ECT Use on Prisoners in Uruguay

SHOCKED! ECT

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The following report on ECT use on prisoners in Uruguay appeared in the report "Human Rights and Mental Health: Uruguay." published by the Mental Disability Rights International (MDRI), a project of the Center for Human Rights & Humanitarian Law, Washington College of Law, American University and the Bazelon Center for Mental Health Law (June 1995).

Unfortunately, Amnesty International still refuses to recognize and investigate forced shock and drugging as "torture or cruel, inhuman or degrading treatment or punishment" (UN Universal Declaration of Human Rights, Article 5).

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a recognized treatment for severe depression, but it is a potentially dangerous treatment that can cause short-term memory loss. Thus, ECT should be restricted to uses in which its efficacy has been clearly demonstrated (e.g. severe depression.). As with other forms of treatment, the MI Principles [UN Principles for the Protection of Persons with Mental Illness] require that ECT be limited to patients for whom it is "appropriate to his or her health needs" and does not cause unjustified "harm...mental distress or physical discomfort.

The frequency of ECT use and the modality of treatment varies by institution. According to institution authorities at Colonia Rossi, Colonia Etchepare, and Musto, ECT is frequently used to control "aggressive behavior" in patients who may or may not have any psychiatric diagnosis. Records reflected this use. At Musto, where institution authorities report that 10% of the patient population receives ECT at any one time, ECT is reported to be used for a wide variety of conditions, including aggressive behavior by people with mental retardation.

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MDRI (Mental Disability Rights International) reviewed the records of two patients at Musto with mental retardation who had received extensive ECT, even though they had no psychiatric diagnosis. In one case, a twenty-seven year old woman with mental retardation and no psychiatric diagnosis received ECT once a week for almost one year. There was no explanation in the record as to what the ECT was supposed to accomplish. The limited narrative in the record states only that she "is aggressive, she constantly escapes from home, she walks and screams." There is no indication that behavioral therapies were used or attempted. The record states that she had several previous admissions at Vilardebo Hospital, and she appears to have been kept continuously at Musto for the last two years.

Authorities reported that bilateral ECT is generally used, a practice which is no more effective than unilateral ECT and which has greater risks of memory loss. The ECT inspected by MDRI are older "sine wave" machines rather than "brief pulse.

Patients are not asked for their consent to take ECT. Where institutions seek consent, they ask families, not patients, for approval. Information on ECT's negative side effects is not provided. (pp.40-41)

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