The electroconvulsive therapy (ECT) is one of those divisive issues in which two different discourses run in parallel, without listening to each other. Thus, the dialectics don´t progress and, no matter how long it takes, we don´t get any closer to any synthesis. If anything, what progresses is the exasperation of each side with the other, and the potential of violence that comes with it.
The psychiatrists build on their clinical experience and on the scientific facts they can find in the professional literature. They consider that ECT is an effective treatment for several psychiatric disorders, particularly for major depression, catatonia and some psychoses. Psychiatrists reckon that ECT is also a safe treatment, whose most important side effects are those derived from the anaesthesia and a minor, temporary, memory loss.
On the other hand, an important part of the lay public, among which we can encounter some pressure groups formed by patients and a few politicians, have a very different view. They consider ECT to be cruel, obsolete and traumatic. They deny the effectiveness of ECT and describe very serious side effects, with patients turning into “lobotomized zombies”. Some of the patients that embody this view have had negative encounters with mental health institutions and accompany their negative view of ECT with a disparaging attitude towards Psychiatry in general.
A key icon behind this negative view of ECT can be found in “One Flew Over the Cuckoo´s Nest” a novel turned into a film that has caught the public imagination. In this story the psychiatric establishment is portrayed as rigid and cruel, and electroshock (and old version of ECT, practiced without anaesthesia) is shown as a hybrid between a treatment and a punishment. Furthermore, the side effects of the electroshock are conflated with those of a lobotomy (the surgical removal of part of the brain) which leaves the patient in a vegetative state (thereby the indelible image of the zombified patient). The devastating effects of the treatment, as shown in the film, have a high emotional impact.
Nowadays, psychiatrists cling to the objective truth they find in science and clinical practice, while the popular view remains mesmerized by the emotional shock provided by art, augmented by the stigma attached to Psychiatry and by some painful personal experiences of some patients in their relationship with mental health treatments (not necessarily with ECT itself).
Throughout history, when different views on the same issue have conflicted, they have frequently been solved using the principle of authority. The opinion of the most revered sage (usually Aristotle) carried the day. Unsurprisingly, there came a time when this solution was no longer considered satisfactory.
Descartes devised a method, the scientific method, to reach an indubitable solution to all queries, marrying the rationalistic approach to think the logic of the issues with the empiricist endeavour to check the facts. The scientific method triggered an exhilarating optimism in the capacity of man to master the universe, to know the mind of God.
It didn´t take long for Kant to clarify that while the scientific method was useful to study phenomena, that is, observable facts, it couldn´t apprehend the noumena, the essence of things in themselves. Although the effectiveness and safety of ECT remains within the realm of the phenomena approachable by science, Kant initiated a process of limiting the faith in the power of science.
In the postmodern world, while scientists and the professionals who follow them preserve a bubble of certainty grounded in the scientific method, large parts of society challenge not only the validity of this method to attain the truth, but the existence of truth itself. Without a truth working as the bedrock on which to support agreements, every individual is free to choose his own version of reality. Many make their choice following Freud´s pleasure principle. Wishful thinking has taken over, throwing us both to idealized paradises and to our darkest nightmares.
Three centuries after Descartes, having rejected both science and truth, we are groping a dark path back to the authority principle. Now the authority does not fall on Aristotle, but on whoever makes the most compelling, emotional claim, or has the media to make himself heard louder or more frequently.
The problem with the ECT does not rely on the usefulness or not of a particular therapeutic method, but on the epistemological foundations of our civilization, which are unstable. For the time being, we´ll keep having parallel, incompatible discourses, with each side despising the other and trying to impose their view… until one gets the power to crush the other.
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