As campaigners protest about mental patients being treated against their will, Sally Weale asks why so many women are still coerced into electro-convulsive therapy

Thursday November 18, 1999
The Guardian

Jennifer Laws used to be a schoolteacher. She used to be able to remember things. Now her memory is shot to pieces. Sometimes she gets into the car and drives off only to stop, bewildered, unable to remember where she's supposed to be going. Her forgetfulness is because a few years ago - she can't remember when exactly - she underwent two courses of electro-convulsive therapy (ECT).

She had suffered from depression from the age of 19. Finally, in her fifties, as a last resort she was given ECT. She felt bullied into having it, she says after the doctor she consulted "more or less said he was not prepared to carry on" unless she went through with it.

"It's barbaric. All I could remember was everyone handling me with rubber gloves. It was horrible."

Depression is a 21st-century condition which will affect millions of us. One in five people reading this will suffer a severe depressive episode at some point in their lives - and if you're a woman, the probability doubles. Yet ECT - where an electric current is passed through the patient's brain to produce a seizure or fit aimed at relieving severe depression - seems to belong to the last century, rather than the next. And it is one of the key treatments available to psychiatrists.

Last month figures revealed that doctors still administer 1,300 ECT treatments a week for depressive illness. Of those patients, almost 68% are women, more than 40% of them over 65.

The government sets out radical new plans for the mental health services in its green paper which was published on Tuesday, including proposals to improve safeguards governing ECT, particularly when administered without the patient's consent. However, this is against a background of increasing use of coercion in the mental health services. This is reflected in other proposals for increased compulsion in treatment, to which women are particularly vulnerable.

So why are so many women still receiving ECT? One reason is that more women suffer from depression. But Pat Butterfield, co-founder of ECT Anonymous, a group which campaigns to have the treatment banned, thinks the reasons are more complicated. "Women are more vulnerable. They are easier to bully. There's this feeling of: oh, it's only a housewife, it doesn't really matter. It's easier to persuade husbands: 'We'll put your wife right. She'll be back and busy around the house before very long.'"

But why do so many older women have it? "It's easier to get them to agree," says Butterfield, who has herself undergone ECT. "They are still awestruck by the medical profession. There's that old-fashioned idea that doctors are gods. They can do no wrong. "

Butterfield says people from all walks of life contact her seeking help and advice after ECT, from nuclear physicists to journalists. Among them is Una Parker, 64, a former nursery group leader from Pontefract, west Yorkshire who had two courses of ECT, each involving seven or eight individual treatment sessions. She had a breakdown and was referred to a consultant psychiatrist who saw her, with her husband, for about 10 minutes.

The consultant asked Parker to leave the room and then told her husband that he could not guarantee that she would ever be normal again, unless he was allowed to treat her with drugs and ECT.

After the first treatment, she ran around the hospital tearing her dressing gown to shreds. She was kept in for a month. Three weeks after being released, she was found in tears and taken to see the psychiatrist who told her how much she needed further ECT. She signed herself back into it.

"It took me a long time to recover from the feeling of being useless. For me and for many people, it's a massive attack on your self-confidence," says Parker, whose daughters were nine and 11 at the time.

She suffered memory loss - a common complaint among former ECT patients. When she got back home, she couldn't remember where she kept her sewing things - items she was used to using regularly. She still has problems with memory. "It's an assault on the person. It's like hitting someone over the head. It didn't just damage me - all the relationships in the family were devastated."

Beryl Manklow's continuing anguish is painfully obvious - she sounds hesitant, anxious and tearful. Manklow, 60, of Rugby, Warwickshire, went to see a consultant about unexplained severe pains in her joints and ended up having ECT. "If they can't come up with an answer straight away, they think it's in your brain. It's not just people who have serious mental problems who have ECT. They gave me four sessions. When I came round, I just felt I had completely changed.

"My personality had changed. I used to be a manageress in the fashion trade, but I could never have gone back to that. My mind just won't do what I want it to. I feel as if I've aged 30 years in the eight years since I had it. It's taken my life away."

ECT Anonymous, which has a growing membership currently standing at 600, is putting together a group legal action seeking compensation for 12 ECT "survivors"; a further 200 cases may follow. In a survey of members last year, many reported memory loss, cognitive impairment, head pains, neck pains and migraine. These symptoms have never disappeared; 85% of the women were unable to return to work after treatment. "It wrecks lives," Butterfield says.

Thankfully, ECT is dwindling in popularity as a new generation of anti-depressants come on the market - in 1991, doctors were administering 2,000 treatments per week. But many, such as Marjorie Wallace, chief executive of Sane, the campaigning mental health body, believe it is important that ECT should exist as an option in the most extreme cases. "ECT can be life-saving for a very few people who are so suicidal and depressed that they are not eating and their kidneys are packing up. Anti-depressants and counselling take some weeks to make a difference and in those cases it may be the only choice."

The psychologist and writer Dorothy Rowe, who has worked in institutions where ECT is given, believes it is a quick-fix treatment used to control and subdue women. She thinks it should be banned: "There are many men psychiatrists who believe all a woman needs to be happy is a home, a husband and children. Any woman who gets depressed and has already got a home, a husband and children - they think - must have endogenous depression. The psychiatric theory is that the best treatment for endogenous depression is ECT - that's why women get it.

"Women become depressed because of the circumstances of their lives. A woman gets older, the big changes in her life come about, she gets through the menopause, her children grow up and leave home, her parents get older and die, her friends die," says Rowe.

"What such women need is care, attention and someone to talk to, but that takes too much time and money. ECT quietens her. She will be very passive and then they can give her medication. But all the research shows that with ECT you just get depressed again."

"The system of psychiatry is not in the business of changing society, or in confronting the problems that are in society. The job of psychiatrists is to keep us quiet. Psychiatry is about social control. When women complain, when they express their distress, they are just shut up."