Why Electric Shock Treatment Still Exists - Electric Shock Treatment

Written by Sunday Times of London

Pat Butterfield set up ECT Anonymous four years ago, after having ECT in 1989. All its 600 members insist that it has ruined or damaged their lives. It's not just the patients making such claims: their relatives back up their stories with statements like, 'My wife isn't the same as she was.' 'Once [doctors] have given you ECT, they're not willing to acknowledge your experience. They'd much prefer to tell you it's your original illness that's giving you problems,' says Butterfield. 'It [ECT] absolutely wrecks your psyche.' She claims most psychologists are against it. 'Psychologists get what's left of people after they've been through psychiatry.' (Psychiatrists are medically trained doctors; they tend to diagnose and treat depression as a physical ailment. Psychologists aim to help people surmount their symptoms by making sense of their experiences.)

One such psychologist is Lucy Johnstone. She is not popular with the medical profession. In a book published last year, Users and Abusers of Psychiatry, she suggested that problems such as depression and schizophrenia weren't illnesses at all but reactions to events in patients' lives. Two years ago, she published a paper detailing the negative psychological effects of ECT. 'There was a lot of anecdotal stuff, so I decided to investigate what ECT is like if you find it an unpleasant experience,' she says. 'Not everyone finds it unpleasant, but there's a significant minority who do - up to a third. What I found was people reporting very strong negative reactions which had left them feeling they couldn't trust staff. They had to pretend to be better, to avoid having ECT again. They used very strong terms like 'humiliated', 'assaulted', 'abused', 'shamed', 'degraded'. There's a lot of debate about whether ECT causes lasting intellectual damage, but this psychological damage seems to me to be just as important.'

Johnstone admits that she had a biased sample - of people who had responded to adverts specifically asking for subjects with negative experiences of ECT. 'Not everyone experiences ECT like that,' she admits. 'But if a significant number do, and if you can't work out in advance who those people are going to be, then you run a high risk of making people worse, not better.'

She believes that ECT and treatments like it have no place in the care of people suffering from depression. 'All the people I spoke to in my research said that, looking back, there were reasons why they were depressed: their mother had died, they were out of work. If that's the case, then obviously electricity through the brain isn't going to help.

If you think about it, there's no reason why an essentially random blow to the head should have a specific effect on some chemicals that may or may not be related to depression. It's so speculative that there's almost no logical chance of it being true. In psychiatry, a lot of theories are stated as facts.'

Even within the psychiatric profession, there is wide dissent over the use of ECT. It is rarely used in Canada, Germany, Japan, China, the Netherlands and Austria, and Italy has passed a law restricting its use. In the US, where more than 100,000 people are treated each year and numbers are increasing, we find one of its strongest critics: Peter Breggin, the director of the International Center for the Study of Psychiatry and Psychology in Bethesda, Maryland. Breggin has been arguing against ECT since 1979. He says that it 'works' by causing a head injury. The aftereffects of such an injury are memory loss and temporary euphoria, which last for up to four weeks - effects that, he claims, can be mistaken for improvement by physicians and patients alike.

Even those committed to using ECT admit that its efficacy varies. The Royal College of Psychiatrists has commissioned two surveys into the quality and scope of ECT treatment in England and Wales over the past 20 years, both conducted by Dr John Pippard. The first, in 1981, made some appalling findings. 'Only one in four doctors received some tuition, but often not until after he had begun administering ECT,' Pippard noted; '27% of clinics had serious deficiencies such as low standards of care, obsolete apparatus, unsuitable buildings. Included in these were 16% with very serious shortcomings: ECT was given in unsuitable conditions, with a lack of respect for the patients' feelings, by staff who were ill-trained, including some who consistently failed to induce seizures.'

On his return in 1992, Pippard found that ECT clinics had improved in terms of equipment and environment. But he concluded: 'There has been little change in the way psychiatrists in training are prepared for and supervised in what they do in the ECT clinic.' Elsewhere, he said: 'ECT requires more of the psychiatrist than just pushing a button.'

This is because patients' seizure thresholds vary up to 40-fold. In other words, the level of electricity needed to induce a seizure varies dramatically from one individual to another. As far back as 1960 it was shown that the severity of side effects was proportional to the dose of electricity used. This may partly explain the negative experiences of some patients. If ECT were administered at the optimal seizure level for each patient, in ideal surroundings, its efficacy would almost certainly be improved. Practitioners admit that relapse rates are high. Nor is it universally accepted that ECT saves lives. The medical literature on suicide rates after treatment is inconsistent and, in a recent review, Breggin claimed that ECT increased the suicide rate. 'Patients frequently find that their prior emotional problems have now been complicated by ECT-induced brain damage and dysfunction that will not go away,' he wrote. 'If their doctors tell them that ECT never causes any permanent difficulties, they become further confused and isolated, creating conditions for suicide.' He accuses the American medical profession of a cover-up - psychiatrists protecting their own interests to avoid being sued by former patients. In his view, ECT should be banned.

Perhaps the thorniest issue in the ECT debate is consent. In Britain, under the Royal College of Psychiatrists' guidelines, valid consent must be obtained from the patient - based on their understanding 'the purpose, nature, likely effects and risks of treatment in broad terms'. Under common law, valid consent is required before any medical treatment can be given, except where the law provides authority to give treatment without consent. According to the 1983 Mental Health Act, a person is presumed to have the capacity to make a decision unless he or she is considered unlikely to take in, or unable to believe or properly weigh up, the relevant information. In other words, if your doctors believe you aren't in a state to know what's best for you, they will make the decision for you.