“Oh, I’m not gonna kill ya. I’m just gonna hurt you really, really bad.” – The Joker, Suicide Squad
In the 2016 box office hit Suicide Squad, the Joker uses electroconvulsive therapy (ECT) to torture Harleen Quinzel, creating the misinformed impression that ECT is an inhumane procedure. This belief stayed with me until I studied the facts about ECT. As a graduate student, I completed a chart review to evaluate clinical outcomes for patients who have been treated with ECT.
In reality, ECT is safe and effective for the treatment of various forms of psychiatric illness, including depression, bipolar disorder and schizophrenia. Annually, more than one million people across the globe are treated with ECT by a team of trained medical staff including psychiatrists, anesthetists and nurses. Electrodes are placed on the patient’s scalp and a brief electrical stimulus is used to induce a therapeutic and closely monitored seizure. Patients are provided with anesthetics and muscle relaxants to reduce apprehension and the risk of adverse events such as impairments in orientation and short-term memory loss that are typically temporary in duration.
Patients have reported favourable attitudes and experiences toward ECT, including feeling well-informed about the procedure and being treated with respect and dignity. In addition, patients say that ECT can gave them their lives back and prevent suicide attempts. Additionally, a literature review reveals that being treated with ECT increases understanding of the procedure and leads to improved attitudes toward it. For family members of patients who have been treated with ECT, treatment also leads to improved knowledge. For many, ECT is a life-saving procedure.
However, there is a clear mismatch between media portrayals of ECT and its current practice. A review examining 52 movies, 21 television programs and two animated sitcoms found that ECT was most often used as a metaphor for repression, control of the mind and behaviour and was portrayed as a memory-erasing, painful and damaging procedure. One patient refused treatment with ECT due to its alarming portrayal in the 1975 film One Flew Over the Cuckoo’s Nest. According to a study reviewing 39 English-language film and television shows, almost all had inaccurate depictions of ECT that were not based on evidence or current clinical practices. Given these media portrayals, it may be unsurprising that up to 75 per cent of patients report anxiety related to ECT.
Even among medical students, media portrayals of ECT can lead to decreased support for this life-saving procedure. A study among medical students found that their knowledge of ECT prior to watching media portrayals of ECT was poor and their attitudes toward ECT were mostly negative. After watching falsely portrayed ECT scenes from several movies, a third of participants decreased their support for the procedure and some admitted they would dissuade a friend or family member from treatment.
We know that ECT works. We know that the media’s portrayal increases apprehension toward ECT. And we know that overall, patients have positive clinical outcomes and experiences with ECT. Inaccurate media portrayals of ECT are dangerous, irresponsible and may be a barrier to this potentially life-saving procedure.