Adverse Psychological Effects of ECT - Effects of ECT

Written by Lucy Johnstone

A man who ended up completing his course of ECT despite his own reluctance and encouragement from the nursing staff to refuse it, put it like this:

`It was like, the consultants and the psychiatrists have such a powerful influence over you. In one sense your life is in their hands and it's wanting to please them, I suppose, because...part of depression is losing your sense of self really, and you're so easily influenced and so easily willing to accept authority'.

One woman found that her refusal to have further courses of ECT was, in fact, respected. Others who were able to be assertive were not so fortunate:

`They asked me if I would agree to it, but they did say if I refused they'd go ahead with it anyway...being forced to stay there is bad enough but being forced to have something that you don't want is ten times worse, so I did agree, yes

`Now what so often happens in psychiatric hospitals is, it's not the psychiatrist that forces you to have it. Long before that happens you get confronted by staff nurses who are very anxious to stop hassle.. . so what they do, they see that you're weak and vulnerable and they say, `You'd better sign', just like that'.

'I said immediately that I didn't want it, and I pointed out that the previous consultant... had said to me that she didn't think I was an appropriate case for ECT.. and he (the consultant) got into a real huff basically and got up and walked out of the room...I felt absolutely devastated. I just burst out crying and didn't know what was going to happen to me, or whether they were going to section me, or what'.

In summary, nearly all participants wanted to emphasise how far their apparent agreement was from being fully informed consent: 'I wasn't physically taken to the suite or anything, I walked there on my own, but If elt it was forced on me'.

What was the actual experience of ECT like?

Six people said that ECT was not particularly frightening to receive, although one woman attributed this to the numbing effects of her medication. All the other participants reported a very high level of fear, with a lack of accurate information sometimes supplemented by observation of other patients who had had ECT and by their own imaginations: 'I really didn't know what to expect, so I was absolutely terrified...I imagined great big metal things being put each side of my head and, like, sparks coming out, thunder and lightning, and my whole body shaking'.

`When you'd been on the ward there were certain people who had had ECT and all the other people were very scared by this.. you would see them afterwards when they couldn't remember who they were and were very confused and had terrible headaches and weren't themselves at all'.

All this generally produced a high level of anticipatory anxiety:

'I remember the very first time I had it, walking down to the ECT (suite) from the ward and I remember feeling very agitated, sick and scared. And when I got into the waiting room there, I came to a standstill. I couldn't go through with it, I didn't want it. They talked to me and said I'd signed the consent form and I was under section '.

`As they wheeled you in you'd see what they used, they'd put some gel on it, they didn't even hide it from you... You were scared, yes'. 'I can remember sitting in the room waiting for treatment and looking at some of the other people who were there as well and I suppose it was almost like a pre-execution room really... We were all sitting there in complete silence. I remember reading in something, I think a hospital pamphlet, (that) it was just like going to the dentist, which is completely absurd.. It's not like going to the dentist'.

One participant reported that the reality was not quite as terrifying. However, the terror of the other participants remained or even increased as the course continued, and many found the immediate after-effects equally devastating:

'I thought maybe second time around it'll be much easier and I won't feel so scared and terrified, but it was just the same, if not a bit more '.

`You dread it, your heart starts pumping, here we go again. Horrible, absolutely terrifying...It's like going to your death, your doom, isn't it'.

'I was absolutely convinced they were trying to kill me...you know, I was so bad and evil, all they could do was get rid of me'. (A woman who was psychotic at the time.)

`They could be doing anything, you don't know what they are doing...you get paranoid and think they are trying to poison you, or do weird experiments or something like that'. (A woman with a diagnosis of paranoia.)

`Afterwards I felt as if I'd been battered...1 was just incapacitated, body and mind, like a heap of scrunched-up bones'.

'...Pains in your head and the memory loss, and sometimes I used to have a bruise. I'd be dribbling, I looked insane...1 felt terrible, I was only 22 and I must have looked 82. I just couldn't do anything'.

When asked what was the most frightening aspect of receiving ECT, participants most commonly mentioned feelings of being helpless and out of control, and worries about long-term damage.

`It's a horrible sensation. You feel like a zombie, they could do what they want with you when you've had that and you would do it, because you don't know no different'.

`It was the whole treatment, being carted off If elt like a slave, taken away to this little room and put on a bed. No control, it was awful '.

`You can't get it out of your head, how would you end up?...you'd be so brain dead you wouldn't know what you were doing '.