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Page 2 of 24
1. Introduction
As part of its Work Plan for 1996/97, Salford Community Health Council (C.H.C.) agreed to undertake a project into the use of electro-convulsive therapy (E.C.T.) in Salford. A project team was established, whose members were:
Mrs. Milly Alvarez
Mrs. Margaret Argyle
Ms. Hazel Blears
Dr. Mark Gabbay
Mr. Sam Portnoy
Rev. Ken Stokes
1.1 Aims:
The aims of the Project were:
1. To assess the use of E.C.T. in Salford.
2. To establish survivors' views about the use of E.C.T.
1.2 Objectives:
The objectives of the Project were:
1. To collate information about E.C.T., its use, effectiveness and side effects.
2. To identify criteria and guidelines against which to assess the use of E.C.T.
3. To identify and assess the use of E.C.T. in Salford.
4. To establish the views of survivors in Salford who have had E.C.T.
1.3 Terminology:
The issue of terminology is a sensitive one. Salford C.H.C. recognises that different people use different terms and strongly object to others. In this report, the term "patient" is used to describe those people having or about to have E.C.T., and the term "survivors" for those people who have had E.C.T.
2. Electro-convulsive Therapy and Its Use
2.1 Electro-Convulsive Therapy.
E.C.T. involves passing an electric current through a person's brain while they are under a general anaesthetic and have been given a muscle relaxant. This produces a convulsion (muscular contractions) modified by the anaesthetic.
There is evidence that seizures were used since the Nineteenth Century to treat schizophrenia (starting in 1834 in Hungary). These seizures were induced via various means such as with insulin and other so-called pharmacological means.
Electro-convulsive therapy (E.C.T.) was first used as a treatment for mental illness in 1938 by Cerletti and Bini (50), and then developed as a mainstream treatment. E.C.T. was used before the development of modern anaesthetics and muscle relaxants. It also predated drug treatments for depression. As such, it has had a significant historical role in influencing the perceptions of people towards mental illness and the potential of different treatments.
In the 1950s and 1960s antipsychotic, antidepressant, and anti-manic drugs were discovered (169). Although E.C.T. was partially replaced by drug treatments with reduced side effects, it continued to be used on a large number of people, the level of which tended to stabilise in the early 1980s.
Internationally, E.C.T. is banned in Italy, while its use is limited in Canada and the Netherlands. E.C.T. is used much less in other European countries than in Great Britain. For example, in West Germany in 1986, E.C.T. was used in 26% of state psychiatric hospitals, 40% of psychiatric departments of general hospitals and in 78% of university hospitals. A total of 500 people had E.C.T. in 1986, (compared with some 22 000 in England) (93). The use of E.C.T. is rare and discouraged by the authorities in Austria, China and Japan.
E.C.T. is perhaps the most controversial treatment currently used by the medical profession. While some survivors report it as helpful or life-saving to them, others find it much less helpful, and many view it as a damaging and threatening tool of psychiatric oppression. Especially controversial are:
- what conditions it is used to treat
- who is given E.C.T.
- its administration
- training of clinical staff
- variations in use and practice
- precisely how it works
- its effectiveness
- its risks and side-effects
- consent to treatment
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