

Why Haven’t We Found a Better Name for Electroconvulsive Therapy?

As Gary Gulman says in The Great Depresh, it’s not much better than “electroshock therapy.” Doctors aren’t terribly concerned.

Still from One Flew Over the Cuckoo's Nest in which Jack Nicholson’s character receives eletroshock therapy.
Jack Nicholson in One Flew Over the Cuckoo’s Nest. United Artists

Comedian Gary Gulman’s depression was so bad that at times he could barely speak, he recounts in his HBO stand-up special released this month (title: The Great Depresh). In 2017, he went to stay in a hospital for a few weeks, which he said was just to figure out his meds. It was really so that he could be strapped to a table so that doctors could induce a series of grand mal seizures in an attempt to reduce his depression.

Gulman, naturally, makes the procedure into a joke: “It used to be called ‘electroshock’ therapy, but they felt ‘electroshock’ was not quite horrifying enough,” he says. So they changed the name to electroconvulsive therapy. This is a weird choice, Gulman explains: “At best, [it’s] a lateral move.”

Comedy involves a lot of creative license. As Gulman has explained to Slate, he wholesale fabricated a documentary about the origin of state abbreviations to do a viral Conan bit. Still, this one is based on the truth—we really have swapped out “electroshock” therapy in favor of “electroconvulsive” therapy. Why shift the name a little without taking the opportunity to do a genuine rebrand?

Developed in the 1930s, ECT (as the pros say) is perhaps most famous for its star turn in One Flew Over the Cuckoo’s Nest, where it’s one of a series of horrors Jack Nicholson’s character has to endure against his will. During the “treatment,” Nicholson is red-faced, writhing, and surrounded by stone-faced doctors dressed in white. This image stuck even among young doctors. Richard Weiner, a psychiatrist at Duke, remembers the time he saw a patient who was referred for ECT when he was a medical resident in the ’70s. “I was very apprehensive—‘Oh my goodness, what is this?,’ ” he recalls thinking.

But the results were undeniable. Following the treatment, his depressed patient was all of a sudden fine. ECT doesn’t always work perfectly for everyone, but it can be a crucial tool for people whose illness has been resistant to medications and therapy, or who have been rendered so unable to care for themselves that other interventions may take catastrophically long to work. Like a round of antibiotics taken to banish a urinary tract infection, Weiner explains, ECT doesn’t banish depression permanently. Rather, it gives patients a boost out of an episode. Weiner was won over by the treatment. Thanks to his prior training as an electrical engineer, he became interested in how the treatment could be carried out with more standardization and rigor—after all, the brain is basically a bunch of biological circuitry. Momentarily a skeptic, he’s been studying and advocating for ECT since.

It’s not hard to be won over, in part just because ECT isn’t all that dramatic. Unlike the old-school way of having patients conscious and jolting on display in Cuckoo’s Nest­, these days patients go under general anesthesia and receive a muscle relaxant before the procedure—Gulman describes falling asleep before he could so much as utter a syllable. The relaxant allows the body to reserve all its glucose and oxygen for the brain, which can burn through a lot of nutrients as it’s flooded with electricity. It also means that during ECT, you just kind of lie there. An ECT patient named Kitty Dukakis allowed 60 Minutes to film a session for a segment that ran last year, in an effort to help ECT’s reputation. Wearing a blue print blouse and pink lipstick as she lay hooked up to monitors, the only sign that Dukakis was having a seizure “was some slight trembling in her feet,” Anderson Cooper narrated. When an outsider comes to observe a round of ECT, Weiner tells, me, “I typically get a comment, ‘Is this all there is?’ ”

The main reason why no one’s pushed for a more palatable public-facing name might be because once you understand what ECT is (and start calling it by an acronym), it just seems pretty normal. “I’ve been in this line of work for a third of a century now, and I’m not sure I understand why there’s so much negative emotion,” says  Keith Rasmussen, a psychiatrist at the Mayo Clinic’s Minnesota campus. It’s true, as Gulman describes, that ECT was once referred to more often as “electroshock therapy.” Part of the reason you don’t see it in the medical literature these days, Rasmussen explains, is indeed “the simple reason that ‘shock’ has so many negative connotations.” But it’s also that “shock” just never really conveyed anything medically, Rasmussen said. “Convulsive” refers to muscle movement during a seizure, so it’s a bit more correct. But since doctors now use muscle relaxants, that’s not exactly right either. Some folks have floated the idea of “electroseizure therapy” … but, well.

Why not just pick something a little more pleasant? Electro-just-lie-there therapy? The experts don’t actually support such a change. “I do think it’s important that patients know what they’re getting into,” says Weiner. ECT might have an unfair stigma, but it is still a serious medical procedure with side effects (namely, some memory loss, a lack of ability to drive yourself home after an appointment). “You don’t want a name that is in any way deceptive.” Still, he acknowledges that ECT can be hard for people to talk about. He guesses that many people know someone who has ECT but aren’t aware they do because it’s so difficult to talk about: “I’ve given ECT to physicians, psychiatrists, lawyers, professors. They don’t go around screaming from the rooftops that they’ve had ECT”

It’s hard to accurately portray the benefits and nuances of, well, anything in its name. The best thing for ECT might be people like Gulman, creating thoughtful, beautiful, funny art that includes ECT as just another facet of life.