ECT - what no one is talking about

In Australia, as in the United States and the United Kingdom, statistics show that the number of patients receiving ECT, or electro-convulsive therapy, has risen drastically over the last ten years. Figures show the use has doubled in this time. In New South Wales, the number of patients receiving ECT has risen from 2093 in 1994-1995 to 5291 in 2005-2006 (“Australia; use of ECT has doubled in a decade”, The Daily Telegraph, November 18, 2006).

ECT is used for the treatment of a wide-range of psychiatric disorders, but is usually used as to treat depression. Even though doctors admit it is only used as a last resort, surveys show that one in four Australians suffer from some kind of depression: considering some of the contentious debate over the practice; the Australian public has cause for concern.

Supporters of ECT argue that, while the procedure is poorly understood and the mechanism for action unknown, as with various other somatic therapies in psychiatry, it is a remarkably effective treatment for intractable depression. A leading US expert, and vocal critic of ECT, Lawrence Stephens J.D., believes the “therapy” causes brain damage, memory loss and diminished intelligence.

At present, there are movements like Mind Freedom which seek to ban the practice of ECT completely. Other groups are seeking to ensure that there is legislation which involves “informed consent”. Some of these groups acknowledge that there are some benefits to the procedure, but believe the practice should only be voluntary. Most agree that the voltage is too high and should be reduced.

The procedure itself has all the hallmarks of a serious operation. Electro-convulsive-therapy basically passes an electrical shock of between 70 to 400 volts, with an amperage of between 200 milliamperes to 1.6 amperes, through an already fragile brain. Sometimes the electrodes are placed on the temples - this is known as a bilateral treatment; and sometimes the electrodes are placed on the front and back of the side of the head (right or left depending on the natural stance of the person as a left or right handed person) - this is known as a unilateral treatment.

Uni-lateral treatments are seen by many critics as contemptible because there is still much research to do regarding how the two sides of the brain actually relate and function. As well as this there is little known about the brain mechanics during and after ECT.

Some psychiatrists falsely claim that the amount of electricity administered is actually very low. The electricity applied in ECT is, typically, as large as the amounts generated in your wall sockets at home. If the current were not limited to the head and were not in such short spells, it would kill you instantly. The electricity from ECT can be so abrasive that it burns the skin. Because of this psychiatrists use “electrode jelly”, also known as “conductive gel”, to prevent skin burns.

As reported with the use of the contestable “Tazor”, the electricity passing through the brain can cause powerful seizures that  have been known to shatter and break patients’ bones during procedures. To prevent this, a muscle relaxant/paralyser drug is administered before treatment. Currently, Lawrence Stephens J.D. believes that with the modern initiatives, the worst thing that can happen to you during a session of ECT is brain damage.

Earlier this year, Patricia, a patient at a hospital in Sydney, received ECT for the last two months of her 10-month admission. Distraught and anxious about the “treatment”, she worried that she would have no recourse to stop the procedure as she doesn’t have any family in Australia. After objecting to plans for further therapy she had become frightened of her doctor.

I decided to help her seek some sort of third party. Initially, she had trouble getting the phone number for the mental health advocacy team. She wanted to complain about “… forgetting her memories”. She eventually got in contact with a doctor, a member, from the “advocacy” team, who tried to charge her $100 for an immediate consultation. After some probing, he said that unless there were “… drastic reasons for postponement …” there was nothing that could be done. In fact, the advocacy team and legal aid are exempt from the tribunals that make recommendations concerning the use of ECT. This, in effect, means that the advocacy team do not have any input into a doctor’s decision to “involuntarily” apply the use of ECT on a patient.

Without consultation with a lawyer, Patricia’s next ECT treatment went ahead. When I went to see her a few hours after her treatment she could not remember my name, or my age, even though I had discussed my age with her three times and she had used my name at least 15 times. She said that, other than severe exhaustion and the loss of memories (amnesia), she felt no different. Her nose was bleeding that day.

I went to see Patricia three days later. She still could not remember my name and her behaviour was as it was before - quite normal (except for some agitation in her mood).

She said that if given the choice she would not have ECT “ever again” and that she would not recommend it to anyone.

As with most controversial practices, people of all types have an opinion. Doctors who support ECT, for instance, argue that it only causes death in one out of 10,000.

A nurse at the hospital, Mark, reported that he had witnessed an ECT procedure and said he would not do it to himself, even though he believed the practice had positive effects on a patient’s rehabilitation. He also said that ECT was not like the famous scene from One flew over the Cuckoo’s Nest, but that nowadays the treatment was “more humane”.

Another patient at the hospital, Edward, believed the practice was about “suppression” and “subjugation” of the people. He said that he believed the brain “is a very fragile instrument” only “used to micro-volts of electricity”, and that it was wrong to “short circuit” such a fine instrument.

In the hope of finding an expert I tried contacting Patricia’s doctor on three occasions. I received no reply. I eventually went in to see him and noticed a commotion as the switchboard sent my message for a request to interview him. After waiting in the lobby for five minutes a stocky European man walked in with a security guard on his left and right. He said quite plainly “If you come here again I will call the police and have you arrested for disturbing my work”. In disbelief I had no recourse but to leave the premises. He would not even defend his “work”.

Doctors who are against ECT believe that the current term is misleading because ECT is not a form of therapy and causes more problems than it purports to cure. It is well known that the practice causes the destruction of memory synapses in the brain resulting in amnesia.

Lawrence Stephen believes that even the validity of ECT’s supporters claims, that the “therapy” cures depression, is mistaken. Most psychiatrists who recommend ECT believe, or assume, that “unhappiness” can be caused by “unknown” biological abnormalities in the brain. They will even readily admit that the practice is experimental while ignoring the facts.

The fact is ECT has caused some patients so much anguish that they have committed suicide after receiving the “treatment”. Ernest Hemmingway, for instance, commited suicide shortly after having received shock therapy at the Menninger Clinic in 1961.

(Hemmingway’s suicide is documented on Wikipedia. There have been various other studies, about suicide after ECT, which are by no means all inclusive or without bias. The figures for suicide are quite low in these studies (i.e. 0.001 per cent), yet this is ironic because supporters of ECT argue that it reduces suicide rates - “mostly”.)

This is one reason many critics believe the practice should be outlawed as soon as possible.

A critical blogger states in ECT.org that the practice is “… draconian, if not evil … an artifact of the infancy of psychiatric development from the fifties”. David Oaks, a mental health consumer advocate, believes the practice is “barbaric”, has a high relapse rate and should be banned as soon as possible.

If the practice is not abolished soon there should at least be rules for informed consent, and the voltage used should be reduced substantially and regulated. Until then more discussion is necessary and the practice should be investigated.