Shock therapy

Shock therapy

Electroconvulsive therapy - in which a small electric current is passed through the brain causing a seizure - is now used much less often than it was in the middle of the last century. But controversially it is now being used in the US and some other countries as a treatment for children who exhibit severe, self-injuring behaviour.

Seventeen-year-old Jonah Lutz is severely autistic. He's also prone to outbursts of violent behaviour, in which he sometimes hits himself repeatedly.

His mother, Amy, is convinced that if it wasn't for electroconvulsive therapy - ECT - he would now have to be permanently institutionalised for his own safety, and the safety of those around him.

The use of ECT featured famously in the 1975 Hollywood movie, One Flew Over the Cuckoo's Nest, starring Jack Nicholson. Set in a mental institution, the Oscar-winning film cemented most people's view of ECT as barbaric.

But Amy describes the modern version of the therapy as little short of miraculous.

"ECT has been transformative for Jonah's life and for our life," she says. "We went for a period of time - for years and years - where Jonah was raging, often multiple times a day, ferociously. The only reason he's able to be at home with us, is because of ECT."

It's estimated that one in 10 severely autistic children like Jonah violently attack themselves, often causing serious injuries ranging from broken noses to detached retinas. No-one really knows why. Some theories link self-injuring behaviour to anxiety caused by an overload of sensory signals, others to frustration as the autistic child struggles to communicate.

Amy and Andy tried countless traditional treatments using medication or behavioural therapy before finally turning to ECT - a treatment that first began to be used on children like Jonah a decade ago, in parts of the US. Each session alleviates his symptoms for up to 10 days at a time - but it's not a cure.

Jonah's doctor, Charles Kellner, ECT director at Mount Sinai Hospital in New York, is so convinced it's effective and safe that he allows Amy to witness the procedure and the BBC to film it.

Prof Kellner says the best way to overcome the negative image of ECT portrayed in popular culture is "to show people what modern ECT is really like, and show them the results with patients like Jonah".

Jonah is one of a few hundred children in the US to receive the controversial treatment. He has had about 260 ECT sessions since the age of 11.

Shock therapy

"There's a lot of interesting new neural imaging research showing that ECT actually reverses some of the brain problems in the major psychiatric illnesses," Kellner explains, as he makes final checks on the wiring around Jonah's temples.

"We don't know exactly why it works in people with autism and superimposed mood disorders, but we think it probably reregulates the circuits in the brain that are deregulated because of autism."

The modern treatment is carried out under general anaesthetic, with muscle relaxants to prevent violent convulsions. At the flick of a switch, Kellner administers just under an amp of electric current in a series of very short pulses.

Jonah's body begins to shake as the current induces a seizure - ECT specialists think this may "reset" the malfunctioning brain. The convulsions last for about 30 seconds.

Amy is unperturbed by what she sees.

"If a doctor says they need to cut open your child's chest to conduct life-saving surgery, you would allow it. That is more barbaric yet we accept it," she says.

Within an hour Jonah is fully alert. He and his mother head out of the hospital and on to the New York street to find an ice cream parlour.

Shock therapy

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For and against ECT

The Royal College of Psychiatrists says ECT is a "safe and effective treatment for severe depression" in adults but acknowledges on its website that some dispute this:


Many doctors and nurses will say that they have seen ECT relieve very severe depressive illnesses when other treatments have failed. Bearing in mind that 15% of people with severe depression will kill themselves, they feel that ECT has saved patients' lives, and therefore the overall benefits are greater than the risks. Some people who have had ECT will agree, and may even ask for it if they find themselves becoming depressed again.


Some see ECT as a treatment that belongs to the past. They say that the side-effects are severe and that psychiatrists have, either accidentally or deliberately, ignored how severe they can be. They say that ECT permanently damages both the brain and the mind, and if it does work at all, does so in a way that is ultimately harmful for the patient. Some would want to see it banned.

You can watch the Our World documentary "My Child, ECT and Me" at 21:30 on Sunday on the BBC News Channel, on BBC World at these times and on the BBC iPlayer.

Shock therapy

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