I had only just finished reading Jonathan Sadowsky's Electroconvulsive Therapy in America when I happened across a prime example of the mythology of electroconvulsive therapy (ECT) in a local museum. In a glass-fronted cupboard sat a rather grubby and rough-around-the-edges ECT machine; propped up next to it was a card informing the visitor that ECT was commonly used in Victorian asylums alongside other ‘horrific’ physical therapies. ECT didn't arrive on the scene until the 1930s, yet is regularly erroneously associated with the Victorian asylum, where perhaps it is seen to be more at home. ‘Mythology’ is, I think, as apt a word to use for this phenomenon as ‘misconception’ – indeed it is a term Sadowsky himself uses when charting perceptions of ECT. For the majority of people, ECT conjures up images of shabby treatment rooms, patients being held down by teams of straining assistants, and the wards of decrepit asylums and mental hospitals. Yet for some it will conjure up images of a rather more modern environment – perhaps somewhere they visited as an outpatient just a week or so ago. And for some of these people, ECT will be credited as a treatment that has spared them a life lived within the walls of a psychiatric hospital, a therapy that has restored their autonomy and sense of self.

These differing opinions of ECT are what interest Sadowsky, in particular how they have developed from ECT's inception in the twentieth century through to its continued use in the present day. The controversy of the title is multiple: controversy surrounding what ECT says about psychiatry as a profession, its medical efficacy and even what it should be called (‘ECT’, for instance, carries less sinister overtones than ‘shock therapy’). The first chapter of the book, ‘Origins and origin myths’, provides an overview of ECT's birth, beginning not with Ugo Cerletti's exploits in Rome, but with a much older Western interest in electricity and its effects on the body. This is a contextual backdrop that is often overlooked in histories of ECT, thus inadvertently suggesting that the treatment came from nowhere as the unwelcome brainchild of the archetypal mad scientist. The opening chapter is a concise but rich portrait of evolving relationships between electricity and the body, from Galvani's frogs to Benjamin Franklin's experiments, and one that also provides a solid overview of the historiography surrounding somatic treatments in psychiatry. I would have welcomed here, in line with the wide-ranging chronological span of the chapter, a little more on the broader geographical context, especially the mechanisms of ECT's spread from the Continent to America; was knowledge of this apparently wondrous treatment exchanged via the same telegraph system that so many psychiatrists appealed to when explaining the ‘electrical’ impulses of the brain, for example? This is a minor quibble, however, and the chapter is perfectly in line with Sadowsky's focus on ECT's controversies rather than on providing its complete history.

In discussing the ethical controversies that continue to surround ECT, Sadowsky draws upon a wide range of sources, including doctors' personal notes, literature, film and first-hand patient accounts. The Snake Pit and One Flew Over the Cuckoo's Nest are emphasized – as in other histories of the treatment – as important elements of ECT's cultural history. They are part of what Sadowsky calls ‘a social memory of uses [of ECT] that were fearsome’ (p. 71) – such as the Scottish-born psychiatrist Ewen Cameron's psychic driving experiments, which combined ECT with large doses of psychotropic drugs and taped messages in an attempt to alter patients’ personalities. These ethically dubious and often outright damaging experiments are discussed here alongside more positive accounts of ECT, such as Norman Endler's 1982 memoir, Holiday of Darkness, and Anne Donahue's 2000 Journal of ECT article that recounted her personal experience of the treatment. Neither of these offers a simple or sugar-coated version of the ECT story, with Donahue's account in particular vividly conveying the disorienting impact of the memory loss that accompanied her treatment. Memory loss, notes Sadowsky, is more prominent in recent accounts of ECT like Donahue's. Why? He suggests that this is partly due to fewer patients writing personal accounts in the earlier twentieth century, and partly because early ECT treatment likely precipitated more alarming side effects than memory loss (including bone fracture as a result of seizures being induced without the use of muscle relaxants). But this is a fascinating question, also suggesting a changing cultural value placed on personal memory – is it an accident that memoirs like Endler's appeared at around the same time as what would later be dubbed the ‘false memory’ phenomenon in America, epitomized in books such as 1980's Michelle Remembers?

It is by raising questions like this that the book proves itself of interest to those beyond the field of the history of psychiatry. As well as offering a portrait of psychiatry's place in the cultural history of twentieth-century America, thorny issues in the history of science and medicine are discussed: historians’ reticence to judge the efficacy of past treatments, the intolerance of ambiguity when it comes to narrating the history of these therapies, the risk of falling into the trap of ‘caricatur[ing] eras in … history’ (p. 91), the role and sensitive use of patient narratives in historical work. When Sadowsky concludes that ‘the history of psychiatry is replete with clinicians and patient advocates claiming the complete and final victory of one modality’, and warns that ‘[h]istorians should not repeat their mistake’ (p. 155), one imagines he is preaching to several of the converted, but his engaging and accessible discussions of these historiographical challenges are nevertheless immensely valuable. Electroconvulsive Therapy in America will thus be an important addition to the shelves of historians of science and medicine as well as historians of psychiatry. One also hopes, given Sadowsky's engaging account of ECT's controvers(ies) and its enduring presence within the popular imagination, that a paperback edition will soon be available for a wider readership.