Adverse Psychological Effects of ECT - Psychological Effects of ECT

Written by Lucy Johnstone

Participants

The study targeted people who had had negative reactions to ECT. They were recruited by posters and flyers asking, `Have you been given ECT? Did you find it upsetting or distressing in any way?' which were distributed through local mental health voluntary organisations. Twenty-two people contacted the researcher, and 20 were eventually found to fit the criteria. There were 12 women and eight men, with an age range of 27-63 years. One of the men was a female-tomale transgender. Ten were unemployed, and ten were involved in voluntary or paid work. Two described themselves as mixed race and the rest described themselves as white.

Participants were not always able to be precise about the details of their treatment, but nine of them reported that they had had more than one course of ECT, and six had had at least one course under section. The most recent course of ECT was 2-5 years ago for five participants; 5-10 years ago for five participants; 10-20 years ago for six participants; and 20-30 years ago for four participants.

It can be seen that within the overall category of adverse reactions to ECT, participants represented a wide range of backgrounds and treatment circumstances.

Method

The aims of the investigation were explained to the participants, and confidentiality was assured. The researcher emphasised that she had no current connections with psychiatric teams. Participants were invited to take part in a semi-structured interview at a place and time convenient to them, concerning all aspects of their experiences of ECT. Interviews were tape-recorded and transcribed, and a thematic analysis was performed on the results.

Results

Themes can be organised under the following main questions.

What were the circumstances in which you came to have ECT?

Participants described their mental states at the time mainly in standard psychiatric terms, for example:

`I'm diagnosed as manic-depressive, and in those years I did suffer from some form of depression rather than mania, and I suppose I went into such deep depression that they thought ECT would help to get me out of it'.

'I was just really depressed and I was getting a bit manic as well, and I didn't seem to be responding to the medication, and they said I should have a course of ECT'.

However, as the interviews progressed, more complex background situations emerged:

'I always knew I had problems that were emotionally-based, to do with my life. And although I'd gone in partly under the influence of drugs, LSD, I also knew when I was growing up that I had some problems '.

'I was a very mixed-up and distressed person, and then my closest friend was killed six weeks after I got married...and my world fell apart'.

'I was in nursing... One day I was a student, the next day I was qualified and in charge of a ward, which I wasn't trained to do. I was just too young for the job '.

`If I look back on what caused the depression and what caused me to try to take my life, it was quite normal, average things...a divorce, I had two children, I was three months pregnant when I left...holding three jobs down, mundane jobs, trying to keep it going really. I was worn out, absolutely worn out'.

What kind of explanation of ECT were you given?

A problem here, as with other questions that asked for specific details about events, was that many participants had uncertain recall due to the effects of ECT itself. As in other surveys, nearly everyone felt that explanations had been completely inadequate or lacking altogether, and that there had been minimal opportunity for discussion.

'I don't remember anything being explained. I think they just said they were going to attach these things. I don't remember any discussion beforehand'.

`She said, "I don't think the Valium 's doing you any good, so I'll put you on ECT".

Why did you agree to have ECT?

Six of the participants had had ECT under section on at least one occasion. The answer to the puzzling question raised by other researchers, of why the others consented despite inadequate explanations and the fact that many of them already had doubts based on the experiences of relatives or other patients, lies in their feelings of extreme desperation and powerlessness.

'I was so ill, I felt so desperate, I didn't know which way to turn. I was just looking for answers as to why I was so strange, so peculiar'.

'I wasn't in a fit state to make any of those decisions. We were just grasping at straws, trying to find an answer'.

`If you're at your wits' end and they've drugged you up to the eyes you don't question.. you're not thinking straight anyway '.

This desperate desire to get better was often coupled with a tendency towards compliance and a strong assumption that `doctor knows best'. Moreover, participants felt they could not risk alienating these powerful people who seemed to hold the key to their cure: 'I was a very compliant young woman, I was very frightened of everybody and that was part of the problem... wouldn't have known how to object, it wasn't on the horizon. You didn't disagree with doctors, you did what they said'.

`You believed that whatever they were going to do was going to work, you believed what you were told really'.

`He is the one with the power, he is the one ultimately that has the answer...if that's the only help you're getting you've got to hang on to it'.