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Electroconvulsive Therapy Machine during its origin days (mid 1700s-late 1800s).        Source: Science Museum, London Wellcome Images (CC BY 4.0)

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The Origins of Electroconvulsive Therapy, also known as 'Shock' Therapy.

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The Origins of Electroconvulsive Therapy, also known as 'Shock' Therapy.

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Electroconvulsive Therapy, also known as 'Shock' Therapy has origins dating back to Ancient Rome. In those days, Romans would utilize the current from electric eels in order to treat common issues such as headaches.  But it wasn't until the mid 1700s that this machine came underway. French Physician J.B El Roy was amongst the first to write about the potential for electricity, or electrical shock to cure neurological issues. Specifically, he wrote about the alleviation of symptoms from what was known as 'hysteria' following "three applications of electric shock"(1) to his patient. These ideas were validated by other notable figures such as Benjamin Franklin and G.B.C Duchenne (know as the "Father of Electrotherapy"(1)), both carrying out their own experiments regarding treatment of mental disorders.

The procedure utilized two electrodes (as shown in the image) soaked in salt solution to safely carry the electric current from the machine to the patient. These electrodes were placed on the temples of the patient and the 'shock' was delivered by the flip of a switch on a scale ranging from "40-100 Volts" (1), depending on the severity of the patient's symptoms. The electrical current was usually delivered for less than a second. The treatment was ultimately a way to induce a seizure in the patient, as it was believed this would decrease the psychotic symptoms being displayed.

This form of therapy was primarily used in Europe, and did not cross over to the US until the 1900s. In its beginning, it was kept mainly to psychiatric/mental hospitals to treat those with psychological ailments. We now know that seizures are a result of excessive neuronal synchronization and disrupt interneuronal communication, so it makes sense as to why they believed that this treatment could have been an effective cure for disorders of the mind. By disrupting interneuronal communication, neurons may be able to more efficiently communicate following the shock. This artifact is important as it marked the beginning of exploration of treatment for illnesses that were often stigmatized/ignored, and raised questions about the role of electricity in the brain.

Source (1): A Historical Review of Electroconvulsive Therapy. https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1256&context=jeffjpsychiatry

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Common symptoms of Schizophrenia.     Source: What is Schizophrenia? https://www.buoyhealth.com/learn/schizophrenia

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First Noted and Successful ECT Patient: Schizophrenic Docent.

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First Noted and Successful ECT Patient: Schizophrenic Docent.

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The first noted and successful patient of ECT was a 40 year old schizophrenic patient in 1938 (2). Common symptoms of the genetic disorder can be seen above. It was theorized that induced seizures would be of help to schizophrenic patients due to a lack of microglia. We know that microglia are dynamic parts of the cortex and help in maintaining cortex health by regulating normal development. We also know that pruning is accelerated in patients with schizophrenia, making efficient connections more sparse. This makes healthy brain development less likely and is researched as possible cause for the symptoms seen in those affected. For this reason, most of the patients that underwent ECT in earlier times were diagnosed with Schizophrenia.
This docent would've been alive during the early 1900s, residing in Italy where ECT research was most prevalent.  He struggled day to day due to emergence of symptoms. He'd be the perfect individual for the exhibit as he was the first human to undergo ECT treatment. Prior to him, most of the testing was on...dogs.
He was delivered an electric current of 110 Volts for 0.2 seconds (2) until a seizure was induced. It was observed that after 10 treatments, he had went from aimlessly wandering the streets of Rome to being reacquainted with his wife and children with a lack of previous psychosis. He would be perfect to lead this exhibit as he was one of the few of his time that were able to almost completely cure his symptoms. Many other patients were not as lucky, facing either death or an increase of symptoms.

Source (2):

A Brief History of Electroconvulsive Therapy. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2020.160103

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3 possible placements of electrodes: (1) Bilateral, (2) Right Unilateral, (3) Bifrontal.    Source: https://www.nejm.org/doi/full/10.1056/nejmct075234

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The Relationship between Electrode Placement and Effectiveness in ECT.

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The Relationship between Electrode Placement and Effectiveness in ECT.

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Electrodes were vital in the procedure, and these three placements were most common. To start, the electrodes were doused in salt water to safely induce seizure in the patient (some patients withstood burns as a result of high voltage without salt water).
During the beginning of its usage, Bilateral placement was most common. But for patients that were not experiencing improvement after treatment, Right Unilateral and Bifrontal were tried for effectiveness. We know that the temporal lobe (Bilateral electrode region) is used for sensory input and processing, while the Frontal Lobe (Right Unilateral, Bifrontal) concerns Executive functioning. Knowing this, it makes sense as to why some patients may not have responded to certain placements. It's possible that patients that exhibited symptoms that are more closely associated with the Temporal lobe, achieved most improvement with that electrode placement. It can explain why ECT is so significant in treatment of depression today, which has symptoms associated with frontal lobe damage.
This also can explain why simply "upping the voltage" was dangerous or fatal for patients. It's possible higher voltage disrupted neuronal communication too significantly, causing an increase in fatal symptoms. This, among other issues were a reason for the public dislike of ECT over time.

