Shock Treatment to be Unplugged?

In the first of a series of monthly debates put on at the Institute of Psychiatry 400 people packed into the Wolfson Lecture theatre to hear the motion: This House believes Electro-Convulsive therapy is barbaric and ineffective. This took place on January 26th 2000.

Prior to the Debate, about 20 user/survivors held a candlelit vigil outside the Institute. They held up a rather fetching blue and silver banner which read STOP SHOCKING OUR BRAINS. People entering were leafleted with an explanation why members of ECT-Anon had boycotted the debate. Pat Butterfield had written to the Debate Chair Raj Persaud saying "There is already enough literature and proof that ECT is harmful to an unacceptable number of people and therefore we believe it is time to stop debating and work towards ensuring that this "treatment" is at the very least strictly controlled, if not banned, as is the case in Italy and Norway."

Raj Persaud introduced a video of an ECT session to show how much less dramatic "modern" ECT is for an observer - rather than the enormous and dangerous seizures that used to be induced before muscle relaxants were introduced in the 1960's. We were told that the Department of Health have recently started collecting figures of treatments - after a 10 year gap - and between January and March 1999, 2800 patients were given ECT, of which 1900 were women.

Judi Clements of MIND proposed the motion. She said that there is no place for such a controversial treatment in modern psychiatry. And it should go the way of other inhumane treatments like camphor-induced shock and cold baths. Experts were quoted as saying that doctors have no idea how it works and that it is now recognised that it causes lasting brain damage. Andy Bithell of ECT-Anon was quoted "ECT is horrible, like walking through a long, dark tunnel with only a new torch to guide you."

Judi gave a balanced picture of what users say about the treatment - a UKAN survey revealed 53% saying it was damaging or not helpful, while 30% said it helped. A MIND survey put this the other way round 37% saying it was unhelpful while 43% saying it was helpful. She concluded by saying ECT was so risky that it should be consigned, like insulin coma, to the historical dustbin of past medical practice.

Psychiatrist Dr Mark Salter spoke against the motion, saying that ECT was a treatment of last resort to be used in cases of extremely severe psychotic depression and that it saved lives. He thought it was very important that doctors retain their absolute scientific objectivity and do not bow to emotion or passion or - it seemed public opinion. He spoke scathingly of the public - saying "the public do not give a damn (about mental illness)". Although he admitted the treatment was crude - it was not as crude as it used to be, yet "brain damage was severe for a small group." Formerly the treatment, unmodified, was brutal, but it is essential to retain this treatment as a life-saver, and "not to throw the therapeutic baby out with the bathwater".

Psychologist Lucy Johnstone spoke about her work in marshalling the evidence that ECT is effective. She offered to supply us with a reading list, and said that some research does not get published unless it fits the prevailing orthodoxy. She concluded that there is no hard evidence that it does work in curing depression. And it causes a massive amount of damage. Is this worth it to help a small minority? she asked.

Dr Tom Stuttaford, former MP and GP and Times Health Correspondent, said that although ECT was not "first choice in the armoury" he had seen the treatment "save lives and save sanity". And a third of his patient list had been in a psychiatric hospital.

-From the floor, I asked whether it was significant that the pro-ECT lobby were both men, when women receive a disproportionate amount of ECT, and there are gender issues here which had not been mentioned. And how come more men than women kill themselves? Dr Stuttaford put this down to the effect of ECT saving lives among women and the fact that women are more likely to come forward than are men. So while he seemed to be suggesting that men should receive more ECT, that does not explain why women make more suicide attempts than men. Nor does it explain why when there are now more men than women on acute wards, men are not getting this apparently effective treatment. Perhaps there is something else going on - like a male-dominated psychiatry more willing to "punish" women on the wards, than they are to men.

A former social worker and mental welfare officer made some powerful comments that ECT is not the only barbaric treatment in psychiatry. He said "We are not televisions to be bashed when we go wrong, but we are human beings." And he suggested that treatments should not be the doctor's choice but the patient's choice. And he also quote former Health Secretary Frank Dobson who had apparently said "mental patients are often a nuisance. Sometimes they are a bloody nuisance."

Communicate's Denise McKenna said that her experience of ECT had left her traumatised. It also gave her a manic episode. And it had destroyed her memory.

Another person from the floor said of ECT "Women are crying out that they do not want it any more."

Statistician Margaret Jessup MBE (chair of Lewisham Users Forum) said that she would not have consented to ECT if she had been given the full information, especially the dangers about Memory Loss.

The Result

The Voting was as follows:

  Before The Debate % After The Debate %
For the motion (anti ECT) 69 17.25 94 23.50
Against the motion (pro ECT) 135 33.75 138 34.50
Abstentions 53 13.25 38 9.50
Presumed did not vote (estimate) 143 35.75 130 32.50
Total 400 100 400 100


Conclusion
Motion not carried
We would not have expected a debate on ECT at the Institute of Psychiatry - a bastion of orthodox psychiatry in the UK, to have come out against it. Although there were a considerable number of user/survivors in the audience, the overall result was not really surprising. However the non-voters and people who abstained at the beginning and then added to the anti-ECT lobby - which showed a significant rise at the end was surprising. Perhaps floaters were persuaded by the arguments of Judi Clements and Lucy Johnstone which were better presented. Perhaps they were persuaded too by the testimony of survivors which rarely seems to filter through to psychiatrists.

However user/survivors afterwards observed that this was not a motion that it was easy to vote for because it was not framed accurately enough. There are many people who consider that ECT is harmful, crude and even barbaric. But there are very few who consider it totally ineffective.

Afterwards users speculated that a better Motion would have been: This house believes that ECT is a crude treatment which is too risky to continue because its effectiveness for some, is outweighed by the permanent harm that it does to many. And tantalisingly, would such a Motion have been passed at the Institute? More excitingly though, user/survivors are rubbing their eyes in disbelief as some see a powerful wind of change blowing through psychiatry. Fuelled by Government pressures, constant survivor nagging, and fired internally by the new wave of Critical Psychiatry, this could be something big - only time will tell. But Professor Robin Murray, incoming Chair of the Institute was observed to vote for the Motion that ECT is barbaric and ineffective.

Mark Roberts - Common Agenda Project Worker - GLAD