Electroconvulsive Therapy Background Paper - Consumer and Public Attitudes Regarding ECT

Written by RESEARCH-ABLE, INC.

III. CONSUMER AND PUBLIC ATTITUDES REGARDING ECT

Introduction

Douglas G. Cameron (26) of the World Association of Electroshock Survivors, addressing the Public Health Committee of the Texas House of Representatives in an April 1995 public hearing to consider a ban on ECT, captured the strong feelings of many ECT opponents with the following statement:

(ECT is) "An instrument which has injured and destroyed the lives of hundreds and thousands of people since its inception and continues to do so today."

Despite support from Cameron and others, proposed legislation to outlaw ECT was not enacted by the Texas legislature.

Comments contained in a two part series in USA Today (27) typify how some of the popular press view ECT:

"After years of decline, shock therapy is making a dramatic and sometimes deadly comeback, practiced now mostly on depressed elderly women who are largely ignorant of shock's true dangers and misled about shock's real risks."

A study (28) based on an Internet survey of ECT recipients choosing to respond, quotes some as saying:

"(ECT was) the worst thing that ever happened to me, and:

"Destroyed my family."

Citizens of Berkeley, California, in a 1982 local referendum, voted to "outlaw" the use of ECT. However, 40 days later, the courts ruled the result of the referendum to be unconstitutional.

The views of ECT opponents are balanced by people such as talk show host Dick Cavett who found ECT "miraculous," (29) and writer Martha Manning who felt as if she got 30 IQ points back once the depression lifted. However, she lost forever some memories before and during ECT. (30)

Although few studies of patient attitudes about ECT have been reported in the literature, a consistent finding among them has been the relationship between good ECT response and favorable attitudes. (31) In a controlled study, Pettinati and her colleagues reported that six months after ECT treatments, most of the patients studied said they would agree to ECT in the future if they were to become depressed again. (32)

Basis of the Opposition to ECT

When it comes to evoking strong feelings for and against a therapy, ECT may be unique among the broad range of current medical and psychiatric treatments. Dramatic impressions and portrayals of its horrors are juxtaposed against the rapid relief and remission of symptoms it often provides. These antithetical pictures combine to keep the controversy raging. The ways in which ECT was used and administered in the past are probably major factors in the continuing dispute. Reports of serious injury such as fractures and/or death resulting from the administration of ECT are now extremely rare. (33) However, the occurrence of these adverse effects in the past continues to promote public concern. Memory loss is the most frequent complaint of ECT recipients. Although its proponents agree that patients may suffer short-term memory deficits (particularly for the periods immediately preceding and following treatment), substantial disagreement exists about the nature, magnitude, and duration of such deficits.

Questions Regarding Persons Giving Voluntary Informed Consent

The patients' rights movement in the 1970's and 1980's heightened public and professional awareness regarding protection of the rights of persons with mental disorders, and the most emotionally-charged concerns about ECT probably center on questions of informed consent. (34) Are patients being fully informed and educated about the nature of ECT, the risks and benefits involved, and the availability of alternative, less intrusive treatments? Have they been told they can withdraw consent at any time during the treatment process? Is it clear that duress or inappropriate pressure has not been used to obtain agreement to the treatment? Is it clear that ECT is not being used to punish or control unruly patients?

Substantial ethical and legal issues may arise in regard to the involuntary administration of ECT. A report from the Wisconsin Coalition for Advocacy (35) indicates that such issues remain problematic in at least some hospitals in the State. The Coalition, which serves as the designated State Protection and Advocacy agency for persons with mental illness, responded to complaints regarding violation of the rights of patients on the psychiatry unit of a hospital in Madison. They reviewed treatment records and conducted in depth interviews that uncovered clear evidence of:

1. coercive practices to obtain patients' consent and failure to honor patients' refusal of treatment;
2. failure to provide sufficient information to patients for informed consent; and
3. consent to treatment by patients who were not mentally competent at the time they gave consent. (36)