ECT shocks to the health system
06-16-1998
The Independent, UK
Sarah Lonsdale
Two electrodes were placed either side of Denise's
head. Up to 200 volts of electricity pulsed
through her brain and, within seconds, nearly two
years of memory were wiped out. "Great black holes
now exist where once I had memories," she says.
"They say you are the sum total of your memories.
Losing them is like a bereavement, part of you
dies."
Denise was treated 10 times with electroconvulsive
therapy (ECT), the psychiatric treatment made
famous by Jack Nicholson in the film One Flew Over
the Cuckoo's Nest. But Denise was not treated in
America in the Sixties. Denise was treated here,
in England, last year.
Denise is one of the 20,000 patients who are given
ECT each year for the treatment of psychiatric
disorders, mainly severe depression and some types
of schizophrenia. Of these, around 2,000 are given
ECT without their consent, putting the UK
incontravention of an EC ruling. This Friday (June
19), ECT 'survivors' will demonstrate outside the
Royal College of Psychiatrists in London.
Denise cannot remember giving her consent for
treatment. All she knows is that in the past she
has always stated her objections to ECT. An
attractive redhead in her early forties who lives
in Camberwell, south London, she describes how she
ended up inthe ECT room: "I studied fine art at
Goldsmiths College in south London into my mid
twenties. Soon after graduating I suffered a bout
of depression. I was treated with anti-depressants
and after about two difficult years, the
depression lifted.
"For the next 10 years, I worked at odd jobs,
trying to support myself while I continued to
paint. I then suffered two terrible bereavements:
two of my sisters died, from illness, within a few
months of each other. I became severely depressed
and was treated at the Maudsley Psychiatric
Hospital in Camberwell with anti-depressants.
Although I suffered from delusions - at times I
believed people were being gassed by the
Government - at all times during my treatment I
stressed I did not want ECT. Never once did I make
an attempt to end my life. I eventually pulled
through and continued life as normally as
possible. I started a job selling investments in
the City.
"Things start to get hazy about two years ago. I
became depressed again at the end of 1996 and a
friend, acting with the best intentions, took me
back to the Maudsley. Apart from a three-week
break, I was at the hospital until May last year.
It says in my records that I was treated with ECT
on 10 occasions between March and May. I am
informed by the nursing staff at the hospital
that, during the tenth episode, I 'overconvulsed'
and for several weeks following that final bout I
was manic. Totally high." During this manic period,
Denise wanted to kill herself: "Not because I was
depressed, but because I was so high I wanted to
release my spirit from my body."
Like many ECT patients, Denise remembers little of
the actual treatment. "All I remember is quite a
pleasant, floaty feeling. They give you a general
anaesthetic and a muscle relaxant before
treatment, to prevent you breaking your ribs. So
for a period of about six weeks I was barely there.
It was a nice, sleepy feeling." Denise is still on
anti- depressants and she has not painted since
being given ECT.
Another ECT 'survivor', Andy Bithell, describes
the shock treatment as being "Rather like arson -
it destroys its own evidence". Andy was treated
with ECT in 1994, against his will and even though
his solicitor was actually at the hospital with
him.Andy has ongoing memory impairment. "It's
horrible. Like walking through a long, dark tunnel
with only a weak torch to guide you. When you look
back, you can only see about six months into the
past. One advantage is that I can read the same
book overand over again and never remember the
plot." A former management consultant, he became
depressed after losing his job and his wife after
suffering from a prolonged bout of post-viral
syndrome.
Andy, 32, is a member of the patient protest group
ECT Anonymous, which is organising the lobby this
Friday. Along with other mental health user groups
such as Reclaim Bedlam and Survivors Speak Out,
the group wants ECT to require both consent of
thepatient and a second opinion. The mental health
charity MIND is backing them. Psychiatric nurses
within the Royal College of Nursing believe that
ECT is over- prescribed by some psychiatrists and
alternatives such as cognitive therapy should be
offered.
It is 60 years ago this year that two Italian
psychiatrists, having observed pigs being stunned
before slaughter, decided to see whether electric
shocks would produce convulsions in humans.
Previously, drugs had been used to induce
convulsions which, it was claimed, inhibited
schizophrenia. Psychiatrists claim that ECT, by
changing the balance of neurotransmitters in the
brain, is an effective treatment for depression,
particularly where urgent treatment is needed.
Professor David Goldberg, Director of Education at
the Institute of Psychiatry in London, says ECT is
effective for patients suffering from depressive
illnesses, and where a patient is suicidal, ECT
can be life saving. "Some-times people are
suffering intensely and would like to have a quick
treatment to relieve their distress," he says. The
last time he ran an ECT unit he would have
prescribed the treatment no more than 10 to 20
times a year. He also says that the administering
of ECT without consent is a "vanishingly
rare phenomenon" and the difficulty some former ECT
patients have in memory retrieval is subjective.
"Research does not support claims of long term
memory loss," he says.
But some psychologists and psychotherapists argue
that ECT has no long- term beneficial effects, and
can actually cause psychological and neurological
damage.
Consultant clinical psychologist Craig Newnes says
that one of the difficulties in assessing the
benefits of ECT is that the Department of Health
ceased collecting data on usage a few years ago,
because it was so difficult to obtain reliable
figures."The last time the figures were collated,
about three years ago, there was a wide variance
of usage from region to region and unit to unit,
suggesting there is no uniform standard of when it
is appropriate to use ECT. Rather, it is used
according to the whim and preference of individual
psychiatrists."
Mr Newnes, who works within the NHS in Shropshire,
says that he would only feel the administering of
ECT was justified if all other treatments have
been tried. "Psychiatrists treat depression as an
illness, whereas in psychology there is the belief
thatit is caused by external events, and that
finding coping mechanisms is the way to treat it."
He dismisses the claim that ECT can be the only
way to save the life of the desperately suicidal:
"God knows how many suicidal patients I have
treated. I have electrocuted none of them."
He adds that one of the reasons why very few
psychologists speak out against ECT is that very
often they are working alongside psychiatric
colleagues in hospitals, and do not want to be
seen to be criticising or undermining colleagues.
"If ECT weregiven only in cases of extreme
depression, then it would not be controversial,"
says Mr Newnes. " But ECT has been given to very
young children - the youngest was 34 months old -
and even to diabetics. I think some psychiatrists
do not help the case for ECT."
Lucy Johnstone, lecturer in clinical psychology at
the University of the West of England in Bristol,
has recently conducted research into the
psychological effects of ECT. "From the outset, I
would stress that not everyone finds ECT to be a
negative experience," she says. "But for people who
had found it distressing, I found that people felt
abused, that ECT was given to them as a punishment
for being bad. They feel worthless and terrified -
the ECT reinforces a lot of the negative feelings
theyalready had. The results can be a lasting
dread of ECT and a lasting distrust of
professionals."
The Department of Health says that there are some
cases of depression, in which all other treatments
have failed, where ECT remains the only safe and
effective treatment and that it is safely
regulated by the Royal College of Psychiatrists.
MIND wants ECT regulated by an independent body.
Last week, however, Paul Bradley, MP for The
Wrekin, who has been raising concerns about ECT
with the department, received notice that Paul
Boateng, Parliamentary Under Secretary of State
for Health, is prepared to meet and discuss his
concerns -something he has until now refused to
do.
"This is a good first step," says Andrew Bithell.
"Maybe in future depressed patients will not be
treated with the same cavalier attitude as I was.
But for me it is already too late. The whole
experience has wrecked my life."
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