Second opinion
This week: is electroconvulsive therapy - ECT - a barbaric treatment for mental illness?


Tracey McVeigh
Observer
Sunday March 12, 2000

YES Tom Keen, senior lecturer in mental health at Plymouth University

ECT is ineffective, unsafe, cruel and crude and causes patients to experience severe and disabling psychological side effects - anything from social unease to memory loss. We have absolutely no idea how shock treatment works, yet it is being administered in this country in a way that is, at times, completely cavalier. Still, cracks are beginning to show in psychiatry's armour of arrogance and some professionals are starting to think twice about using it.

In simple terms, ECT makes people have convulsions, which makes you wonder when you consider that we try to stop epileptics having convulsions because we think they're bad for them. Fits are bad for the brain, and while there is no question that ECT does jolt the patient out of a state of mind, is this benefit worth the cost? The evidence is that this effect doesn't last long and offers only temporary relief, and an awful lot of people who have ECT once do not want to go through it again. Yes, surveys have offered evidence of patients who believe that the benefits outweigh the costs, but I do think that when people have ECT and say they would choose it again, it might well say more about their psychological state than how effective the treatment is. They are often motivated by guilt, masochism or self-loathing.

There really should be a full debate around the whole issue of ECT now. I think in 20 years' time we will look back and think, 'What the hell were we doing?'

NO Dr Mark Salter, psychiatrist

ECT is saving the lives of some of my patients. These are people who are suffering from a depression so severe that they think they are responsible for all the pain and suffering in the whole world. They want to die because they don't think they deserve to be released from their pain.

All experienced and responsible psychiatrists who work in this country today will recognise that people suffering from this sort of psychotic depression will almost certainly benefit from ECT. There is no doubt in my mind of that at all.

At any one time, 5 per cent of the human population are suffering from a depression that we should recognise as an illness. These are the people that we used to shove in asylums to be force-fed and force-watered. The mentally ill still face stigma today which precludes people who have benefited from ECT coming out and talking about it. A history of mental illness means you aren't going to get life insurance and you can forget about having a mortgage.

There are 12,000 ECT treatments being administered in England and Wales each year, which is probably a sign that it is being used too much, but the evidence is overwhelmingly that it works. Yes, the effects of ECT often don't last very long, but I would rather have six or seven weeks relief from a psychiatric illness than none at all. Also, at least two people I have given ECT in the past five years are still well now.