psychotherapist and visiting professor in health sciences at Trinity
College, Dublin, writes in the Guardian that he hopes new advice
on the use of electroconvulsive treatment in psychiatry will lead
to more responsible use of a 'dubious therapy'
10, 2003. Source:
new guidelines from the national institute for clinical excellence
(Nice) on electroconvulsive therapy (ECT) may not please psychiatrists
who were hoping for more control over the administration of the
treatment, and nor will they please the radical service user groups
that have called for its abolition.
Nice has been remarkably honest about the dearth of research supporting
the use of ECT, and its candid guidelines acknowledge the uncertainty
surrounding this controversial treatment.
administered for 60 years, there have been few rigorously controlled
trials of ECT. This reflects badly on the scientific pretensions
of psychiatric medicine.
the sustained campaigns by patients and mental health charities
over the last 30 years about the alleged barbarity of ECT, it is
astonishing that there have been no studies either of users' views
on the treatment or its impact on their quality of life. This reinforces
the arrogant image of psychiatry, which has played "father
figure" for far too long, especially without independent support
for its "clinical judgements".
remain the therapeutic mainstay of psychiatric treatment. Despite
the rise of psychotherapy and other "talking treatments",
most people still appreciate there is a role for medication in the
management of and recovery from mental illness. After all, tablets
or injections are used in almost all areas of medicine.
is different. It is a relic from psychiatry's past, where whirling
chairs, water torture and the use of insulin to induce coma, before
using drugs to induce seizures, were the order of the day.
the Italian psychiatrist, Ugo Cerletti, first developed the electric
shock apparatus in the 1930s, he recognised that its main effect
was to produce brain damage. Later in life he admitted that the
idea of "submitting a man to convulsant electric discharges
was barbaric and dangerous", adding that "in everyone's
mind was the spectre of the electric chair".
views found support in the various coalitions around the world that
have called for its abolition, with San Francisco - once a hotbed
for its use - among the first cities in the USA to ban ECT in its
other bizarre, outmoded psychiatric "therapies", ECT is
dogged by its history. Many early proponents acknowledged openly
that ECT damaged the patient's personality and intellectual capacity.
The testimonies of those who oppose its use today suggest that many
continue to fear such after effects.
Nice guidelines offer a balanced perspective on the use of ECT.
They acknowledge that no one can explain with any authority its
effect, while recognising that, in a very limited number of circumstances,
the risks involved might be justified.
its recommendation for doctors to ensure that patients consent to
the treatment where possible will mark a confident step towards
more responsible and accountable use of a dubious and dangerous
Hepworth, art teacher, Indiana, USA.
June 2, 2003
article is typical of those written by professionals one or more
steps removed from direct patient care or personal experience.
have had two successful courses of ECT over the last 10 years, the
latter being this year, and having substantially less side effects.
I would still make the same treatment choice as 10 years ago, despite
some transient confusion and a small amount of permanant memory
loss. This year the only side effects I noticed, apart from a severe
headache following the procedure, were a slight reduction in verbal
fluency for a few weeks.
is all very well for these officials to highlight every little possible
side effect, but it should be compared with long-term drug side-
effects, not to mention the long term often fatal side effects of
unsuccessfully treated depression.
is a very controversial subject, about which emotions run high and
to my mind unecessarily so. If I had not been so determined to have
the treatment my doctors would have gone on ad infinitum adjusting
meds every 6 weeks or so.
had had way enough of that- anyone who has been severly depressed
for a significant length of time, knows the gargantuan feat of surviving
one day longer, after reaching a certain point, never mind six weeks.
people are usually able to make rational decisions, so why treat
them like mentally retarded minors for whom decisions have to be
feel it's medical malpractice to withold ECT and totally unecessary.
The fatality risk is less than that of childbirth, (and far less
distressing) , and we don't see restrictions being placed on having
gave me my life back literally and that of my family."
3: NICE releases new guidelines for ECT
3: New ECT advice weak, says Sainsbury Centre for Mental Health
3: RCP launches new accreditation service to raise standards for
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