Source (3): Electroconvulsive Therapy for Depression. https://www.nejm.org/doi/full/10.1056/nejmct075234

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 How ECT's Dangerous History led to its Stigmatization.

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 How ECT's Dangerous History led to its Stigmatization.

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ECT for decades has carried along a negative connotation.  Most of the stigmatization of ECT came from its orgins prior to it being available for human use. This video walks through the different treatment ideas and options until current times. Prior to ECT's approval of use on humans, electric currents were being used on pigs in slaughter houses before their death. Due to this, many people began to see ECT as something that was "barbaric" and a "torture device" unfit for human beings. In fact, many people often times compared it to the electric chair, a device used in executions (1). But while it did help patients, mostly with depression in managing their symptoms, it came with one problem. Many patients reported memory loss and cognitive impairment from high voltage currents effects on inter neural communication. It 's usage and prevalence was largely due to a lack of antipsychotic medications, as schizophrenics were the main patients. It's commonly associated with mental/psychiatric hospitals that are still heavily taboo in today's times. For one, ECT was heavily associated with torture due to it at times being used as such in psychiatric hospitals as a way of controlling and abusing severely ill patients. This is represented and reaffirmed in media, such as American Horror Story (2012), which portrays ECT as solely a torture device for wrongly admitted patients that were deemed difficult to control. This led to the de-popularization of the treatment, especially as alternatives were developed such as antipsychotics and antidepressants, with much fewer side effects. This is important because the amount of symptoms post treatment were inefficient for most patients, causing there to be more research into another way. this lead to chemicals being developed that stimulated and regulated release of neurotransmitters (SSRIs) that are most used today. Another reason for its lack of popularity is due to the involuntary seizures patients would experience from the electrical currents, which was lessened by the use of a mouthguard. it also shows the progression into the demonization of ECT and why it is portrayed so violently in media.

Source (4): https://www.youtube.com/watch?v=xOF9B2NcpLU

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The Dangerous History of Electroconvulsive Therapy, and How It's Used Today

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Patient clenching on mouthguard during ECT.                Source: https://bigthink.com/mind-brain/shock-treatment-may-be-the-best-therapy-for-major-depression/

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The mouthguard was the most vital part of the procedure outside of the machine itself. When subjected to ECT, patients were required to place a piece of rubber or silicone and clench down on it in order to prevent themselves from tongue laceration, or biting their own tongue off (5). The mouthguard acted to absorb the currents being delivered.

In earlier times, patients would be solely given the mouthguard. The only drug they may have been administered were barbiturates, which they believed would aid in the treatment of schizophrenia and calm the patient. This is due to the electrical currents causing convulsions, in which have resulted in patients "breaking their bones" and "tearing their ligaments"(5). We now know that barbiturates have effects on our GABA production and act as a central nervous system depressants that slow down heart rate and subsequently breathing rates, giving patients a calm for a smoother, less anxiety ridden treatment. Now it is common practice for the patient to be given general anesthesia which is much safer and effective, providing adequate muscle relaxation. Mouth guards are still used alongside the anesthesia for ECT, but also have more recreational and broad usages outside of the hospital.

Source (5): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272521/

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Effects of ECT in patients with Depression.                  Source: https://www.hopkinsmedicine.org/news/articles/how-ect-relieves-depression 

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ECT fell out of popularity with most mental disorders, but today it still use to treat depression. Even now, many scientists still aren't completely sure why it is so effective in treating clinical depression, but they hypothesize that it causes "molecular changes" in the brain that aids in increased communication between neurons that respond to antidepressants.
With the rise of antidepressants and antipsychotics though, most people are opting out of taking the risk with ECT due to it being linked with long term memory loss. There are less recorded side effects of medications.  ECT has definitely lost public trust, but as of currently there is limited information saying that it is any less effective than antidepressants.

Source: https://www.hopkinsmedicine.org/news/articles/how-ect-relieves-depression

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Brain damage as a result of ECT. Source: https://www.bbc.com/news/uk-52900074

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Seen above is neuroimaging of a brain following treatment using ECT. For the viewer's sake, the red shading indicates damage done to critical brain areas. Knowing the placement of electrodes for ECT, it is easy to see that the damage was primarily isolated to the two sides of the brain where electrodes are common. Researchers are now arguing amongst the credibility of prior research that ruled out brain damage and memory loss as major issues regarding ECT. Now that there is more accessible knowledge and higher levels of technology, researchers are going back to see if past findings are true. They are now curious as to whether past data was accurate or not and considering that long term effects are more severe than recorded. This isn't difficult to consider, considering that the basis of the treatment relied on the divergence of communication between necessary neurons, which by itself sounds concerning. This goes to show that there is never 100% certainty in neuroscience especially, and that through more rigorous research we can find the most efficient ways to treat different ailments.

Source: https://www.bbc.com/news/uk-52900074