Shock tactics

Phil Barker, a 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'

May 10, 2003. Source: http://society.guardian.co.uk

"The 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.

However, 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.

Although administered for 60 years, there have been few rigorously controlled trials of ECT. This reflects badly on the scientific pretensions of psychiatric medicine.

Given 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".

Drugs 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.

ECT 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.

When 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".

His 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 public services.

Like 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.

The 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.

Hopefully, 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 technology."

.......

Comment from: Tina Hepworth, art teacher, Indiana, USA.
Date: June 2, 2003

"This article is typical of those written by professionals one or more steps removed from direct patient care or personal experience.

"I have had two successful courses of ECT over the last 10 years, the latter being this year, and having substantially less side effects.

"However, 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.

"It 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.

"ECT 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.

"I 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.

"Depressed people are usually able to make rational decisions, so why treat them like mentally retarded minors for whom decisions have to be made.

"I 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 children!

"ECT gave me my life back literally and that of my family."

........

See also:
May 3: NICE releases new guidelines for ECT
May 3: New ECT advice weak, says Sainsbury Centre for Mental Health
May 3: RCP launches new accreditation service to raise standards for ECT

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