Mental Illness Primer for Speculative Fiction Writers 5: Electro-convulsive Therapy

Key Learning Points So Far:

The portrayal of mental illness by writers/creators affects stigma. Stigma leads to negative treatment once individual is identified (‘marked’) as mentally unwell.

Mental illness is difficult to define but is socio-culturally determined. Cultural context is important when depicting a character as mentally ill. There should be no drug/alcohol intoxication or organic illness. Behaviour/experience also needs to be sustained in order to attribute it to mental illness.

The assessment of mental illness should draw information from as many sources as possible (self, others, mental health workers), and should consider a change from the baseline.

Examination of Buffy s6ep17 shows superficial attendance to reality of mental illness. 

Trigger Warning: Up to 1 in 4 people can be affected by mental illness so if any of the topics discussed here affect you contact your health professional (General Practitioner in the UK).

Scope: This is for creators of speculative fiction. The idea is to improve depiction of the mentally ill in narratives like film, books, music videos etc. It is just a primer, therefore it will not go into too much detail.

Spoiler Alert: Here there be spoilers. Deal with it. I will try not to reference anything currently showing in cinemas, but I make no promises.

Part 4: Electro-convulsive Therapy

One Flew Over the Cuckoo's Nest

One Flew Over the Cuckoo’s Nest

I’m going to go ahead and say this from the start: Electro-convulsive Therapy (ECT) is both safe and effective. ECT is a controversial topic, but not a controversial treatment. The problems with public acceptance of modern ECT are understandable, but historical and subjective. As a writer/filmmaker, you need to know how ECT was performed in the historical era you are writing in.

The essential feature of ECT is the induction of seizures by way of electric current.   Electricity gets a bad rap in psychiatry, yet it is used all the time in medical treatment e.g. Defibrillators, TENS (Transcutaneous Electrical Nerve Stimulation) machines, diathermy in surgery to name a few. Nobody gets upset about all this, so it is not electricity that is the problem.


Convulsive treatment started in the late 1930s out of an erroneous belief that people with epilepsy did not suffer from schizophrenia. The scientists of the day decided that induced seizures might cure schizophrenia. They used electricity, but also chemicals like cardiazol. With time electricity became the only method of inducing seizures.

We do, however, need to place the use of ECT in historical context. There have been, unfortunately, many abuses of psychiatry. Some of these have been nefarious, others well-meaning though paternalistic, but all led to some degree of suffering. This is not a talk on history, but a few key points should be noted. Psychiatrists in Nazi Germany subscribed to Lebensunwertes leben (‘lives unworthy of life’) and allowed or encouraged thousands of patients to be killed in ‘Action T4’ which is  believed to have been a dress-rehearsal for the extermination of Jews and Roma. The Soviets also gave us something called ‘Sluggish Schizophrenia’ which was a euphemism for dissident behaviour and the use of psychiatry for social control.

Asylums were seen by some as places to keep the mentally ill apart and (with hints of eugenics) to stop them from breeding. Interesting side note: being gay was considered a mental illness at this time.  The plight of patients on the Greek Island of Leros discovered in 1989 should remind us that such abuses are still possible in modern times. All kinds of purported ‘treatments’ emerged including insulin coma therapy, water dousing, centrifuging, mechanical restraints, psychosurgery, shock treatment, etc. By the end of WWII only ECT, psycho-surgery and Insulin Coma therapy survived as effective physical treatments for serious mental illness.

In the 1950s psychotropic drugs were discovered (by mistake while we were trying to make antihistamines). The simultaneous massive social change at the time along with the work of Goffman, Laing and Foucault as well as a financial incentive for governments led to the progressive closure of asylums. I am aware that I have simplified and collapsed a number of events and interpretations, but you can look these up. They are a matter of public record.

What’s important with respect to ECT is that it still drags around the historical and socio-cultural baggage of the asylums, inhuman treatment, coercion, paternalism, experimentation, eugenics and the immense human suffering that preceded modern mental health treatment.

When is ECT given today?

 ·        Severe depression ·        Catatonia·        Prolonged or severe mania·        Especially if there is refusal of food or drink 

What Does Modern ECT Involve?

In simple terms the psychiatrist explains the procedure and reasons for choosing that treatment option. They should seek consent in writing. The individual should undergo a physical assessment to ensure that there are no physical ailments that might make ECT risky. There should be a baseline memory test. Ideally, there should be a chat with an anaesthetist. After double-checking the consent, anaesthesia and muscle relaxation is induced. The pulse of electricity is applied with electrodes and seizure activity is monitored. The patient then goes on to recovery.

So, in summary:   Consent, anaesthesia, muscle relaxation, seizure, recovery.

It is usually about as dangerous as a dental procedure. You can read more about it from the Royal College of Psychiatry page

The events in the Jack Nicholson film may have happened once, but not any longer. ‘One Flew Over the Cuckoo’s Nest’ was already dated at the time of its release in 1975. It was based on a book published in 1962 (during the wave of asylum closures mentioned above).

Smallville s3e9 ‘Asylum’: Lex Luthor gets ECT

Lex Luthor gets science fictional ECT

Lex Luthor gets science fictional ECT

 ECT is a plot device in this TV programme about the early years of Superman. Short term memory loss is a side-effect of ECT. Lex Luthor’s father wishes for his son to forget something so he engineers a dose of ECT to perform a memory wipe. It would have been more useful to get Clark Kent to kiss Luthor. This episode is an incredibly negative portrayal of the mentally ill and displays ignorance of how ECT works. It describes ECT as “draconian” and risking irreparable brain damage and successful in 50%. ECT cannot be used to wipe memories. The patient will not remember the treatment or scream. ECT in the episode is done without anaesthesia.

Similarly in Batman # 471 where Killer Croc is given ECT, there are visible sparks, there is no anaesthesia, and the doctors wear surgical masks.

This is the second time Killer Croc appears in this talk. Co-incidence?

This is the second time Killer Croc appears in this talk. Co-incidence?

Some criticism has been levelled at ‘Homeland’ Season one’s portrayal of ECT because the recipient winces when the treatment is applied. I’ve seen what looks like a wince in some patients, although it could be seizure-related.

Please read this 2012 Guardian article from someone who has experienced ECT.

Summary: ECT is both effective and safe. Try to avoid mass media as source material.

Next: Suicide and the Sandman 


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Filed under comics, creativity, film, graphic_novel, mental_illness, movie, neuroscience, non_fiction, psychiatry, psychology, review, story, writer, writing

One response to “Mental Illness Primer for Speculative Fiction Writers 5: Electro-convulsive Therapy

  1. Pingback: Mental Illness Primer for Speculative Fiction Creators: Contents page | Long Time After Midnight

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