Content warning: This article describes non consensual medical procedures performed on individuals and contains descriptions of depression and suicidal ideation.
The recent development of a brain implant used to detect and treat depression could fundamentally alter the future of treatments. Before treatment, Sarah* was suffering from severe intractable depression—she was depressed since her childhood, and had suicidal thoughts various times an hour as an adult. Her brain did not respond to therapy, medication, or even electroshock therapy.
Sarah’s life changed when she chose to participate in an experimental treatment at the University of California, San Francisco. After researchers recorded and analyzed her brain’s electrical signals for ten consecutive days, they determined a pattern of neural activity for her depressive symptoms. After Sarah underwent two brain surgeries, researchers then placed an implant responding to her brain patterns at the back of her skull.
The implant itself is a chip that detects depression–related activities in emotional circuits, then electrically stimulates these places to mitigate depressive emotions. Whenever the device was switched on, Sarah reportedly noticed a drastic increase in her mood—finding joy in her hobbies again, being able to make decisions, and having other pleasurable experiences. Sarah previously had a score of 36 out of 54 on the Montgomery–Asberg Depression Rating scale, a scoring system which rates the severity of depressive symptoms. After two weeks, her score was at 14. Fifteen months later, her score is now under ten.
Her success story has been publicized all over the press and media. About 30% of depressed people have treatment–resistant depression, meaning that this discovery could better the lives of tens of thousands of people.
Scientists are considering personalizing this therapy for other patients with severe depressive symptoms, so that each patient can undergo individualized electrical probing to figure out which brain stimulation areas are best to treat their depression.
While this discovery is groundbreaking, the thought of inserting a brain chip into someone's skull can be chilling—especially given the historically violent use of electroconvulsive therapy (ECT).
ECT was invented in 1938 by Italian researchers Ugo Cerletti and Lucio Bini, who used electric currents to induce seizures in a schizophrenic patient. After nine treatments, the patient was able to move back in with his wife and resume working. ECT quickly became widely popular in the United States and Western Europe to treat mental illness.
However, the use of ECT quickly took on a very dark form. It began in Nazi Germany in 1939, when Adolf Hitler authorized German doctors to euthanize psychiatric patients that were considered to be “incurable”—a euphemism for patients that were treatment–resistant, and therefore costly to the state. This decree was used as an alleged justification for German doctors to kill tens of thousands of patients, with the main goal being to free up hospital beds for wounded Nazi soldiers.
After the “euthanasia” extermination operation was banned in 1941, German psychiatrists began to reframe ECT as a war–related treatment. Once again, this was another facade used to justify the use of ECT in the Auschwitz concentration camp, mainly as motivation for psychiatric patients to continue working.
The 1950s were no better. American doctors performed ECT on non–consenting asylum patients, namely on women who suffered from depression. These women were often locked up in asylums and considered “nymphomaniacs” or “hysterical”.
In the 1960s, ECT was used as conversion therapy for gay men. Patients would be shown pictures of naked men and given electric shocks—sometimes to their genitals—upon arousal. This was implemented in both the United Kingdom and the United States until the mid–1970s.
Up until the 1980s, patients were not given any anesthetics, and were deprived of muscle relaxants to keep their muscles from reacting violently to electric shocks. This resulted in long–term memory loss, injury, or reduced brain function. It was only 50 years after its initial use that ECT began to be administered safely, not to mention consensually.
Naturally, ECT’s troubling past has affected how we perceive it today. Countless books and horror movies include scenes of ECT being used as a brutal torture method to control “unruly” asylum patients. One of the most famous scenes is Jack Nicholson’s character convulsing while nurses attempt to restrain him in One Flew Over the Cuckoo’s Nest. The Internet is also home to an excess of inaccurate and biased information about ECT, perpetuating false claims that ECT causes permanent brain damage and long–term memory loss. All of this cultural propaganda drives the stigma that ECT is not only ineffective, but also painful and inhumane.
For better or for worse, our culture determines our scientific progress. When public perspectives of ECT are mostly negative, this delegitimizes science and makes hospitals less likely to administer ECT to those who need it. It also causes people who could benefit from ECT to choose a less stigmatized treatment method. On a national level, it provides little incentive for the federal government to fund research and development projects for affordable mental health care and ECT treatment.
The reality is that ECT, if administered correctly, can be a safe and life–changing treatment for depressive patients. During the procedure itself, patients receive a muscle relaxant and general anesthetic to reduce muscle spasms. While undergoing the seizure, patients are unconscious and do not experience any pain. Their brain waves and vital signs are also monitored to ensure safety. The modern ECT mortality rate is about one in 10,000 patients, which is ten times safer than childbirth.
ECT’s effects have also proven to be beneficial. Not only is ECT the only method that aids treatment–resistant depression, ECT also has the fastest results. In fact, in more than 80% of cases, ECT helped alleviate the most severe symptoms of mania and severe depression. Comparatively, antidepressant pills are less effective: Around 60% of people respond to antidepressants by about two months with about a 50% reduction in their symptoms, and about 80% of people stop antidepressants within a month.
In a sense, we are our own worst enemy. By judging a scientific treatment for what it used to be, we are blinded to its future potential.
Though Sarah’s success demonstrates the progress made in ECT technology, there are still many questions. The biomarkers used to treat Sarah’s depression do not necessarily apply to all depressive patients, and the long–term duration of the effects of the stimulation procedures are unknown. Simultaneously, the treatment is still a long way from being an affordable alternative: with a price tag of about $30,000.
At this point, we shouldn’t perceive ECT as the human rights violation it once was, nor should we perceive it as an absolute cure for depression. Rather, we should just see it for what it is: hope.
*This name has been changed for anonymity purposes.